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Algodayan S, Balachandar R, Papathanasiou N, Bomanji J, Porter JB, Waung J. Bone mineral density in adult thalassaemias: a retrospective longitudinal study. Nucl Med Commun 2024; 45:658-665. [PMID: 38832440 DOI: 10.1097/mnm.0000000000001864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES In this study, we aim to evaluate the long-term impact of thalassaemia on bone mineral density (BMD) through sequential analysis, compare changes in BMD values between male and female patients and find any correlation between BMD and biochemical markers in the adult thalassaemia group. BMD is a bone mineral density test using dual-energy X-ray to measure calcium hydroxyapatite per unit of bone, reflecting bone strength. METHODS We conducted a longitudinal retrospective observational cohort study to determine the changes in BMD values and biochemical parameters in adult thalassaemia patients. BMD was assessed at the lumbar spine (L1-L4) and proximal femora using Hologic's bone dual-energy X-ray absorptiometry. Five serial BMD values were retrieved from electronic records. Biochemical parameters, including serum calcium, phosphorus and 25-hydroxyvitamin D levels, were also assessed. RESULTS A total of 108 patients (47 males and 61 females; median age: 44 years) with thalassaemia major 71 patients, intermedia 20 patients, haemoglobin E disease 14 patients and thalassaemia-alpha three patients were included. The incidence of low BMD in patients with thalassaemia increased from 64 to 74% over three decades of analysis. Females and thalassaemia major patients had lower hip BMD values and corresponding Z -scores. CONCLUSION There is a progressive decline in BMD values in adult thalassaemia, which was apparent in female thalassaemia major patients. No changes in biochemical parameters, however, were observed over long-term assessments.
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Affiliation(s)
- Sarah Algodayan
- Department of Imaging, Institute of Nuclear Medicine, University College London Hospital, London, UK
- Department of Radiology, Imam Abdulrahman Bin Faisal University Hospital, Dammam, Saudi Arabia
| | - Ramya Balachandar
- Department of Imaging, Institute of Nuclear Medicine, University College London Hospital, London, UK
| | | | - Jamshed Bomanji
- Department of Imaging, Institute of Nuclear Medicine, University College London Hospital, London, UK
| | - John B Porter
- Department of Haematology, University College London Hospital
| | - Julian Waung
- Department of Haematology, University College London Hospital
- Department of Endocrinology, Whittington Hospital, London, UK
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Shamoon RP, Yassin AK, Omar N, Saeed MD, Akram R, Othman NN. Magnitude of Bone Disease in Transfusion-Dependent and Non-Transfusion-Dependent β-Thalassemia Patients. Cureus 2024; 16:e56012. [PMID: 38606231 PMCID: PMC11007755 DOI: 10.7759/cureus.56012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction β-Thalassemia is a common inherited disease in the northern part of Iraq. A considerable number of transfusion-dependent (TDT) and non-transfusion-dependent (NTDT) β-thalassemia patients suffer bone problems. The objective of this study was to evaluate the degree of bone disease in the TDT and NTDT patients using a dual-energy X-ray absorptiometry (DEXA) scan. Patients and methods In this study, 53 TDT and 20 NTDT patients aged ≥10 years were enrolled. Their bone status was assessed using the DEXA scan at the lumbar spine (L1-L4) and femoral neck. The effect of physical, biochemical, and hormonal characteristics on the bone mineral density (BMD) parameters was evaluated. The value of the BMD Z-score was the measure to decide on the magnitude of bone disease. Results and discussion The mean age of the enrolled patients was 24.1 years. The BMD Z-score values were significantly lower among the TDT patients at the lumbar spine and femoral neck (BMD Z-score: -2.05 and -1.51 versus -2.29 and -0.71; p=0.044 and 0.009, respectively). The proportion of osteoporosis at the lumbar spine was significantly higher in the TDT group than in the NTDT group (69.8% versus 40%; p <0.001). The BMD Z-score correlated significantly with patient BMI and parathyroid hormone (PTH) level in both the TDT and NTDT groups. No correlation was found with age, hemoglobin (Hb), and serum levels of calcium, vitamin D, ferritin, phosphorus, and alkaline phosphatase (ALP). Conclusions Impaired bone density was encountered at high proportions in our thalassemia patients. TDT patients suffered more severe bone disease than NTDT patients.
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Affiliation(s)
- Rawand P Shamoon
- Department of Pathology, College of Medicine, Hawler Medical University, Erbil, IRQ
- Department of Laboratory Medical Sciences, College of Health Sciences, Catholic University in Erbil, Erbil, IRQ
- Department of Hematology, Nanakali Hospital for Blood Diseases and Cancer, Erbil, IRQ
| | - Ahmed K Yassin
- Department of Internal Medicine, College of Medicine, Hawler Medical University, Erbil, IRQ
- Department of Hematology, Nanakali Hospital for Blood Diseases and Cancer, Erbil, IRQ
| | - Negar Omar
- Department of Physiotherapy and Rehabilitation, Erbil Teaching Hospital, Erbil, IRQ
| | | | - Reving Akram
- Department of Hematology, Thalassemia Care Center, Erbil, IRQ
| | - Naska N Othman
- Department of Pediatrics, Thalassemia Care Center, Erbil, IRQ
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Komninaka V, Flevari P, Karkaletsis G, Androutsakos T, Karkaletsi T, Ntanasis-Stathopoulos I, Ntelaki EE, Terpos E. Gaucher-like Cells in Thalassemia Intermedia: Is It a Challenge? Diseases 2023; 11:161. [PMID: 37987272 PMCID: PMC10660717 DOI: 10.3390/diseases11040161] [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: 10/07/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
We describe two cases of thalassemia intermedia (TI) patients with the presence of Gaucher-like cells in hematopoietic tissue biopsies, raising diagnostic dilemmas. The first is a 56-year-old female with bone lesions, splenomegaly, hypochromic microcytic anemia and Gaucher-like cells in the bone marrow, with a final diagnosis of TI, and the second is a 69-year-old male with TI, monoclonal gammopathy of undetermined significance (MGUS) that accelerated to multiple myeloma (MM) requiring treatment, bone disease and Gaucher-like cells in the bone marrow and the spleen, and heterozygoty of Gaucher disease (GD). Gaucher-like cells are difficult to differentiate from true Gaucher cells, that are the hallmark of GD suspicion. These cells are usually reported in the lymphohematopoietic system. They have been described in myeloproliferative disorders, hematological malignancies, infectious diseases, hemoglobinopathies and other hemolytic anemias. The presence of Gaucher-like cells in patients with thalassemia major has been well documented, whereas there are limited references regarding cases with thalassemia intermedia. The identification of these cells in thalassemia probably reflects the high cell turnover. The bony complications in GD and TIare not yet fully explained in the literature, and this raises the question of whether Gaucher-like cells could play a pathogenetic role in the bone disease of thalassemia, as Gaucher cells are considered to play a similar role in bone complications of GD. Moreover, given the rarity and similarity of Gaucher and Gaucher-like cells, we would like to highlight that the presence of Gaucher-like cells in the bone marrow should not be overlooked, as they might be obscuring an underlying pathology, in order to ensure that hematologists, internists and hematopathologists will be promptly and accurately diagnosed.
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Affiliation(s)
- Veroniki Komninaka
- Centre of Excellence in Rare Haematological (Haemoglobinopathies) & Rare Metabolic (Gaucher Disease) Diseases, Laiko General Hospital, 11527 Athens, Greece (P.F.)
| | - Pagona Flevari
- Centre of Excellence in Rare Haematological (Haemoglobinopathies) & Rare Metabolic (Gaucher Disease) Diseases, Laiko General Hospital, 11527 Athens, Greece (P.F.)
| | - Georgios Karkaletsis
- Medical School, Otto von Guericke University Magdeburg (OVGU), 39120 Magdeburg, Germany
| | - Theodoros Androutsakos
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Theofili Karkaletsi
- Medical School, Charité—Berlin University of Medicine, 10117 Berlin, Germany
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Evaggelia-Eleni Ntelaki
- Centre of Excellence in Rare Haematological (Haemoglobinopathies) & Rare Metabolic (Gaucher Disease) Diseases, Laiko General Hospital, 11527 Athens, Greece (P.F.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Teawtrakul N, Chansai S, Yamsri S, Chansung K, Wanitpongpun C, Lanamtieng T, Phiphitaporn P, Fucharoen S, Pongchaiyakul C. The association of growth differentiation factor-15 levels and osteoporosis in patients with thalassemia. Am J Med Sci 2023:S0002-9629(23)01173-4. [PMID: 37146903 DOI: 10.1016/j.amjms.2023.05.002] [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: 08/18/2022] [Accepted: 05/01/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Ineffective erythropoiesis (IE) is a significant risk factor for osteoporosis in individuals with thalassemia. Growth differentiation factor-15 (GDF15), a biomarker of IE, was found to be elevated in thalassemia patients. This study aimed to examine the association between GDF15 levels and osteoporosis in patients with thalassemia. METHODS A cross-sectional study was conducted in 130 adult patients with thalassemia in Thailand. Bone mineral density (BMD) at the lumbar spine was evaluated by dual-energy X-ray absorptiometry (DXA), and with a Z-score of less than -2.0 SD was defined as osteoporosis. GDF-15 was measured using the enzyme-linked immunosorbent assay (ELISA). Logistic regression analysis was used to examine the associated factors with the development of osteoporosis. Receiver operator characteristic (ROC) curve analysis was used to estimate the threshold of GDF15 in predicting osteoporosis. RESULTS Osteoporosis was detected in 55.4% (72/130) of the patients. Advanced age and high GDF15 levels were positively associated with osteoporosis, while an increased hemoglobin level was negatively associated with osteoporosis in patients with thalassemia. In this study, the GDF15 level's ROC demonstrated a good performance in predicting osteoporosis (AUC=0.77). CONCLUSIONS The prevalence of osteoporosis is high among adult thalassemia patients. Age and high GDF15 levels were significantly associated with osteoporosis in this study. A higher hemoglobin level is associated with a lower risk of osteoporosis. This study suggest that GDF15 could be used as a predictive biomarker for osteoporosis in patients with thalassemia. Adequate red blood cell transfusions and suppression of GDF15 function may be beneficial in preventing osteoporosis.
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Affiliation(s)
- Nattiya Teawtrakul
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002.
| | - Siriyakorn Chansai
- Medical science program, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand 40002; Centre for Research and Development of Medical Diagnostics Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Supawadee Yamsri
- Centre for Research and Development of Medical Diagnostics Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Kanchana Chansung
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Chinadol Wanitpongpun
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Theerin Lanamtieng
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Pisa Phiphitaporn
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Supan Fucharoen
- Centre for Research and Development of Medical Diagnostics Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002
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Habbash F, Al-Bati W, Al-Hashim H, Aldossari M, Alali A, Alalyani K, Al-Ebrahim Z, Hamed N, Eraqe S, Binayfan Z, Al Marri A, Aljaber T. Endocrine Complications and the Effect of Compliance with Chelation Therapy in Patients with Beta Thalassemia Major in Eastern Province of Saudi Arabia. J Blood Med 2022; 13:763-774. [PMID: 36514312 PMCID: PMC9741829 DOI: 10.2147/jbm.s386594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background Endocrinopathies and metabolic complications are common in beta thalassemia major patients receiving blood transfusions. Chelation therapy has a role in preventing or delaying such complications. However, patients may face difficulties adhering to chelation therapy for several reasons. Aim To evaluate endocrine complications in beta thalassemia major patients (2-30 years) in the Eastern Province of Saudi Arabia and compare the onset of endocrine complications among compliant and noncompliant patients. Moreover, we assessed the barriers that hinder compliance with chelating therapy. Methods A cross-sectional study was conducted on 89 patients (43 males and 46 females) aged 2 to 30 years attending different hospitals in the Eastern Province of Saudi Arabia. A semi-structured questionnaire was used to collect demographic data and medical histories. The questionnaires were completed by face-to-face interviews with the patients or their caregivers, and the required laboratory data were retrieved from the medical records of patients. Results The most prevalent abnormality was underweight detected in (40.9%) of patients, followed by subclinical hypothyroidism (37.7%), short stature (35.2%), hypothyroidism in (17.0%) and diabetes mellitus in (13.6%). A significant difference between those who were compliant with iron chelation therapy and those who were not in terms of the prevalence of short stature (P value=0.05) and hypothyroidism (P value=0.05). The percentage of patients who were not compliant with chelation therapy was 21.6% and 9.1% of patients were not taking them at all. Conclusion Despite the role of chelation therapy in the management of iron overload, the risk of secondary endocrine and metabolic complications remained considerable. Subclinical hypothyroidism and short stature were the most frequent endocrine complications encountered in this study.
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Affiliation(s)
- Fatema Habbash
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Wegdan Al-Bati
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Howra Al-Hashim
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Maryam Aldossari
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain,Correspondence: Maryam Aldossari, Tel +966 558322420, Email
| | - Ahmed Alali
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Khalid Alalyani
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Zainab Al-Ebrahim
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Nouf Hamed
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Samma Eraqe
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ziyad Binayfan
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Azzam Al Marri
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Thamer Aljaber
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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Endocrinal Complications in Children and Adolescents with Thalassemia Major in Central India: An Observational Study. Indian J Pediatr 2022; 89:983-988. [PMID: 34480715 DOI: 10.1007/s12098-021-03883-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the prevalence of short stature, delayed puberty, hypothyroidism, and diabetes mellitus in multiply transfused patients of beta thalassemia major and their correlation with serum ferritin. METHODS A descriptive observational study was conducted in a tertiary care center in Indore, Madhya Pradesh from 2014 to 2016. All children with thalassemia major of the age group 8 to 18 y attending outpatient department or admitted in ward were included in the study. Detailed clinical history, demographic data, compliance to transfusion and chelation therapy, and growth parameters were recorded. Blood samples to look for endocrinopathies and serum ferritin were assessed. Tanner staging was done to assess for delayed puberty. RESULTS Mean age of study participants (n = 50) was 15.98 ± 3.4 y. Short stature (n = 44; 88%), delayed puberty (n = 33; 71.7%), hypothyroidism (n = 6; 16%), and diabetes mellitus (n = 5; 10%) were the endocrinal abnormalities found. Mean serum ferritin level was 3122 ± 2117 ng/mL. Serum ferritin had significant positive correlation with serum TSH (thyroid stimulating hormone), fasting blood sugars, postprandial blood sugar, and delayed puberty. CONCLUSION Evaluation of endocrinopatines must be carried out in thalassemia major patients regularly by pediatricians to detect and treat endocrinal complications. Importance of chelation therapy must be emphasized frequently to parents and patients.
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Lidoriki I, Stavrou G, Schizas D, Frountzas M, Fotis L, Kapelouzou A, Kokkota S, Fyntanidou B, Kotzampassi K. Nutritional Status in a Sample of Patients With β-Thalassemia Major. Cureus 2022; 14:e27985. [PMID: 36120275 PMCID: PMC9468758 DOI: 10.7759/cureus.27985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 01/19/2023] Open
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Al-Saadi EK. Identification of osteopenia and osteoporotic changes in pediatric thalassemia patients at thalassemia center, Misan city, Iraq; An intervention study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Thalassemia syndrome is a heterogeneous group of hereditary disorders affecting the synthesis of globin chains of adult hemoglobin's, leading to ineffective erythropoiesis, hemolysis, and moderate to severe anemia. To identify the incidence of osteopenia and osteoporosis and it is relation to some of the probable risk factors of decreasing BMD among thalassemia patients attended Misan thalassemia center in Misan city in Iraq.
Methods: A randomized cross-sectional study, applied through a period from September 2020 to September 2021, on 50 thalassemia patients attended thalassemia Center Amarah, Misan, Iraq. 24 were males and 26 were females, we divided them in to two groups according to age (10-14) years, (>14-18) years. They were scanned for bone mineral density (BMD) at lumbar spine.
Results: 90% of patients had reduction in BMD patients mostly among THM patients. 40% had positive family history of thalassemia, Vitamin D3 level were low in (80%) of patients & DEXA studies were mostly between [(-1) -(-2.5)] before treatment that slightly improved after therapy in ranges of osteopenia but not in osteoporosis which increase severity as well.
Conclusions: Most thalassemia patient had severe anemia, corrected by frequent blood transfusion are complicated by increasing serum ferritin level and decreasing level of vitamin D3 in association with reduction in bone density mass in ranges of osteopenia and osteoporosis which correlates positively with increasing ages, early age at diagnosis and female gender this altered bone mass density require family awareness for better nutrition and optimum medical therapy and compliance to improve outcomes.
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Evaluation of the combination therapy of hydroxyurea and thalidomide in β-thalassemia. Blood Adv 2022; 6:6162-6168. [PMID: 35477175 PMCID: PMC9772794 DOI: 10.1182/bloodadvances.2022007031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 01/19/2023] Open
Abstract
Transfusion-related complications and lack of resources in low-to-middle-income countries have led to a search for novel therapies to reduce the need for blood transfusions in patients with β-thalassemia. Hydroxyurea (HU) has demonstrated promising outcomes; additionally, thalidomide has also shown improvement in hemoglobin (Hb) levels for patients with β-thalassemia in some studies. This study presents the findings of a single-arm nonrandomized trial to evaluate the efficacy of combination therapy of HU and thalidomide in children with β-thalassemia. A total of 135 patients (median age, 6 [interquartile range, 3-10] years), 77 (57%) males and 58 (43%) females, were followed first using HU alone, for 6 months, and then using the combination of HU and thalidomide for another 6 months. The primary outcome was a response to therapy, as measured by the number of transfusions required and Hb levels, for patients while receiving HU alone and then while using the combination therapy. Study findings showed a significant decline in blood transfusion volume (P < .001) and a significant increase in median Hb levels within 3 and 6 months of the combination therapy (P < .001). Eighty-nine (65.93%) participants were good responders, 16 (11.85%) were responders, and 30 (22.22%) were nonresponders, whereas the responders had variable genetic mutations. A total of 38 adverse events were reported that resolved on supportive treatment or temporary hold of the intervention. The combination therapy demonstrated promising results and could be considered for a diverse patient population with β-thalassemia. This trial was registered at www.clinicaltrials.gov as #NCT05132270.
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Tunç S, Sarbay H. Management of Endocrine Complications Affecting Survival and Quality of Life in Children and Adolescents with Thalassemia Major: A Single Center Experience. CYPRUS JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4274/cjms.2021.3362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Jitpirasakun S, Pooliam J, Sriwichakorn C, Sanpakit K, Nakavachara P. Differences in longitudinal growth patterns of children and adolescents with transfusion-dependent hemoglobin E/β-thalassemia and those achieving successful hematopoietic stem-cell transplantation. Int J Hematol 2022; 115:575-584. [PMID: 35192188 DOI: 10.1007/s12185-021-03279-4] [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: 09/06/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Short stature is a very common endocrinopathy among children with transfusion-dependent (TD) thalassemia. Hematopoietic stem-cell transplantation (HSCT) is the only effective curative treatment for TD thalassemia. This study aimed to identify and compare the longitudinal growth patterns of children with TD hemoglobin E (Hb E)/β-thalassemia against those of children successfully undergoing HSCT. MATERIALS AND METHODS We reviewed the medical records of 39 patients with TD Hb E/β-thalassemia receiving regular blood transfusions, and 39 post-HSCT patients. Longitudinal weight and height Z-scores at each year of age were recorded for TD patients, and longitudinal weight and height Z-scores at each year before and after HSCT were obtained for post-HSCT patients. RESULTS The mean weight and height Z-scores of TD patients decreased gradually and were lowest at age 13. However, post-HSCT subjects saw significant improvement in their mean weight and height Z-scores 6 and 3 years after HSCT, respectively, relative to pre-HSCT baseline values. CONCLUSIONS Longitudinal growth patterns differed between patients successfully undergoing HSCT and children and adolescents with TD Hb E/β-thalassemia. HSCT significantly improved height outcomes of children and adolescents with TD Hb E/β-thalassemia.
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Affiliation(s)
- Sansanee Jitpirasakun
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Julaporn Pooliam
- Research Group and Research Network Division, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Charotorn Sriwichakorn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kleebsabai Sanpakit
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pairunyar Nakavachara
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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Khamees M, Wadaha H, Meshay H. Changes in coagulation status in patients with β-thalassemia in Iraq: A case-control study. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_53_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Goldberg EK, Lal A, Fung EB. Nutrition in Thalassemia: A Systematic Review of Deficiency, Relations to Morbidity, and Supplementation Recommendations. J Pediatr Hematol Oncol 2022; 44:1-11. [PMID: 34486568 PMCID: PMC8732300 DOI: 10.1097/mph.0000000000002291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/24/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Reports of nutritional deficiencies in patients with thalassemia (Thal) are common. Despite its importance, however, nutritionally focused research in Thal has been limited by inadequate sample size, inconsistent methodology, a lack of control comparisons, and few interventional trials. Due to these limitations, clinicians lack evidence-based nutrition recommendations to support clinical decision-making. This systematic review summarizes observed relationships between nutrition and morbidity in Thal published in the last 3 decades. METHODS PubMed, Web of Science, and Embase were screened for articles pertaining to nutrition in Thal using comprehensive search terms. Studies performed in humans, written in English, and published between 1990 and 2020 were included. Over 2100 manuscripts were identified, from which 97 were included. RESULTS Patients with Thal were most often deficient in vitamins A, C, D, selenium, and zinc. Prevalence of nutritional deficiency was positively correlated with age and iron overload. Evidence to support the role of vitamin D and zinc for bone health was observed; zinc was also found to improve glucose metabolism. CONCLUSIONS Due to the risk for multinutrient deficiency, nutritional status should be assessed annually in patients with Thal with prompt nutrient replacement when deficiency is detected. Routine supplementation with vitamin D and zinc is recommended.
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Affiliation(s)
| | - Ashutosh Lal
- Division of Hematology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Ellen B Fung
- Children's Hospital Oakland Research Institute (CHORI)
- Division of Hematology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
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Seyyar SA, Tıskaoğlu NS, Gürbostan G, Pekpak E, Sayglı O. Increased Endothelial Cell Density in Childhood Patients With Thalassemia Major. Eye Contact Lens 2021; 47:660-663. [PMID: 34173366 DOI: 10.1097/icl.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE We aimed to compare specular microscopy, biometric, refractive, and anterior segment topographic parameters in children with thalassemia major (TM) with normal children of the same age. MATERIAL METHOD This cross-sectional study included 55 eyes of 55 patients with TM and 63 eyes of 63 age-sex-matched healthy children; all patients with TM were receiving treatment with blood transfusions every 3 to 4 weeks and an oral iron chelator deferasirox (DFX) (ICL670) tablet. A comprehensive ophthalmic examination was performed, including refraction (spherical equivalent), best-corrected visual acuity, slit-lamp bio microscopy, specular examination, optical biometry, intraocular pressure, anterior segment topography, and fundus examination. RESULTS Endothelial cell density (ECD) was 3,138 in the TM group and 2,996 in the control group (P=0.003). The mean central corneal thickness was significantly thinner in the TM group (P=0.010). Flat keratometry (K1) was 43.5 D in the study group and 42.9 D in the control group (P=0.039). The mean anterior chamber depth (ACD) was shallower in the TM group (P=0.004); axial length (AL) was significantly shorter in the TM group (P=0.002). CONCLUSION This study shows that there are differences in ECD, AL, keratometry values, ACD, and anterior segment parameters of pediatric patients with TM compared with healthy controls.
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Affiliation(s)
- Sevim Ayca Seyyar
- Ophthalmology Department (S.A.S.), Kocaeli Derince Education and Research Hospital; Ophthalmology Department (N.S.T.), Ersin Arslan Education and Research Hospital; and Ophthalmology Department (G.G., E.P., O.S.), Gaziantep University Hospital
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15
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Nimkarn N, Songdej D, Dumrongwongsiri O, Sirachainan N, Chuansumrit A. Age as a major factor associated with zinc and copper deficiencies in pediatric thalassemia. J Trace Elem Med Biol 2021; 68:126817. [PMID: 34298330 DOI: 10.1016/j.jtemb.2021.126817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/09/2021] [Accepted: 07/03/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with thalassemia encounter increased consumption of zinc (Zn) and copper (Cu) from chronic hemolysis and increased excretion from iron chelation. Iron-enriched diet restriction may result in low Zn and Cu intakes. Recent data on Zn and Cu status among Thai pediatric patients with thalassemia are lacking. This study aimed to identify frequencies and determine risk factors of Zn and Cu deficiencies among patients with thalassemia. METHODS Patients with transfusion-dependent thalassemia (TDT) receiving iron chelation ≥12 months and nonTDT (NTDT) aged 2-20 years were recruited. Serum Zn and Cu were measured. Dietary intakes were ascertained by interviews. RESULTS A total of 209 patients (TDT = 126, NTDT = 83) were enrolled. Zn deficiency seemed to be associated with disease severity as median (IQR) Zn level of TDT was lower than that of NTDT [77 (69-85) vs. 80 (72-88) mcg/dL, p = 0.05], while higher frequency of Zn deficiency was identified in the former (24 % vs. 14 %). In TDT, Zn deficiency was associated with patients >10 years (OR 4.6; 95 %CI 1.1-6.4, p = 0.03), which likely resulted from combined low dietary Zn intake, prolonged exposures to hemolysis and iron chelators. Frequencies of Cu deficiency were similarly low in TDT and NTDT (8% and 7%) with comparable median (IQR) Cu levels of 103 (90-124) and 110 (92-132) mcg/dL, respectively (p = 0.13). Cu levels were inversely associated with age (r=-0.65 and r=-0.62 in TDT and NTDT, respectively; p < 0.001). CONCLUSION Compared with younger patients, Zn and Cu deficiencies were more common among patients with thalassemia >10 years. Age was a major factor associated with both Zn and Cu deficiencies.
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Affiliation(s)
- Norrarath Nimkarn
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Duantida Songdej
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Oraporn Dumrongwongsiri
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ampaiwan Chuansumrit
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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16
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Charoenngam N, Rittiphairoj T, Ponvilawan B. Fracture prevalence in thalassemia: a systematic review and meta-analysis. Arch Osteoporos 2021; 16:171. [PMID: 34773506 DOI: 10.1007/s11657-021-01026-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Multiple observational studies have reported high prevalence of fracture in patients with thalassemia. However, most of these studies have included limited number of patients, and only few of them have reported prevalence of fracture among patients with different types and severity of thalassemia. OBJECTIVE This systematic review and meta-analysis was conducted to summarize all available data of fracture prevalence among patients with thalassemia. METHODS A systematic review was conducted using EMBASE and MEDLINE databases from inception to June 2021 to determine studies that reported prevalence of fracture in thalassemia patients. The pooled prevalence with 95% confidence interval (95%CI) of fracture across studies was determined using a random-effect, generic inverse variance method. RESULTS After two rounds of systematic review, a total of 25 studies with 4934 patients were included in the meta-analysis. The pooled prevalence of fracture among patients with thalassemia was 16% (95%CI, 15-17%, I2 = 94.3%). The subgroup analyses showed that the pooled prevalence of fracture was 4% (95%CI, 2-6%; I2 = 70.4%) among patients with alpha thalassemia, 17% (95%CI, 16-19%; I2 = 93.2%) among patients with beta thalassemia, 18% (95%CI, 16-19%; I2 = 89.0%) among patients with transfusion-dependent thalassemia, and 7% (95%CI, 4-10%; I2 = 94.2%) among patients with non-transfusion-dependent thalassemia. CONCLUSION Fracture is common in patients with thalassemia, and may be more prevalent in beta thalassemia and transfusion-dependent thalassemia than in alpha thalassemia and non-transfusion-dependent thalassemia.
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Affiliation(s)
- Nipith Charoenngam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, 330 Mt Auburn St, Cambridge, MA, USA.
- Section Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | - Ben Ponvilawan
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Atmakusuma TD, Tenggara JB. Correlation of Transferrin Saturation and Serum Ferritin with Bone Mass Density in Adult Transfusion Dependent Beta-Thalassemia Patients. J Blood Med 2021; 12:827-832. [PMID: 34526831 PMCID: PMC8437418 DOI: 10.2147/jbm.s328547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of regular blood transfusions and iron chelation therapy to treat thalassemia has improved survival and increased the incidence of osteoporosis. Moreover, iron toxicity is one of the contributing factors that reduce bone mass density in adult transfusion-dependent beta-thalassemia patients. Therefore, this study aims to determine the proportion of low bone mass density in adult thalassemia patients and transferrin saturation, as well as serum ferritin, which correlates to the skeletal condition. METHODS This is a cross-sectional study conducted in Thalassemia and Hematology Medical Oncology Clinics of Cipto Mangunkusumo Hospital in March 2016. The anthropometric data and hemoglobin levels were obtained before transfusion. Subsequently, the average ferritin levels, bone mineral density, and radiographic results were obtained. RESULTS The percentage of adult thalassemia major and intermedia patients with low bone mass density was 68%. Also, there was a weak inverse correlation between bone mass density and transferrin saturation (r = -0.329, p = 0.01), while no correlation was shown between bone mass density and ferritin (r = -0.088, p = 0.504). The transferrin saturation cutoff point value used to distinguish the incidence of low and normal bone density in patients with transfusion-dependent beta-thalassemia was 89.5%. In addition, there was weak correlation between Singh index and bone mass density (r = 0.273, p = 0.038). CONCLUSION Among the transfusion-dependent beta-thalassemia patients, 68% had low bone mass density, which inversely correlated to transferrin saturation. Furthermore, the cutoff value of transferrin saturation to differentiate the incidence of low and normal bone density in thalassemia major compared to thalassemia intermedia was 89.5%. Singh Index correlates weakly with bone mass density and might be used to detect low bone mass density in remote healthcare facilities.
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Affiliation(s)
- Tubagus Djumhana Atmakusuma
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Jeffry Beta Tenggara
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Division of Hematology-Medical Oncology, Department of Internal Medicine, MRCCC Siloam Hospital Jakarta, Jakarta, Indonesia
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Ansaf A, Faraj SA, Kazem S. The Correlation between Pituitary Gonadotrophins, Gonadal Sex Steroid Hormone with Ferritin Level in Pubertal Females with Thalassemia Major at Wassit Province - Iraq 2020. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Thalassemia Major still a growing disease in Iraq with no clear plan for prevention.
Failure to get a secondary sexual character, amenorrhea, and then the inability to get pregnant is one the increasingly common problems in female patients with huge burden effects. Despite recent advances in iron chelation therapy, still, excess iron deposition in pituitary gonadotropic and gonadal cells remains one of the major causes for gonadal failure.
Objectives: To evaluate the effect of iron overloads measured by serum ferritin on pituitary gonadotrophins measured by FSH, LH, and the gonadal sex steroid measured by estrogen in pubertal females with thalassemia Major.
Methods: 41 female patients randomly selected in a cross-sectional study with diagnosed Thalassemia Major registered in Al-Kut Hereditary Blood Disease Center in the south of Iraq.
Demographic data were evaluated including (age, type of chelation therapy, compliance for treatment and mean hemoglobin levels, and presence of amenorrhea). Serum ferritin, hemoglobin, FSH, LH, Estrogen levels were collected from patient's files.
Results: the age of the studied sample were range from 14-43 years. The majority of the studied patients 33(80.5%) were suffering from primary amenorrhea and only six had a normal menstrual cycle. Twenty-six (63.4%) patients had serum ferritin levels of more than 3000 ng/dl.
A low average serum FSH, LH, and Estrogen concentration were observed in the group with serum ferritin levels more than 3000ng/dl in a statistically significant p-value, 0.001, 0.002, and 0.003 respectively with inverse Pearson's correlation (-0.4 and p-value 0.0009 for FSH), (- 0.2 with no significant p-value 0.12, for LH) and (-0.3 with significant p. value 0.02 for estrogen level).
Conclusions:
In this study majority of females with thalassemia, Major suffer from disruption of pituitary gonadotropins and possible gonadal sex steroid. High ferritin still is a statistically significant risk factor for gonadal failure.
The needs for more strict iron control, early screening, and proper treatment of gonadotropin and gonadal sex steroid deficiency around the age of 13 years are essential to be offered. More studies and a larger sample are needed to confirm and/or add other risk factors in pubertal thalassemic females.
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Arab-Zozani M, Kheyrandish S, Rastgar A, Miri-Moghaddam E. A Systematic Review and Meta-Analysis of Stature Growth Complications in β-thalassemia Major Patients. Ann Glob Health 2021; 87:48. [PMID: 34164261 PMCID: PMC8194969 DOI: 10.5334/aogh.3184] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Blood transfusion is a traditional treatment for β-thalassemia (β-thal) that improves the patients' anemia and lifespan, but it may lead to iron overload in parenchymal tissue organs and endocrine glands that cause their dysfunctions as the iron regulatory system can't excrete excess iron from the bloodstream. Objective To evaluate the prevalence of iron-related complications (short stature, growth retardation, and growth hormone deficiency) in β-thalassemia major (βTM) patients. Methods We performed an electronic search in PubMed, Scopus, and Web of Sciences to evaluate the prevalence of growth hormone impairment in β-thalassemia major (βTM) patients worldwide. Qualities of eligible studies were assessed by the Joanna Briggs Institute checklist for the prevalence study. We used Comprehensive Meta-Analysis (Version 2) to calculate the event rate with 95% CIs, using a random-effects model for all analyses. Findings Seventy-four studies were included from five continents between 1978 and 2019; 70.27% (Asia), 16.21% (Europe), 6.75% (Africa), 2.70% (America), 1.35% (Oceania), and 2.70% (Multicenter). The overall mean age of the participants was about 14 years. The pooled prevalence of short stature (ST) was 48.9% (95% CI 35.3-62.6) and in male was higher than female (61.9%, 95% CI 53.4-69.7 vs. 50.9%, CI 41.8-59.9). The pooled prevalence of growth retardation (GR) was 41.1% and in male was higher than in female (51.6%, 95% CI 17.8-84 vs. 33.1%, CI 9.4-70.2). The pooled prevalence of growth hormone deficiency (GHD) was 26.6% (95% CI 16-40.8). Conclusion Our study revealed that near half of thalassemia patients suffer from growth impairments. However, regular evaluation of serum ferritin levels, close monitoring in a proper institute, suitable and acceptable treatment methods besides regular chelation therapy could significantly reduce the patients' complications.
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Affiliation(s)
- Morteza Arab-Zozani
- Social Determination of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Setare Kheyrandish
- Department of Hematology and Blood Banking, School of Paramedical Sciences, Birjand University of Medical Sciences, Birjand, Iran
| | - Amirhossein Rastgar
- Department of Hematology and Blood Banking, School of Paramedical Sciences, Birjand University of Medical Sciences, Birjand, Iran
| | - Ebrahim Miri-Moghaddam
- Cardiovascular Disease Research Center & Department of Molecular Medicine, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
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20
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Alhillawi ZH, Al-Hakeim HK, Moustafa SR, Maes M. Increased zinc and albumin but lowered copper in children with transfusion-dependent thalassemia. J Trace Elem Med Biol 2021; 65:126713. [PMID: 33453474 DOI: 10.1016/j.jtemb.2021.126713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/11/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Measurements of copper and zinc in transfusion-dependent thalassemia (TDT) show contradictory results. AIM OF THE STUDY To examine serum levels of these minerals in TDT in relation to iron overload indices and erythron variables. METHODS This study recruited 60 children with TDT and 30 healthy controls aged 3-12 years old. RESULTS Zinc was significantly higher in TDT children than in controls, while copper and the copper to zinc ratio were significantly lowered in TDT. Serum zinc was significantly associated with the number of blood transfusions and iron overload variables (including serum iron and TS%) and negatively with erythron variables (including hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin). Serum copper was significantly and negatively associated with the same iron overload and erythron variables. The copper to zinc ratio was significantly correlated with iron, TS%, ferritin, hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin. Albumin levels were significantly higher in TDT children than in control children. CONCLUSION Our results suggest that the increase in zinc in children with TDT may be explained by iron loading anemia and hemolysis and the consequent shedding of high amounts of intracellular zinc into the plasma. Increased albumin levels and treatment with Desferral may further contribute towards higher zinc levels in TDT. We suggest that the elevations in zinc in TDT are a compensatory mechanism protecting against infection, inflammation, and oxidative stress. Previous proposals for prophylactic use of zinc supplements in TDT may not be warranted.
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Affiliation(s)
| | | | - Shatha Rouf Moustafa
- Clinical Analysis Department, College of Pharmacy, Hawler Medical University, Havalan City, Erbil, Iraq.
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Research Centre, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
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21
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Zardkhoni SZ, Moghaddam AG, Rad F, Ghatee MA, Omidifar N, Ghaedi M, Etemadfar P. Serum Zinc Level in β-Thalassemia Major: A Retrospective Study in Southwest Iran. Hemoglobin 2021; 45:103-106. [PMID: 33896336 DOI: 10.1080/03630269.2021.1918149] [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: 12/31/2022]
Abstract
Thalassemia, which is associated with compound complications, is the most common hereditary anemia in the world. The zinc level is different in patients with thalassemias. This study aimed to determine the zinc status and its relationship with demographic factors and chelation therapy in β-thalassemia major (β-TM) patients. This cross-sectional study was conducted on 102 β-thalassemia (β-thal), patients. Zinc level was evaluated in subjects using the atomic absorption method. The results were analyzed through descriptive statistics, χ2 and Mann-Whitney U tests. Of 102 cases, 92 patients were eligible and evaluated. The mean age was 23 (minimum 11, maximum 43) years. Forty-six percent of cases were males and 54.0% were females. Of the 92 patients taking iron chelators, 29.3% used deferoxamine (DFO), 16.3% deferasirox (DFX), 20.6% DFO and deferiprone (DFP), and 33.8% DFO and DFP. All cases had zinc deficiency, 89.1% had zinc levels <40.0 mg/dL, and 10.9% with zinc levels >40.0 mg/dL. There was a significant relationship between gender and group with zinc levels greater than 40.0 mg/dL and those with less than 40.0 mg/dL. Zinc deficiency is highly prevalent among patients with thalassemia in the city of Yasuj, Iran. There was a significant relationship between zinc levels and gender although no significance was observed between zinc level and age, body mass index (BMI), ferritin, and chelation factors; it is recommended that these patients be periodically evaluated for zinc level. In case of a lack of laboratory evaluation, the use of prophylactic zinc supplementation should be considered for these patients.
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Affiliation(s)
| | - Abdolkarim G Moghaddam
- Department of Pediatrics, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Fariba Rad
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohammad A Ghatee
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.,Department of Medical Parasitology and Mycology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Navid Omidifar
- Department of Medical Pathology, Faculty of Anatomical and Clinical Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrorang Ghaedi
- Department of Chemistry, Faculty of Yasuj University, Yasuj, Iran
| | - Peyman Etemadfar
- Department of Pediatrics, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.,Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Yang Y, Kang X, Hu S, Chen B, Xie Y, Song B, Zhang Q, Wu H, Ou Z, Xian Y, Fan Y, Li X, Lai L, Sun X. CRISPR/Cas9-mediated β-globin gene knockout in rabbits recapitulates human β-thalassemia. J Biol Chem 2021; 296:100464. [PMID: 33639162 PMCID: PMC8024976 DOI: 10.1016/j.jbc.2021.100464] [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] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 01/19/2023] Open
Abstract
β-thalassemia, an autosomal recessive blood disorder that reduces the production of hemoglobin, is majorly caused by the point mutation of the HBB gene resulting in reduced or absent β-globin chains of the hemoglobin tetramer. Animal models recapitulating both the phenotype and genotype of human disease are valuable in the exploration of pathophysiology and for in vivo evaluation of novel therapeutic treatments. The docile temperament, short vital cycles, and low cost of rabbits make them an attractive animal model. However, β-thalassemia rabbit models are currently unavailable. Here, using CRISPR/Cas9-mediated genome editing, we point mutated the rabbit β-globin gene HBB2 with high efficiency and generated a β-thalassemia rabbit model. Hematological and histological analyses demonstrated that the genotypic mosaic F0 displayed a mild phenotype of anemia, and the heterozygous F1 exhibited typical characteristics of β-thalassemia. Whole-blood transcriptome analysis revealed that the gene expression was altered in HBB2-targeted when compared with WT rabbits. And the highly expressed genes in HBB2-targeted rabbits were enriched in lipid and iron metabolism, innate immunity, and hematopoietic processes. In conclusion, using CRISPR-mediated HBB2 knockout, we have created a β-thalassemia rabbit model that accurately recapitulates the human disease phenotype. We believe this tool will be valuable in advancing the investigation of pathogenesis and novel therapeutic targets of β-thalassemia and associated complications.
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Affiliation(s)
- Yi Yang
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiangjin Kang
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shiqi Hu
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bangzhu Chen
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yingjun Xie
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bing Song
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Quanjun Zhang
- CAS Key Laboratory of Regenerative Biology, Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Han Wu
- CAS Key Laboratory of Regenerative Biology, Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Zhanhui Ou
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yexing Xian
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yong Fan
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaoping Li
- Key Laboratory for Stem Cells and Tissue Engineering, Center for Stem Cell Biology and Tissue Engineering, Zhongshan Medical School, Sun Yat-Sen University, Ministry of Education, Guangzhou, China.
| | - Liangxue Lai
- CAS Key Laboratory of Regenerative Biology, Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.
| | - Xiaofang Sun
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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Yılmaz K, Kan A, Çetincakmak MG, Uzel VH, Yılmaz D, Deniz MA, Hattapoglu S. Relationship Between Pituitary Siderosis and Endocrinological Disorders in Pediatric Patients with Beta-Thalassemia. Cureus 2021; 13:e12877. [PMID: 33633906 PMCID: PMC7899051 DOI: 10.7759/cureus.12877] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Excess iron accumulation occurs mainly in organs such as reticuloendothelial cells, the pituitary gland, and the pancreas in beta-thalassemia because of blood transfusions. In the present study, it was aimed to investigate the relationship between T2* values on magnetic resonance imaging (MRI) and clinically diagnosed pituitary endocrinological disorders in children with thalassemia major. Methods This study enrolled patients diagnosed with beta-thalassemia at pediatric hematology outpatient clinics. In the study, in addition to the medical history of the patients, routinely performed tests, including hemoglobin electrophoresis, routine biochemical tests, and tests for pubertal development (follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, etc.), as well as iron deposition measured by hepatic MRI T2* (STAR) sequence, were retrospectively assessed. A total of 29 patients were enrolled. Results Hypothyroidism was detected in 34.6% (9/26) of patients, short stature in 37% (10/27), and pubertal retardation in 50% (14/28) of the patients. There was no significant correlation between hypothyroidism and pituitary MRI T2* values. No significant correlation was found between laboratory parameters and pituitary MRI examination. Although the sensitivity of T2* levels could rise above 80%, their specificity remained low. This is one of the major limitations of the pituitary MR T2* study for the prediction of short stature. The best lower cut-off level of MR T2* to predict short stature was found 14.6 ms. Conclusion The diagnostic specificity pituitary MR examination levels for short stature were detected as low. Thus, the clinical standardization and validation of pituitary MR T2* values examination are needed before clinical follow-up and multifaceted studies are needed.
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Affiliation(s)
- Kamil Yılmaz
- Pediatrics, Dicle University School of Medicine, Diyarbakir, TUR
| | - Ahmet Kan
- Pediatric Allergy, Dicle University School of Medicine, Diyarbakir, TUR
| | | | - V Hulya Uzel
- Pediatric Oncology, Dicle University School of Medicine, Diyarbakir, TUR
| | - Deniz Yılmaz
- Pathology, Dicle University School of Medicine, Diyarbakir, TUR
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Bandarian F, Namazi N, Amini MR, Pajouhi M, Mehrdad N, Larijani B. Endocrinology and Metabolism Research Institute from inception to maturity: an overview of 25-year activity. J Diabetes Metab Disord 2020:1-7. [PMID: 33042897 PMCID: PMC7532120 DOI: 10.1007/s40200-020-00645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022]
Abstract
Endocrinology and Metabolism Research Institute (EMRI) was founded in 1993. EMRI progressed step by step from inception and reached to its maturation during the past 25 years. EMRI has expanded and progressed in different aspects including human resources and infrastructures (laboratories and new technologies) and has obtained the first rank in the country in endocrinology research. It has also collaborated with regional and international organizations such as World Health Organization (WHO), International Osteoporosis Foundation (IOF), and American Association of Clinical Endocrinologists (AACE). This article provides an overview of EMRI activities during a quarter of a century.
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Affiliation(s)
- Fatemeh Bandarian
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazli Namazi
- Evidence Based Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Amini
- Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Pajouhi
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular- Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Beneath Dr. Shariati Hospital, Gomnam Highway, Tehran, Iran
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The Trabecular Bone Score as a Predictor for Thalassemia-Induced Vertebral Fractures in Northeastern Thailand. Anemia 2020; 2020:4634709. [PMID: 32774916 PMCID: PMC7396121 DOI: 10.1155/2020/4634709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/26/2020] [Accepted: 07/08/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction Thalassemia bone disease is one of the disease-related complications in patients with thalassemia. Prevalence of fractures and the role of a trabecular bone score (TBS) as a predictive factor for fractures were evaluated in patients with thalassemia. Methods A cross-sectional study was conducted in patients with thalassemia aged ≥18 years at Srinagarind Hospital, Khon Kaen University, Thailand. A lateral thoracolumbar radiograph and bone mineral density (BMD) at the lumbar spine and hip, as well as the TBS measured by dual-energy X-ray absorptiometry (DXA), were evaluated in all patients. Results Among 86 patients, 14 patients were found to have radiographic vertebral fracture yielding a prevalence of 16.3%. All patients who had fractures were β-thalassemia/Hb E. Combined low BMD and TBS at lumbar spines and a presence of endocrinopathies were significantly associated with vertebral fractures. Conclusions The prevalence of vertebral fractures in patients with thalassemia was not uncommon. A combined low BMD and TBS and a presence of endocrinopathies were associated with vertebral fractures. These findings suggested that BMD testing and TBS measurement have a clinical implication as a screening tool for evaluating the risk of vertebral fractures in thalassemic patients, particularly in β-thalassemia/Hb E who have endocrinopathies.
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Using LIBS as a diagnostic tool in pediatrics beta-thalassemia. Lasers Med Sci 2020; 36:957-963. [PMID: 32778983 DOI: 10.1007/s10103-020-03117-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 08/01/2020] [Indexed: 01/19/2023]
Abstract
Beta-thalassemia major is a common inherited single-gene disorder. Thalassemic patients are at risk of changes in some important trace elements. To detect alteration of iron, copper, zinc, and calcium serum levels in beta-thalassemia major patients, laser-induced breakdown spectroscopy (LIBS) was used. This study was conducted on 40 beta-thalassemia major and 40 healthy young patients (age: 12-18 years old; male:female = 1:1). Venous blood samples were collected from both groups and analyzed for the serum levels of iron, calcium, zinc, and copper by exposing the samples to LIBS. The intensities of the tested elements were detected using the Kestrel Spec computer software and analyzed with an SPSS 25 program. Thalassemic patients had significantly higher serum iron (p = < 0.001) and copper (p = < 0.005) while they had significantly lower serum zinc (p = < 0.005) and calcium (p= > 0.005) when compared with control. Also, thalassemic patients had significantly lower body weight and height as they were less than the 3rd percentile by 82.5% and p < 0.001. LIBS is a safe and efficient tool to detect alteration of some serum trace elements in beta-thalassemia patients.
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An Evaluation of Bone Health Parameters in Regularly Transfused Beta-Thalassemia Major Patients. J Pediatr Hematol Oncol 2020; 42:381-385. [PMID: 32011565 DOI: 10.1097/mph.0000000000001733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As beta-thalassemia major patients need regular blood transfusions due to the severe hemoglobin deficiency, the occurrence of related bone defects with simultaneous fluctuations in the biochemical and hematologic parameters is seen. The hospital-based cross-sectional observational study was done to determine and correlate the bone mineral density (BMD) with biochemical parameters and hematologic parameters in 50 regularly transfused beta-thalassemia major patients of older than 6 years of age. Descriptive statistics were analyzed with SPSS version 20.0 software. A P<0.05 was considered as statistically significant. The prevalence of suboptimal BMD at lumbar spine was 86% and at femur neck was 74%. A statistically significant correlation of BMD was found with mean pretransfusion hemoglobin values, serum calcium levels, and serum vitamin D levels (P<0.05). It was concluded that continuous monitoring of the BMD, biochemical, and hematologic parameters in regularly transfused beta-thalassemia major patients may help assess the ongoing deficiencies; helping to maintain timely and regular blood transfusions with supplementation of calcium, vitamin D to ensure good bone health.
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Sadullah RK, Atroshi SD, Al-Allawi NA. Complications and Challenges in the Management of Iraqi Patients with β-Thalassemia Major: A Single-center Experience. Oman Med J 2020; 35:e152. [PMID: 32724663 PMCID: PMC7383834 DOI: 10.5001/omj.2020.72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/09/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES We sought to assess the complications and challenges facing the management of β-thalassemia major (β-TM) in Iraq. METHODS A total of 150 consecutive patients with β-TM who were registered at a main thalassemia center in Northern Iraq were enrolled in the study. The patients had their records reviewed, were clinically evaluated, and investigated for various complications. RESULTS Our patient cohort had a median age of 13 years (range: 1-35 years) and a male to female ratio of 1:1.2. Their median serum ferritin was 2762 µg/L, all were on regular transfusions, 94.7% were on chelation therapy, and 38.0% were splenectomized. Pre-transfusion hemoglobin levels were 3 9.0 g/dL in 38.7% of the patients. Short stature was encountered in 33.9% of those aged ≤ 20 years, and skeletal changes were noted in 50.7%. Iron overload associated complications, including hypogonadism, hypothyroidism, hypoparathyroidism, diabetes mellitus, and heart failure, were encountered in 52.8%, 7.3%, 3.3%, 3.3%, and 2.7%, respectively. Hepatitis C virus (HCV) antibodies were detectable in 35.3%, while HIV antibodies and hepatitis B surface antigen were not detectable in any. Patients with diabetes mellitus, heart failure, HCV antibodies, and hypoparathyroidism were significantly older than those without these complications. Hypogonadism was the only complication associated with significantly higher serum ferritin levels. Hypogonadism, heart failure, HCV antibodies, and diabetes were significantly more frequent among the splenectomized patients. CONCLUSIONS The management of β-TM in this cohort of Iraqi patients is still suboptimal, and the need to ensure timely transfusions and optimize chelation, as well as a more robust iron overload assessment, should be underscored.
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Affiliation(s)
| | - Sulav D. Atroshi
- Department of Pathology, College of Medicine, University of Duhok, Duhok, Iraq
| | - Nasir A. Al-Allawi
- Department of Pathology, College of Medicine, University of Duhok, Duhok, Iraq
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Maheri M, Rohban A, Sadeghi R, Joveini H. Predictors of Quality of Life in Transfusion-dependent Thalassemia Patients Based on the PRECEDE Model: A Structural Equation Modeling Approach. J Epidemiol Glob Health 2020; 10:157-163. [PMID: 32538032 PMCID: PMC7310774 DOI: 10.2991/jegh.k.191001.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/18/2019] [Indexed: 01/19/2023] Open
Abstract
This study aimed to determine the predictors of Quality of Life (QoL) in Transfusion-Dependent Thalassemia (TDT) patients based on PRECEDE (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation) model. This cross-sectional analytical study was performed on 389 TDT patients who were under treatment in four thalassemia centers in Tehran, Iran. Data gathering instrument consisted of three parts: socioeconomic and demographic information, the Persian version of the six standardized questionnaires for measuring some of the potential predictive factors of QoL in TDT patients based on the PRECEDE model constructs, and a researcher-made questionnaire to assess knowledge of patients about health- and QoL-promoting behaviors and enabling factors involved in health- and QoL-promoting behaviors. Using AMOS 23.0, the structural equation modeling with maximum likelihood estimation was conducted to test the proposed hypotheses. Associations of QoL with all of the PRECEDE model constructs, including anxiety–depression, self-efficacy, perceived barriers, knowledge, enabling factors, and reinforcing factors were significant (all p < 0.001). Anxiety–depression and perceived barriers were the significant negative predictors of QoL in TDT patients, whereas health-promoting lifestyle was the significant positive predictor of QoL in TDT patients. The final conceptual model of the study was adequately fit and can be applied as a framework for future educational-supportive programs aimed at improving the QoL in TDT patients.
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Affiliation(s)
- Mina Maheri
- Department of Public Health, School of Health, Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Alireza Rohban
- School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Sadeghi
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Joveini
- Department of Health Education, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
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A Double-blind Randomized Controlled Trial of Curcumin for Improvement in Glycemic Status, Lipid Profile and Systemic Inflammation in β-Thalassemia Major. J Herb Med 2020. [DOI: 10.1016/j.hermed.2019.100324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Zarghamian P, Azarkeivan A, Arabkhazaeli A, Mardani A, Shahabi M. Hepcidin gene polymorphisms and iron overload in β-thalassemia major patients refractory to iron chelating therapy. BMC MEDICAL GENETICS 2020; 21:75. [PMID: 32268883 PMCID: PMC7140315 DOI: 10.1186/s12881-020-01011-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/25/2020] [Indexed: 11/10/2022]
Abstract
Background β Thalassemia is one of the most common groups of hereditary haemoglobinopathies. Affected people with thalassemia major are dependent on regular blood transfusion which on the long term leads to iron overload. Hepcidin is a peptide hormone and an important regulator of iron homeostasis, especially in thalassemia. Expression of this hormone is influenced by polymorphisms within the hepcidin gene, HAMP. Several studies emphasized the role of single nucleotide polymorphisms (SNPs) located in the promoter region of the gene. This study aimed to analyze the association between three SNPs in promoter of HAMP, c.-582A > G, c.-443C > T, and c.-153C > T, with iron overload in β-thalassemia major patients. Methods A total of 102 samples from β thalassemia major patients were collected. Genomic DNA was extracted and segments of DNA encompassing rs10421768 and rs142126068 were sequenced. Statistical analysis was performed by SPSS Statistics 23 using independent t test and Fisher’s exact test. Results A total of 102 adult β-thalassemia major patients were genotyped for three SNPs in the promoter region of HAMP gene by PCR and direct sequencing. Most of the patients (71.3%) were iron overloaded (based on plasma ferritin > 1000 ng/ml) in spite of receiving regular iron-chelating therapy. Our analysis revealed a statistically significant difference between the level of cardiac iron accumulation and c.-582A > G variant (p = 0.02). For c.-443C > T statistical analysis was on the edge of the significant relationship between the minor allele and serum ferritin (p = 0.058). All samples were homozygous for allele C of c.-153C > T. Conclusions Despite chelating therapy, iron overload is still one of the main complications of thalassemia. Our findings and others emphasize the role of hepcidin -582A > G polymorphism as a key component of iron homeostasis in these patients.
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Affiliation(s)
- Parinaz Zarghamian
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Hemmat Expressway, IBTO Building, Tehran, 1449613111, Iran
| | - Azita Azarkeivan
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Hemmat Expressway, IBTO Building, Tehran, 1449613111, Iran
| | - Ali Arabkhazaeli
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Hemmat Expressway, IBTO Building, Tehran, 1449613111, Iran
| | - Ahmad Mardani
- Department of Hemovigilance, Iranian Blood Transfusion Organization, Tehran, Iran
| | - Majid Shahabi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Hemmat Expressway, IBTO Building, Tehran, 1449613111, Iran.
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Shaykhbaygloo R, Moradabadi A, Taherahmadi H, Rafiei M, Lotfi F, Eghbali A. Correlation of Cardiac and Liver Iron Level with T2*MRI and Vitamin D3 Serum Level in Patients with Thalassemia Major. J Blood Med 2020; 11:83-87. [PMID: 32210653 PMCID: PMC7073435 DOI: 10.2147/jbm.s227012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/26/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Thalassemia is a hypochromic microcytic anemia, which is characterized by congenital disorders. In thalassemia patients, bone diseases are one of the causes of mortality. Our goal was to investigate the association between vitamin D deficiency and increased iron uptake by cardiac myocytes and hepatocytes. Materials and Methods Forty patients with thalassemia major were studied in Amir Kabir Hospital, Arak, Iran. The information obtained through clinical examination. Serum ferritin level was determined by ELISA and T2*MRI performed for measuring iron content in the heart and the liver. Results The average age of the patients was 23.8 ± 10.7 years. The mean T2*MRI values were 23.7 ± 7. The vitamin D3 level in 33 patients (82.5% cases) was less than 20 ng/dl, 2 patients (5%) in the range of 20-30 ng/dl, and the others had above 30 ng/dl. Correlation between vitamin D and age was 0.611. Correlation coefficient between heart and liver T2*MRI with ferritin level in patients was 0.437 and 0.335, respectively. Conclusion Due to significant associations, the periodic measurement of vitamin D, as well as PTH, is recommended for patients with thalassemia major.
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Affiliation(s)
| | | | | | - Mohammad Rafiei
- Biostatistics and Epidemiology Department, Arak University of Medical Science, Arak, Iran
| | - Fariborz Lotfi
- Pediatric Department, Arak University of Medical Science, Arak, Iran
| | - Aziz Eghbali
- Pediatric Department, Arak University of Medical Science, Arak, Iran
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Al-Agha AE, Bawahab NS, Nagadi SA, Alghamdi SA, Felemban DA, Milyani AA. Endocrinopathies complicating transfusion-dependent hemoglobinopathy. Saudi Med J 2020; 41:138-143. [PMID: 32020146 PMCID: PMC7841625 DOI: 10.15537/smj.2020.2.24845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To investigate the prevalence and significance of different endocrinopathies in children and adolescents with transfusion-dependent thalassemia and sickle-cell anemia. METHODS This is a descriptive, retrospective study between January 2010 and July 2018 in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Data was collected through reviewing electronic hospital medical records then filling out data collection sheets and was interpreted through the IBM SPSS Statistics for Windows version 20.0 (IBM Corp, Armonk, NY, USA). Results: The total sample size was 119 patients, gender equality was almost achieved with 55.5% being male and 45.5% being female. The most common endocrinopathies were identified in the following order of short stature (39.5%), diabetes mellitus (29.4%), hypogonadism (12.6%), osteopenia (12.6%), osteoporosis (9.2%), hypothyroidism (9.2%), hypocortisolism (3.4%), and hypoparathyroidism (2.5%). All of which were statistically significant in their relationship to hemoglobinopathies with the exception of osteopenia and osteoporosis. Hypogonadism and hypocortisolism were found to be statistically significant in their relationship to a positive history of splenectomy at p=0.026 and p=0.012. Short stature was found to be statistically significant in its relationship to the male gender with a p=0.001. Conclusion: Endocrinopathy is a frequent complication of hemoglobinopathies, for which the most common were found to be short stature, diabetes mellitus, and low bone mineral density.
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Affiliation(s)
- Abdulmoein E Al-Agha
- Department of Paediatric Endocrinology, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Motta I, Mancarella M, Marcon A, Vicenzi M, Cappellini MD. Management of age-associated medical complications in patients with β-thalassemia. Expert Rev Hematol 2019; 13:85-94. [DOI: 10.1080/17474086.2020.1686354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Irene Motta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Mancarella
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Marcon
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Vicenzi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
BACKGROUND Thalassemia major is a genetic disease with a recessive autosomal pattern of inheritance that occurs as a result of disorder in hemoglobin synthesis. Researchers aimed to investigate the cutoff of ferritin for the development of hypothyroidism in patients with thalassemia major. MATERIALS AND METHODS This was a retrospective analytic cross-sectional study that was conducted on the medical records of patients with thalassemia major. Overt hypothyroidism was defined as thyroid stimulating hormone (TSH) level of >6.5 mIU/L and T4 level of < 4.2 ng/dL and subclinical hypothyroidism was defined as TSH level of >6.5 mIU/L and T4 level of >4.2 ng/dL. Data were gathered by a form including age, sex, weight, height, body mass index, thyroid test results, and the mean of last 3 consecutive hemoglobin and ferritin levels. RESULTS In this study, 67 patients were evaluated. The mean age of the participants was 15.37±3.73 years. The frequency of subclinical hypothyroidism was 10.4%, and no cases of clinical hypothyroidism were noted as well as secondary hypothyroidism. Although there was a significant linear correlation between mean ferritin level and TSH (P=0.008), no significant correlation was noted between levels of ferritin and T4 levels. As ferritin was significantly correlated with TSH, the results showed that the mean serum level of ferritin in β-thalassemia major patients with hypothyroidism was higher than that in β-thalassemia major patients with normal thyroid status (P=0.013). The cutoff point for ferritin was 1953 ng/mL (sensitivity=85.7%, specificity=60%). CONCLUSION It seems that considering the development of hypothyroidism by reaching the ferritin cutoff point, intensification of the iron chelation regimen along with a shorter interval for laboratory endocrine examinations can be recommended.
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Denosumab in transfusion-dependent thalassemia osteoporosis: a randomized, placebo-controlled, double-blind phase 2b clinical trial. Blood Adv 2019; 2:2837-2847. [PMID: 30381400 DOI: 10.1182/bloodadvances.2018023085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022] Open
Abstract
Denosumab (DNM) is a fully human monoclonal antibody against the receptor activator of nuclear factor kappa-B ligand (RANKL) that has been licensed for the treatment of different types of osteoporosis. However, the prospective data for the evaluation of DNM efficacy on transfusion-dependent thalassemia (TDT)-induced osteoporosis are rather limited. Thus, we conducted a randomized, placebo-controlled, double-blind, phase 2b clinical trial to evaluate DNM in TDT osteoporosis. Patients were assigned to receive either 60 mg DNM (n = 32) or placebo (n = 31) subcutaneously on day 0 and 180 during a total of 12 months of follow-up. The percentage increase of L1-L4 bone mineral density was higher in the DNM group than the placebo group (5.92% ± 5.25% vs 2.92% ± 5.56%, respectively; P = .043), whereas the advantage of DNM regarding wrist bone mineral density was much higher compared with placebo (-0.26% ± 5.31% vs -3.92% ± 8.71%, respectively; P = .035). No grade 3 or 4 toxicity was observed. DNM reduced pain scores that remained unaltered in the placebo group. DNM showed a significant reduction of soluble RANKL (sRANKL), sRANKL/osteoprotegerin ratio, C-telopeptide of collagen type I, tartrate-resistant acid phosphatase isoform-5b, and bone-specific alkaline phosphatase between baseline and the 12th month (P < .01 for all comparisons) without changes in dickkopf-1, sclerostin, and osteocalcin. On the contrary, placebo patients showed an increase in sRANKL, osteoprotegerin, dickkopf-1, sclerostin, C-telopeptide of collagen type I, tartrate-resistant acid phosphatase isoform-5b, and bone-specific alkaline phosphatase during the study period (P < .01 for all comparisons). In conclusion, DNM increased lumbar spine and wrist bone mineral density and reduced pain and bone remodeling markers, and thus it is another valuable option for the management of TDT-induced osteoporosis. This trial was registered at www.clinicaltrials.gov as #NCT02559648.
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Gaudio A, Morabito N, Catalano A, Rapisarda R, Xourafa A, Lasco A. Pathogenesis of Thalassemia Major-associated Osteoporosis: A Review with Insights from Clinical Experience. J Clin Res Pediatr Endocrinol 2019; 11:110-117. [PMID: 29991466 PMCID: PMC6571534 DOI: 10.4274/jcrpe.galenos.2018.2018.0074] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/01/2018] [Indexed: 01/19/2023] Open
Abstract
Due to increasing life expectancy in thalassemia major (TM), osteoporosis is emerging as a significant problem. Its aetiology is multifactorial, culminating in increased bone resorption and impaired remodelling. Hypogonadism and marrow expansion seem to play an important role, but iron overload, deferoxamine toxicity, a defective growth hormone-insulin-like growth factor-1 axis and multiple endocrinopathies may represent additional causes of bone damage. Many of these patients, though under appropriate treatment programs, do not achieve normal peak bone mass. The receptor activator of nuclear factor kappa-ß (RANK)/RANK ligand/osteoprotegerin and the Wnt/β-catenin systems work as major mediators of imbalanced bone turnover and bone loss. Additional genetic factors, such as collagen type 1 alpha 1 and vitamin D receptor gene polymorphisms, may exert some influence on the enhanced fracture risk observed in TM. To date, in spite of adequate hormone replacement, chelating therapy and acceptable haemoglobin levels, subjects with TM display impaired bone density and imbalanced bone turnover, thus the puzzle of the pathogenesis of TM-induced osteoporosis remains far from being solved.
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Affiliation(s)
- Agostino Gaudio
- University of Catania, Department of Clinical and Experimental Medicine, Catania, Italy
| | - Nancy Morabito
- University of Messina, Department of Clinical and Experimental Medicine, Messina, Italy
| | - Antonino Catalano
- University of Messina, Department of Clinical and Experimental Medicine, Messina, Italy
| | - Rosario Rapisarda
- University of Catania, Department of Clinical and Experimental Medicine, Catania, Italy
| | - Anastasia Xourafa
- University of Catania, Department of Clinical and Experimental Medicine, Catania, Italy
| | - Antonino Lasco
- University of Messina, Department of Clinical and Experimental Medicine, Messina, Italy
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Hassan T, Zakaria M, Fathy M, Arafa M, El Gebaly S, Emam A, Abdel Wahab A, Shehab M, Salah H, Malek M, El Gerby K. Association between genotype and disease complications in Egyptian patients with beta thalassemia: A Cross-sectional study. Sci Rep 2018; 8:17730. [PMID: 30531823 PMCID: PMC6286337 DOI: 10.1038/s41598-018-36175-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/11/2018] [Indexed: 01/19/2023] Open
Abstract
In beta thalassemia, the degree of globin chain imbalance is determined by the nature of the mutation of the β-gene. β° refers to the complete absence of production of β-globin on the affected allele. β+ refers to alleles with some residual production of β-globin. The homozygous state results in severe anemia that necessitates regular blood transfusion. On the other hand, frequent blood transfusion can lead to iron overload resulting in progressive dysfunction of the heart, Liver as well as multiple endocrinopathies. We studied the impact of genotype on the development of disease complications in patients with β thalassemia. A Cross sectional study was carried on 73 patients with beta thalassemia. Genotyping was determined by DNA sequencing technique. Routine investigations as well as MRI liver and heart were performed to assess iron overload. We found that β+β+ was the most common genotype in our patients followed by β°β° and β°β+. Mean Liver iron content (LIC) was significantly higher in β°β° compared to β°β+ and β+β+ genotypes and mean cardiac T2* was significantly lower in β°β° compared to β°β+ and β+β+ genotypes. Hepatic complications, hepatitis C, cardiac complications and some endocrinopathies were significantly higher in patients with β°β° genotype compared to other genotypes which explain the role of the underlying genetic defect in thalassemia patients in development of disease complications.
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Affiliation(s)
| | | | - Manar Fathy
- Pediatric, Zagazig University, Zagazig, Egypt
| | | | | | - Ahmed Emam
- Pediatric, Zagazig University, Zagazig, Egypt
| | | | | | - Hosam Salah
- Clinical pathology, Zagazig University, Zagazig, Egypt
| | - Mai Malek
- Microbiology, Zagazig University, Zagazig, Egypt
| | - Khaled El Gerby
- Radiodiagnosis departments, Zagazig University, Zagazig, Egypt
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Tangngam H, Mahachoklertwattana P, Poomthavorn P, Chuansumrit A, Sirachainan N, Chailurkit LO, Khlairit P. Under-recognized Hypoparathyroidism in Thalassemia. J Clin Res Pediatr Endocrinol 2018; 10:324-330. [PMID: 29726397 PMCID: PMC6280323 DOI: 10.4274/jcrpe.0020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Symptomatic hypoparathyroidism [symptomatic hypocalcemia without elevated serum parathyroid hormone (PTH)] in patients with thalassemia is relatively rare. Asymptomatic mild hypocalcemia without elevated PTH, which is considered hypoparathyroidism, may be more common but under-recognized. METHODS Sixty-six transfusion-dependent thalassemic patients and 28 healthy controls were enrolled. Serum calcium (Ca), phosphate (P), creatinine (Cr), albumin, intact PTH, 25-hydroxyvitamin D (25-OHD), plasma intact fibroblast growth factor-23 (FGF-23), urinary Ca, P and Cr were measured. Tubular reabsorption of P was calculated. RESULTS Thalassemic patients had significantly lower median serum Ca levels than the controls [8.7 (7.8-9.7) vs 9.6 (8.7-10.1) mg/dL, p<0.001]. Hypoparathyroidism was found in 25 of 66 (38%) patients. Symptomatic hypoparathyroidism was not encountered. Thalassemic patients also had significantly lower median plasma FGF-23 levels than the controls [35.7 (2.1-242.8) vs 53.2 (13.3-218.6) pg/mL, p=0.01]. In patients with hypoparathyroidism, median plasma FGF-23 level was significantly lower than that of normoparathyroid patients [34.8 (2.1-120.0) vs 43.1 (3.2-242.8) pg/mL, p=0.048]. However, serum P, Cr, intact PTH and 25-OHD levels were not significantly different in the two groups. CONCLUSION Hypoparathyroidism was not uncommon in patients with transfusion-dependent thalassemia treated with suboptimal iron chelation. Plasma intact FGF-23 level in hypoparathyroid patients was lower than that of normoparathyroid patients.
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Affiliation(s)
- Hataitip Tangngam
- Mahidol University Faculty of Medicine, Ramathibodi Hospital, Department of Pediatrics, Bangkok, Thailand
| | - Pat Mahachoklertwattana
- Mahidol University Faculty of Medicine, Ramathibodi Hospital, Department of Pediatrics, Bangkok, Thailand,* Address for Correspondence: Mahidol University Faculty of Medicine, Ramathibodi Hospital, Departments of Pediatrics, Bangkok, Thailand Phone: +6622011394 E-mail:
| | - Preamrudee Poomthavorn
- Mahidol University Faculty of Medicine, Ramathibodi Hospital, Department of Pediatrics, Bangkok, Thailand
| | - Ampaiwan Chuansumrit
- Mahidol University Faculty of Medicine, Ramathibodi Hospital, Department of Pediatrics, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Mahidol University Faculty of Medicine, Ramathibodi Hospital, Department of Pediatrics, Bangkok, Thailand
| | - La-or Chailurkit
- Mahidol University Faculty of Medicine, Ramathibodi Hospital, Department of Medicine, Bangkok, Thailand
| | - Patcharin Khlairit
- Mahidol University Faculty of Medicine, Ramathibodi Hospital, Department of Pediatrics, Bangkok, Thailand
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Bone Mineral Density (BMD) and Chemical Biomarkers Among Patients with Thalassemia Major and Intermedia in Iran. HEALTH SCOPE 2018. [DOI: 10.5812/jhealthscope.64137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tsartsalis AN, Lambrou GI, Tsartsalis D, Savvidis C, Karantza M, Terpos E, Kanaka-Gantenbein C, Chrousos GP, Kattamis A. The role of biphosphonates in the management of thalassemia-induced osteoporosis: a systematic review and meta-analysis. Hormones (Athens) 2018; 17:153-166. [PMID: 29858849 DOI: 10.1007/s42000-018-0019-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 03/01/2018] [Indexed: 01/13/2023]
Abstract
Thalassemia Major (TM) is a clinical entity with a high prevalence of low bone mass. The aim of the present study was to perform a meta-analysis of all available data on the role of bisphosphonates (BPs) in the therapy of thalassemia major-induced osteoporosis. The PRISMA recommendations for reporting systematic reviews and meta-analyses were used to guide the present study. We searched PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) through March 31, 2017 for articles related to thalassemia and BPs. To meta-analytically synthesize the primary endpoint, we used the standardized mean difference (SMD) after Hedges's g transformation under the scenario of a random effects model. Heterogeneity across studies was examined using the I2 statistic. Nine randomized controlled trials (RCTs) containing original data were included in this review. Three studies were performed in Italy, one in Australia, three in Greece, one in Cyprus, and one in China. The BPs investigated included zoledronate, alendronate, pamidronate, clodronate, and neridronate. Zoledronate and alendronate showed a tendency to perform best as compared to neridronate and the placebo effect with respect to femoral neck, lumbar spine, total hip, and total body in terms of bone mass density (g/cm2). BPs and in particular, zolendronate, were quite effective in the treatment of osteoporosis. These findings suggested that bisphosphonates are still a front-line treatment of osteoporosis in TM. However, to draw more meaningful and significant conclusions for the use and efficacy of BP in TM, larger and more complete RCTs should be conducted.
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Affiliation(s)
- Athanasios N Tsartsalis
- Department of Endocrinology Diabetes and Metabolism, Naval Hospital of Athens, Dinokratous 70, 11521, Athens, Greece.
| | - George I Lambrou
- First Department of Pediatrics, Choremeio Research Laboratory, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
- Division of Endocrinology Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
- Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
| | - Dimitrios Tsartsalis
- Department of Clinical Physiology, Linköping University, Linköping, SE-58183, Linköping, Sweden
| | - Christos Savvidis
- Department of Endocrinology and Metabolism "Hippocration" General Hospital, Vasilissis Sofias 114, 11527, Athens, Greece
| | - Maria Karantza
- First Department of Pediatrics, Choremeio Research Laboratory, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, Medical School, "Alexandra" General Hospital, National and Kapodistrian University of Athens, Lourou, 11527, Athens, Greece
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
| | - George P Chrousos
- First Department of Pediatrics, Choremeio Research Laboratory, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
- Division of Endocrinology Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
- Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
| | - Antonis Kattamis
- Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
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Relation of anthropometric measurements to ocular biometric changes and refractive error in children with thalassemia. Eur J Ophthalmol 2018; 28:139-143. [PMID: 27834467 DOI: 10.5301/ejo.5000903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate and correlate anthropometric, biometric, and refractive error changes in thalassemia major (TM). METHODS One hundred children with TM and another hundred healthy controls were recruited. Height, weight, body mass index (BMI), and occipitofrontal circumference (OFC) were the anthropometric parameters recorded. Full ophthalmologic examination was performed, including best-corrected visual acuity, cycloplegic refraction, slit-lamp examination, Goldmann applanation tonometry, indirect ophthalmoscopy, keratometry (K readings), and ocular biometry. RESULTS Compared to controls, children with TM were shorter and lighter, with a smaller BMI (p<0.001); however, no significant difference existed in OFC. Regarding ocular biometric data, patients with thalassemia had steeper mean K readings (p = 0.03), shorter axial length (AXL) (p = 0.005), shorter vitreous chamber depth (p<0.001), and thicker crystalline lens (p<0.001) than controls. Patients with thalassemia had a significant myopic shift (p = 0.003). Multiple regression analyses only showed a significant correlation between corneal astigmatism and both weight and height (β = -0.05 and p = 0.03 and β = 0.06 and p = 0.04, respectively). Spherical equivalent was significantly correlated to K readings, lens thickness, and anterior chamber depth (p<0.0001 for all parameters). CONCLUSIONS Compared to controls, children with TM have significant retardation in general and ocular growth (smaller BMI and shorter AXL). Ocular growth changes probably resulted in compensatory biometric changes (steeper corneas and thicker lenses) to reach emmetropization, with an exaggerated response and subsequent myopic shift. However, growth retardation is not directly related to ocular growth changes, myopic shift, or variations in biometric parameters.
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Abstract
Essential trace elements deficiency including zinc and copper are frequently reported in the literature, but the results are controversial. The aim of this study was to evaluate zinc and copper levels in thalassemia major (TM) patients who were on regular transfusion and iron chelation therapy. In a case-control cross-sectional study 43 TM patients and 43 age-matched and sex-matched healthy controls were examined. Patients were selected by convenience sampling method from TM patients who were registered in Thalassemia Clinic during 6 months. Serum zinc and copper levels were evaluated in all subjects. Zinc and copper dietary intake were also assessed. The median zinc level in the participants was significantly lower than the control group (35 [6.3 to 298] vs. 173 [3.1 to 584] μg/dL; P<0.05), but the mean copper level was significantly higher in the patients in comparison with the control group (260±118 vs. 201±69 μg/dL; P<0.05). In contrast, the mean zinc and copper dietary intake in the patient's group were significantly lower than the control group. The mean serum zinc and copper levels in the patient's group were not different according to iron chelation therapy type. Also, zinc and copper levels in the patient's group were not statistically significant based on ferritin level, age, and duration of therapy. Essential trace elements level change and deficiency might occur in TM patients. Hence, routine assessment of these elements is recommended for better management.
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Fahmey SS, Taha G, El-Refaey A, Adly S. Skin Disorders in Egyptian Children with β-Thalassemia Major. J Trop Pediatr 2018; 64:104-109. [PMID: 28510704 DOI: 10.1093/tropej/fmx035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thalassemia major is one of the common genetic disorders in Egypt. Skin disorders are usually neglected and frequently underdiagnosed among these patients. OBJECTIVE This work aimed to study the frequency and pattern of skin manifestations in Egyptian children with β-thalassemia. METHODS Fifty-four β-thalassemia major patients being followed at the Hematology Clinic of Beni-Suef University Hospital were selected to participate in this study. All patients underwent detailed history evaluation, clinical examination and laboratory investigations, including complete blood count and serum ferritin. All patients were examined by a dermatologist to record any skin disorders. RESULTS Pruritus (37%), scars (33.3%), hyperpigmentation (31.5%) and xerosis (22.2%) were the most common findings. We found significant relations between serum ferritin and the occurrence of scars, hyperpigmentation, xerosis and ephelides (p <0.05). Also, significant associations between use of deferoxamine and scars (p=0.004), hyperpigmentation (p=0.004), xerosis (p=0.03) and ephelides (p=0.042) were found. CONCLUSION Skin disorders are frequent in Egyptian children with thalassemia major. Careful skin examination is required to provide early diagnosis.
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Affiliation(s)
- Sameh S Fahmey
- Department of Pediatrics, Beni-Suef University, Beni Suef 62511, Egypt
| | - Gamal Taha
- Department of Pediatrics, Beni-Suef University, Beni Suef 62511, Egypt
| | | | - Sherry Adly
- Department of Pediatrics, Beni-Suef University, Beni Suef 62511, Egypt
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Stefanopoulos D, Papaioannou NA, Papavassiliou AG, Mastorakos G, Vryonidou A, Michou A, Dontas IA, Lyritis G, Kassi E, Tournis S. A contemporary therapeutic approach to bone disease in beta-thalassemia - a review. J Frailty Sarcopenia Falls 2018; 3:13-25. [PMID: 32300690 PMCID: PMC7155348 DOI: 10.22540/jfsf-03-013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 01/19/2023] Open
Abstract
Homozygous beta-thalassemia represents a serious hemoglobinopathy, in which an amazing prolongation in the survival rate of patients has been achieved over recent decades. A result of this otherwise positive evolution is the fact that bone problems have become a major issue in this group of patients. Through an in-depth review of the related literature, the purpose of this study is to present and comment on the totality of the data that have been published to date pertaining to the prevention and treatment of thalassemia bone-disease, focusing on: the contribution of diet and lifestyle, the treatment of hematologic disease and its complications, the management of hypercalciuria, the role of vitamins and minerals and the implementation of anti-osteoporosis medical regimen. In order to comprehensively gather the above information, we mainly reviewed the international literature through the PubMed database, searching for the preventive and therapeutic data that have been published pertaining to thalassemia bone-disease over the last twenty-nine years. There is no doubt that thalassemia bone-disease is a complication of a multi-factorial etiopathology, which does not follow the rules of classical postmenopausal osteoporosis. Bisphosphonates have been the first line of treatment for many years now, with varied and usually satisfactory results. In addition, over the last few years, more data have arisen for the use of denosumab, teriparatide, and other molecules that are in the clinical trial phase, in beta-thalassemia.
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Affiliation(s)
- Dimitrios Stefanopoulos
- Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, KAT Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikolaos A. Papaioannou
- Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, KAT Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Athanassios G. Papavassiliou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Mastorakos
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology, Diabetes & Metabolism, General Hospital Korgialenio-Benakio, Athens, Greece
| | - Aikaterini Michou
- Deparment of Endocrinology, “Elena Venizelou” General Hospital, Athens, Greece
| | - Ismene A. Dontas
- Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, KAT Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Eva Kassi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- First Department of Internal Medicine - Medical School- Laikon Hospital - National and Kapodistrian University of Athens, Greece
| | - Symeon Tournis
- Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, KAT Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Dejkhamron P, Wejaphikul K, Mahatumarat T, Silvilairat S, Charoenkwan P, Saekho S, Unachak K. Vitamin D deficiency and its relationship with cardiac iron and function in patients with transfusion-dependent thalassemia at Chiang Mai University Hospital. Pediatr Hematol Oncol 2018; 35:52-59. [PMID: 29359982 DOI: 10.1080/08880018.2018.1424280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vitamin D deficiency is common in patients with thalassemia. Vitamin D deficiency could be related to cardiac dysfunction. Increased parathyroid hormone (PTH) is also known to be associated with heart failure. OBJECTIVES To determine the prevalence of Vitamin D deficiency and to explore the impact of Vitamin D deficiency on cardiac iron and function in patients with transfusion-dependent thalassemia. METHOD A cross-sectional study in patients with Transfusion-dependent thalassemia was conducted. Patients with liver disease, renal disease, type 1 diabetes, malabsorption, hypercortisolism, malignancy, and contraindication for MRI were excluded. Calcium, phosphate, PTH, vitamin D-25OH were measured. CardiacT2* and liver iron concentration (LIC) and left ventricular ejection fraction (LVEF) were determined. Results Sixty-one (33M/28F) patients with Transfusion-dependent thalassemia were enrolled. The prevalence of Vitamin D deficiency was 50.8%. Patients with cardiac siderosis had tendency for lower D-25OH than those without siderosis (15.9 (11.7-20.0) vs. 20.2 (15.85-22.3) ng/mL); p = 0.06). Serum calcium, phosphate, PTH, LIC, cardiac T2*, and LVEF were not different between the groups with or without Vitamin D deficiency. Patients with Vitamin D deficiency had significantly lower hemoglobin levels compared to those without Vitamin D deficiency (7.5 (6.93-8.33) vs. 8.1 (7.30-8.50) g/dL; p = 0.04). The median hemoglobin in the last 12 months was significantly correlated with D-25OH. Cardiac T2* had significant correlation with PTH. CONCLUSION Vitamin D deficiency is prevalent in patients with Transfusion-dependent thalassemia. Vitamin D level is correlated with hemoglobin level. Vitamin D status should be routinely assessed in these patients. Low PTH is correlated with increased cardiac iron. This study did not demonstrate an association between Vitamin D deficiency and cardiac iron or function in patients with Transfusion-dependent thalassemia.
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Affiliation(s)
- Prapai Dejkhamron
- a Department of Pediatrics , Faculty of Medicine, Chiang Mai University , Chiang Mai , Thailand
| | - Karn Wejaphikul
- a Department of Pediatrics , Faculty of Medicine, Chiang Mai University , Chiang Mai , Thailand
| | - Tuanjit Mahatumarat
- a Department of Pediatrics , Faculty of Medicine, Chiang Mai University , Chiang Mai , Thailand
| | - Suchaya Silvilairat
- a Department of Pediatrics , Faculty of Medicine, Chiang Mai University , Chiang Mai , Thailand
| | - Pimlak Charoenkwan
- a Department of Pediatrics , Faculty of Medicine, Chiang Mai University , Chiang Mai , Thailand
| | - Suwit Saekho
- b Department of Radiological Technology , Faculty of Associated Medical Sciences, Chiang Mai University , Chiang Mai , Thailand
| | - Kevalee Unachak
- a Department of Pediatrics , Faculty of Medicine, Chiang Mai University , Chiang Mai , Thailand
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Wong SH, Omar J, Ismail TST. Multiple Endocrinologic Complications in Thalassemia Major. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2017. [DOI: 10.15324/kjcls.2017.49.4.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Siong Hu Wong
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Julia Omar
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Tuan Salwani Tuan Ismail
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Singh P, Seth A. Growth and endocrine issues in children with thalassemia. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2017. [DOI: 10.1016/j.phoj.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Ansari S, Kiumarsi A, Azarkeivan A, Allameh MM, Amir kashani D, Razaghi Azar M. Fertility Assessment in Thalassemic Men. THALASSEMIA REPORTS 2017. [DOI: 10.4081/thal.2017.6362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Male infertility in β-thalassemia patients is typically considered to be the consequence of iron deposition in the endocrine glands. Adult male patients with β-thalassemia, on regular blood transfusions, are prone to developing acquired hypogonadism. The aim of this study was to evaluate the fertility indicators in male patients with β-thalassemia major and intermedia. In this study we evaluated testicular volume, semen parameters and serum FSH, LH, and Testosterone concentrations in 62 male patients in reproductive age, with major and intermedia thalassemia, at a tertiary care hospital in Tehran, Iran. The range of serum ferritin level in our patients was from 182 to 11053 ng/mL (mean 2067 ng/mL). The mean concentration of sperm was 61.04 million per milliliter. The mean volume of right and left testes was 11.4 cc and 11.7 cc, respectively. Those patients who had lower testicular volumes significantly had lower sperm concentration, lower percents of motile and also lower percents of normal morphologic sperms (p = 0.04). The frequency of hypogonadism was significantly higher in patients whose testicular volume was lower (p = 0.02). Hypogonadism and hypothyroidism were seen in 22.6% and 17.7% of patients, respectively. Patients with hypogonadism had significantly lower ejaculate volume, lower sperm concentration, lower percents of motile and progressively motile sperms and also lower percents of normal morphologic sperms (p = 0.001). This study suggests that in thalassemic men, concentrations of serum testosterone, LH, FSH has significant correlation with sperm parameters and testicular volume.
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Mukherjee A, Soto C. Prion-Like Protein Aggregates and Type 2 Diabetes. Cold Spring Harb Perspect Med 2017; 7:cshperspect.a024315. [PMID: 28159831 DOI: 10.1101/cshperspect.a024315] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Type 2 diabetes (T2D) is a highly prevalent metabolic disease characterized by chronic insulin resistance and β-cell dysfunction and loss, leading to impaired insulin release and hyperglycemia. Although the mechanism responsible for β-cell dysfunction and death is not completely understood, recent findings suggest that the accumulation of misfolded aggregates of the islet amyloid polypeptide (IAPP) in the islets of Langerhans may play an important role in pancreatic damage. Misfolding and aggregation of diverse proteins and their accumulation as amyloid in different organs is the hallmark feature in a group of chronic, degenerative diseases termed protein misfolding disorders (PMDs). PMDs include highly prevalent human illnesses such as Alzheimer's and Parkinson's disease, as well as more than 25 rarer disorders. Among them, prion diseases are unique because the pathology can be transmitted by a proteinaceous infectious agent, termed a prion, which induces disease by propagating protein misfolding and aggregation. This phenomenon has a striking resemblance to the process of protein misfolding and aggregation in all of the PMDs, suggesting that misfolded aggregates have an intrinsic potential to be transmissible. Indeed, recent studies have shown that the pathological hallmarks of various PMDs can be induced in vivo under experimental conditions by inoculating tissue extracts containing protein aggregates into animal models. In this review, we describe our current understanding of the molecular mechanism underlying the prion-like transmission of protein aggregates and its possible role in T2D.
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Affiliation(s)
- Abhisek Mukherjee
- Mitchell Center for Alzheimer's Disease and Related Brain Disorders, Department of Neurology, University of Texas Health Science Center, McGovern Medical School, Houston, Texas 77030
| | - Claudio Soto
- Mitchell Center for Alzheimer's Disease and Related Brain Disorders, Department of Neurology, University of Texas Health Science Center, McGovern Medical School, Houston, Texas 77030
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