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Murad H, Moassas F, Ali B, Katranji E, Mukhalalaty Y. The Spectrum of α-Thalassemia Mutations in Syrian Patients. Hemoglobin 2023; 47:245-248. [PMID: 38146675 DOI: 10.1080/03630269.2023.2296927] [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: 10/11/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023]
Abstract
α-Thalassemia (α-thal) is a globally prevalent genetic disorder of hemoglobin (Hb) structure where the rate of α-globin chain synthesis is reduced or absent due to the presence of α-globin mutation(s). The aim of this study is to define the spectrum of α-globin gene mutations and evaluate their allele frequency in a group of α-thal carriers. A total of 55 individuals with possible α-thal patients were referred from the thalassemia centers in Syria. They have unexplained hypochromia and microcytosis. All patients were genetically tested for 21 common α-globin gene mutations using reverse hybridization kit. Seven different α-globin gene mutations and 13 different genotypes were detected in 55 patients. The two most frequently encountered mutations were -α3.7 deletion (47.1%) and --MED mutation (21.4%). The most commonly observed genotype was -α3.7/αα (40%), followed by --MED/αα genotype (21.8%). We determined the most common α thalassemia mutations in the Syrian patients. α-Thalassemia mutations with deletions were mostly observed in our study.
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Affiliation(s)
- Hossam Murad
- Molecular Biology and Biotechnology Department, Atomic Energy Commission of Syria, Damascus, Syria
| | - Faten Moassas
- Molecular Biology and Biotechnology Department, Atomic Energy Commission of Syria, Damascus, Syria
| | - Bouthina Ali
- Molecular Biology and Biotechnology Department, Atomic Energy Commission of Syria, Damascus, Syria
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Gurlek Gokcebay D, Küpeli S, Gürsel O, Arman Bilir O, Akyay A, Pekpak E, Akbayram S, Öncül Y, Meral Güneş A, Kirkiz S, Çakı Kılıç S, Ok Bozkaya İ, Ozbek NY. Hematopoietic stem cell transplantation activities and HRQOL of refugee or asylum seeker children in Turkey: A multicenter study. Pediatr Transplant 2022; 26:e14397. [PMID: 36207767 DOI: 10.1111/petr.14397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND Refugee or asylum seekers (RAS) children are at increased risk of physical, developmental, and behavioral health issues. The aim of this study was to evaluate clinical and psychosocial outcomes of hematopoietic stem cell transplantation (HSCT) in RAS children and compare health-related quality of life (HRQOL) to those of Turkish peers. METHODS This retrospective study included patients who underwent HSCT aged 0-18 years and completed 100-day post-transplant. The PedsQL 4.0 Generic Core Scale was used in children over 5 years old to compare HRQOL. RESULTS A total of 166 RAS patients (M/F: 106 /60) underwent 174 HSCTs (six patients had two, and one had three HSCT) compared to 66 Turkish patients. The mean age of the patients in the RAS group was 7.8 ± 4.9 years and similar to controls. A total of 124 patients (75%) were from Syria, and 49 (25%) were from other countries in the Middle East and Africa. The cause of migration was war in 121 (74%) RAS patients. Complications of HSCT were no different between the groups. However, the rate of neutropenic sepsis was significantly higher in the RAS group (p = 0.004). The total scores of HRQOL were not different between RAS and controls. In the RAS group, ratings of social functioning were lower in patients with consanguinity or non-malignant disease or who had match-related donors. DISCUSSION Identifying areas of difficulty in subscales of HRQOL may help physicians to classify patients who need additional supportive care. Regular monitoring and supporting physical needs may result in better functional outcomes after HSCT.
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Affiliation(s)
- Dilek Gurlek Gokcebay
- Pediatric Bone Marrow Transplantation Unit, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Serhan Küpeli
- Faculty of Medicine Pediatric Bone Marrow Transplantation Unit, Çukurova University, Adana, Turkey
| | - Orhan Gürsel
- Pediatric Bone Marrow Transplantation Unit, University of Health Sciences Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ozlem Arman Bilir
- Pediatric Bone Marrow Transplantation Unit, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Arzu Akyay
- Faculty of Medicine Pediatric Bone Marrow Transplantation Unit, İnönü University, Malatya, Turkey
| | - Esra Pekpak
- Faculty of Medicine Pediatric Bone Marrow Transplantation Unit, Gaziantep University, Gaziantep, Turkey
| | - Sinan Akbayram
- Faculty of Medicine Pediatric Bone Marrow Transplantation Unit, Gaziantep University, Gaziantep, Turkey
| | - Yurday Öncül
- Faculty of Medicine Pediatric Bone Marrow Transplantation Unit, İnönü University, Malatya, Turkey
| | - Adalet Meral Güneş
- Faculty of Medicine Pediatric Bone Marrow Transplantation Unit, Uludağ University, Bursa, Turkey
| | - Serap Kirkiz
- Faculty of Medicine Pediatric Bone Marrow Transplantation Unit, Gazi University, Ankara, Turkey
| | - Suar Çakı Kılıç
- Pediatric Bone Marrow Transplantation Unit, University of Health Sciences Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - İkbal Ok Bozkaya
- Pediatric Bone Marrow Transplantation Unit, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Namık Yasar Ozbek
- Pediatric Bone Marrow Transplantation Unit, University of Health Sciences Ankara City Hospital, Ankara, Turkey
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Jaing TH, Chang TY, Chen SH, Lin CW, Wen YC, Chiu CC. Molecular genetics of β-thalassemia: A narrative review. Medicine (Baltimore) 2021; 100:e27522. [PMID: 34766559 PMCID: PMC8589257 DOI: 10.1097/md.0000000000027522] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT β-thalassemia is a hereditary hematological disease caused by over 350 mutations in the β-globin gene (HBB). Identifying the genetic variants affecting fetal hemoglobin (HbF) production combined with the α-globin genotype provides some prediction of disease severity for β-thalassemia. However, the generation of an additive composite genetic risk score predicts prognosis, and guide management requires a larger panel of genetic modifiers yet to be discovered.Presently, using data from prior clinical trials guides the design of further research and academic studies based on gene augmentation, while fundamental insights into globin switching and new technology developments have inspired the investigation of novel gene therapy approaches.Genetic studies have successfully characterized the causal variants and pathways involved in HbF regulation, providing novel therapeutic targets for HbF reactivation. In addition to these HBB mutation-independent strategies involving HbF synthesis de-repression, the expanding genome editing toolkit provides increased accuracy to HBB mutation-specific strategies encompassing adult hemoglobin restoration for personalized treatment of hemoglobinopathies. Allogeneic hematopoietic stem cell transplantation was, until very recently, the curative option available for patients with transfusion-dependent β-thalassemia. Gene therapy currently represents a novel therapeutic promise after many years of extensive preclinical research to optimize gene transfer protocols.We summarize the current state of developments in the molecular genetics of β-thalassemia over the last decade, including the mechanisms associated with ineffective erythropoiesis, which have also provided valid therapeutic targets, some of which have been shown as a proof-of-concept.
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Affiliation(s)
- Tang-Her Jaing
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Wei Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Chi Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Hamad L, Kreidieh K, Hamdan MB, Nakouzi G, Yazbek S. Mapping the Diverse Genetic Disorders and Rare Diseases Among the Syrian Population: Implications on Refugee Health and Health Services in Host Countries. J Immigr Minor Health 2021; 22:1347-1367. [PMID: 32172498 DOI: 10.1007/s10903-020-00987-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this systematic review is to provide physicians and researchers with a comprehensive list of reported genetic disorders in patients of Syrian origin-those who have become part of the largest displaced population globally-and to highlight the need to consider migrant population-based risk for the development of genetic disease control and prevention programs. This review was performed based on the 2015 PRISMA and the international prospective register of systematic reviews. The present review reports on a total of 166 genetic disorders (only 128 reported on OMIM) identified in the Syrian population. Of these disorders, 27% are endocrine-, nutritional- and metabolic-related diseases. Second to metabolic disorders are congenital malformations, deformations and chromosomal abnormalities. Diseases of the blood and the blood-forming organs accounted for 13% of the total genetic disorders. The majority of the genetic disorders reported in Syrian patients followed an autosomal recessive mode of inheritance. These findings are a reflection of the high rates of consanguineous marriages that favor the increase in incidence of these diseases. From the diseases that followed an autosomal recessive mode of inheritance, 22% are reported to be only present in Syria and other regional countries. Twelve of these genetic diseases were identified to be strictly diagnosed in individuals of Syrian origin. The present systematic review highlights the need to develop programs that target genetic disorders affecting Syrian migrants in host countries. These programs would have potential financial and economic benefits, as well as a positive impact on the physical and mental health of members of the Syrian refugee community and those of their host societies. In turn, this would decrease the burden on the health systems in host countries.
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Affiliation(s)
- Lina Hamad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khalil Kreidieh
- Office of Faculty Affairs, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mirna Bou Hamdan
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Riad El Solh, P.O Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Ghunwa Nakouzi
- Department of Clinical Pathology, Cleveland Clinic Hospital, Cleveland, OH, USA.
| | - Soha Yazbek
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Riad El Solh, P.O Box 11-0236, Beirut, 1107 2020, Lebanon.
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Gunes AK, Gozden HE. The Spectrum of Beta-Thalassemia Mutations in Syrian Refugees and Turkish Citizens. Cureus 2021; 13:e15434. [PMID: 34258108 PMCID: PMC8254855 DOI: 10.7759/cureus.15434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction and objectives Neighboring the border between Turkey and Syria, Sanliurfa is one of the Turkish provinces with the highest number of Syrian refugees in our country. We aimed to find out the spectrum of beta-globin gene mutations in adult Turkish citizens and Syrian refugees with beta-thalassemia major. Results Of the participants, 35 patients (70%) were Turkish citizens and 15 patients (30%) were Syrian. The most common mutation in Turkish patients was found to be IVS-I-110 (G>A) with a frequency of 28.8%, followed by IVS-I-6 (T>C) with a frequency of 15.5%. Other common mutations were IVS-I-1 (G>A) and codon 39 (C>T) with frequencies of 11.1%. These four mutations accounted for 65.5% of all mutations in the Turkish cohort. The most common mutations in Syrian refugee patients were IVS-I-1 (G>A), IVS-II-1 (G>A), IVS-I-5 (G>C), and codon 5 (-CT), all with a frequency of 15.7%, accounting for 62.8% of all mutations in the Syrian patients. In the analysis, codon 5 (-CT) mutation (15.7% vs 0%, p=0.023) was found significantly higher in Syrian refugees compared to Turkish citizens. Discussion and conclusions A wide spectrum of mutations was detected in beta-thalassemia major patients living in the Sanliurfa region. Mutational profiles in Turkish and Syrian patients were found to be significantly different from each other. Because marriages between Syrian refugees and Turkish citizens are increasing in our region, the genetic findings and the mutational profiles in Turkish and Syrian patients obtained in this study are thought to become useful for future prenatal molecular diagnostic tests.
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Affiliation(s)
- Ahmet Kursad Gunes
- Department of Hematology, Ankara City Hospital, Ankara, TUR.,Department of Hematology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, TUR
| | - Hilmi Erdem Gozden
- Department of Hematology, Abdulhamid Han Education and Research Hospital, Istanbul, TUR.,Department of Hematology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, TUR
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Murad H, Moassas F, Fakseh NAL. A rare gene variation cap +1 (A>C) (HBB: c. -50A>C) associated with codon 5 (-CT) (HBB: c.17_18delCT) mutation in Syrian family. Mol Genet Genomic Med 2021; 9:e1602. [PMID: 33491330 PMCID: PMC8104179 DOI: 10.1002/mgg3.1602] [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: 09/20/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 12/04/2022] Open
Abstract
Background CAP+1 [A>C] (HBB:c.‐50A>C) is a rare silent β‐thalassemia (β‐thal) mutation. Carrier individuals of this mutation show borderline hemoglobin (Hb), mean corpuscular volume (MCV) and Hb A2 levels. This mutation was previously reported in combination with different β‐thalassemia mutations, leading to variable phenotypes. Case presentation Here, we describe for the first time the combination of silent CAP+1 [A>C] (HBB:c.‐50A>C) mutation with β0 codon 5 [‐CT] (HBB:c.17_18delCT) mutation in a Syrian proband, leading to beta thalassemia intermedia (TI). Conclusions The compound heterozygotes of the silent CAP+1 (A>C) together with another severe beta gene mutation, are phenotypically severe enough to present at an early age and require appropriate therapeutic modalities.
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Affiliation(s)
- Hossam Murad
- Molecular Biology and Biotechnology Department, Human Genetics Div, Atomic Energy Commission of Syria, Damascus, Syria
| | - Faten Moassas
- Molecular Biology and Biotechnology Department, Human Genetics Div, Atomic Energy Commission of Syria, Damascus, Syria
| | - Nour A L Fakseh
- Molecular Biology and Biotechnology Department, Human Genetics Div, Atomic Energy Commission of Syria, Damascus, Syria
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Khan AM, Al-Sulaiti AM, Younes S, Yassin M, Zayed H. The spectrum of beta-thalassemia mutations in the 22 Arab countries: a systematic review. Expert Rev Hematol 2020; 14:109-122. [PMID: 33317346 DOI: 10.1080/17474086.2021.1860003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate the mutational spectrum in the HBB gene in Arab patients with β-thal. METHODS Authors searched five databases (PubMed, Science Direct, Scopus, Web of Science, and Google Scholar) from the time of inception until March 2020. RESULTS The authors search strategy yielded 3,229 citations, of which 48 eligible studies captured. 105 mutations were captured, of these, 99 were shared between Arabs and other ethnic groups, six mutations were unique to Arabs (c.92 + 2 T > G, c.-240 G > A, c.150delC, c.420dupT, deletion of 192 bp spanning exon 1, intron 1, and the first two bases of exon 2 of HBB gene, and deletion of 9.6 kb, including exon 1 and intron 2 of HBB gene). The most common HBB gene mutations among Arabs were c.93-21 G > A, c.118 C > T, c.92 + 1 G > A, c.92 + 6 T > C, c.92 + 5 G > C, c.315 + 1 G > A, and c.27dupG. Consanguinity is high among Arab patients with β-thal. Migration into Arab countries led to allelic heterogeneity among Arab patients with β-thal. CONCLUSION Our findings present a platform for further genetic epidemiological studies for Arab patients with β-thal.
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Affiliation(s)
- Aisha Moeen Khan
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University , Doha, Qatar
| | - Asma Mohammed Al-Sulaiti
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University , Doha, Qatar
| | - Salma Younes
- Translational Research Institute, Women's Wellness and Research Center, Hamad Medical Corporation , Qatar
| | - Mohamed Yassin
- Department of Hematology and BMT, National Center for Cancer Care and Research, Hamad Medical Corporation , Doha, Qatar
| | - Hatem Zayed
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University , Doha, Qatar
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Shoujaa A, Moasses F, Mukhalalaty Y, Murad H, Al-Quobaili F. Genotype/Phenotype Correlation of β-Thalassemia in Syrian Patients: A Cross-Sectional Study. Hemoglobin 2020; 44:42-46. [PMID: 31903828 DOI: 10.1080/03630269.2019.1709207] [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: 10/25/2022]
Abstract
β-Thalassemia (β-thal) is an inherited blood disorder caused by reduced or absent synthesis of β-globin chains leading to imbalance of globin chain synthesis. β0-Thalassemia (β0-thal), refers to the complete absence of β-globin chain production on the affected allele. β+-Thalassemia (β+-thal) refers to alleles with some residual production of β-globin chain. We studied the correlation of genotype/phenotype of β-thal disease in Syrian patients. A cross-sectional study was carried out on 260 patients with β-thal. Genotyping was determined by a DNA sequencing technique. Routine investigations were performed to assess the complete blood count (CBC), serum ferritin, Hb A2 and Hb F levels. We found that the β0/β0 genotype was the most common in our patients followed by β+/β+ and β0/β+. Patients with β0/β0 received transfusions at an earlier age and more frequently when compared to those with β0/β+ and β+/β+ genotypes. Moreover, patients with β0/β0 had higher levels of Hb F and lower levels of Hb A2 compared to those with β0/β+ and β+/β+ genotypes. All patients with β-thal intermedia (β-TI) carry the β+/β+ genotype, while all patients with β0/β0 and β0/β+ genotypes presented with transfusion-dependent β-thal major (β-TM).
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Affiliation(s)
- Ahmad Shoujaa
- Faculty of Pharmacy, Damascus University, Damascus, Syria
| | - Faten Moasses
- Biotechnology and Molecular Biology Department, Atomic Energy Commission of Syria, Damascus, Syria
| | | | - Hossam Murad
- Biotechnology and Molecular Biology Department, Atomic Energy Commission of Syria, Damascus, Syria
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Abstract
β-Thalassemia (β-thal) is the most common hereditary genetic blood disorder. The aims of this study were: (i) to determine the mutation types and the frequency of these mutations in β-thal patients to obtain the ethnic origins of the population in Siirt Province; (ii) to evaluate the pathogenicity of these mutations by performing in silico analysis; (iii) to reveal the genotype-phenotype correlation by comparing the clinical manifestation of our patients to the specific mutations in this population. This study included 34 patients (18 males and 16 females) with a mean age of 9.1 ± 3.6 years (range 3-16 years). All mutations were determined using sequence analysis methods, and the mutations were analyzed using bioinformatics tools. Thirteen different mutations were detected in the patients: IVI-I-110 (G>A) (HBB: c.93-21G>A) (38.9%); IVS-II-1 (G>A) (HBB: c.315_1G>A) (11.1%); -30 (T>A) (HBB: c.-80T>A) (9.25%) and IVS-I-1 (G>A) (HBB: c.92 + 1G>A) (9.25%), were the most common, and these mutations constituted 68.5% of the cases. Missense codon 6 (A>T) (HBB: c.20A>T) was not pathogenic; however, all the intronic mutations (IVS-I-1, IVS-I-110, IVS-II-1) and frameshift mutations [codon 44 (-C) (HBB: c.135delC) and codons 36/37 (-T) (HBB: c.112delT)] resulted in disease. These mutations can be used to determine the ethnic origin of the Siirt population and, in affected pregnant women, to develop prenatal strategies. A fatal phenotype can be identified by in silico analysis; however, mutations that are unknown prior to marriage, pregnancy, and childbirth or new mutations can be less accurately identified.
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Affiliation(s)
- Sedat Yılmaz
- Department of Medical Biochemistry, Medicine Faculty of Adıyaman University , Adıyaman , Turkey
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Yassouf MY, Alquobaili F, Kabalan Y, Mukhalalaty Y. Compliance with Deferoxamine Therapy and Thyroid Dysfunction of Patients with β-Thalassemia Major in Syria. Hemoglobin 2019; 43:218-221. [PMID: 31373517 DOI: 10.1080/03630269.2019.1639517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hypothyroidism is one of the common endocrine complications described in patients with β-thalassemia major (β-TM). Studies have reported its incidence and severity depending on the region, quality of management and treatment protocols. The reported thyroid dysfunction includes overt hypothyroidism, subclinical hypothyroidism and rarely, central hypothyroidism. The main aims of this study were to identify the incidence of hypothyroidism in 82 patients with β-TM in Syria, and also to evaluate the effect of compliance with deferoxamine (DFO) therapy on the patients' thyroid function. Out of the 82 patients included in this study, 24 had subclinical hypothyroidism (29.27%) and one patient had overt hypothyroidism (1.22%). It was demonstrated by this study that noncompliance with DFO therapy increases the risk of thyroid dysfunction 6.38-times compared to compliance with DFO [risk ratio (RR) = 6.385; 95% confidence interval (95% CI) 2.40-16.95)]. These results emphasize the importance of compliance with chelation therapy to minimize the burden of thyropathy on patients' quality of life, and also augment the rationale for a routine follow-up and endocrine evaluation for early detection and management of these complications.
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Affiliation(s)
- M Yousuf Yassouf
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University , Damascus , Syria
| | - Faizeh Alquobaili
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University , Damascus , Syria
| | - Younes Kabalan
- Department of Endocrinology, Faculty of Medicine, Damascus University , Damascus , Syria
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Yazal Erdem A, Demir Yenigürbüz F, Pekpak E, Akıncı B, Aktekin E, Bayram C, Yıldırmak ZY, Ataseven E, Akbayram S, Şaşmaz İ, Taburoğlu Yılmaz B, Özkan A, Akpınar Tekgündüz S, Köse D, Karapınar T, Büyükavcı M, Sal E, Bayhan T, Kirkiz S, Ünal Ş, Vergin RC, Çil M, Malbora B, Ayçiçek A, Yaralı HN, Özbek NY. Refugee children with beta-thalassemia in Turkey: Overview of demographic, socioeconomic, and medical characteristics. Pediatr Blood Cancer 2019; 66:e27636. [PMID: 30706992 DOI: 10.1002/pbc.27636] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/24/2018] [Accepted: 01/14/2019] [Indexed: 11/07/2022]
Abstract
AIM Since the beginning of the Syrian civil war, more than 3.5 million Syrians have been under temporary protection status in Turkey. Because beta-thalassemia (BT) is a prevalent disorder in the Mediterranean countries, we decided to estimate the prevalence of and make an overview of the demographic, socioeconomic, medical characteristics, and healthcare problems of refugee children with BT. PATIENTS Eighteen Turkish Pediatric Hematology Oncology Centers (PHOC) with 318 refugee children from 235 families participated in the study. The mean age of the patients was 8.1 ± 4.8 years (0.5-21 years). The mean time after immigration to Turkey was 2.5 ± 1.5 years (range, 0.1-7 years). Seventy-two (22.6%) of them were born and diagnosed with BT in Turkey. On physical examination, 82 patients (26%) were underweight and 121 patients (38%) were stunted. The appearance of a thalassemic face was reported for 207 patients (65.1%). Hepatomegaly and splenomegaly were reported in 217 (68.2%) and 168 (52.8%) patients, respectively. The median ferritin level was 2508 ng/mL (range, 17-21 000 ng/mL) at the first admission, and 2841 ng/mL (range, 26-12 981 ng/mL) at the last visit after two years of follow-up in a PHOC (P > 0.05). The most frequently encountered mutation was IVSI-110 (G>A) (31%). Before immigration, only 177 patients (55.6%) reported the use of chelators; after immigration it increased to 268 (84.3%). CONCLUSION Difficulties in communication, finding a competent translator capable in medical terminology, nonregular use of medications, and insensitivity to prenatal diagnosis were preliminary problems. The current extent of migration poses emerging socioeconomic and humanitarian challenges for refugee patients with BT.
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Affiliation(s)
- Arzu Yazal Erdem
- Pediatric Hematology and Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Esra Pekpak
- Pediatric Hematology and Oncology, Gaziantep Cengiz Gökçek Children and Maternity Hospital, Gaziantep, Turkey
| | - Burcu Akıncı
- Pediatric Hematology and Oncology, Şanlıurfa Children's Hospital, Şanlıurfa, Turkey
| | - Elif Aktekin
- Pediatric Hematology and Oncology, Konya Training and Research Hospital, Konya, Turkey
| | - Cengiz Bayram
- Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Suleyman Research and Training Hospital, İstanbul, Turkey
| | - Zeynep Yıldız Yıldırmak
- Pediatric Hematology and Oncology, University of Health Sciences, İstanbul Hamidiye Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Eda Ataseven
- Pediatric Hematology and Oncology, Izmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Sinan Akbayram
- Pediatric Hematology and Oncology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - İlgen Şaşmaz
- Pediatric Hematology and Oncology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Başak Taburoğlu Yılmaz
- Pediatric Hematology and Oncology, Adana City Training and Research Hospital, Adana, Turkey
| | - Ayşe Özkan
- Pediatric Hematology and Oncology, Adana City Training and Research Hospital, Adana, Turkey
| | | | - Doğan Köse
- Pediatric Hematology and Oncology, Diyarbakır Children's Hospital, Diyarbakır, Turkey
| | - Tuba Karapınar
- Pediatric Hematology and Oncology, İzmir Dr Behçet Uz Children Training and Research Hospital, İzmir, Turkey
| | - Mustafa Büyükavcı
- Pediatric Hematology and Oncology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Ertan Sal
- Pediatric Hematology and Oncology, Batman State Hospital, Batman, Turkey
| | - Turan Bayhan
- Pediatric Hematology and Oncology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Serap Kirkiz
- Pediatric Hematology and Oncology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Şule Ünal
- Department of Pediatrics, Division of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Raziye Canan Vergin
- Pediatric Hematology and Oncology, İzmir Dr Behçet Uz Children Training and Research Hospital, İzmir, Turkey
| | - Metin Çil
- Pediatric Hematology and Oncology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Barış Malbora
- Pediatric Hematology and Oncology, Izmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ali Ayçiçek
- Pediatric Hematology and Oncology, İstanbul Kanuni Sultan Suleyman Research and Training Hospital, İstanbul, Turkey
| | - Hüsniye Neşe Yaralı
- Pediatric Hematology and Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Namık Yaşar Özbek
- Pediatric Hematology and Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
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Murad H, Moassas F, Ali B, Alachkar W. A compound heterozygous −29 A>G and IVS-I-1 G>A mutation of HBB gene leading to β-thalassemia intermedia in a Syrian patient: A case report. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1581448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hossam Murad
- Atomic Energy Commission of Syria (AECS), Damascus, Syria
| | - Faten Moassas
- Atomic Energy Commission of Syria (AECS), Damascus, Syria
| | - Bashar Ali
- Atomic Energy Commission of Syria (AECS), Damascus, Syria
| | - Walid Alachkar
- Atomic Energy Commission of Syria (AECS), Damascus, Syria
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Faraon R, Daraghmah M, Samarah F, Srour MA. Molecular characterization of β-thalassemia intermedia in the West Bank, Palestine. BMC HEMATOLOGY 2019; 19:4. [PMID: 30820323 PMCID: PMC6380065 DOI: 10.1186/s12878-019-0135-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 02/07/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND We aimed to investigate the molecular basis of β-Thalassemia intermedia (TI) in the West Bank region and its management practices. METHODS This was a case series multi-center study and included 51 cases of TI. DNA sequencing was used to analyze β-globin gene mutations. Common α-globin gene mutations were screened by Gap-PCR (-α3.7, -α4.2, --MED, αααanti3.7) or DNA sequencing (α2-IVS II 5 nt del). XmnI -158 C > T polymorphisms of Gγ-globin gene was determined by RFLP-PCR. RESULTS Seven β-globin gene mutations were observed, namely IVS-I -6 C > T, IVS-I-110 G > A, IVS-II-1 G > A, IVS-I-1 G > A, Codon 37 Trp > Stop, beta - 101 and IVS-II-848 C > A. Ten genotypes were observed. Homozygosity for IVS-I-6 accounted for the majority of TI cases with a frequency of 74.5%. The second common β-globin gene genotype was homozygote IVS-I-110 G > A (5.8%) and homozygote IVS-II-1 G > A (5.8%). The remaining seven genotypes were each detected in about 2% of patients. α-Thalassemia mutations were seen in five patients (9.8%), and included (-α3.7, αααanti3.7 and α2-IVSII-5 nt del). XmnI polymorphism was observed in four patients (7.8%), three homozygotes and one heterozygote. CONCLUSIONS Homozygosity for the mild β-globin gene IVS-I-6 allele was the major contributing factor for the TI phenotype among the study subjects. The role of XmnI SNP and α-thalassemia mutations in ameliorating the TI phenotype was observed in few patients for each factor. The beta - 101 C > T mutation was diagnosed in one patient in homozygote state for the first time in Palestine.
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Affiliation(s)
- Rashail Faraon
- Department of Medical Laboratory Sciences, Al-Quds University, East Jerusalem, Palestine
| | - Mahmoud Daraghmah
- Palestine Thalassemia Patients’ Friends Society, Al-Bireh, Palestine
| | - Fekri Samarah
- Department of Medical Laboratory Sciences, Arab-American University, Jenin, Palestine
| | - Mahmoud A. Srour
- Department of Medical Laboratory Sciences, Al-Quds University, East Jerusalem, Palestine
- Department of Biology & Biochemistry, Birzeit University, P.O. Box 14, Birzeit, Palestine
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Moassas F, Alabloog A, Murad H. Description of a Rare β-Globin Gene Mutation: -86 (C>G) (HBB: c.-136C>G) Observed in a Syrian Family. Hemoglobin 2018; 42:203-205. [PMID: 30173596 DOI: 10.1080/03630269.2018.1500918] [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: 10/28/2022]
Abstract
We present the description of a β-thalassemia (β-thal) -86 (C>G) (HBB: c.-136C>G) mutation in a Syrian family from Damascus, As-Suwayda Province, Syria, who was referred to the laboratory for prenatal diagnosis (PND). The mutation was found in the mother in a homozygous state, while it was in the father and in the amniotic fluid sample in a heterozygous state. This mutation is located at -86 within the proximal CACCC box in the promoter of the β-globin gene and is possibly linked with a phenotype of β+-thal. Polymerase chain reaction-restriction fragment length polymorphism (PCR/RFLP) analysis indicated that the -86 mutation was linked with haplotype I [+ - - - - + +]. We propose that Lebanon may be the origin of this mutation. To the best of our knowledge, this is the first report describing this mutation in As-Suwayda Province. These findings provide novel information on the region-specificity of this mutation in southwestern Syria.
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Affiliation(s)
- Faten Moassas
- a Molecular Biology and Biotechnology Department, Human Genetics Division , Atomic Energy Commission of Syria , Damascus , Syria
| | - Ayman Alabloog
- a Molecular Biology and Biotechnology Department, Human Genetics Division , Atomic Energy Commission of Syria , Damascus , Syria
| | - Hossam Murad
- a Molecular Biology and Biotechnology Department, Human Genetics Division , Atomic Energy Commission of Syria , Damascus , Syria
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Murad H, Moasses F, Dabboul A, Mukhalalaty Y, Bakoor AO, Al-Achkar W, Jarjour RA. Geographical distribution of β-globin gene mutations in Syria. Hematology 2018; 23:697-704. [DOI: 10.1080/10245332.2018.1461291] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Hossam Murad
- Molecular Biology and Biotechnology Department, Human Genetics Division, Atomic Energy Commission of Syria, Damascus, Syria
| | - Faten Moasses
- Molecular Biology and Biotechnology Department, Human Genetics Division, Atomic Energy Commission of Syria, Damascus, Syria
| | - Amir Dabboul
- Molecular Biology and Biotechnology Department, Human Genetics Division, Atomic Energy Commission of Syria, Damascus, Syria
| | | | | | - Walid Al-Achkar
- Molecular Biology and Biotechnology Department, Human Genetics Division, Atomic Energy Commission of Syria, Damascus, Syria
| | - Rami A. Jarjour
- Molecular Biology and Biotechnology Department, Human Genetics Division, Atomic Energy Commission of Syria, Damascus, Syria
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Erythroferrone: An Erythroid Regulator of Hepcidin and Iron Metabolism. Hemasphere 2018; 2:e35. [PMID: 31723763 PMCID: PMC6745900 DOI: 10.1097/hs9.0000000000000035] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/04/2018] [Accepted: 02/23/2018] [Indexed: 12/21/2022] Open
Abstract
Iron homeostasis ensures adequate iron for biological processes while preventing excessive iron accumulation, which can lead to tissue injury. In mammalian systems, iron availability is controlled by the interaction of the iron-regulatory hormone hepcidin with ferroportin, a molecule that functions both as the hepcidin receptor as well as the sole known cellular exporter of iron. By reducing iron export through ferroportin to blood plasma, hepcidin inhibits the mobilization of iron from stores and the absorption of dietary iron. Among the many processes requiring iron, erythropoiesis is the most iron-intensive, consuming most iron circulating in blood plasma. Under conditions of enhanced erythropoiesis, more iron is required to provide developing erythroblasts with adequate iron for heme and hemoglobin synthesis. Here the hormone erythroferrone, produced by erythroblasts, acts on hepatocytes to suppress hepcidin production, and thereby increase dietary iron absorption and mobilization from stores. This review focuses on the discovery of erythroferrone and recent advances in understanding the role of this hormone in the regulation of iron homeostasis during states of increased erythropoietic demand. Gaps in our understanding of the role of erythroferrone are highlighted for future study.
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Jarjour RA, Jamra RA. Mutations of familial Mediterranean fever in Syrian patients and controls: Evidence for high carrier rate. GENE REPORTS 2017. [DOI: 10.1016/j.genrep.2016.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Li CK. New trend in the epidemiology of thalassaemia. Best Pract Res Clin Obstet Gynaecol 2017; 39:16-26. [DOI: 10.1016/j.bpobgyn.2016.10.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/21/2016] [Accepted: 10/14/2016] [Indexed: 01/19/2023]
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Murad H, Moassas F, Jarjour R, Mukhalalaty Y, Al-Achkar W. Prenatal Molecular Diagnosis of β-Thalassemia and Sickle Cell Anemia in the Syrian Population. Hemoglobin 2014; 38:390-3. [DOI: 10.3109/03630269.2014.978455] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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