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Salvatici M, Caslini C, Alesci S, Arosio G, Meroni G, Ceriotti F, Ammirabile M, Drago L. The Application of Clinical and Molecular Diagnostic Techniques to Identify a Rare Haemoglobin Variant. Int J Mol Sci 2024; 25:6781. [PMID: 38928486 PMCID: PMC11204072 DOI: 10.3390/ijms25126781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Haemoglobin disorders represent a heterogeneous group of inherited conditions that involve at least one genetic abnormality in one or more of the globin chains, resulting in changes in the structure, function, and/or amount of haemoglobin molecules, which are very important for their related clinical aspects. Detecting and characterizing these disorders depends primarily on laboratory methods that employ traditional approaches and, when necessary, newer methodologies essential for solving a number of diagnostic challenges. This review provides an overview of key laboratory techniques in the diagnosis of haemoglobinopathies, focusing on the challenges, advancements, and future directions in this field. Moreover, many haemoglobinopathies are benign and clinically silent, but it is not uncommon to find unexpected variants during routine laboratory tests. The present work reported a rare and clinically interesting case of identification of haemoglobin fractions in an adult man by the determination of glycated haemoglobin (HbA1c) during a routine laboratory assessment, highlighting how the correct use of laboratory data can modify and improve the patient's clinical management.
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Affiliation(s)
- Michela Salvatici
- UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, Via Fantoli 16/15, 20138 Milan, Italy;
| | - Cecilia Caslini
- Bianalisi, Clinical Laboratory, Via Mattavelli 3, 20841 Carate Brianza, Italy; (C.C.); (S.A.); (G.A.); (G.M.)
| | - Simona Alesci
- Bianalisi, Clinical Laboratory, Via Mattavelli 3, 20841 Carate Brianza, Italy; (C.C.); (S.A.); (G.A.); (G.M.)
| | - Grazia Arosio
- Bianalisi, Clinical Laboratory, Via Mattavelli 3, 20841 Carate Brianza, Italy; (C.C.); (S.A.); (G.A.); (G.M.)
| | - Giuliana Meroni
- Bianalisi, Clinical Laboratory, Via Mattavelli 3, 20841 Carate Brianza, Italy; (C.C.); (S.A.); (G.A.); (G.M.)
| | - Ferruccio Ceriotti
- Clinical Pathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; (F.C.); (M.A.)
| | - Massimiliano Ammirabile
- Clinical Pathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; (F.C.); (M.A.)
| | - Lorenzo Drago
- UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, Via Fantoli 16/15, 20138 Milan, Italy;
- Clinical Microbiology and Microbiome Laboratory, Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
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Abbasali F, Mahmoud K, Hengameh N, Mina D, Setare D, Hale D, Sima D. Rare and New Mutations of B-Globin in Azari Population of Iran, a Considerable Diversity. Balkan J Med Genet 2023; 25:51-62. [PMID: 37265972 PMCID: PMC10230832 DOI: 10.2478/bjmg-2022-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Background Thalassemia, as the most common single-gene genetic disorder, is related to a defect in the synthesis of one or more hemoglobin chains. More than 200 mutations have been identified in the β-globin gene. Globally, every susceptible racial group has its own specific spectrum of the common mutations that are well-known to a particular geographic region. On the other hand, varying numbers of diverse rare mutations may occur. Materials and Methods The subjects of the study included 2113 heterozygote or homozygote β-thalassemia cases selected among couples who participated in the Iranian national thalassemia screening program from January 2011 to November 2019. Molecular characterization of the β-thalassemia mutation was initially carried out by the amplification-refractory mutation system-polymerase chain reaction (ARMS-PCR) technique for common mutations, followed by sequencing, Gap PCR, and Multiple ligation-dependent probe amplification (MLPA) methods - in cases not detected by the ARMS-PCR. Results The existence of 39 rare and new point mutations and 4 large deletions were described in our cohort. Sicilian (-13,337bp) deletion, CD36/37 (-T), and CD15 TGG>TGA were encountered more often than the others in a decreasing order, in terms of frequency. The least frequent mutations/deletions were deletion from HBD exon 1 to HBB promoter, 619 bp deletion, Deletion from up HBBP1-Exon3 HBBP1 and up HBB-0.5Kb down HBB, CAP+8 C>A, CD37 (G>A), CD6 (-A), IVSI-2 (T>C), IVSII-705 T>G, and IVSII-772 (G>A). Each occurred once. Five mutations/variants were also determined which have not been reported previously in Iran. Conclusion According to the findings of the study, the Northwestern Iranian population displayed a wide variety of thalassemia allelic distributions. Identification of rare and new mutations in the β-thalassemia in the national population is beneficial for screening programs, genetic counseling, and prenatal diagnosis.
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Affiliation(s)
- F.H. Abbasali
- Hematology & Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - K.Sh. Mahmoud
- Medical Genetic Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Ebne Sina Medical Genetics Laboratory, Specialized and Sub-specialized Outpatient Clinics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - N. Hengameh
- Ebne Sina Medical Genetics Laboratory, Specialized and Sub-specialized Outpatient Clinics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - D.H. Mina
- Ebne Sina Medical Genetics Laboratory, Specialized and Sub-specialized Outpatient Clinics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - D. Setare
- Ebne Sina Medical Genetics Laboratory, Specialized and Sub-specialized Outpatient Clinics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - D.M Hale
- Ebne Sina Medical Genetics Laboratory, Specialized and Sub-specialized Outpatient Clinics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - D.M. Sima
- Medical Genetic Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Ebne Sina Medical Genetics Laboratory, Specialized and Sub-specialized Outpatient Clinics, Tabriz University of Medical Sciences, Tabriz, Iran
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Isley LJ, Chamberlain AK, Callum P, Shamonki J. Comparison of methodologies to detect hemoglobinopathy carriers in a multi-ethnic sperm donor population. J Genet Couns 2021; 30:1399-1406. [PMID: 33788337 DOI: 10.1002/jgc4.1406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/22/2021] [Accepted: 02/11/2021] [Indexed: 11/10/2022]
Abstract
An estimated 7% of the world's population are carriers for a hemoglobin disorder. Current guidelines recommend carrier screening by complete blood count, with follow-up hemoglobin electrophoresis or fractionation based on abnormal result or ethnicity. Advances in molecular genetic testing are thought to increase carrier detection. This study compares carrier screening methodologies in a multi-ethnic sperm donor population. A retrospective analysis was conducted using data from a US sperm bank. All men underwent carrier screening for hemoglobin disorders via complete blood count, hemoglobin fractionation, and molecular testing. Results were compared using counts and percentages. McNemar's exact test was used to examine differences in the marginal probabilities of screening methodologies. Of the 438 tested, 25 (5.7%) were identified as carriers of at least one hemoglobin disorder by molecular testing. Seventeen (68%) of those carriers were missed by recommended methods. No identified carriers were detected by recommended methods but missed by molecular testing. The difference between these discordant pairs was significant (p-value < 0.001). The majority (44%) of carriers were mixed ethnicity, followed by 36% White. Results indicate that molecular screening methodologies have a greater ability to detect carriers of hemoglobin disorders compared to currently recommended methods in a multi-ethnic population.
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Zhou JY, Jiang F, Li J, Chen GL, Li DZ. Coinheritance of Hb City of Hope ( HBB: c.208G>A) and β-Thalassemia: Compromising the Molecular Diagnosis of the Codons 71/72 (+A) ( HBB: c.216_217insA) Mutation by Reverse Dot-Blot Hybridization. Hemoglobin 2019; 43:145-147. [PMID: 31268351 DOI: 10.1080/03630269.2019.1626741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
More than 900 abnormal hemoglobin (Hb) β chain variants have now been characterized. The majority are due to point mutations resulting in a single amino acid substitution within the globin gene involved, with nearly twice as many β chain variants identified compared to α chain variants. Although most of these variants are clinically and hematologically silent, they can interact with different thalassemia mutations, which could sometimes render laboratory diagnostics in a routine setting difficult. In this study, we present a case of coinheritance of Hb City of Hope [β69(E13)Gly→Ser; HBB: c.208G>A] and β-thalassemia (β-thal), that compromises the molecular diagnosis of β-thal trait.
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Affiliation(s)
- Jian-Ying Zhou
- a Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Fan Jiang
- a Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Jian Li
- a Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Gui-Lan Chen
- a Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Dong-Zhi Li
- a Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , People's Republic of China
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Mella F, Yamashiro Y, Adhiyanto C, Tanaka T, Nitta T, Amao Y, Kimoto M. A Coincidental Discovery of a New Stable Variant (Hb Hachioji or HBB: c.187C>T) in a Patient with Chronic Hemolytic Anemia of Unexplained Origin. Hemoglobin 2018. [PMID: 29513125 DOI: 10.1080/03630269.2018.1429279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We report a new hemoglobin (Hb) variant, Hb Hachioji (HBB: c.187C>T), which was detected in a 32-year-old male with hemolytic anemia. The proband had undergone splenectomy in his childhood after being diagnosed with hereditary spherocytosis (HS) with no clinical improvement. A recent study showed that Heinz bodies were frequently observed in his red cells, however, no abnormal band was separated by isoelectric focusing (IEF), and the isopropanol (instability) test was negative. Direct sequencing revealed that the proband was a heterozygous carrier of a novel mutation (GCT>GTT) at codon 62 of the β-globin gene, leading to an alanine to valine substitution. This variant was named Hb Hachioji. Characterization at the mRNA level by cDNA sequencing detected βHachioji mRNA, as well as βA mRNA. Subsequently, study of the proband's family indicated that his father was a carrier of this Hb variant, although unexpectedly, the father was asymptomatic and clinically healthy. Oxygen affinity measurement of total Hb showed no alteration in the P50 and oxygen equilibrium curve. The presence of Hb Hachioji was confirmed by mass spectrometry (MS). Hb Hachioji comprised approximately 50.0% of the total Hb and was a stable variant. The phenotypic discrepancy between these two carriers suggests that Hb Hachioji may not be associated with the hemolytic involvement in the proband. P4.2Nippon, which is the primary cause of most cases of Japanese HS, was absent in the proband's parents. The coexistence of glucose-6-phosphate dehydrogenase (G6PD) deficiency was ruled out. Thus, the cause of hemolytic involvement in this patient remains unclear.
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Affiliation(s)
- Ferania Mella
- a Department of Health Sciences , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Yasuhiro Yamashiro
- a Department of Health Sciences , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Chris Adhiyanto
- b Faculty of Medicine and Health Sciences , Syarif Hidayatullah State Islamic University , Jakarta , Indonesia
| | - Tatehiko Tanaka
- a Department of Health Sciences , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Takenori Nitta
- c Division of Structural Biology , Medical Institute of Bioregulation, Kyushu University , Fukuoka , Japan
| | - Yuki Amao
- a Department of Health Sciences , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Masafumi Kimoto
- d Department of Clinical Laboratory , Fukuyama Medical Center , Fukuyama , Japan
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Silver AJ, Larson JL, Silver MJ, Lim RM, Borroto C, Spurrier B, Morriss A, Silver LM. Carrier Screening is a Deficient Strategy for Determining Sperm Donor Eligibility and Reducing Risk of Disease in Recipient Children. Genet Test Mol Biomarkers 2016; 20:276-84. [PMID: 27104957 PMCID: PMC4892196 DOI: 10.1089/gtmb.2016.0014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aims: DNA-based carrier screening is a standard component of donor eligibility protocols practiced by U.S. sperm banks. Applicants who test positive for carrying a recessive disease mutation are typically disqualified. The aim of our study was to examine the utility of a range of screening panels adopted by the industry and the effectiveness of the screening paradigm in reducing a future child's risk of inheriting disease. Methods: A cohort of 27 donor applicants, who tested negative on an initial cystic fibrosis carrier test, was further screened with three expanded commercial carrier testing panels. These results were then compared to a systematic analysis of the applicants' DNA using next-generation sequencing (NGS) data. Results: The carrier panels detected serious pediatric disease mutations in one, four, or six donor applicants. Because each panel screens distinct regions of the genome, no single donor was uniformly identified as carrier positive by all three panels. In contrast, systematic NGS analysis identified all donors as carriers of one or more mutations associated with severe monogenic pediatric disease. These included 30 variants classified as “pathogenic” based on clinical observation and 66 with a high likelihood of causing gene dysfunction. Conclusion: Despite tremendous advances in variant identification, understanding, and analysis, the vast majority of disease-causing mutation combinations remain undetected by commercial carrier screening panels, which cover a narrow, and often distinct, subset of genes and mutations. The biological reality is that all donors and recipients carry serious recessive disease mutations. This challenges the utility of any screening protocol that anchors donor eligibility to carrier status. A more effective approach to reducing recessive disease risk would consider joint comprehensive analysis of both donor and recipient disease mutations. This type of high-resolution recessive disease risk analysis is now available and affordable, but industry practice must be modified to incorporate its use.
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Affiliation(s)
| | | | | | | | | | | | - Anne Morriss
- 1 GenePeeks, Inc. , Cambridge, Massachusetts.,2 GenePeeks, Inc. , New York, New York
| | - Lee M Silver
- 1 GenePeeks, Inc. , Cambridge, Massachusetts.,2 GenePeeks, Inc. , New York, New York.,3 Department of Molecular Biology, Princeton University , Princeton, New Jersey
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