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Zhang F, Zhan J, Wang Y, Cheng J, Wang M, Chen P, Ouyang J, Li J. Enhancing thalassemia gene carrier identification in non-anemic populations using artificial intelligence erythrocyte morphology analysis and machine learning. Eur J Haematol 2024; 112:692-700. [PMID: 38154920 DOI: 10.1111/ejh.14160] [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: 09/15/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Non-anemic thalassemia trait (TT) accounted for a high proportion of TT cases in South China. OBJECTIVE To use artificial intelligence (AI) analysis of erythrocyte morphology and machine learning (ML) to identify TT gene carriers in a non-anemic population. METHODS Digital morphological data from 76 TT gene carriers and 97 controls were collected. The AI technology-based Mindray MC-100i was used to quantitatively analyze the percentage of abnormal erythrocytes. Further, ML was used to construct a prediction model. RESULTS Non-anemic TT carriers accounted for over 60% of the TT cases. Random Forest was selected as the prediction model and named TT@Normal. The TT@Normal algorithm showed outstanding performance in the training, validation, and external validation sets and could efficiently identify TT carriers in the non-anemic population. The top three weights in the TT@Normal model were the target cells, microcytes, and teardrop cells. Elevated percentages of abnormal erythrocytes should raise a strong suspicion of being a TT gene carrier. TT@Normal could be promoted and used as a visualization and sharing tool. It is accessible through a URL link and can be used by medical staff online to predict the possibility of TT gene carriage in a non-anemic population. CONCLUSIONS The ML-based model TT@Normal could efficiently identify TT carriers in non-anemic people. Elevated percentages of target cells, microcytes, and teardrop cells should raise a strong suspicion of being a TT gene carrier.
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Affiliation(s)
- Fan Zhang
- Department of Laboratory Science, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieyu Zhan
- Department of Pediatric, Baiyun District Maternal and Child Healthcare Centre, Guangzhou, China
| | - Yang Wang
- Department of Laboratory Science, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing Cheng
- Department of Laboratory Science, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meinan Wang
- IVD Domestic Clinical Application Department, Mindray Biomedical Electronics Co., Ltd, Shenzhen City, China
| | - Peisong Chen
- Department of Laboratory Science, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Juan Ouyang
- Department of Laboratory Science, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junxun Li
- Department of Laboratory Science, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Rao E, Kumar Chandraker S, Misha Singh M, Kumar R. Global distribution of β-thalassemia mutations: An update. Gene 2024; 896:148022. [PMID: 38007159 DOI: 10.1016/j.gene.2023.148022] [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: 08/12/2023] [Revised: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 11/27/2023]
Abstract
One excellent illustration of how a single gene abnormality may result in a spectrum of disease incidence is the incredible phenotypic variety of β-thalassemia, which spans from severe anemia and transfusion needs to an utterly asymptomatic sickness. However, genetic causes of β-thalassemia and how the anemia's severity might be altered at various stages in its pathophysiology have been well investigated. There are currently known to be more than 350 mutations that cause genetic disease. However only 20 β thalassemia mutations account for more than 80% of the β thalassemia mutation across the globe due to phenomenon of geographical clustering where each population has a few common mutations together with a varying number of rare ones. Due to migration of the population, the spectrum of thalassemia mutation in changing from time to time. In this review, efforts are made to collate β globin gene mutations in different countries and populations.
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Affiliation(s)
- Ekta Rao
- ICMR-National Institute of Research in Tribal Health, Jabalpur, M.P, India
| | | | - Mable Misha Singh
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ravindra Kumar
- ICMR-National Institute of Research in Tribal Health, Jabalpur, M.P, India.
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Wan Z, Bai X, He C, Zhang Y, Wang Y, Shen K, Meizi L, Wang Q, Dongsheng W, Feng Y, Yang A. Distinct lipid profile in haemolytic anaemia-related gallstones compared with the general gallstone. Ann Med 2023; 55:2203514. [PMID: 37141158 PMCID: PMC10161937 DOI: 10.1080/07853890.2023.2203514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Pigment gallstones are not uncommon among patients with chronic haemolytic anaemia. But their clinical characteristics have not been described in detail and not been directly compared with the general gallstone population. METHODS Patients at Peking Union Medical College Hospital with haemolytic anaemia and subsequent gallstones from January 2012 to December 2022 were included. Cases were matched (1:2) based on age, sex and location of stones to randomly select non-anaemia patients with gallstones (controls). RESULTS Screening 899 cases of gallstones, we finally included 76 cases and 152 controls. Total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) for cases were 3.02 ± 0.98 mmol/L, 0.89 ± 0.30 mmol/L and 1.58 ± 0.70 mmol/L, respectively, significantly lower than those in the control group (all p < 0.001). TC and HDL were both lower than the normal range, but triglyceride and LDL were within the normal range. Multiple stones were significantly more common for cases (n = 59, 78%) than for controls (n = 44, 29%, p < 0.001). The mean diameter of the maximal gallstone was 1.2 ± 0.6 cm and 1.5 ± 1.0 cm for cases and controls (p = 0.120), respectively. Stones in the elderly (p = 0.002 for univariate analysis, and 0.001 for multivariate analysis) and stones in the bile duct (p = 0.005 for univariate analysis, and 0.009 for multivariate analysis) were found to occur in a shorter period after anaemia. CONCLUSION The lipid profile of haemolytic anaemia with gallstones was distinct, low TC, low HDL, and increased-to-normal LDL, compared with the general gallstone population. Patients with haemolytic anaemia were recommended an abdominal ultrasound if aged older than 50 years, with more frequent follow-up visits.KEY MESSAGESClinical characteristics of gallstones following chronic haemolytic anaemia were described and compared with the general gallstone population.The lipid profiles were distinctly different between the patients with gallstones following chronic haemolytic anaemia and the general gallstone population.Elder patients were complicated with gallstones in a shorter period after anaemia and thus were recommended an abdominal ultrasound if aged older than 50 years, with more frequent follow-up visits.
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Affiliation(s)
- Ziqi Wan
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Eight-Year Program, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chengqing He
- Eight-Year Program, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yueyi Zhang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Kaini Shen
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Meizi
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Wang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wu Dongsheng
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yunlu Feng
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Aiming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Hamid M, Keikhaei B, Galehdari H, Saberi A, Sedaghat A, Shariati G, Mohammadi-Anaei M. Genotype-phenotype correlation in patients with deletional and nondeletional mutations of Hb H disease in Southwest of Iran. Sci Rep 2022; 12:4856. [PMID: 35319015 PMCID: PMC8941133 DOI: 10.1038/s41598-022-08986-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
We studied the alpha-globin gene genotypes, hematologic values, and transfusion-dependence of patients with Hb H disease. Molecular characterization of alpha-thalassemia was performed. We identified 120 patients with Hb H disease. Of these patients, 35 (29.16%) had deletional form of Hb H disease, and 85 (70.83%) had different form of non-deletional Hb H disease. The most frequently observed Hb H genotypes were --Med/-α3.7 in 33 patients (27.5%), αCD19(-G) α/αCD19(-G) α in 25 cases (20.83%), αpolyA2α/αpolyA2α in 15 (12.5%), and αpolyA1α/αpolyA1α in 13 (10.83%) respectively. The probability of receiving at least one transfusion blood in deletional form was observed in 3 of 35 (8.57%) patients which just seen in 3 of 33 (9%) patients with --Med/-α3.7 genotype. This form was also observed in 8 of 85 (9.4%) patients in non-deletional Hb H diseases which five of them had Med deletion in compound with alpha globin point mutations. Nondeletional Hb H disease was more severe than deletional Hb H disease requiring more blood transfusions. We can recommend that Med deletion in compound with alpha-globin point mutations, polyA1 and constant spring in homozygous form needs to be taken into consideration when offering counseling to high-risk couples.
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Affiliation(s)
- Mohammad Hamid
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran.
| | - Bijan Keikhaei
- Research Center for Thalassemia and Hemoglobinopathy, Health Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamid Galehdari
- Department of Genetics, Faculty of Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Alihossein Saberi
- Department of Medical Genetic, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Sedaghat
- Department of Endocrinology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholamreza Shariati
- Department of Medical Genetic, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. .,Narges Medical Genetics and PND Laboratory, Ahvaz, Iran.
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Doulgeraki A, Fragodimitri C, Athanasopoulou H, Drakaki K, Karabatsos F, Schiza V, Yousef J, Monopolis I, Chatziliami A. Chronic Hemolysis May Adversely Affect Skeletal Health. A Cross-Sectional Study of a Pediatric Population. Hemoglobin 2021; 45:30-36. [PMID: 33557624 DOI: 10.1080/03630269.2021.1879129] [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: 01/19/2023]
Abstract
Hereditary hemolytic disorders cause ineffective erythropoiesis and bone marrow hyperplasia. Little is known about their effect on growth and skeletal health. The aim of this study was to evaluate growth, bone and body composition of non transfusion-dependent (NTD) pediatric patients with chronic hemolysis. A detailed history and clinical examination, dual-energy X-ray absorptiometry (DXA) of the lumbar spine (LS) and total body less head (TBLH) and bone turnover markers were performed. Thirty-nine patients (22 males and 17 females, 20 prepubertal), aged 11.4 ± 3.6 years [14 had β-thalassemia intermedia (β-TI), 17 α-thalassemia (α-thal) and eight hereditary spherocytosis (HS)] were evaluated. Fifty-seven previously studied controls were used for statistical analysis. The patients had lower weight and body mass index (BMI) (Z-scores -0.2 and -0.3, respectively, p < 0.05). Post-traumatic fractures were reported by 28.0% of the patients. Compared to controls, they had lower lumbar and subcranial bone mineral density (BMD), as well as reduced fat mass (FM), whereas muscle mass was not affected. One in three patients had low vitamin D and there was increased bone resorption and reduced bone formation. Correlations between different parameters revealed a potential role of osteocalcin, hemoglobin (Hb) and lactate dehydrogenase (LDH) as prognostic markers for bone health, in the setting of chronic hemolysis. Hereditary spherocytosis (HS) patients were the least affected in terms of growth and bone profile. Chronic hemolysis may lead to impaired growth and bone health, even in young, NTD patients. The degree of hemolysis determines bone health risk. Regular surveillance of bone health is justifiable.
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Affiliation(s)
- Artemis Doulgeraki
- Department of Bone and Mineral Metabolism, Institute of Child Health, Athens, Greece
| | | | - Helen Athanasopoulou
- Department of Bone and Mineral Metabolism, Institute of Child Health, Athens, Greece
| | - Kalliopi Drakaki
- Thalassemia Unit, Agia Sophia Children's Hospital, Athens, Greece
| | - Fotis Karabatsos
- Thalassemia Unit, Agia Sophia Children's Hospital, Athens, Greece
| | - Vasiliki Schiza
- Thalassemia Unit, Agia Sophia Children's Hospital, Athens, Greece
| | | | - Ioannis Monopolis
- Department of Bone and Mineral Metabolism, Institute of Child Health, Athens, Greece
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Adekile A, Sukumaran J, Thomas D, D'Souza T, Haider M. Alpha thalassemia genotypes in Kuwait. BMC MEDICAL GENETICS 2020; 21:170. [PMID: 32831051 PMCID: PMC7444039 DOI: 10.1186/s12881-020-01105-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/10/2020] [Indexed: 12/04/2022]
Abstract
Background The frequency of the alpha thalassemia trait is approximately 40% in the Kuwaiti population, but there has been no comprehensive study of the prevalent alleles. This is a report of patients who were referred for molecular diagnosis over a 20-year period. Methods This is a retrospective study of the α-globin genotypes obtained in the Hemoglobin Research Laboratory of the Department of Pediatrics, Kuwait University from 1994 to 2015. Genotyping was performed by a combination of PCR, allele-specific oligonucleotide hybridization and reverse dot blot hybridization (Vienna Lab Strip Assay). Results Four hundred samples were characterized and analyzed from individuals aged < 1 month to 80 years, with a median of 6 years from 283 unrelated families. Most (90.8%) were Kuwaiti nationals. The commonest genotype was homozygosity for the polyadenylation-1 mutation (αPA-1α/α PA-1α) in 33.3% of the samples, followed by heterozygosity (αα/α PA-1α) for the same mutation in 32.3%. PA-1 was therefore the most frequent allele (0.59). The frequency of the α0 (−-MED) allele was 0.017. Rare alleles that were found in very low frequencies included α0 (−-FIL) in a Filipino child, Hb Constant Spring, Hb Adana, and Hb Icaria. Conclusion There is a wide variety of alpha thalassemia alleles among Kuwaitis, but nondeletional PA-1 is by far the most common cause of the moderate to severe HbH (β4 tetramer) disease phenotype. The α0 (−MED) allele is also encountered, which has implications for premarital counseling, especially for the possibility of having babies with alpha thalassemia major (Barts hydrops fetalis).
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Affiliation(s)
- Adekunle Adekile
- Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait.
| | - Jalaja Sukumaran
- Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Diana Thomas
- Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Thomas D'Souza
- Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Mohammad Haider
- Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
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Ameen R, Al Shemmari SH, Marsh SGE. HLA Haplotype Frequencies and Genetic Profiles of the Kuwaiti Population. Med Princ Pract 2020; 29:39-45. [PMID: 30870850 PMCID: PMC7024892 DOI: 10.1159/000499593] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/14/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the HLA haplotype frequencies and genetic profiles of the Kuwaiti population. MATERIALS AND METHODS Whole venous blood was obtained from 595 healthy, unrelated Kuwaiti volunteers. The study population was genotyped for HLA class I (HLA-A, HLA-B, and HLA-C) and class II (HLA-DRB1 and HLA-DQB1) loci using sequence-specific oligonucleotide (SSO) probe-based hybridization and high-resolution HLA genotyping. Haplotype frequencies were estimated using an implementation of the expectation maximization algorithm that resolves both phase and allelic ambiguity. The Kuwaiti population was compared with other populations from the US National Marrow Donor Program (NMDP), by running a principal component analysis (PCA) on the relevant haplotype frequencies. RESULTS The most common HLA class I alleles in Kuwait were HLA-A*02:01g, HLA-C*06:02g, and HLA-B*50:01g with frequencies of 16, 14, and 12%, respectively. The most common HLA class II alleles in Kuwait were HLA-DQB1*02:01g and HLA-DRB1*07:01 with frequencies of 29.7 and 16.5%, respectively. The most common Kuwaiti haplotype observed was HLA-A*02:01g∼HLA-C*06:02g∼HLA-B*50:01g∼HLA-DRB1*07:01∼HLA-DQB1*02:01g at a frequency of 2.3%. The PCA demonstrated close genetic proximity of the Kuwaiti population with Middle Eastern, Southeast Asian, and North African populations in the NMDP. CONCLUSION Identifying the haplotype diversity in the Kuwaiti population will contribute to the selection of an HLA-match for HSCT, disease associations, pharmacogenomics, and knowledge of pop-ulation HLA diversity.
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Affiliation(s)
- Reem Ameen
- Medical Laboratory Department, Health Sciences Center, Kuwait University, Kuwait City, Kuwait,
| | - Salem H Al Shemmari
- Medicine Department, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Steven G E Marsh
- Anthony Nolan Research Institute and UCL Cancer Institute, Royal Free Campus, London, United Kingdom
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Tartaglione I, Russo C, Elefante A, Caiazza M, Casale M, Di Concilio R, Ciancio A, De Michele E, Amendola G, Gritti P, Carafa PA, Ferrantino T, Centanni A, Ippolito N, Caserta V, Oliveto T, Granato I, Femina G, Esposito F, Ponticorvo S, Russo AG, Canna A, Ermani M, Cirillo M, Perrotta S, Manara R. No evidence of increased cerebrovascular involvement in adult neurologically-asymptomatic β-Thalassaemia. A multicentre multimodal magnetic resonance study. Br J Haematol 2019; 185:733-742. [PMID: 30836432 DOI: 10.1111/bjh.15834] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/12/2019] [Indexed: 11/28/2022]
Abstract
Multi-factorial causes jeopardize brain integrity in β-thalassaemia. Intracranial parenchymal and vascular changes have been reported among young β-thalassaemia patients but conventional magnetic resonance imaging (MRI) findings are contradictory making early MRI and magnetic resonance angiography (MRA)/venography monitoring a matter of debate. This study prospectively investigated 75 neurologically asymptomatic β-thalassaemia patients (mean-age 35·2 ± 10·7 years; 52/75 transfusion-dependent; 41/75 splenectomised) using a 3T magnetic resonance scanner; clinical, laboratory and treatment data were also collected. White matter ischaemic-like abnormalities, intracranial artery stenoses, aneurysms and sinus venous thrombosis were compared between patients and 56 healthy controls (mean-age 33·9 ± 10·8 years). No patient or control showed silent territorial or lacunar strokes, intracranial artery stenoses or signs of sinus thrombosis. White matter lesions were found both in patients (35/75, 46·7%) and controls (28/56, 50·0%), without differences in terms of number (4·0 ± 10·6 vs. 4·6 ± 9·1, P = 0·63), size and Fazekas' Score. Intracranial aneurysms did not differ between patients and controls for incidence rate (7/75, 9·3% vs. 5/56, 8·9%), size and site. Vascular and parenchymal abnormality rate did not differ according to treatments or clinical phenotype. According to this study, asymptomatic β-thalassaemia patients treated according to current guidelines do not seem to carry an increased risk of brain and intracranial vascular changes, thus weakening recommendations for regular brain MRI monitoring.
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Affiliation(s)
- Immacolata Tartaglione
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Camilla Russo
- Neuroradiologia, Università degli Studi di Napoli "Federico II", Napoli, Italy
| | - Andrea Elefante
- Neuroradiologia, Università degli Studi di Napoli "Federico II", Napoli, Italy
| | - Martina Caiazza
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Maddalena Casale
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | | | - Angela Ciancio
- Unità Operativa Ematologia - Day Hospital di Talassemia, Ospedale "Madonna delle Grazie", Matera, Italy
| | - Elisa De Michele
- Medicina Trasfusionale AUO "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Giovanni Amendola
- Dipartimento di Pediatria, Ospedale "Umberto I", Nocera Inferiore, Italy
| | - Paolo Gritti
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Pasquale A Carafa
- Dipartimento di Salute Mentale, Servizio Psichiatrico di Diagnosi e Cura, ASL Salerno, Salerno, Italy
| | - Teresa Ferrantino
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Antonella Centanni
- Ambulatorio di Psicologia, Ospedale "Umberto I", Nocera Inferiore, Italy
| | - Noemi Ippolito
- Ambulatorio di Psicologia, Ospedale "Umberto I", Nocera Inferiore, Italy
| | - Violetta Caserta
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Tiziana Oliveto
- Ambulatorio di Psicologia, Ospedale "Umberto I", Nocera Inferiore, Italy
| | - Ilaria Granato
- Ambulatorio di Psicologia, Ospedale "Umberto I", Nocera Inferiore, Italy
| | - Gianluca Femina
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Sezione di Neuroscienze, Università di Salerno, Salerno, Italy
| | - Fabrizio Esposito
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Sezione di Neuroscienze, Università di Salerno, Salerno, Italy
| | - Sara Ponticorvo
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Sezione di Neuroscienze, Università di Salerno, Salerno, Italy
| | - Andrea G Russo
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Sezione di Neuroscienze, Università di Salerno, Salerno, Italy
| | - Antonietta Canna
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Sezione di Neuroscienze, Università di Salerno, Salerno, Italy
| | - Mario Ermani
- Dipartimento di Neuroscienze (DNS), Unità di Statistica e di Informatica, Scuola di Medicina, Università of Padova, Padova, Italy
| | - Mario Cirillo
- Dipartimento di Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, Università della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Renzo Manara
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Sezione di Neuroscienze, Università di Salerno, Salerno, Italy
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Zhang Q, Fan X, Xu M, Zhang Y, Xu H, Wen X, Zhou W. Hb H Disease Caused by Multiple Mutations in the Polyadenylation Signal Site and - - SEA/αα. Hemoglobin 2018; 41:189-192. [PMID: 28950779 DOI: 10.1080/03630269.2017.1366917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Thalassemia is the most common monogenic disease, with the highest incidence in Guangxi Zhuang Autonomous Region, People's Republic of China (PRC). The blood test result was not consistent with α-globin gene testing in one of the patients during daily screening. It was confirmed that there were multiple mutations at the α2-globin gene polyadenylation (polyA) signal site: HBA2: c.*64(T>C), HBA2: c.*68(A>C), HBA2: c.*71(G>A), HBA2: c.*74(C>A), HBA2: c.*82(G>A), HBA2: c.*92(A>G) and HBA2: c.*98(T>C) and compound - -SEA/αα by sequencing of the HBA1 and HBA2 genes of the proband and core family members. After that, we found a further two cases of unrelated patients with this type of mutation. The mutation is not an accidental phenomenon, and likely to occur with a considerable incidence in Guangxi Zhuang Autonomous Region, PRC. We analyzed the hematological manifestations of this type of thalassemia and showed that it was a Hb H (β4) disease caused by rare mutations. We suggest that it is essential to pay attention to this mutation during future clinical diagnoses and genetic counseling of patients.
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Affiliation(s)
- Qiang Zhang
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China.,b Department of Genetic Metabolism , Prenatal Diagnostic Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region , Nanning , Guangxi Zhuang Autonomous Region , People's Republic of China
| | - Xin Fan
- b Department of Genetic Metabolism , Prenatal Diagnostic Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region , Nanning , Guangxi Zhuang Autonomous Region , People's Republic of China
| | - Mingli Xu
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Yijia Zhang
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Huiling Xu
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Xiaojun Wen
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China
| | - Wanjun Zhou
- a Department of Medical Genetics , School of Basic Medical Sciences, Southern Medical University , Guangzhou , Guangdong Province , People's Republic of China
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Miri-Moghaddam E, Bahrami S, Naderi M, Bazi A, Karimipoor M. Molecular Characterization of β-Thalassemia Intermedia in Southeast Iran. Hemoglobin 2017; 40:173-8. [PMID: 27117567 DOI: 10.3109/03630269.2016.1167735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Inheritance of mild mutations within the β-globin gene and coinheritance of α-thalassemia (α-thal) are known as two important genetic modifiers in β-thalassemia (β-thal) intermedia (β-TI). We aimed to evaluate the spectrum of β- and α-thal mutations in β-TI patients in Southeast Iran. Common β- and α-globin gene mutations were detected by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) and multiplex gap-PCR, respectively. There were 26 male (57.8%) and 19 female (42.2%) patients. HBB: c.92 + 5T > C [IVS-I-5 (G > C)] and HBB: c.-138C + 1G > A [IVS-II-I (G > A)] represented the prevalent alleles with respective frequencies of 60.0 and 10.0%. Other β-globin mutations included HBB: c.-138C > T [-88 (C > T)], HBB: c.27_28insG [frameshift codons (FSC) 8/9 (+G)], HBB: c.46delT [codon 15 (-T)], HBB: c.93-22_95del (IVS-I, 25 del), and the 619 bp deletion (NG_000007.3: g.71609_72227del619). The predominant genotypic combinations were β(0)/β(0) (68.9%), β(0)/β(+ )(8.9%) and β(+)/β(+ )(2.2%). Coinheritance of α-thal was observed in 33.0% of the patients, with the -α(3.7) (rightward) (NG_000006.1: g.34164_37967del3804) as the most common deletion (86.0%). One patient was diagnosed with the -α(4.2) (leftward) (AF221717) and one with the - -(MED) (g.24664_41064del16401) deletions, while no patients carried the -(α)(20.5) (g.15164_37864del22701), α(-5 nt) (HBA2: c.95 + 2_95_6delTGAGG) or codon 19 (-G) (HBA2: c.56delG) mutations. The alleviating molecular mechanism was not explainable by β(+ )or concurrent α-thal in more than half of our β-TI patients. This encourages conducting more studies to identify other contributing factors, especially Hb F-inducing genetic modifiers.
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Affiliation(s)
- Ebrahim Miri-Moghaddam
- a Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences , Zahedan , Iran.,b Department of Genetics , Faculty of Medicine, Zahedan University of Medical Sciences , Zahedan , Iran
| | - Sara Bahrami
- c Department of Biology , Payame Noor University , Zahedan , Iran
| | - Majid Naderi
- d Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences , Zahedan , Iran.,e Department of Pediatric Hematology & Oncology , Faculty of Medicine, Zahedan University of Medical Sciences , Zahedan , Iran
| | - Ali Bazi
- f Faculty of Allied Medical Sciences , Zabol University of Medical Sciences , Zabol , Iran
| | - Morteza Karimipoor
- g Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran , Tehran , Iran
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Kontoghiorghe CN, Kontoghiorghes GJ. Efficacy and safety of iron-chelation therapy with deferoxamine, deferiprone, and deferasirox for the treatment of iron-loaded patients with non-transfusion-dependent thalassemia syndromes. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:465-81. [PMID: 26893541 PMCID: PMC4745840 DOI: 10.2147/dddt.s79458] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prevalence rate of thalassemia, which is endemic in Southeast Asia, the Middle East, and the Mediterranean, exceeds 100,000 live births per year. There are many genetic variants in thalassemia with different pathological severity, ranging from a mild and asymptomatic anemia to life-threatening clinical effects, requiring lifelong treatment, such as regular transfusions in thalassemia major (TM). Some of the thalassemias are non-transfusion-dependent, including many thalassemia intermedia (TI) variants, where iron overload is caused by chronic increase in iron absorption due to ineffective erythropoiesis. Many TI patients receive occasional transfusions. The rate of iron overloading in TI is much slower in comparison to TM patients. Iron toxicity in TI is usually manifested by the age of 30-40 years, and in TM by the age of 10 years. Subcutaneous deferoxamine (DFO), oral deferiprone (L1), and DFO-L1 combinations have been effectively used for more than 20 years for the treatment of iron overload in TM and TI patients, causing a significant reduction in morbidity and mortality. Selected protocols using DFO, L1, and their combination can be designed for personalized chelation therapy in TI, which can effectively and safely remove all the excess toxic iron and prevent cardiac, liver, and other organ damage. Both L1 and DF could also prevent iron absorption. The new oral chelator deferasirox (DFX) increases iron excretion and decreases liver iron in TM and TI. There are drawbacks in the use of DFX in TI, such as limitations related to dose, toxicity, and cost, iron load of the patients, and ineffective removal of excess iron from the heart. Furthermore, DFX appears to increase iron and other toxic metal absorption. Future treatments of TI and related iron-loading conditions could involve the use of the iron-chelating drugs and other drug combinations not only for increasing iron excretion but also for preventing iron absorption.
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Affiliation(s)
| | - George J Kontoghiorghes
- Postgraduate Research Institute of Science, Technology, Environment and Medicine, Limassol, Cyprus
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