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Grooms AJ, Burris BJ, Badu-Tawiah AK. Mass spectrometry for metabolomics analysis: Applications in neonatal and cancer screening. MASS SPECTROMETRY REVIEWS 2024; 43:683-712. [PMID: 36524560 PMCID: PMC10272294 DOI: 10.1002/mas.21826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Chemical analysis by analytical instrumentation has played a major role in disease diagnosis, which is a necessary step for disease treatment. While the treatment process often targets specific organs or compounds, the diagnostic step can occur through various means, including physical or chemical examination. Chemically, the genome may be evaluated to give information about potential genetic outcomes, the transcriptome to provide information about expression actively occurring, the proteome to offer insight on functions causing metabolite expression, or the metabolome to provide a picture of both past and ongoing physiological function in the body. Mass spectrometry (MS) has been elevated among other analytical instrumentation because it can be used to evaluate all four biological machineries of the body. In addition, MS provides enhanced sensitivity, selectivity, versatility, and speed for rapid turnaround time, qualities that are important for instance in clinical procedures involving the diagnosis of a pediatric patient in intensive care or a cancer patient undergoing surgery. In this review, we provide a summary of the use of MS to evaluate biomarkers for newborn screening and cancer diagnosis. As many reviews have recently appeared focusing on MS methods and instrumentation for metabolite analysis, we sought to describe the biological basis for many metabolomic and additional omics biomarkers used in newborn screening and how tandem MS methods have recently been applied, in comparison to traditional methods. Similar comparison is done for cancer screening, with emphasis on emerging MS approaches that allow biological fluids, tissues, and breath to be analyzed for the presence of diagnostic metabolites yielding insight for treatment options based on the understanding of prior and current physiological functions of the body.
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Affiliation(s)
- Alexander J Grooms
- Department of Chemistry and Biochemistry, The Ohio State University, Ohio, Columbus, USA
| | - Benjamin J Burris
- Department of Chemistry and Biochemistry, The Ohio State University, Ohio, Columbus, USA
| | - Abraham K Badu-Tawiah
- Department of Chemistry and Biochemistry, The Ohio State University, Ohio, Columbus, USA
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2
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Pines M, Sheth S. Clinical Classification, Screening, and Diagnosis in Beta-Thalassemia and Hemoglobin E/Beta-Thalassemia. Hematol Oncol Clin North Am 2023; 37:313-325. [PMID: 36907605 DOI: 10.1016/j.hoc.2022.12.003] [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: 03/12/2023]
Abstract
This article reviews the classification of beta-thalassemia syndromes, correlating clinical severity and genotype in the earlier classification, and broadening it recently based on clinical severity and transfusion status. The classification is dynamic, and individuals may progress from transfusion-independent to transfusion-dependent. Early and accurate diagnosis prevents delays in instituting treatment and comprehensive care, and precludes inappropriate and potentially harmful interventions. Screening can inform risk in an individual and subsequent generations when partners may be carriers as well. This article discusses the rationale for screening of the at-risk population. In the developed world, a more precise genetic diagnosis must be considered.
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Affiliation(s)
- Morgan Pines
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, P-695, 525 East 68th Street, New York, NY 10065, USA; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H1117A, New York, NY 10065, USA
| | - Sujit Sheth
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, P-695, 525 East 68th Street, New York, NY 10065, USA.
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3
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Li Z, Chen D, Shu Y, Yang J, Zhang J, Ming Wang, Wan K, Zhou Y, He X, Zou L, Yu C. A reliable and high throughput HPLC-HRMS method for the rapid screening of β-thalassemia and hemoglobinopathy in dried blood spots. Clin Chem Lab Med 2023; 61:1075-1083. [PMID: 36645719 DOI: 10.1515/cclm-2022-0706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/20/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Traditional methods for β-thalassemia screening usually rely on the structural integrity of hemoglobin (Hb), which can be affected by the hemolysis of red blood cells and Hb degradation. Here, we aim to develop a reliable and high throughput method for rapid detection of β-thalassemia using dried blood spots (DBS). METHODS Hb components were extracted from a disc (3.2 mm diameter) punched from the DBS samples and digested by trypsin to produce a series of Hb-specific peptides. An analytical system combining high-resolution mass spectrometry and high-performance liquid chromatography was used for biomarker selection. The selected marker peptides were used to calculate delta/beta (δ/β) and beta-mutated/beta (βM/β) globin ratios for disease evaluation. RESULTS Totally, 699 patients and 629 normal individuals, aged 3 days to 89 years, were recruited for method construction. Method assessment showed both the inter-assay and intra-assay relative standard deviation values were less than 10.8%, and the limits of quantitation for the proteo-specific peptides were quite low (1.0-5.0 μg/L). No appreciable matrix effects or carryover rates were observed. The extraction recoveries ranged from 93.8 to 128.7%, and the method was shown to be stable even when the samples were stored for 24 days. Prospective applications of this method in 909 participants also indicated good performance with a sensitivity of 100% and a specificity of 99.6%. CONCLUSIONS We have developed a fast, high throughput and reliable method for screening of β-thalassemia and hemoglobinopathy in children and adults, which is expected to be used as a first-line screening assay.
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Affiliation(s)
- Ziwei Li
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China.,Chongqing University Fuling Hospital, Chongqing, P.R. China
| | - Deling Chen
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China.,Chongqing University Fuling Hospital, Chongqing, P.R. China
| | - Yan Shu
- Chongqing University Fuling Hospital, Chongqing, P.R. China
| | - Jing Yang
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Juan Zhang
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Ming Wang
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Kexing Wan
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Yinpin Zhou
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China.,Chongqing University Fuling Hospital, Chongqing, P.R. China
| | - Xiaoyan He
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Lin Zou
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Chaowen Yu
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
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4
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Bender MA, Hulihan M, Dorley MC, Aguinaga MDP, Ojodu J, Yusuf C. Newborn Screening Practices for Beta-Thalassemia in the United States. Int J Neonatal Screen 2021; 7:ijns7040083. [PMID: 34940053 PMCID: PMC8703506 DOI: 10.3390/ijns7040083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Beta-thalassemia, a heritable condition of abnormal hemoglobin production, is not a core condition on the United States Recommended Uniform Screening Panel (RUSP) for state and territorial newborn screening (NBS) programs. However, screening for sickle cell disease (which is on the core RUSP) also detects reduced or absent levels of hemoglobin (Hb) A and certain other Hb variants associated with beta-thalassemia and, thus, allows for a timely referral to appropriate healthcare to minimize sequalae of the disease. The Association of Public Health Laboratories' Hemoglobinopathy Workgroup administered a comprehensive survey of all U.S. NBS programs to assess beta-thalassemia testing methodologies, the cutoffs for defining beta-thalassemia major, and the reporting and follow-up practices. Forty-six (87%) of the programs responded. Thirty-nine of the 46 responding programs (85%) report some form of suspected beta-thalassemia; however, the screening methods, the percentage of Hb A used as a cutoff for an indication of beta-thalassemia major, and the screening follow-up vary widely. The standardization of technical and reporting procedures may improve access to specialty care prior to severe complications, increase genetic counseling, and provide data needed to better understand the public health impact and clinical outcomes of beta-thalassemia in the United States.
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Affiliation(s)
- Michael A. Bender
- Clinical Research Division, Department of Pediatrics, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98109, USA;
| | - Mary Hulihan
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Division of Blood Disorders, Atlanta, GA 30329, USA;
| | - Mary Christine Dorley
- Tennessee Department of Health Laboratory Services, Nashville, TN 37243, USA;
- College of Health Professions, School of Health Sciences, Walden University, Minneapolis, MN 55401, USA
| | - Maria del Pilar Aguinaga
- Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, TN 37208, USA;
- Meharry Sickle Cell Center, Meharry Medical College, Nashville, TN 37208, USA
| | - Jelili Ojodu
- Association of Public Health Laboratories, Silver Spring, MD 20910, USA;
- Correspondence:
| | - Careema Yusuf
- Association of Public Health Laboratories, Silver Spring, MD 20910, USA;
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Mensah C, Sheth S. Optimal strategies for carrier screening and prenatal diagnosis of α- and β-thalassemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:607-613. [PMID: 34889395 PMCID: PMC8791174 DOI: 10.1182/hematology.2021000296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The thalassemias are inherited quantitative disorders of hemoglobin synthesis with a significant worldwide burden, which result in a wide spectrum of disease from the most severe transfusion-dependent form to the mildest asymptomatic carrier state. In this article, we discuss the importance of carrier, prenatal, and newborn screening for thalassemia. We examine the rationale for who should be screened and when, as well as the current methodology for screening. Deficiencies in the newborn screening program are highlighted as well. With the advent of inexpensive and rapid genetic testing, this may be the most practical method of screening in the future, and we review the implications of population-based implementation of this strategy. Finally, a case-based overview of the approach for individuals with the trait as well as prospective parents who have a potential fetal risk of the disease is outlined.
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Affiliation(s)
- Cheryl Mensah
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Sujit Sheth
- Division of Hematology and Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY
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6
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Padilla CD, Therrell BL, Alcausin MMLB, de Castro RC, Gepte MBP, Reyes MEL, Jomento CM, Suarez RCN, Maceda EBG, Abarquez CG, Posecion JEWC, Andal AP, Elizaga ALG, Halili-Mendoza BC, Otayza MPVK, Hoppe CC. Successful Implementation of Newborn Screening for Hemoglobin Disorders in the Philippines. Int J Neonatal Screen 2021; 7:30. [PMID: 34204320 PMCID: PMC8293152 DOI: 10.3390/ijns7020030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
The Philippine newborn bloodspot screening (NBS) program began in 1996 with 24 hospitals and was formalized by legislation in 2004. The NBS panel was recently expanded to include a number of additional hereditary congenital conditions. Expertise and experiences from other NBS programs already screening for hemoglobinopathies were essential to its successful integration into the ongoing dried bloodspot NBS program in the Philippines. Building on clinical experiences and population data from Filipinos born in California, USA, hemoglobinopathies (including thalassemias) were selected for inclusion in the expanded screening panel. Hemoglobinopathy NBS, using high performance liquid chromatography, was implemented in a stepwise manner into the seven regional NBS screening laboratories. A central university laboratory provides confirmatory testing using both capillary electrophoresis and molecular methodologies. NBS results indicating carriers are followed up with educational fact sheets, while results of presumptive disease are referred for confirmatory testing and follow-up with a hematologist. Long-term care is provided through newborn screening continuity clinics across the country. Hemoglobinopathy NBS is now included in the national insurance package and screening uptake continues to increase nationally, exceeding 90% of all newborns in 7400+ hospitals and birthing centers nationwide prior to the COVID-19 pandemic.
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Affiliation(s)
- Carmencita D. Padilla
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (R.C.d.C.J.); (M.B.P.G.); (M.E.L.R.); (C.M.J.); (R.C.N.S.); (E.B.G.M.)
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Bradford L. Therrell
- National Newborn Screening and Global Resource Center, Austin, TX 78759, USA;
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Maria Melanie Liberty B. Alcausin
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (R.C.d.C.J.); (M.B.P.G.); (M.E.L.R.); (C.M.J.); (R.C.N.S.); (E.B.G.M.)
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Reynaldo C. de Castro
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (R.C.d.C.J.); (M.B.P.G.); (M.E.L.R.); (C.M.J.); (R.C.N.S.); (E.B.G.M.)
| | - Maria Beatriz P. Gepte
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (R.C.d.C.J.); (M.B.P.G.); (M.E.L.R.); (C.M.J.); (R.C.N.S.); (E.B.G.M.)
| | - Ma. Elouisa L. Reyes
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (R.C.d.C.J.); (M.B.P.G.); (M.E.L.R.); (C.M.J.); (R.C.N.S.); (E.B.G.M.)
| | - Charity M. Jomento
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (R.C.d.C.J.); (M.B.P.G.); (M.E.L.R.); (C.M.J.); (R.C.N.S.); (E.B.G.M.)
| | - Riza Concordia N. Suarez
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (R.C.d.C.J.); (M.B.P.G.); (M.E.L.R.); (C.M.J.); (R.C.N.S.); (E.B.G.M.)
| | - Ebner Bon G. Maceda
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (R.C.d.C.J.); (M.B.P.G.); (M.E.L.R.); (C.M.J.); (R.C.N.S.); (E.B.G.M.)
| | - Conchita G. Abarquez
- Newborn Screening Center—Mindanao, Southern Philippine Medical Center, Davao 8000, Philippines;
| | | | - Alma P. Andal
- Newborn Screening Center—Southern Luzon, Daniel O. Mercado Medical Center, Tanauan City 4232, Philippines;
| | - Anna Lea G. Elizaga
- Newborn Screening Center—National Institutes of Health, Quezon City 1101, Philippines;
| | - Bernadette C. Halili-Mendoza
- Newborn Screening Center—Central Luzon, Angeles City University Foundation Medical Center, Angeles City 2009, Philippines;
| | - Maria Paz Virginia K. Otayza
- Newborn Center—Northern Luzon, Mariano Marcos Memorial Hospital and Medical Center, Batac City 2906, Philippines;
| | - Carolyn C. Hoppe
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA 94609, USA;
- Global Blood Therapeutics, Inc., South San Francisco, CA 94080, USA
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Kattamis A, Forni GL, Aydinok Y, Viprakasit V. Changing patterns in the epidemiology of β-thalassemia. Eur J Haematol 2020; 105:692-703. [PMID: 32886826 PMCID: PMC7692954 DOI: 10.1111/ejh.13512] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/19/2023]
Abstract
β‐thalassemia major is an inherited hemoglobinopathy that requires lifelong red blood cell transfusions and iron chelation therapy to prevent complications due to iron overload. Traditionally, β‐thalassemia has been more common in certain regions of the world such as the Mediterranean, Middle East, and Southeast Asia. However, the prevalence of β‐thalassemia is increasing in other regions, including Northern Europe and North America, primarily due to migration. This review summarizes the available data on the changing incidence and prevalence of β‐thalassemia as well as factors influencing disease frequency. The data suggest that the epidemiology of β‐thalassemia is changing: Migration has increased the prevalence of the disease in regions traditionally believed to have a low prevalence, while, at the same time, prevention and screening programs in endemic regions have reduced the number of affected individuals. Various approaches to prevention and screening have been used. Region‐specific prevention and treatment programs, customized to align with local healthcare resources and cultural values, have been effective in identifying patients and carriers and providing information and care. Significant challenges remain in universally implementing these programs.
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Affiliation(s)
- Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Gian Luca Forni
- Centro della Microcitemia e Anemie Congenite e del Dismetabolismo del Ferro, Ospedale Galliera, Genoa, Italy
| | - Yesim Aydinok
- Department of Pediatric Hematology and Oncology, Ege University Hospital, Izmir, Turkey
| | - Vip Viprakasit
- Department of Pediatrics & Thalassemia Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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8
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Hockham C, Ekwattanakit S, Bhatt S, Penman BS, Gupta S, Viprakasit V, Piel FB. Estimating the burden of α-thalassaemia in Thailand using a comprehensive prevalence database for Southeast Asia. eLife 2019; 8:40580. [PMID: 31120421 PMCID: PMC6533055 DOI: 10.7554/elife.40580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 05/01/2019] [Indexed: 12/27/2022] Open
Abstract
Severe forms of α-thalassaemia, haemoglobin H disease and haemoglobin Bart’s hydrops fetalis, are an important public health concern in Southeast Asia. Yet information on the prevalence, genetic diversity and health burden of α-thalassaemia in the region remains limited. We compiled a geodatabase of α-thalassaemia prevalence and genetic diversity surveys and, using geostatistical modelling methods, generated the first continuous maps of α-thalassaemia mutations in Thailand and sub-national estimates of the number of newborns with severe forms in 2020. We also summarised the current evidence-base for α-thalassaemia prevalence and diversity for the region. We estimate that 3595 (95% credible interval 1,717–6,199) newborns will be born with severe α-thalassaemia in Thailand in 2020, which is considerably higher than previous estimates. Accurate, fine-scale epidemiological data are necessary to guide sustainable national and regional health policies for α-thalassaemia management. Our maps and newborn estimates are an important first step towards this aim. Editorial note: This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).
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Affiliation(s)
- Carinna Hockham
- The George Institute for Global Health, Sydney, Australia.,Evolutionary Ecology of Infectious Disease Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Supachai Ekwattanakit
- Thalassaemia Centre, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Samir Bhatt
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, United Kingdom
| | - Bridget S Penman
- Warwick Infectious Disease Epidemiology Research, School of Life Sciences, Warwick University, Coventry, United Kingdom
| | - Sunetra Gupta
- Evolutionary Ecology of Infectious Disease Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Vip Viprakasit
- Thalassaemia Centre, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Department of Paediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Frédéric B Piel
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
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Goonasekera H, Paththinige C, Dissanayake V. Population Screening for Hemoglobinopathies. Annu Rev Genomics Hum Genet 2018; 19:355-380. [DOI: 10.1146/annurev-genom-091416-035451] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hemoglobinopathies are the most common single-gene disorders in the world. Their prevalence is predicted to increase in the future, and low-income hemoglobinopathy-endemic regions need to manage most of the world's affected persons. International organizations, governments, and other stakeholders have initiated national or regional prevention programs in both endemic and nonendemic countries by performing population screening for α- and β-thalassemia, HbE disease, and sickle cell disease in neonates, adolescents, reproductive-age adults (preconceptionally or in the early antenatal period), and family members of diagnosed cases. The main aim of screening is to reduce the number of affected births and, in the case of sickle cell disease, reduce childhood morbidity and mortality. Screening strategies vary depending on the population group, but a few common screening test methods are universally used. We discuss the salient features of population-screening programs around the globe as well as current and proposed screening test methodologies.
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Affiliation(s)
- H.W. Goonasekera
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;, ,
| | - C.S. Paththinige
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;, ,
- Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - V.H.W. Dissanayake
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;, ,
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Abstract
Available and flexible choice of methods for screening and detecting β-thalassemia (β-thal) can promote control of thalassemia in developing countries. In this study, two methods, the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) and reverse dot-blot hybridization assays were developed to detect common β-thal mutations in 244 thalassemia patients and 152 healthy people in North Vietnam. The most common mutation was codon 26 (G>A), also known as Hb E (HBB: c.79G>A), accounting for 26.4% of the total studied chromosomes, followed by codons 41/42 (-TCTT) (HBB: c.126_129delCTTT) and codon 17 (A>T) (HBB: c.c.52A>T), accounting for 19.4 and 16.4%, respectively. In addition, codon 95 (+A) (HBB: c.c.287_288insA) that is known as the Vietnamese mutation, accounted for 0.6%. Moreover, the heterozygous state of the four mutations was also found in healthy people, of which Hb E was again the most common mutation with a frequency 3.0%. The results of this study provide available methods and indicative data for preventive and control strategies concerning the genetic diagnosis of thalassemia.
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Affiliation(s)
- Lan Thi Thuong Vo
- a Faculty of Biology , Vietnam National University, University of Science , Thanh Xuan , Hanoi , Vietnam
| | - Trang Thu Nguyen
- a Faculty of Biology , Vietnam National University, University of Science , Thanh Xuan , Hanoi , Vietnam
| | - Hai Xuan Le
- b National Institute of Hematology and Blood Transfusion , Cau Giay , Hanoi , Vietnam
| | - Ha Thi Thu Le
- a Faculty of Biology , Vietnam National University, University of Science , Thanh Xuan , Hanoi , Vietnam
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11
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Li CK. New trend in the epidemiology of thalassaemia. Best Pract Res Clin Obstet Gynaecol 2017; 39:16-26. [DOI: 10.1016/j.bpobgyn.2016.10.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/21/2016] [Accepted: 10/14/2016] [Indexed: 01/19/2023]
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12
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Vichinsky E. Non-transfusion-dependent thalassemia and thalassemia intermedia: epidemiology, complications, and management. Curr Med Res Opin 2016; 32:191-204. [PMID: 26479125 DOI: 10.1185/03007995.2015.1110128] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The non-transfusion-dependent thalassemias (NTDTs), including thalassemia intermedia (TI), hemoglobin E beta thalassemia, and hemoglobin H disease, have sometimes been regarded as less severe than their transfusion-dependent variants; however, these disorders carry a substantial disease burden (e.g., splenomegaly, iron overload, skeletal effects, and cardiopulmonary disease). The aim of this review is to increase clinician awareness of the growing global problem of NTDT and TI, and discuss the current management strategies for these conditions. METHODS Recent peer-reviewed articles (publication years 2000 through 2015) addressing the epidemiology, complications, management, and monitoring of NTDT were identified in the PubMed database and reviewed. RESULTS The changing epidemiology of thalassemia constitutes a growing health problem. Increased clinician awareness is necessary for the appropriate diagnosis and management of patients with NTDT. CONCLUSIONS Management of NTDT requires a comprehensive approach, beginning with screening and prenatal diagnosis, monitoring for iron overload and associated complications, and iron chelation therapy. Several novel strategies are in the early stages of investigation and may help increase treatment options in patients with NTDT. Importantly, ethnic or cultural barriers may exist within the affected populations and need to be considered in the management approach.
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Affiliation(s)
- Elliott Vichinsky
- a UCSF Benioff Children's Hospital, Oakland , University of California , San Francisco, CA , USA
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Derderian SC, Jeanty C, Walters MC, Vichinsky E, MacKenzie TC. In utero hematopoietic cell transplantation for hemoglobinopathies. Front Pharmacol 2015; 5:278. [PMID: 25628564 PMCID: PMC4290536 DOI: 10.3389/fphar.2014.00278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/28/2014] [Indexed: 12/01/2022] Open
Abstract
In utero hematopoietic cell transplantation (IUHCTx) is a promising strategy to circumvent the challenges of postnatal hematopoietic stem cell (HSC) transplantation. The goal of IUHCTx is to introduce donor cells into a naïve host prior to immune maturation, thereby inducing donor–specific tolerance. Thus, this technique has the potential of avoiding host myeloablative conditioning with cytotoxic agents. Over the past two decades, several attempts at IUHCTx have been made to cure numerous underlying congenital anomalies with limited success. In this review, we will briefly review the history of IUHCTx and give a perspective on alpha thalassemia major, one target disease for its clinical application.
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Affiliation(s)
- S Christopher Derderian
- Department of Surgery, Eli and Edythe Broad Center of Regeneration Medicine, University of California San Francisco San Francisco, CA, USA
| | - Cerine Jeanty
- Department of Surgery, Eli and Edythe Broad Center of Regeneration Medicine, University of California San Francisco San Francisco, CA, USA
| | - Mark C Walters
- Children's Hospital and Research Center Oakland Oakland, CA, USA
| | | | - Tippi C MacKenzie
- Department of Surgery, Eli and Edythe Broad Center of Regeneration Medicine, University of California San Francisco San Francisco, CA, USA
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Abstract
Thalassemia, once a rarity in the United States, is increasingly encountered in clinical practice due to shifts in immigration. Early carrier screening in at-risk populations can help clinicians implement genetic counseling and prevent new cases. Chronic transfusions are the mainstay of therapy for patients with severe thalassemia (beta thalassemia major), and are used intermittently in individuals with milder forms of thalassemia (Hb H/H Constant Spring disease and beta thalassemia intermedia). Iron overload is a major source of morbidity and mortality in individuals with transfusion and non-transfusion-dependent thalassemia, necessitating iron chelation therapy. Iron overload contributes to increased risk of cirrhosis, heart failure, and endocrinopathies, while ineffective erythropoiesis and hemolysis contribute to multiple complications, including splenomegaly, extramedullary hematopoiesis, pulmonary hypertension, and thrombosis. An understanding of the importance of carrier screening, complications, monitoring, and management strategies, coupled with collaboration with a hematologist with thalassemia expertise, is essential to reduce the morbidity and mortality in patients with thalassemia.
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Affiliation(s)
- Farzana A Sayani
- a Perelman School of Medicine, University of Pennsylvania , Division of Hematology-Oncology, Department of Medicine , Philadelphia , USA
| | - Janet L Kwiatkowski
- b Perelman School of Medicine, University of Pennsylvania , Children's Hospital of Philadelphia, Division of Hematology, Department of Pediatrics , Philadelphia , USA
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Xie XM, Zhou JY, Li J, Li R, Liao C, Li DZ. Implementation of newborn screening for hemoglobin h disease in mainland china. Indian J Hematol Blood Transfus 2014; 31:242-6. [PMID: 25825565 DOI: 10.1007/s12288-014-0432-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/03/2014] [Indexed: 11/26/2022] Open
Abstract
Hemoglobin H disease is the most severe non-fatal form of α-thalassemia syndrome characterized by pronounced microcytic hypochromic hemolytic anemia. It is predominantly seen in Southeast Asia, the Middle East and the Mediterranean. Studies suggest that hemoglobin H disease is not as benign a disorder as previously thought. Newborn screening for hemoglobin H disease is especially appealing because the screening test is based on the detection of hemoglobin Bart's (γ4) that is only possible within the newborn period. In this study, we reported on a 4-year period of newborn screening program at a mainland Chinese hospital, which detected 35 babies with hemoglobin H disease in a total of 26 152 newborns. The overall prevalence for hemoglobin H disease among all newborns in southern China is ~1 in 1,000. These children need appropriate follow-up and potential comprehensive care during their growth and development.
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Affiliation(s)
- Xing-Mei Xie
- Prenatal Diagnostic Center, Guangzhou Maternal & Neonatal Hospital, Guangzhou Women & Children Medical Center, Guangzhou Medical University, Jinsui Road 9, Zhujiang New Town, Guangzhou, 510623 Guangdong People's Republic of China
| | - Jian-Ying Zhou
- Prenatal Diagnostic Center, Guangzhou Maternal & Neonatal Hospital, Guangzhou Women & Children Medical Center, Guangzhou Medical University, Jinsui Road 9, Zhujiang New Town, Guangzhou, 510623 Guangdong People's Republic of China
| | - Jian Li
- Prenatal Diagnostic Center, Guangzhou Maternal & Neonatal Hospital, Guangzhou Women & Children Medical Center, Guangzhou Medical University, Jinsui Road 9, Zhujiang New Town, Guangzhou, 510623 Guangdong People's Republic of China
| | - Ru Li
- Prenatal Diagnostic Center, Guangzhou Maternal & Neonatal Hospital, Guangzhou Women & Children Medical Center, Guangzhou Medical University, Jinsui Road 9, Zhujiang New Town, Guangzhou, 510623 Guangdong People's Republic of China
| | - Can Liao
- Prenatal Diagnostic Center, Guangzhou Maternal & Neonatal Hospital, Guangzhou Women & Children Medical Center, Guangzhou Medical University, Jinsui Road 9, Zhujiang New Town, Guangzhou, 510623 Guangdong People's Republic of China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Maternal & Neonatal Hospital, Guangzhou Women & Children Medical Center, Guangzhou Medical University, Jinsui Road 9, Zhujiang New Town, Guangzhou, 510623 Guangdong People's Republic of China
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Diagnostic utility of isoelectric focusing and high performance liquid chromatography in neonatal cord blood screening for thalassemia and non-sickling hemoglobinopathies. Clin Chim Acta 2014; 427:23-6. [PMID: 24095765 DOI: 10.1016/j.cca.2013.09.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/23/2013] [Accepted: 09/24/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thalassemia syndromes are highly prevalent in Southeast Asia. In Thailand, high performance liquid chromatography (HPLC) is the most common technique routinely performed in diagnosis of thalassemia and hemoglobinopathies, while isoelectric focusing (IEF) is rarely employed. We compared the diagnostic utility of IEF and HPLC in neonatal screening for thalassemia and non-sickling hemoglobinopathies. METHODS Two-hundred and forty-one cord blood samples were analyzed using IEF and HPLC, β-thalassemia short program. The results were correlated with red cell indices and molecular analyses. Hemoglobin (Hb) Bart's was quantified only on IEF. RESULTS Of 241 newborns, IEF and HPLC yielded 85.4% and 76.4% sensitivity to identify α-thalassemia syndrome, respectively. HbBart's≥2% yielded 100% sensitivity to identify 2 α-globin gene deletions and/or mutations, while MCV≤95fl and MCH≤30pg yielded 100% sensitivity to identify 2 α-globin gene deletions. DNA analysis revealed HbE mutation in all 61 subjects with HbA2>1% on both IEF and HPLC. CONCLUSION IEF is an effective method in neonatal screening for thalassemia and non-sickling hemoglobinopathies. The HbBart's level, MCV and MCH are helpful for identifying α-thalassemia. The presence of HbA2 higher than 1% in cord blood indicates HbE carriers in Southeast Asian newborns.
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Jindatanmanusan P, Riolueang S, Glomglao W, Sukontharangsri Y, Chamnanvanakij S, Torcharus K, Viprakasit V. Diagnostic applications of newborn screening for α-thalassaemias, haemoglobins E and H disorders using isoelectric focusing on dry blood spots. Ann Clin Biochem 2013; 51:237-47. [DOI: 10.1177/0004563213491078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Neonatal screening for haemoglobin (Hb) disorders is a standard of care in several developed countries with the main objective to detect Hb S. Such practice has not been established in Thailand where α-thalassaemia and haemoglobin E (Hb E) are highly prevalent. Early identification of thalassaemias could be helpful and strengthen the programme for prevention and control for severe thalassaemias. Methods Data from isoelectric focusing (IEF) and Isoscan® for detecting types and amount (%) of each haemoglobin in 350 newborn’s dried blood spots were analysed and compared with the comprehensive genotype analysis by DNA studies as a gold standard. Results Based on genetic profiles, there were 10 different categories: (1) normal ( n = 227), (2) α+-thalassaemia trait ( n = 14), (3) α0-thalassaemia trait ( n = 13), (4) β0-thalassaemia trait ( n = 7), (5) Hb E trait ( n = 72), (6) Hb E trait with α0-thalassaemia or homozygous α+-thalassaemia ( n = 5), (7) Hb E trait with α+-thalassaemia trait ( n = 5), (8) homozygous Hb E ( n = 3), (9) homozygous Hb E with α0-thalassaemia trait ( n = 1) and (10) Hb H disease ( n = 3). The presence of Hb Bart’s and Hb E were used to identify cases with α-thalassaemia and Hb E, respectively. We set 0.25% of Hb Bart’s and 1.5% of Hb E as a cut-off level to detect α+-thalassaemia trait (sensitivity 92.86% and specificity 74.0%) and Hb E trait with 100% of both sensitivity and specificity for IEF diagnosis. Conclusion Although molecular diagnosis seems to be better for definitive diagnosis of thalassaemia syndromes at birth, however, using our reference range described herein, IEF can be applied in a resource-limiting setting with acceptable reliability.
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Affiliation(s)
- Punyanuch Jindatanmanusan
- Hematology Division, Phramongkutklao Hospital, Bangkok, Thailand
- Department of Clinical Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchada Riolueang
- Department of Immunology, Siriraj Hospital Mahidol University, Bangkok, Thailand
- Thalassemia Centre, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waraporn Glomglao
- Division of Hematology/Oncology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Kitti Torcharus
- Department of Clinical Pathology, Phramongkutklao Hospital, Bangkok, Thailand
| | - Vip Viprakasit
- Thalassemia Centre, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Hematology/Oncology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
α-Thalassemia mutations affect up to 5% of the world's population. The clinical spectrum ranges from an asymptomatic condition to a fatal in utero disease. Hemoglobin H disease results from mutations of three α-globin genes. Deletional forms result in a relatively mild anemia, whereas nondeletional mutations result in a moderate to severe disease characterized by ineffective erythropoiesis, recurrent transfusions, and growth delay. Hemosiderosis develops secondary to increased iron absorption, as well as transfusion burden. Hemoglobin Bart's hydrops fetalis is usually a fatal in utero disease caused by the absence of α genes. Population screening to identify at-risk couples is essential. Affected pregnancies result in severe fetal and maternal complications. Doppler ultrasonography with intrauterine transfusion therapy may improve the fetal prognosis but creates ethical challenges for the family and health providers.
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Affiliation(s)
- Elliott P Vichinsky
- Department of Hematology/Oncology, Children's Hospital & Research Center Oakland, Oakland, CA 94609, USA.
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Birth prevalence of disorders detectable through newborn screening by race/ethnicity. Genet Med 2012; 14:937-45. [PMID: 22766612 DOI: 10.1038/gim.2012.76] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of this study was to describe the birth prevalence of genetic disorders among different racial/ethnic groups through population-based newborn screening data. METHODS Between 7 July 2005 and 6 July 2010 newborns in California were screened for selected metabolic, endocrine, hemoglobin, and cystic fibrosis disorders using a blood sample collected via heel stick. The race and ethnicity of each newborn was self-reported by the mother at the time of specimen collection. RESULTS Of 2,282,138 newborns screened, the overall disorder detection rate was 1 in 500 births. The disorder with the highest prevalence among all groups was primary congenital hypothyroidism (1 in 1,706 births). Birth prevalence for specific disorders varied widely among different racial/ethnic groups. CONCLUSION The California newborn screening data offer a unique opportunity to explore the birth prevalence of many genetic disorders across a wide spectrum of racial/ethnicity classifications. The data demonstrate that racial/ethnic subgroups of the California newborn population have very different patterns of heritable disease expression. Determining the birth prevalence of these disorders in California is a first step to understanding the short- and long-term medical and treatment needs faced by affected communities, especially those groups that are impacted by more severe disorders.
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Chen Q, Fabry ME, Rybicki AC, Suzuka SM, Balazs TC, Etzion Z, de Jong K, Akoto EK, Canterino JE, Kaul DK, Kuypers FA, Lefer D, Bouhassira EE, Hirsch RE. A transgenic mouse model expressing exclusively human hemoglobin E: indications of a mild oxidative stress. Blood Cells Mol Dis 2012; 48:91-101. [PMID: 22260787 PMCID: PMC3310900 DOI: 10.1016/j.bcmd.2011.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/04/2011] [Accepted: 11/22/2011] [Indexed: 11/19/2022]
Abstract
Hemoglobin (Hb) E (β26 Glu→Lys) is the most common abnormal hemoglobin (Hb) variant in the world. Homozygotes for HbE are mildly thalassemic as a result of the alternate splice mutation and present with a benign clinical picture (microcytic and mildly anemic) with rare clinical symptoms. Given that the human red blood cell (RBC) contains both HbE and excess α-chains along with minor hemoglobins, the consequence of HbE alone on RBC pathophysiology has not been elucidated. This becomes critical for the highly morbid β(E)-thalassemia disease. We have generated transgenic mice exclusively expressing human HbE (HbEKO) that exhibit the known aberrant splicing of β(E) globin mRNA, but are essentially non-thalassemic as demonstrated by RBC α/β (human) globin chain synthesis. These mice exhibit hematological characteristics similar to presentations in human EE individuals: microcytic RBC with low MCV and MCH but normal MCHC; target RBC; mild anemia with low Hb, HCT and mildly elevated reticulocyte levels and decreased osmotic fragility, indicating altered RBC surface area to volume ratio. These alterations are correlated with a mild RBC oxidative stress indicated by enhanced membrane lipid peroxidation, elevated zinc protoporphyrin levels, and by small but significant changes in cardiac function. The C57 (background) mouse and full KO mouse models expressing HbE with the presence of HbS or HbA are used as controls. In select cases, the HbA full KO mouse model is compared but found to be limited due to its RBC thalassemic characteristics. Since the HbEKO mouse RBC lacks an abundance of excess α-chains that would approximate a mouse thalassemia (or a human thalassemia), the results indicate that the observed in vivo RBC mild oxidative stress arises, at least in part, from the molecular consequences of the HbE mutation.
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Affiliation(s)
- Qiuying Chen
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
| | - Mary E. Fabry
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
| | - Anne C. Rybicki
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
- Montefiore Medical Center, Bronx, NY
| | - Sandra M. Suzuka
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
| | - Tatiana C. Balazs
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
| | - Zipora Etzion
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
| | - Kitty de Jong
- Children’s Hospital of Oakland, Research Institute, CA
| | - Edna K. Akoto
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
| | - Joseph E. Canterino
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
| | - Dhananjay K. Kaul
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
| | | | - David Lefer
- Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Eric E. Bouhassira
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY
| | - Rhoda Elison Hirsch
- Department of Medicine/Hematology, Albert Einstein College of Medicine, Bronx, NY
- Department of Anatomy & Structural Biology, Albert Einstein College of Medicine, Bronx, NY
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Hustace T, Fleisher JM, Sanchez Varela AM, Podda A, Alvarez O. Increased prevalence of false positive hemoglobinopathy newborn screening in premature infants. Pediatr Blood Cancer 2011; 57:1039-43. [PMID: 21584936 DOI: 10.1002/pbc.23173] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 03/29/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objective was to investigate the specificity of the hemoglobinopathy newborn screening in premature neonates as compared to term neonates. PROCEDURE The screening results from infants suspected to have hemoglobinopathy disease identified by the Florida Newborn Screening Program for years 2002-2007 were compared to the corresponding confirmatory testing. The risks for false positives for preterm and full term newborns were calculated by Chi-square or the Cochran-Armitage test for trend. Isoelectric focusing and HPLC were the methods of hemoglobin screening. RESULTS Over 2,300 neonates (1/576 neonates born in Florida) were suspected to have hemoglobinopathy. The most common abnormal pattern in term and preterm infants (gestational age 22-36 weeks) suggesting disease at screening was FS. Overall, 93% of the children who screened positive for FCA and 64% of infants identified with FSA were later confirmed with trait. FSC was confirmed in 96% of the cases in both preterm and term infants. Compared to term newborns, preterm newborns were more likely to have a false positive result for FS or FC at screening. Twenty-three percent of preterms with FS and 59% of preterms with FC were diagnosed as traits by confirmatory testing, compared to only 2% and 6% for term infants (P < 0.001). CONCLUSIONS As compared to term newborns, more preterm newborns with trait were misidentified as having sickle cell anemia or hemoglobin C at screening. We speculate that abnormal hemoglobins may precede the development of hemoglobin A during fetal life.
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Affiliation(s)
- Tally Hustace
- Division of Pediatric Hematology, University of Miami, Miami, Florida, USA
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