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Diamantidis MD, Karanikola RA, Polyzoudi C, Delicou S, Manafas A, Savera H, Xydaki A, Kotsiafti A, Tsangalas E, Ikonomou G, Mani E, Ntoulas K, Alexiou E, Argyrakouli I, Koskinas J, Fotiou P. Clinical significance of mutational variants in beta and alpha genes in patients with hemoglobinopathies from two large Greek centers: a complex interplay between genotype and phenotype. J Mol Med (Berl) 2023; 101:1073-1082. [PMID: 37420139 DOI: 10.1007/s00109-023-02342-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
Hemoglobinopathies affect patients in the wider Mediterranean area consisting of 4 distinct subgroups: beta thalassemia major (TM), beta thalassemia intermedia (TI), sickle cell disease (SCD) and hemoglobin H disease (alpha thalassemia). The clinical spectrum varies from mild to severe. Complex interactions between genes and environmental factors form the clinical manifestations. There is an unmet need to clarify these multifactorial mechanisms. This is the first Greek study describing mutational alleles (HBB and HBA1/HBA2 gene variants) in 217 patients with hemoglobinopathies of two large centers in Greece (Larissa and Athens) and associating particular genotypes or gene variants with clinical manifestations (transfusion frequency, complications). Thus, the complex interplay between corresponding genotypes and phenotypes was investigated. Our results are in accordance with previous national studies with limited variations, due to regional prevalence of specific gene variants, as expected. It is also a description of the prevalence of hemoglobinopathies in the Greek population. The type and prevalence of beta and alpha globin gene variants differ significantly among countries. We also confirm the well-known observation of many studies that in our beta thalassemic or SCD patients, co-inheritance of variants in the alpha globin genes, leading to absence or reduction of alpha globin synthesis were associated with milder clinical course, whereas the inheritance of additional alpha genes (triplication) led to a more severe clinical phenotype. In cases in whom the genotype and phenotype did not correlate, factors like the function or modification of possible regulatory genes or additional nutritional-environmental effects should be investigated. KEY MESSAGES: • This is the first Greek study, fully molecularly defining the beta and alpha mutational alleles in 217 patients with hemoglobinopathies of two large centers in Greece and correlating particular genotypes or gene variants with clinical manifestations (transfusion frequency, complications). • In the beta thalassemic or SCD patients of our cohort, co-inheritance of variants in the alpha globin genes, leading to absence or reduction of alpha globin synthesis were associated with milder clinical course (confirmation of a well-known previous observation). • The inheritance of additional alpha genes (triplication) led to a more severe clinical phenotype (confirmation of a well known previous observation). • The function or modification of possible regulatory genes should be investigated in cases in whom the genotype and phenotype did not correlate.
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Affiliation(s)
- Michael D Diamantidis
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece.
| | - Rebecca-Anastasia Karanikola
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Chrysoula Polyzoudi
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Sophia Delicou
- Thalassemia and Sickle Cell Disease Unit, Hippokration General Hospital of Athens, Athens, Greece
| | - Achilles Manafas
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Helen Savera
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Aikaterini Xydaki
- Thalassemia and Sickle Cell Disease Unit, Hippokration General Hospital of Athens, Athens, Greece
| | - Angeliki Kotsiafti
- Thalassemia and Sickle Cell Disease Unit, Hippokration General Hospital of Athens, Athens, Greece
| | - Evangelos Tsangalas
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Georgia Ikonomou
- Thalassemia Prevention Unit, General Hospital of Larissa, Larissa, Greece
| | - Eirini Mani
- Thalassemia Prevention Unit, General Hospital of Larissa, Larissa, Greece
| | - Konstantinos Ntoulas
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Evangelos Alexiou
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Ioanna Argyrakouli
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - John Koskinas
- Thalassemia and Sickle Cell Disease Unit, Hippokration General Hospital of Athens, Athens, Greece
| | - Paraskevi Fotiou
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
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Dore MP, Fanciulli G, Pes GM. Is Glucose-6-Phosphate Dehydrogenase Deficiency a Risk Factor for Autoimmune Thyroid Disease? A Retrospective Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032709. [PMID: 36768075 PMCID: PMC9916078 DOI: 10.3390/ijerph20032709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The risk of developing thyroid disorders (TDs) in subjects with inherited glucose-6-phosphate dehydrogenase (G6PD) deficiency is unknown. The aim of this study was to explore the association between autoimmune (AITD) and G6PD deficiency in Northern Sardinia, in a population with a high frequency of these two conditions. METHODS In this retrospective single-center case-control study, demographic and clinical data were collected from patients examined in a tertiary referral Gastroenterology Section of a teaching hospital. RESULTS In 8894 subjects examined (64.7% females), 1218 patients were diagnosed with TDs; more specifically, 767 were diagnosed with AITD and 451 were not (non-AITD). Overall, G6PD deficiency was more prevalent in TD patients compared with patients without TD (controls) (16.7% vs. 11.2%; p < 0.0001). Multivariable logistic regression analysis (after adjusting for age, sex, excess weight and smoking habits), confirmed a higher risk of AITD among G6PD deficient patients with an odds ratio (OR) of 1.36 and 95% confidence interval (CI) of 1.11-1.6, female patients (OR 1.33, 95% CI 1.07-1.65) and overweight patients (OR 1.22, 95% CI 1.03-1.44). CONCLUSIONS The risk of AITD is increased in carriers of G6PD deficiency. A careful assessment of thyroid function is advisable in patients with inherited G6PD defects.
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Affiliation(s)
- Maria Pina Dore
- Dipartimento di Medicina, Chirurgia e Farmacia, Clinica Medica, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
- Baylor College of Medicine, One Baylor Plaza Blvd, Houston, TX 77030, USA
| | - Giuseppe Fanciulli
- Dipartimento di Medicina, Chirurgia e Farmacia, Clinica Medica, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
- Endocrine Unit, AOU Sassari, 07100 Sassari, Italy
| | - Giovanni Mario Pes
- Dipartimento di Medicina, Chirurgia e Farmacia, Clinica Medica, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
- Sardinia Longevity Blue Zone Observatory, 08040 Ogliastra, Italy
- Correspondence: ; Tel.: +39-347-4539532
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Nanou A, Toumpeki C, Fanis P, Bianchi N, Cosenza LC, Zuccato C, Sentis G, Giagkas G, Stephanou C, Phylactides M, Christou S, Hadjigavriel M, Sitarou M, Lederer CW, Gambari R, Kleanthous M, Katsantoni E. Sex-specific transcriptional profiles identified in β-thalassemia patients. Haematologica 2021; 106:1207-1211. [PMID: 32817281 PMCID: PMC8018115 DOI: 10.3324/haematol.2020.248013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Aikaterini Nanou
- Basic Research Center, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Chrisavgi Toumpeki
- Basic Research Center, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Pavlos Fanis
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, Nicosia
| | - Nicoletta Bianchi
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy
| | | | - Cristina Zuccato
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy
| | - George Sentis
- Basic Research Center, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Giorgos Giagkas
- Basic Research Center, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Coralea Stephanou
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, Nicosia
| | - Marios Phylactides
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, Nicosia
| | | | | | - Maria Sitarou
- Thalassemia Clinic Larnaca, Larnaca General Hospital, Larnaca, Cyprus
| | - Carsten W Lederer
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, Nicosia
| | - Roberto Gambari
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy
| | - Marina Kleanthous
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, Nicosia
| | - Eleni Katsantoni
- Basic Research Center, Biomedical Research Foundation, Academy of Athens, Athens, Greece
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Thyroid Disorders in Homozygous β-Thalassemia: Current Knowledge, Emerging Issues and Open Problems. Mediterr J Hematol Infect Dis 2019; 11:e2019029. [PMID: 31205633 PMCID: PMC6548211 DOI: 10.4084/mjhid.2019.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/08/2019] [Indexed: 12/19/2022] Open
Abstract
Changes in thyroid function and thyroid function tests occur in patients with β-thalassemia major (TM). The frequency of hypothyroidism in TM patients ranges from 4% to 29 % in different reports. The wide variation has been attributed to several factors such as patients’ genotype, age, ethnic heterogeneity, treatment protocols of transfusions and chelation, and varying compliance to treatment. Hypothyroidism is the result of primary gland failure or insufficient thyroid gland stimulation by the hypothalamus or pituitary gland. The main laboratory parameters of thyroid function are the assessments of serum thyroid-stimulating hor-mone (TSH) and serum free thyroxine (FT4). It is of primary importance to interpret these measurements within the context of the laboratory-specific normative range for each test. An elevated serum TSH level with a standard range of serum FT4 level is consistent with subclinical hypothyroidism. A low serum FT4 level with a low, or inappropriately normal, serum TSH level is consistent with secondary hypothyroidism. Doctors caring for TM patients most commonly encounter subjects with subclinical primary hypothyroidism in the second decade of life. Several aspects remain to be elucidated as the frequency of thyroid cancer and the possible existence of a relationship between thyroid dysfunction, on one hand, cardiovascular diseases, components of metabolic syndrome (insulin resistance) and hypercoagulable state, on the other hand. Further studies are needed to explain these emerging issues. Following a brief description of thyroid hormone regulation, production and actions, this article is conceptually divided into two parts; the first reports the spectrum of thyroid disease occurring in patients with TM, and the second part focuses on the emerging issues and the open problems in TM patients with thyroid disorders.
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