A Novel -72 (T→A) β-Promoter Mutation Causing Slightly Elevated HbA2 in a Vietnamese Heterozygote

The Effect of HBB: c.-121C>T Variant [-71 (C>T)] on the β-Globin Promoter: Case Series Study

One of the effective strategies in controlling thalassemia is recognition of carriers, followed by prenatal diagnosis (PND) to prevent the occurrence of new cases. There are some rare mutations and variants, for which there are not enough evidences of their effects, and can lead to misdiagnosis and even cause confusion in decision about termination of pregnancy. That is why it is very critical to know the effect of each mutation on the β chain gene. The variant of HBB: c.-121C>T [-71 (C>T)] located in the CAAT box of the promoter region, is a rare mutation. We report seven patients in Hormozagn Province, Iran, who were referred to the PND Center of Hormozgan University of Medical Science (HUMS), Bandar Abbas, Iran during 10 years (2010-2020). Briefly, this mutation causes minor changes in blood indices [mean corpuscular volume (MCV): 75.0 ± 4.0 fL; mean corpuscular hemoglobin (MCH): 25.8 ± 2.5 pg; Hb A₂: 3.4 ± 0.5%] showed anemia with a trait milder than minor β-thalassemia (β-thal). Though the existence of α mutations (deletions/point mutations) along with HBB: c.-121C>T can change blood indices due to the changes in α/β ratio. The phenotype of β-thal intermedia (β-TI) was observed in one case, who was a compound heterozygosity for codon 15 (G>A)/-71(C>T) (HBB: c.48G>A/HBB: c.-121C>T. The analysis of transcription level by real-time polymerase chain reaction (real-time PCR) confirmed that this allele induces a mild β⁺ phenotype due to a decrease in the transcription level.

Identification of Circulating Endocan-1 and Ether Phospholipids as Biomarkers for Complications in Thalassemia Patients

Despite advances in our knowledge and attempts to improve therapies, β-thalassemia remains a prevalent disorder with increased risk for the development of cardiomyopathy. Using an untargeted discovery-based lipidomic workflow, we uncovered that transfusion-dependent thalassemia (TDT) patients had a unique circulating lipidomic signature consisting of 387 lipid features, allowing their significant discrimination from healthy controls (Q-value < 0.01). In particular, TDT patients had elevated triacylglycerols and long-chain acylcarnitines, albeit lower ether phospholipids or plasmalogens, sphingomyelins, and cholesterol esters, reminiscent of that previously characterized in cardiometabolic diseases resulting from mitochondrial and peroxisomal dysfunction. Discriminating lipid (sub)classes correlated differentially with clinical parameters, reflecting blood (ether phospholipids) and iron (cholesterol ester) status or heart function (triacylglycerols). We also tested 15 potential serum biomarkers related to cardiometabolic disease and found that both lipocalin-2 and, for the first time, endocan-1 levels were significantly elevated in TDT patients and showed a strong correlation with blood parameters and three ether diacylglycerophosphatidylcholine species. In conclusion, this study identifies new characteristics of TDT patients which may have relevance in developing biomarkers and therapeutics.