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Diamantidis MD, Karanikola RA, Polyzoudi C, Delicou S, Manafas A, Savera H, Xydaki A, Kotsiafti A, Tsangalas E, Ikonomou G, Mani E, Ntoulas K, Alexiou E, Argyrakouli I, Koskinas J, Fotiou P. Clinical significance of mutational variants in beta and alpha genes in patients with hemoglobinopathies from two large Greek centers: a complex interplay between genotype and phenotype. J Mol Med (Berl) 2023; 101:1073-1082. [PMID: 37420139 DOI: 10.1007/s00109-023-02342-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
Hemoglobinopathies affect patients in the wider Mediterranean area consisting of 4 distinct subgroups: beta thalassemia major (TM), beta thalassemia intermedia (TI), sickle cell disease (SCD) and hemoglobin H disease (alpha thalassemia). The clinical spectrum varies from mild to severe. Complex interactions between genes and environmental factors form the clinical manifestations. There is an unmet need to clarify these multifactorial mechanisms. This is the first Greek study describing mutational alleles (HBB and HBA1/HBA2 gene variants) in 217 patients with hemoglobinopathies of two large centers in Greece (Larissa and Athens) and associating particular genotypes or gene variants with clinical manifestations (transfusion frequency, complications). Thus, the complex interplay between corresponding genotypes and phenotypes was investigated. Our results are in accordance with previous national studies with limited variations, due to regional prevalence of specific gene variants, as expected. It is also a description of the prevalence of hemoglobinopathies in the Greek population. The type and prevalence of beta and alpha globin gene variants differ significantly among countries. We also confirm the well-known observation of many studies that in our beta thalassemic or SCD patients, co-inheritance of variants in the alpha globin genes, leading to absence or reduction of alpha globin synthesis were associated with milder clinical course, whereas the inheritance of additional alpha genes (triplication) led to a more severe clinical phenotype. In cases in whom the genotype and phenotype did not correlate, factors like the function or modification of possible regulatory genes or additional nutritional-environmental effects should be investigated. KEY MESSAGES: • This is the first Greek study, fully molecularly defining the beta and alpha mutational alleles in 217 patients with hemoglobinopathies of two large centers in Greece and correlating particular genotypes or gene variants with clinical manifestations (transfusion frequency, complications). • In the beta thalassemic or SCD patients of our cohort, co-inheritance of variants in the alpha globin genes, leading to absence or reduction of alpha globin synthesis were associated with milder clinical course (confirmation of a well-known previous observation). • The inheritance of additional alpha genes (triplication) led to a more severe clinical phenotype (confirmation of a well known previous observation). • The function or modification of possible regulatory genes should be investigated in cases in whom the genotype and phenotype did not correlate.
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Affiliation(s)
- Michael D Diamantidis
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece.
| | - Rebecca-Anastasia Karanikola
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Chrysoula Polyzoudi
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Sophia Delicou
- Thalassemia and Sickle Cell Disease Unit, Hippokration General Hospital of Athens, Athens, Greece
| | - Achilles Manafas
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Helen Savera
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Aikaterini Xydaki
- Thalassemia and Sickle Cell Disease Unit, Hippokration General Hospital of Athens, Athens, Greece
| | - Angeliki Kotsiafti
- Thalassemia and Sickle Cell Disease Unit, Hippokration General Hospital of Athens, Athens, Greece
| | - Evangelos Tsangalas
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Georgia Ikonomou
- Thalassemia Prevention Unit, General Hospital of Larissa, Larissa, Greece
| | - Eirini Mani
- Thalassemia Prevention Unit, General Hospital of Larissa, Larissa, Greece
| | - Konstantinos Ntoulas
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Evangelos Alexiou
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - Ioanna Argyrakouli
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
| | - John Koskinas
- Thalassemia and Sickle Cell Disease Unit, Hippokration General Hospital of Athens, Athens, Greece
| | - Paraskevi Fotiou
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, First Department of Internal Medicine, General Hospital of Larissa, Tsakalov St. 1, 41 221, Larissa, Greece
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Diamantidis MD, Pitsava S, Zayed O, Argyrakouli I, Karapiperis K, Chatzoulis C, Alexiou E, Manafas A, Tsangalas E, Karakoussis K. Concomitant Presence of Hb Agrinio and - -Med Deletion in a Greek Male Patient with Hemoglobinopathy H: More Severe Phenotype and Literature Review. Hematol Rep 2023; 15:483-490. [PMID: 37606495 PMCID: PMC10443284 DOI: 10.3390/hematolrep15030050] [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: 04/11/2023] [Revised: 05/17/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023] Open
Abstract
Hemoglobin (Hb) Agrinio is a rare non-deletional a-globin mutation observed almost exclusively in Greek, Spanish or other Mediterranean families. The clinical manifestations of a carrier of a single Hb Agrinio mutation (single heterozygosity) depend on the concomitant presence or absence of other mutations or variants in the beta, alpha or other modifying genes. We present a Greek patient harboring a Hb Agrinio variant plus the - -Med alpha deletional allele, having an infrequent severe form of alpha thalassemia, in contrast to the typical alpha thalassemic patient and requiring regular red blood cell (RBC) transfusions and chelation treatment. We also provide a concise literature review regarding alpha thalassemic hemoglobin variants and their molecular and clinical combinations. A phase 2, double-blind, randomized, placebo-controlled, multicenter clinical trial to determine the efficacy and safety of luspatercept (BMS-986346/ACE-536) for the treatment of anemia in adults with alpha thalassemia with the participation of our center is currently recruiting patients (NCT05664737).
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Affiliation(s)
- Michael D. Diamantidis
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Stefania Pitsava
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Omar Zayed
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Ioanna Argyrakouli
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Konstantinos Karapiperis
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Christos Chatzoulis
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Evangelos Alexiou
- Radiology Department, General Hospital of Larissa, 41221 Larissa, Greece;
| | - Achilles Manafas
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Evangelos Tsangalas
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
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Szepetowski S, Berger C, Joly P, Baron-Joly S, Huguenin Y, Cantais A, Brun S, Ged C, Badens C, Thuret I, Giansily-Blaizot M, Pissard S, Aguilar-Martinez P. Homozygosity for the hyperunstable hemoglobin variant Hb Agrinio (HBA2:c.89T>C) leads to severe antenatal anemia: Eight new cases in three families. Am J Hematol 2022; 97:E393-E395. [PMID: 36052950 DOI: 10.1002/ajh.26687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Sarah Szepetowski
- Pediatric Onco-Hematology Department, Reference Center on Rare Red Cell Disorders, La Timone Children's Hospital, APHM, Marseille, France
| | - Claire Berger
- Pediatric Onco-Hematology Department, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Philippe Joly
- Biology Center "Biochimie des pathologies érythrocytaires", Lyon Est Hospital Group, Bron, France
| | | | - Yoann Huguenin
- Pediatric Onco-Hematology Department, Bordeaux University Hospital, Bordeaux, France
| | - Aurélie Cantais
- Neonatal Pediatric Care unit, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Sophie Brun
- Department of Hematological biology, Nîmes University Hospital, Nîmes, France
| | - Cécile Ged
- Biochemistry Department, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Badens
- INSERM, Marseille Medical Genetics, Aix Marseille University, Marseille, France
| | - Isabelle Thuret
- Pediatric Onco-Hematology Department, Reference Center on Rare Red Cell Disorders, La Timone Children's Hospital, APHM, Marseille, France
| | - Muriel Giansily-Blaizot
- Department of Hematological biology, Reference Center on Rare Red Cell Disorders, Montpellier University Hospital, Montpellier, France
| | - Serge Pissard
- Molecular Genetic Laboratory, Henri Mondor University Hospital, Créteil, France
| | - Patricia Aguilar-Martinez
- Department of Hematological biology, Reference Center on Rare Red Cell Disorders, Montpellier University Hospital, Montpellier, France
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Dimishkovska M, Kuzmanovska M, Kocheva S, Martinova K, Karanfilski O, Stojanoski Z, Plaseska-Karanfilska D. First Cases of Hb Agrinio Described in Patients from the Republic of Macedonia. Hemoglobin 2017; 41:308-310. [PMID: 29219637 DOI: 10.1080/03630269.2017.1397016] [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: 10/18/2022]
Abstract
Previous molecular analyses of α-thalassemia (α-thal) in the Republic of Macedonia have identified the following genetic defects: -α3.7 (rightward), -(α)20.5 and - -MED I deletions and Hb Icaria [α142, Term→Lys (α2), HBA2: c.427T>A] and polyadenylation signal (polyA) [AATAAA>AATGAA (α2), HBA2: c.*92A>G] point mutations. Here, we report two unrelated patients from the Romani population in the Republic of Macedonia, homozygotes for the α2-globin gene variant Hb Agrinio [α29(B10)Leu→Pro; HBA2: c.89T>C]. To date, Hb Agrinio has been described only in individuals of Greek, Cypriot and Spanish origin. Both of our patients had early presentation of the disease (3.5 years and 2 months, respectively) with frequent blood transfusions from early infancy. They have a severe intermediate phenotype of thalassemia (Hb H disease) with hemoglobin (Hb) levels of 7.8 and 7.7 g/dL, respectively. Although the HBA2: c.89T>C mutation results in an α+ allele, the severe phenotype of the homozygotes is due to the production of hyperunstable α chains that undergo post translational precipitation. This leads to a greater degree of red cell damage and hemolytic anemia. The detection of Hb Agrinio in two unrelated families of Romani ethnic origin, may suggest it is a founder mutation in this population living in the Republic of Macedonia. Considering the severity of the clinical presentation of the homozygotes or compound heterozygotes for this rare Hb variant, a targeted molecular screening for Hb Agrinio mutation carriers should be considered in all patients of Romani ethnic origin with manifested microcytosis.
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Affiliation(s)
- Marija Dimishkovska
- a Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov , ' Macedonian Academy of Science and Arts , Skopje , Republic of Macedonia
| | - Maja Kuzmanovska
- a Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov , ' Macedonian Academy of Science and Arts , Skopje , Republic of Macedonia
| | - Svetlana Kocheva
- b University Pediatric Clinic, Medical Faculty , Skopje , Republic of Macedonia
| | - Kata Martinova
- b University Pediatric Clinic, Medical Faculty , Skopje , Republic of Macedonia
| | - Oliver Karanfilski
- c University Clinic for Hematology, Medical Faculty , Skopje , Republic of Macedonia
| | - Zlate Stojanoski
- c University Clinic for Hematology, Medical Faculty , Skopje , Republic of Macedonia
| | - Dijana Plaseska-Karanfilska
- a Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov , ' Macedonian Academy of Science and Arts , Skopje , Republic of Macedonia
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de la Fuente-Gonzalo F, Nieto JM, Ricard P, Anguita J, Martínez R, Cervera A, Villegas A, González FA, Ropero P. Hb Cervantes, Hb Marañón, Hb La Mancha and Hb Goya: Description of 4 new haemoglobinopathies. Clin Biochem 2015; 48:662-7. [DOI: 10.1016/j.clinbiochem.2015.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 11/29/2022]
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González Borrachero ML, de la Fuente-Gonzalo F, González FA, Nieto JM, Villegas A, Ropero P. [Delta⁰-thalassemia by insertion of 27 base pairs in δ-globin gene with decreased hemoglobin A₂ levels]. Med Clin (Barc) 2015; 144:312-6. [PMID: 25579773 DOI: 10.1016/j.medcli.2014.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE We describe a novel delta-thalassemia mutation causing decreased hemoglobin (Hb) A2 levels associated with Hb Watts, variant Hb resulting from a trinucleotide deletion in Spain. PATIENTS AND METHOD Hb variant analysis was performed by cation-exchange high performance liquid chromatography (HPLC) and capillary zone electrophoresis. Polymerase chain reaction and DNA sequence analyses were used to identify mutations in the δ- and α-globin genes. RESULTS Abnormal Hb was observed on capillary zone electrophoresis in Z6 and by cation-exchange HPLC a slower peak than HbA was observed at an retention time of 4.19min. This variant Hb is called Hb Watts [α2 74(EF3)Asp->0 or α2 75(EF4)Asp->0; HBA2:c.226_228delGAC]. The decreased HbA2 percentage owes to an insertion of 27nt between nt 83 and 84 of IVS-I of the δ-globin gene. CONCLUSIONS When analyzing a chromatogram, the possibility of the existence of delta-thalassemia or an HbA2 variant should be considered, apart from alfa-, beta-thalassemia and structural haemoglobinopathies. To this end, each of the peaks and their percentages should be considered to allow for correct interpretation and to avoid misdiagnosis as much as possible.
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Affiliation(s)
| | | | | | - Jorge M Nieto
- Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, España
| | - Ana Villegas
- Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, España
| | - Paloma Ropero
- Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, España.
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de la Fuente-Gonzalo F, Ropero P, Martínez-Nieto J, Villegas A, González FA, Díaz-Mediavilla J. [Association between hemoglobin Groene Hart and hemoglobin J-Paris-I: first case in Spain]. Med Clin (Barc) 2015; 144:212-5. [PMID: 24530052 DOI: 10.1016/j.medcli.2013.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 10/14/2013] [Accepted: 10/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Thalassemias are the most frequent monogenic disorder around the world. α-thalassemias are due to a deficiency of synthesis in the alpha-globin chain of the hemoglobin (Hb). Hb Groene Hart is a hyperunstable variant. In this work, we have studied 24 cases affected by Hb Groene Hart, one of them associated with Hb J-Paris-I. PATIENTS AND METHODS Twenty-four patients from 17 unrelated families were included in this study. The characterization was done by sequencing. RESULTS α1 gene sequencing showed the mutation CCT→TCT (Pro→Ser) at codon 119 (Hb Groene Hart) in all patients. In one case, there was an association with Hb J-Paris-I. CONCLUSIONS In the Hb Groene Hart, the residue 119 of alpha-globin chain is affected. This amino acid has a key role in preserving the stability of alpha-globin chain. It is also remarkable the presence of this variant in both the immigrant and native population. Thus, the identification of Hb Groene Hart carriers should be considered in the screening of α-thalassemia in Spain, as it is done in Northern Africa.
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Affiliation(s)
| | - Paloma Ropero
- Servicio de Hematología, Hospital Clínico San Carlos, Madrid, España
| | | | - Ana Villegas
- Servicio de Hematología, Hospital Clínico San Carlos, Madrid, España
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Heterozygosity for deletion of hypersensitive site 3 in the human locus control region has an unexpected minor effect on red cell phenotype. J Hum Genet 2014; 59:585-7. [PMID: 25186056 DOI: 10.1038/jhg.2014.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/06/2014] [Accepted: 08/08/2014] [Indexed: 11/09/2022]
Abstract
The locus control region (LCR) is a genetic region that regulates the expression of the β-globin locus (HBB locus). This region is composed of several DNase I hypersensitive sites (HSs) in which the regulatory functions of the LCR may reside. To date, some individuals bearing deletions of several HSs or even the complete LCR have been described. Although the globin genes of the HBB locus are intact, most of these patients suffer thalassemia due to the reduced expression of such genes. The LCR and the HSs forming it have been thoroughly studied in different genetic models. However, seemingly contradictory results are often obtained. Here, we describe the first deletion found in humans exclusively affecting the HS3 element of the LCR. The adult carrying this deletion shows very mild hematological modifications, indicating that HS3 deletion does not severely impair the β-gene expression. Our results also reveal limitations of the murine models when studying the native mouse genes for understanding human diseases like thalassemias.
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