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Williams LA, Adamski J, Kinard TN, Ertz-Archambault NM, Lu Q, Gray K, Herrick JL, Su L, Padrnos L. The first reported use of red blood cell exchange to treat hemoglobin Evans with secondary methemoglobinemia. J Clin Apher 2023; 38:755-759. [PMID: 37665037 DOI: 10.1002/jca.22086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
This manuscript describes a novel approach for treating patients with long-term sequelae from hemoglobin Evans (Hb Evans). After instituting conservative therapies for approximately 2 years, our patient's symptoms continually worsened. Therefore, we performed red blood cell exchange (RBCx) to reduce his Hb Evans percentage and his co-existing elevation of methemoglobin. Our assumptions of clinical benefit were based on our collective experience performing RBCx for patients with sickle cell disease. After the first exchange, pre- and post-laboratory results supported our approach and the patient experienced marked improvement in his clinical signs and symptoms. This report provides preliminary proof of principle for the use of RBCx to treat Hb Evans and other non-Hb S hemoglobinopathies.
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Affiliation(s)
- Lance A Williams
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Theresa N Kinard
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | | | - Qun Lu
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Kristin Gray
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Jennifer L Herrick
- Department of Laboratory Medicine and Pathology (Hematopathology), Mayo Clinic, Rochester, Minnesota, USA
| | - Leon Su
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Leslie Padrnos
- Department of Hematology/Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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Rizzuto V, Koopmann TT, Blanco-Álvarez A, Tazón-Vega B, Idrizovic A, Díaz de Heredia C, Del Orbe R, Pampliega MV, Velasco P, Beneitez D, Santen GWE, Waisfisz Q, Elting M, Smiers FJW, de Pagter AJ, Kerkhoffs JLH, Harteveld CL, Mañú-Pereira MDM. Usefulness of NGS for Diagnosis of Dominant Beta-Thalassemia and Unstable Hemoglobinopathies in Five Clinical Cases. Front Physiol 2021; 12:628236. [PMID: 33613322 PMCID: PMC7893112 DOI: 10.3389/fphys.2021.628236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/13/2021] [Indexed: 12/30/2022] Open
Abstract
Unstable hemoglobinopathies (UHs) are rare anemia disorders (RADs) characterized by abnormal hemoglobin (Hb) variants with decreased stability. UHs are therefore easily precipitating, causing hemolysis and, in some cases, leading to dominant beta-thalassemia (dBTHAL). The clinical picture of UHs is highly heterogeneous, inheritance pattern is dominant, instead of recessive as in more prevalent major Hb syndromes, and may occur de novo. Most cases of UHs are not detected by conventional testing, therefore diagnosis requires a high index of suspicion of the treating physician. Here, we highlight the importance of next generation sequencing (NGS) methodologies for the diagnosis of patients with dBTHAL and other less severe UH variants. We present five unrelated clinical cases referred with chronic hemolytic anemia, three of them with severe blood transfusion dependent anemia. Targeted NGS analysis was performed in three cases while whole exome sequencing (WES) analysis was performed in two cases. Five different UH variants were identified correlating with patients’ clinical manifestations. Four variants were related to the beta-globin gene (Hb Bristol—Alesha, Hb Debrousse, Hb Zunyi, and the novel Hb Mokum) meanwhile one case was caused by a mutation in the alpha-globin gene leading to Hb Evans. Inclusion of alpha and beta-globin genes in routine NGS approaches for RADs has to be considered to improve diagnosis’ efficiency of RAD due to UHs. Reducing misdiagnoses and underdiagnoses of UH variants, especially of the severe forms leading to dBTHAL would also facilitate the early start of intensive or curative treatments for these patients.
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Affiliation(s)
- Valeria Rizzuto
- Translational Research in Child and Adolescent Cancer - Rare Anemia Disorders Research Laboratory, Vall d'Hebron Research Institute, ERN-EuroBloodNet Member, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Badalona, Spain.,Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Tamara T Koopmann
- Department of Clinical Genetics, Leiden University Medical Center, ERN-EuroBloodNet Member, Leiden, Netherlands
| | - Adoración Blanco-Álvarez
- Hematologic Molecular Genetics Unit, Hematology Department, Hospital Universitari Vall d'Hebron, ERN-EuroBloodNet Member, Barcelona, Spain
| | - Barbara Tazón-Vega
- Hematologic Molecular Genetics Unit, Hematology Department, Hospital Universitari Vall d'Hebron, ERN-EuroBloodNet Member, Barcelona, Spain
| | - Amira Idrizovic
- Translational Research in Child and Adolescent Cancer - Rare Anemia Disorders Research Laboratory, Vall d'Hebron Research Institute, ERN-EuroBloodNet Member, Barcelona, Spain
| | - Cristina Díaz de Heredia
- Oncohematologic Pediatrics Department, Hospital Universitari Vall d'Hebron, ERN-EuroBloodNet Member, Barcelona, Spain
| | - Rafael Del Orbe
- Hematology Department, Hospital Universitario Cruces, Barakaldo, Spain
| | | | - Pablo Velasco
- Oncohematologic Pediatrics Department, Hospital Universitari Vall d'Hebron, ERN-EuroBloodNet Member, Barcelona, Spain
| | - David Beneitez
- Red Blood Cell Disorders Unit, Hematology Department, Hospital Universitari Vall d'Hebron, ERN-EuroBloodNet Member, Barcelona, Spain
| | - Gijs W E Santen
- Department of Clinical Genetics, Leiden University Medical Center, ERN-EuroBloodNet Member, Leiden, Netherlands
| | - Quinten Waisfisz
- Department of Clinical Genetics, VU Medical Center, Amsterdam, Netherlands
| | - Mariet Elting
- Department of Clinical Genetics, VU Medical Center, Amsterdam, Netherlands
| | - Frans J W Smiers
- Department of Pediatric Hematology, Leiden University Medical Center, Leiden, Netherlands
| | - Anne J de Pagter
- Department of Pediatric Hematology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Cornelis L Harteveld
- Department of Clinical Genetics, Leiden University Medical Center, ERN-EuroBloodNet Member, Leiden, Netherlands
| | - Maria Del Mar Mañú-Pereira
- Translational Research in Child and Adolescent Cancer - Rare Anemia Disorders Research Laboratory, Vall d'Hebron Research Institute, ERN-EuroBloodNet Member, Barcelona, Spain
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Horri-Naceur A, Timson DJ. In Silico Analysis of the Effects of Point Mutations on α-Globin: Implications for α-Thalassemia. Hemoglobin 2020; 44:89-103. [PMID: 32420790 DOI: 10.1080/03630269.2020.1739067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hemoglobinopathies are inherited diseases that impair the structure and function of the oxygen-carrying pigment hemoglobin (Hb). Adult Hb consists of two α and two β subunits. α-Thalassemia (α-thal) affects the genes that code for the α-globin chains, HBA1 and HBA2. Mutations can result in asymptomatic, mild or severe outcomes depending on several factors, such as mutation type, number of mutations and the location at which they occur. PredictSNP was used to estimate whether every possible single nucleotide polymorphism (SNP) would have a neutral or deleterious effect on the protein. These results were then used to create a plot of predicted tolerance to change for each residue in the protein. Tolerance to change was negatively correlated with the residue's sequence conservation score. The PredictSNP data were compared to clinical reports of 110 selected variants in the literature. There were 29 disagreements between the two data types. Some of these could be resolved by considering the role of the affected residue in binding other molecules. The three-dimensional structures of some of these variant proteins were modeled. These models helped explain variants which affect heme binding. We predict that where a point mutation alters a residue that is intolerant to change, is well conserved and or involved in interactions, it is likely to be associated with disease. Overall, the data from this study could be used alongside biochemical and clinical data to assess novel α-globin variants.
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Affiliation(s)
- Agathe Horri-Naceur
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, East Sussex, UK
| | - David J Timson
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, East Sussex, UK
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Hayakawa I, Hataya H, Kaneko T. Choledocholithiases in a child with Hemoglobin Evans [alpha2 62(E11) Val→Met]. Clin Case Rep 2016; 4:661-3. [PMID: 27386123 PMCID: PMC4929800 DOI: 10.1002/ccr3.588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 04/12/2016] [Accepted: 04/30/2016] [Indexed: 11/18/2022] Open
Abstract
We present the first description of choledocholithiases in a 10‐year‐old boy with Hemoglobin Evans. Although biliary stones are much less common in children than in adults, epigastric pain in children with known hemolytic status should alert the physician to the possibility of biliary colic.
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Affiliation(s)
- Itaru Hayakawa
- Department of General Pediatrics Tokyo Metropolitan Children's Medical Center Tokyo Japan
| | - Hiroshi Hataya
- Department of General Pediatrics Tokyo Metropolitan Children's Medical Center Tokyo Japan
| | - Takashi Kaneko
- Department of Hematology and Oncology Tokyo Metropolitan Children's Medical Center Tokyo Japan
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Ishimaru S, Saito Y, Yokokawa Y, Yuza Y, Kaneko T. First report of an Asian family with hemoglobin Evans [α2 62 (E11) Val → Met]. Pediatr Int 2016; 58:301-3. [PMID: 26662577 DOI: 10.1111/ped.12775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/21/2015] [Accepted: 07/29/2015] [Indexed: 11/30/2022]
Abstract
Hemoglobin Evans is an unstable variant caused by a single nucleotide mutation that produces a valine-to-methionine substitution at residue 62 of the α-globin chain. It has not been reported in the Asian population and only three cases have been reported worldwide. We diagnosed a Japanese boy with chronic hemolytic anemia with hemoglobin Evans after genetic testing. This is the first familial case of hemoglobin Evans in an Asian population.
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Affiliation(s)
- Sae Ishimaru
- Division of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Yuya Saito
- Division of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Yuichi Yokokawa
- Division of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Yuki Yuza
- Division of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Takashi Kaneko
- Division of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
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Strader MB, Hicks WA, Kassa T, Singleton E, Soman J, Olson JS, Weiss MJ, Mollan TL, Wilson MT, Alayash AI. Post-translational transformation of methionine to aspartate is catalyzed by heme iron and driven by peroxide: a novel subunit-specific mechanism in hemoglobin. J Biol Chem 2014; 289:22342-57. [PMID: 24939847 DOI: 10.1074/jbc.m114.568980] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A pathogenic V67M mutation occurs at the E11 helical position within the heme pockets of variant human fetal and adult hemoglobins (Hb). Subsequent post-translational modification of Met to Asp was reported in γ subunits of human fetal Hb Toms River (γ67(E11)Val → Met) and β subunits of adult Hb (HbA) Bristol-Alesha (β67(E11)Val → Met) that were associated with hemolytic anemia. Using kinetic, proteomic, and crystal structural analysis, we were able to show that the Met → Asp transformation involves heme cycling through its oxoferryl state in the recombinant versions of both proteins. The conversion to Met and Asp enhanced the spontaneous autoxidation of the mutants relative to wild-type HbA and human fetal Hb, and the levels of Asp were elevated with increasing levels of hydrogen peroxide (H2O2). Using H2(18)O2, we verified incorporation of (18)O into the Asp carboxyl side chain confirming the role of H2O2 in the oxidation of the Met side chain. Under similar experimental conditions, there was no conversion to Asp at the αMet(E11) position in the corresponding HbA Evans (α62(E11)Val → Met). The crystal structures of the three recombinant Met(E11) mutants revealed similar thioether side chain orientations. However, as in the solution experiments, autoxidation of the Hb mutant crystals leads to electron density maps indicative of Asp(E11) formation in β subunits but not in α subunits. This novel post-translational modification highlights the nonequivalence of human Hb α, β, and γ subunits with respect to redox reactivity and may have direct implications to α/β hemoglobinopathies and design of oxidatively stable Hb-based oxygen therapeutics.
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Affiliation(s)
- Michael Brad Strader
- From the Laboratory of Biochemistry and Vascular Biology, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland 20892
| | - Wayne A Hicks
- From the Laboratory of Biochemistry and Vascular Biology, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland 20892
| | - Tigist Kassa
- From the Laboratory of Biochemistry and Vascular Biology, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland 20892
| | - Eileen Singleton
- the Department of Biochemistry and Cell Biology, Rice University, Houston, Texas 77251
| | - Jayashree Soman
- the Department of Biochemistry and Cell Biology, Rice University, Houston, Texas 77251
| | - John S Olson
- the Department of Biochemistry and Cell Biology, Rice University, Houston, Texas 77251
| | - Mitchell J Weiss
- the Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, and
| | - Todd L Mollan
- From the Laboratory of Biochemistry and Vascular Biology, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland 20892
| | - Michael T Wilson
- the Department of Biological Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, United Kingdom
| | - Abdu I Alayash
- From the Laboratory of Biochemistry and Vascular Biology, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland 20892,
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Steiner LA, Van Hoff J, Kutlar F, Gallagher PG. Aplastic Crisis Revealing the Diagnosis of Hb Evans [α62(E11)Val→Met,GTG→ATG (α2)] in a Hispanic Kindred: Case Report and Review. Hemoglobin 2009; 31:409-16. [DOI: 10.1080/03630260701590301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Traeger-Synodinos J, Harteveld CL, Kanavakis E, Giordano PC, Kattamis C, Bernini LF. Hb Aghia Sophia [alpha62(E11)Val-->0 (alpha1)], an "in-frame" deletion causing alpha-thalassemia. Hemoglobin 1999; 23:317-24. [PMID: 10569720 DOI: 10.3109/03630269909090747] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this report we describe a case of Hb H disease due to the interaction of the --(MED 1) deletion with a new alpha(+)-thalassemia determinant. The molecular analysis of the proband's genomic DNA was carried out by polymerase chain reaction amplification and sequencing of both alpha genes of the alpha(+)-thalassemia chromosome and revealed a deletion of codon 62 of the alpha1 gene. This DNA triplet codes for a valine residue at the E11 alpha helix, which is located in the interior of the heme pocket. Substitutions of valine E11 with other amino acid residues in the alpha as well as beta polypeptide chains lead, in the heterozygous carrier, either to Hb M disease or to congenital non-spherocytic hemolytic anemia. We assume that the deletion of valine at alpha62(E11) disrupts the conformation of the alpha chain to such an extent that the mutated subunit is rapidly removed by proteolysis. The final result is an alpha-thalassemia phenotype rather than an unstable hemoglobin syndrome. This conclusion is supported by the apparent absence of an abnormal alpha chain in the peripheral blood of the patient.
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Affiliation(s)
- J Traeger-Synodinos
- First Department of Pediatrics Aghia Sophia Children Hospital Athens University, Greece
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Molchanova TP, Pobedimskaya DD, Huisman TH. The differences in quantities of alpha 2- and alpha 1-globin gene variants in heterozygotes. Br J Haematol 1994; 88:300-6. [PMID: 7803274 DOI: 10.1111/j.1365-2141.1994.tb05022.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We have identified through sequencing of amplified DNA the mutations in the alpha 2- and alpha 1-globin genes in 63 individuals with a heterozygosity for an alpha chain abnormal haemoglobin (Hb). Moreover, we developed a reverse transcription/polymerase chain reaction (RT/PCR) based procedure for the determination of the alpha 2- and alpha 1-mRNA ratio in normal individuals. The numbers of alpha 2 and alpha 1 variants were nearly the same. The average percentage of the abnormal Hb in heterozygotes with alpha 2 mutations (23.5%) was slightly higher than that in heterozygotes with alpha 1 mutations (19.7%) (stable Hbs only). These percentages correspond to a ratio of alpha 2 to alpha 1 of 1.19 to 1 at the protein level. Variations in the number of active alpha-globin genes and in the stability of the variants (greatly) affected the percentages of the abnormal protein. The average ratio between the alpha 2- and alpha 1-mRNAs in 12 normal individuals was 2.6-2.75 to 1, about as expected from published data, and 2.0 to 1 for two persons with an alpha-thalassaemia-2 (alpha-thal-2) (-3.7 kb) heterozygosity. The high relative mRNA (alpha 2) level which is about twice the relative level of the alpha 2 protein suggests a less efficient translation of the alpha 2-mRNA.
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Affiliation(s)
- T P Molchanova
- Laboratory of Protein Chemistry, Medical College of Georgia, Augusta 30912-2100
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Harkness M, Harkness DR, Kutlar F, Kutlar A, Wilson JB, Webber BB, Codrington JF, Huisman TH. Hb Sun Prairie or alpha(2)130(H13)Ala----Pro beta 2, a new unstable variant occurring in low quantities. Hemoglobin 1990; 14:479-89. [PMID: 2079430 DOI: 10.3109/03630269009005801] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A severe hemolytic anemia with microcytosis and hypochromia was present in a young adopted Indian patient. Reversed phase high performance liquid chromatographic methodology and heat stability tests detected an unstable alpha chain which was present in 3 to 5% of the total hemoglobin. A larger quantity of the alpha X chain was obtained by preparative reversed phase high performance liquid chromatography. Structural analyses identified an Ala----Pro replacement at position 130 of the alpha chain. The instability of the variant, named Hb Sun Prairie, is comparable to that of Hb Bibba [alpha 136 (H19)Leu----Pro]. Gene mapping failed to detect an alpha-thalassemia deletion (alpha alpha/alpha alpha), while dot-blot analysis of amplified DNA with synthetic probes localized a G----C mutation in codon 130 (resulting in the Ala----Pro mutation) of the alpha 2-globin genes of both chromosomes. These results suggest a homozygosity for the G----C mutation and the condition alpha 2(G----C)alpha 1/alpha 2(G----C)alpha 1 adequately explains the rather severe clinical status of this child, including the marked microcytosis and hypochromia. Unfortunately, family studies to exclude the presence of a large deletion involving all zeta- and alpha-globin genes were not possible.
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Affiliation(s)
- M Harkness
- Department of Pediatrics, University of Wisconsin, Madison 53792
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