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Zoller H, Schaefer B, Vanclooster A, Griffiths B, Bardou-Jacquet E, Corradini E, Porto G, Ryan J, Cornberg M. EASL Clinical Practice Guidelines on haemochromatosis. J Hepatol 2022; 77:479-502. [PMID: 35662478 DOI: 10.1016/j.jhep.2022.03.033] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022]
Abstract
Haemochromatosis is characterised by elevated transferrin saturation (TSAT) and progressive iron loading that mainly affects the liver. Early diagnosis and treatment by phlebotomy can prevent cirrhosis, hepatocellular carcinoma, diabetes, arthropathy and other complications. In patients homozygous for p.Cys282Tyr in HFE, provisional iron overload based on serum iron parameters (TSAT >45% and ferritin >200 μg/L in females and TSAT >50% and ferritin >300 μg/L in males and postmenopausal women) is sufficient to diagnose haemochromatosis. In patients with high TSAT and elevated ferritin but other HFE genotypes, diagnosis requires the presence of hepatic iron overload on MRI or liver biopsy. The stage of liver fibrosis and other end-organ damage should be carefully assessed at diagnosis because they determine disease management. Patients with advanced fibrosis should be included in a screening programme for hepatocellular carcinoma. Treatment targets for phlebotomy are ferritin <50 μg/L during the induction phase and <100 μg/L during the maintenance phase.
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Delanghe JR, Speeckaert MM, De Buyzere ML. The evolutionary adaptation of hemochromatosis associated mutations during the neolithic. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 161:530-531. [PMID: 27348451 DOI: 10.1002/ajpa.23045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/12/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Joris R Delanghe
- Department of Clinical chemistry, Ghent University, Ghent, Belgium.
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Heath KM, Axton JH, McCullough JM, Harris N. The evolutionary adaptation of the C282Y mutation to culture and climate during the European Neolithic. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 160:86-101. [PMID: 26799452 PMCID: PMC5066702 DOI: 10.1002/ajpa.22937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 12/20/2015] [Accepted: 12/20/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The C282Y allele is the major cause of hemochromatosis as a result of excessive iron absorption. The mutation arose in continental Europe no earlier than 6,000 years ago, coinciding with the arrival of the Neolithic agricultural revolution. Here we hypothesize that this new Neolithic diet, which originated in the sunny warm and dry climates of the Middle East, was carried by migrating farmers into the chilly and damp environments of Europe where iron is a critical micronutrient for effective thermoregulation. We argue that the C282Y allele was an adaptation to this novel environment. MATERIALS AND METHODS To address our hypothesis, we compiled C282Y allele frequencies, known Neolithic sites in Europe and climatic data on temperature and rainfall for statistical analysis. RESULTS Our findings indicate that the geographic cline for C282Y frequency in Europe increases as average temperatures decrease below 16°C, a critical threshold for thermoregulation, with rainy days intensifying the trend. DISCUSSION The results indicate that the deleterious C282Y allele, responsible for most cases of hemochromatosis, may have evolved as a selective advantage to culture and climate during the European Neolithic.
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Affiliation(s)
- Kathleen M. Heath
- Department of Earth and Environmental SystemsIndiana State UniversityTerre HauteIN47809
| | - Jacob H. Axton
- Department of BiologyIndiana State UniversityTerre HauteIN47809
| | | | - Nathan Harris
- Department of AnthropologyUniversity of UtahSalt Lake CityUT84112
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Branco CC, Gomes CT, De Fez L, Bulhões S, Brilhante MJ, Pereirinha T, Cabral R, Rego AC, Fraga C, Miguel AG, Brasil G, Macedo P, Mota-Vieira L. Carriers of the Complex Allele HFE c.[187C>G;340+4T>C] Have Increased Risk of Iron Overload in São Miguel Island Population (Azores, Portugal). PLoS One 2015; 10:e0140228. [PMID: 26501199 PMCID: PMC4621060 DOI: 10.1371/journal.pone.0140228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/22/2015] [Indexed: 11/28/2022] Open
Abstract
Iron overload is associated with acquired and genetic conditions, the most common being hereditary hemochromatosis (HH) type-I, caused by HFE mutations. Here, we conducted a hospital-based case-control study of 41 patients from the São Miguel Island (Azores, Portugal), six belonging to a family with HH type-I pseudodominant inheritance, and 35 unrelated individuals fulfilling the biochemical criteria of iron overload compatible with HH type-I. For this purpose, we analyzed the most common HFE mutations– c.845G>A [p.Cys282Tyr], c.187C>G [p.His63Asp], and c.193A>T [p.Ser65Cys]. Results revealed that the family’s HH pseudodominant pattern is due to consanguineous marriage of HFE-c.845G>A carriers, and to marriage with a genetically unrelated spouse that is a -c.187G carrier. Regarding unrelated patients, six were homozygous for c.845A, and three were c.845A/c.187G compound heterozygous. We then performed sequencing of HFE exons 2, 4, 5 and their intron-flanking regions. No other mutations were observed, but we identified the -c.340+4C [IVS2+4C] splice variant in 26 (74.3%) patients. Functionally, the c.340+4C may generate alternative splicing by HFE exon 2 skipping and consequently, a protein missing the α1-domain essential for HFE/ transferrin receptor-1 interactions. Finally, we investigated HFE mutations configuration with iron overload by determining haplotypes and genotypic profiles. Results evidenced that carriers of HFE-c.187G allele also carry -c.340+4C, suggesting in-cis configuration. This data is corroborated by the association analysis where carriers of the complex allele HFE-c.[187C>G;340+4T>C] have an increased iron overload risk (RR = 2.08, 95% CI = 1.40−2.94, p<0.001). Therefore, homozygous for this complex allele are at risk of having iron overload because they will produce two altered proteins—the p.63Asp [c.187G], and the protein lacking 88 amino acids encoded by exon 2. In summary, we provide evidence that the complex allele HFE-c.[187C>G;340+4T>C] has a role, as genetic predisposition factor, on iron overload in the São Miguel population. Independent replication studies in other populations are needed to confirm this association.
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Affiliation(s)
- Claudia C. Branco
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
- BioISI – Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisboa, Lisboa, Portugal
| | - Cidália T. Gomes
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Laura De Fez
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Sara Bulhões
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Maria José Brilhante
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Tânia Pereirinha
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Rita Cabral
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Ana Catarina Rego
- Gastroenterology Department, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Cristina Fraga
- Hematology Department, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - António G. Miguel
- Pneumology Department, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Gracinda Brasil
- Internal Medicine Department, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Paula Macedo
- Internal Medicine Department, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Luisa Mota-Vieira
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
- BioISI – Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisboa, Lisboa, Portugal
- * E-mail:
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Toste S, Relvas L, Pinto C, Bento C, Abade A, Ribeiro ML, Manco L. Intragenic haplotype analysis of common HFE mutations in the Portuguese population. J Genet 2015; 94:329-33. [PMID: 26174684 DOI: 10.1007/s12041-015-0510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sandra Toste
- Research Centre for Anthropology and Health (CIAS), Department of Life Sciences, University of Coimbra, 3000 Coimbra,
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Vieira FMJ, Nakhle MC, Abrantes-Lemos CP, Cançado ELR, Reis VMSD. Precipitating factors of porphyria cutanea tarda in Brazil with emphasis on hemochromatosis gene (HFE) mutations. Study of 60 patients. An Bras Dermatol 2014; 88:530-40. [PMID: 24068123 PMCID: PMC3760927 DOI: 10.1590/abd1806-4841.20132048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/09/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Porphyria cutanea tarda is the most common form of porphyria, characterized by
the decreased activity of the uroporphyrinogen decarboxylase enzyme. Several
reports associated HFE gene mutations of hereditary hemochromatosis with porphyria
cutanea tarda worldwide, although up to date only one study has been conducted in
Brazil. OBJECTIVES Investigation of porphyria cutanea tarda association with C282Y and H63D
mutations in the HFE gene. Identification of precipitating factors (hepatitis C,
HIV, alcoholism and estrogen) and their link with HFE mutations. METHODS An ambispective study of 60 patients with PCT was conducted during the period
from 2003 to 2012. Serological tests for hepatitis C and HIV were performed and
histories of alcohol abuse and estrogen intake were investigated. HFE mutations
were identified with real-time PCR. RESULTS Porphyria cutanea tarda predominated in males and alcohol abuse was the main
precipitating factor. Estrogen intake was the sole precipitating factor present in
25% of female patients. Hepatitis C was present in 41.7%. All HIV-positive
patients (15.3%) had a history of alcohol abuse. Allele frequency for HFE
mutations, i.e., C282Y (p = 0.0001) and H63D (p = 0.0004), were significantly
higher in porphyria cutanea tarda patients, compared to control group. HFE
mutations had no association with the other precipitating factors. CONCLUSIONS Alcohol abuse, hepatitis C and estrogen intake are prevalent precipitating
factors in our porphyria cutanea tarda population; however, hemochromatosis in
itself can also contribute to the outbreak of porphyria cutanea tarda, which makes
the research for HFE mutations necessary in these patients
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Leandro B, Paneque M, Sequeiros J, Porto G. Insufficient Referral for Genetic Counseling in the Management of Hereditary Haemochromatosis in Portugal: A Study of Perceptions of Health Professionals Requesting HFE Genotyping. J Genet Couns 2014; 23:770-7. [DOI: 10.1007/s10897-013-9681-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 12/11/2013] [Indexed: 01/04/2023]
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Khusainova RI, Khusnutdinova NN, Litvinov SS, Khusnutdinova EK. Analysis of H63D mutation in hemochromatosis (HFE) gene in populations of Central Eurasia. RUSS J GENET+ 2013. [DOI: 10.1134/s1022795412120046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Diagnostic utility of HFE variants in Spanish patients: association with HLA alleles and role in susceptibility to acute lymphoblastic leukemia. Gene 2012. [PMID: 23178241 DOI: 10.1016/j.gene.2012.10.090] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Two single nucleotide polymorphisms (SNPs) in the Human Hemochromatosis (HFE) gene, C282Y and H63D, are the major variants associated to altered iron status and it is well known that these mutations are in linkage disequilibrium with certain Human Leukocyte Antigen (HLA)-A alleles. In addition, the C282Y SNP has been previously suggested to confer susceptibility to acute lymphoblastic leukemia (ALL). We have aimed to assess the diagnosis utility of these polymorphisms in a population of Spanish subjects with suspicion of hereditary iron overload and to evaluate the effect of their associations with HLA-A alleles on the susceptibility to ALL. Both the 63DD [OR=4.31 (1.7-11.2)] and 282YY (p for trend=0.02) genotypes were more frequently found among subjects with suspicion of iron overload than among controls. 282YY carriers displayed significantly higher transferrin saturation index (TSI) values (p<0.001) as well as serum iron (p=0.01) and ferritin (p=0.01) levels. In addition, transferrin levels were lower in these subjects (p=0.01). Likewise, patients who were carriers of the compound heterozygous diplotype (282CY/63HD) showed significantly higher TSI and serum iron and ferritin concentrations. The H63D SNP did not significantly affect the analytical parameters measured. All 282YY carriers and 69.2% of compound heterozygotes showed an altered biochemical index. The frequencies of the HFE SNPs in ALL pediatric patients were lower than those found in controls, whereas the HLA-A*24 allele was significantly overrepresented in the patients group [OR=3.76 (1.9-7.3)]. No HFE-HLA-A associations were found to modulate the ALL risk. These results suggest that it may be useful to test for both HFE H63D and C282Y polymorphisms in patients with iron overload, as opposed to just genotyping for the C282Y SNP, which is customary in some healthcare centers. These HFE variants and their associations with HLA-A alleles were not observed to be relevant for the susceptibility to ALL in our population.
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Kucinskas L, Juzenas S, Sventoraityte J, Cedaviciute R, Vitkauskiene A, Kalibatas V, Kondrackiene J, Kupcinskas L. Prevalence of C282Y, H63D, and S65C mutations in hereditary HFE-hemochromatosis gene in Lithuanian population. Ann Hematol 2011; 91:491-5. [PMID: 21947086 DOI: 10.1007/s00277-011-1338-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 09/02/2011] [Indexed: 10/17/2022]
Abstract
HFE-hemochromatosis is a common autosomal recessive disease caused by HFE gene mutations and characterized as iron overload and failure of different organs. The aim of this study was to determine the prevalence of C282Y (c.845 G>A), H63D (c.187 C>G), and S65C (c.193A>T) alleles of HFE gene in the Lithuanian population. One thousand and eleven healthy blood donors of Lithuanian nationality were examined in four different ethnic Lithuanian regions to determine HFE gene alleles and genotype frequencies. The samples of DNA were analyzed for the presence of restriction fragment length polymorphism and validated by DNA sequencing. Among 1,011 blood donors tested, the frequency of C282Y, H63D, and S65C alleles were 2.6%, 15.9%, and 1.9%, respectively. One third of the tested subjects (n = 336) had at least one of the C282Y or H63D HFE gene mutations. The screening of Lithuanian blood donors has detected 13 (1.3%) subjects with a genotype C282Y/C282Y or C282Y/H63D responsible for the development of HFE-hemochromatosis. The prevalence of C282Y mutation was significantly higher among the inhabitants of Zemaitija (Somogitia) at the Baltic Sea area (5.9%) in comparison to the regions of continental part of Lithuania (2.4% in Dzukija, 2.3% in Aukstaitija, and 2% in Suvalkija, p < 0.05). These data support the hypothesis that the p.C282Y mutation originated from Scandinavia and spread with the Vikings along the Baltic Sea coast. The first epidemiological investigation of HFE gene mutations in ethnic Lithuanians showed that the frequencies of H63D, C282Y, and S65C of HFE gene alleles are similar to the other North-Eastern Europeans, especially in the Baltic region (Estonia, Latvia), Poland, and part of Russia (Moscow region).
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Affiliation(s)
- Laimutis Kucinskas
- Institute of Biological System and Genetic Research, Lithuanian University of Health Sciences, Mickeviciaus 9, Kaunas, LT 44307, Lithuania.
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Bettencourt A, Silva AM, Santos E, Gomes S, Mendonça D, Costa PP, Faustino P, Silva BM. HFE gene polymorphisms and severity in Portuguese patients with multiple sclerosis. Eur J Neurol 2011; 18:663-6. [PMID: 20586792 DOI: 10.1111/j.1468-1331.2010.03109.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High iron concentrations have been reported in oligodendrocytes, myelin and macrophages in multiple sclerosis (MS) lesions. It has been proposed that HFE gene polymorphisms could have a role in MS. METHODS The C282Y and H63D HFE variants frequencies were determined in 373 patients with MS and compared with a normal population. RESULTS No significant association was found between HFE polymorphisms and disease susceptibility. An analysis of the association of genotypes with disease severity was performed, and the C282Y allele was more frequent in the aggressive group. CONCLUSIONS Patients carrying the C282Y variant seem to have a worse prognosis.
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Affiliation(s)
- A Bettencourt
- UMIB - Instituto de Ciências Biomédicas Abel Salazar (ICBAS-UP), Porto, Portugal.
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Adler G, Clark JS, Łoniewska B, Ciechanowicz A. Prevalence of 845G>A HFE mutation in Slavic populations: an east-west linear gradient in South Slavs. Croat Med J 2011; 52:351-7. [PMID: 21674831 PMCID: PMC3118720 DOI: 10.3325/cmj.2011.52.351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIM To compare A allele frequencies of the 845G>A mutation of 10 Slavic populations in central, eastern, and southern Europe between each other and with other European populations. METHODS The 845G>A mutation from the DNA of 400 Polish neonates collected in 2005-2006 was analyzed by polymerase chain reaction-restriction fragment length polymorphism. The data were compared with reports from other countries. RESULTS We identified 381 GG homozygotes, 18 GA heterozygotes, and 1 AA homozygote. The 845A allele frequency was 2.5%, which makes the summary figure for Poland from this and previous studies 3.5%. The average prevalence for Poland and other West Slavic countries was 3.6%, similar to Russia (inhabited by the East Slavs, 3.5%). The average prevalence in South Slavic countries was 2.2%, gradually decreasing from 3.6% in Slovenia to 0% in Bulgaria, with a longitudinal linear gradient (adjusted R(2)=0.976, P<0.001). CONCLUSIONS The West and East Slavs, together with Finland, Estonia, Germany, Austria, Hungary, Slovenia, and Croatia, form a group with 845A allele frequencies between 3% and 4%. In the South Slavs, there is a gradual decline in the prevalence of 845A allele from northwest to southeast, with a surprisingly exact east-west linear gradient.
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Affiliation(s)
- Grazyna Adler
- Pomeranian Medical University, Department of Medical Biology, Szczecin, Poland.
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Olsson KS, Konar J, Dufva IH, Ricksten A, Raha-Chowdhury R. Was the C282Y mutation an Irish Gaelic mutation that the Vikings helped disseminate? HLA haplotype observations of hemochromatosis from the west coast of Sweden. Eur J Haematol 2010; 86:75-82. [PMID: 20946107 DOI: 10.1111/j.1600-0609.2010.01536.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
UNLABELLED The HLA-related hemochromatosis mutation C282Y is thought to have originated in Ireland in a person with HLA-A3-B14 and was spread by Vikings. Irish people with two HLA-A3 alleles had a high risk of hemochromatosis. In this study, from west Sweden, we wanted to test these hypotheses. METHODS HFE mutations in controls, bone marrow donors with HLA-A3/A3 and patients with hemochromatosis. HLA haplotypes, extended haplotype analysis and pedigree studies. RESULTS The allelic C282Y frequency 0.04, (CI 0.01-0.07) was lower (P < 0.001) in Sweden than in Ireland 0.10 (CI 0.08-0.11), and Swedish bone marrow donors with HLA-A3/A3 (n = 77) had a low risk of hemochromatosis. HLA haplotypes available from 239/262 (91.5%) proband patients homozygous for C282Y showed a dominance of A3-B7 and A3-B14 both in linkage disequilibrium with controls (P < 0.001). Pedigree studies extended into the 17th century supported a local founder effect of A3-B14 in the county of Bohuslän. The A3-B14 haplotype may well be the original and A3-B7 the result of centromeric recombinations. The haplotype diversity and recombination events were not different from a Celtic series. These findings do not support the hypothesis of the C282Y mutation being of an Irish Celtic origin. CONCLUSIONS The C282Y frequency shows a west to east decline from Ireland through the north of Europe. Vikings may have been involved in the spread of C282Y, but the mutation is probably older and may have been spread in Europe by earlier seafarers.
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Affiliation(s)
- Karl Sigvard Olsson
- Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
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Spínola C, Brehm A, Spínola H. Prevalence of H63D, S65C, and C282Y hereditary hemochromatosis gene variants in Madeira Island (Portugal). Ann Hematol 2010; 90:29-32. [PMID: 20714725 DOI: 10.1007/s00277-010-1034-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/25/2010] [Indexed: 11/30/2022]
Abstract
Hereditary HFE Hemochromatosis is an inherited disorder of iron metabolism that results from mutations in the HFE gene. Almost all patients with hereditary hemochromatosis show a C282Y mutation in homozygosity or in compound heterozygosity with H63D. Also, the mutation S65C has been shown to be associated to a milder iron overload. Since allele and genotype frequencies of these three variants of the HFE gene vary between populations, the determination of their prevalence in Madeira Island will clarify the population susceptibility to hereditary hemochromatosis. One hundred and fifty-four samples from Madeira Island were genotyped for the three most common HFE gene mutations, H63D, C282Y, and S65C, by polymerase chain reaction followed by restriction fragment length polymorphism analysis. Results have shown a prevalence of 20.5%, 0.33%, and 1% for H63D, C282Y, and S65C, respectively. Accordingly to our estimates, both genotypes associated to hereditary hemochromatosis, C282Y homozygotes and C282/H63D compound heterozygotes, could be present in Madeira Island population in 1,648 individuals, which represents 0.65% of the total population.
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Affiliation(s)
- Carla Spínola
- Human Genetics Laboratory, University of Madeira, Campus da Penteada, 9000-390 Funchal, Portugal
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Correia AP, Pinto JP, Dias V, Mascarenhas C, Almeida S, Porto G. CAT53 and HFE alleles in Alzheimer's disease: A putative protective role of the C282Y HFE mutation. Neurosci Lett 2009; 457:129-32. [DOI: 10.1016/j.neulet.2009.03.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 03/25/2009] [Accepted: 03/27/2009] [Indexed: 12/30/2022]
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Machado MV, Ravasco P, Martins A, Almeida MR, Camilo ME, Cortez-Pinto H. Iron homeostasis and H63D mutations in alcoholics with and without liver disease. World J Gastroenterol 2009; 15:106-11. [PMID: 19115475 PMCID: PMC2653287 DOI: 10.3748/wjg.15.106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the prevalence of HFE gene mutation and indices of disturbed iron homeostasis in alcoholics with and without liver disease.
METHODS: One hundred and fifty-three heavy drinkers (defined as alcohol consumption > 80 g/d for at least 5 years) were included in the study. These comprised 78 patients with liver disease [liver disease alcoholics (LDA)] in whom the presence of liver disease was confirmed by liver biopsy or clinical evidence of hepatic decompensation, and 75 subjects with no evidence of liver disease, determined by normal liver tests on two occasions [non-liver disease alcoholics (NLDA)], were consecutively enrolled. Serum markers of iron status and HFE C282Y and H63D mutations were determined. HFE genotyping was compared with data obtained in healthy blood donors from the same geographical area.
RESULTS: Gender ratio was similar in both study groups. LDA patients were older than NLDA patients (52 ± 10 years vs 48 ± 11 years, P = 0.03). One third and one fifth of the study population had serum transferrin saturation (TS) greater than 45% and 60% respectively. Serum iron levels were similar in both groups. However, LDA patients had higher TS (51 ± 27 vs 36 ± 13, P < 0.001) and ferritin levels (559 ± 607 ng/mL vs 159 ± 122 ng/mL, P < 0.001), and lower total iron binding capacity (TIBC) (241 ± 88 &mgr;g/dL vs 279 ± 40 &mgr;g/dL, P = 0.001). The odds ratio for having liver disease with TS greater than 45% was 2.20 (95% confidence interval (CI): 1.37-3.54). There was no difference in C282Y allelic frequency between the two groups. However, H63D was more frequent in LDA patients (0.25 vs 0.16, P = 0.03). LDA patients had a greater probability of carrying at least one HFE mutation than NLDA patients (49.5% vs 31.6%, P = 0.02). The odds ratio for LDA in patients with H63D mutation was 1.57 (95% CI: 1.02-2.40).
CONCLUSION: The present study confirms the presence of iron overload in alcoholics, which was more severe in the subset of subjects with liver disease, in parallel with an increased frequency of H63D HFE mutation.
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Soria NW, Cossy Isasi S, Chaig MR, Gerez de Burgos NM. Analysis of C282Y and H63D mutations of the hemochromatosis gene (HFE) in blood donors from Córdoba, Argentina. Ann Hematol 2008; 88:77-9. [PMID: 18633618 DOI: 10.1007/s00277-008-0532-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 06/05/2008] [Indexed: 12/16/2022]
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18
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Oliveira G, Ataíde A, Marques C, Miguel TS, Coutinho AM, Mota-Vieira L, Gonçalves E, Lopes NM, Rodrigues V, Carmona da Mota H, Vicente AM. Epidemiology of autism spectrum disorder in Portugal: prevalence, clinical characterization, and medical conditions. Dev Med Child Neurol 2007; 49:726-33. [PMID: 17880640 DOI: 10.1111/j.1469-8749.2007.00726.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this study was to estimate the prevalence of autistic spectrum disorder (ASD) and identify its clinical characterization, and medical conditions in a paediatric population in Portugal. A school survey was conducted in elementary schools, targeting 332,808 school-aged children in the mainland and 10,910 in the Azores islands. Referred children were directly assessed using the Diagnostic and Statistical Manual of Mental Disorders (4th edn), the Autism Diagnostic Interview-Revised, and the Childhood Autism Rating Scale. Clinical history and a laboratory investigation was performed. In parallel, a systematic multi-source search of children known to have autism was carried out in a restricted region. The global prevalence of ASD per 10,000 was 9.2 in mainland, and 15.6 in the Azores, with intriguing regional differences. A diversity of associated medical conditions was documented in 20%, with an unexpectedly high rate of mitochondrial respiratory chain disorders.
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Affiliation(s)
- Guiomar Oliveira
- Centro de Desenvolvimento da Criança, Hospital Pediátrico de Coimbra, Coimbra, Portugal.
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19
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Floreani A, Rosa Rizzotto E, Basso D, Navaglia F, Zaninotto M, Petridis I, DI Andrea O, Testa R, Marra M, Baldo V, Chiaramonte M. An open population screening study for HFE gene major mutations proves the low prevalence of C282Y mutation in Central Italy. Aliment Pharmacol Ther 2007; 26:577-86. [PMID: 17661761 DOI: 10.1111/j.1365-2036.2007.03401.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The C282Y mutation in the HFE gene is responsible for most cases of hereditary haemochromatosis. AIM To investigate the allele frequency of HFE mutations and the associations between mutations and cases of iron overload or liver diseases in an open population of Central Italy. METHODS A total of 502 individuals over 8 years of age, comprising 203 males and 299 females, who were residents in Arsita (a small town in Central Italy), were assayed for: C282Y, H63D and S65C mutations of the HFE gene by TaqMan probes; body mass index, serum ferritin, transferrin saturation, transaminases, GGT, glucose, insulin, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, HBV and HCV serum markers. Information was obtained on alcohol intake. Liver ultrasound was performed in 334 (67%) subjects. RESULTS The allele frequencies for C282Y, H63D and S65C were 2%, 15%, and 0.01%, respectively. C282Y/wt was found in 19 subjects (4%), H63D/wt in 127 (25%), H63D/H63D in 11 (2%) and S65C/wt in one (2.0 per thousand). No homozygosity for C282Y or compound mutation (C282Y/H63D) was found in the study population, but 27 subjects (5%) had TfSat >45% (including 10 subjects with high serum ferritin). Overall, 49 subjects (9.8%) were HCV-RNA-positive. Logistic regression analysis indicated that male gender (P = 0.000) and hepatic steatosis (P = 0.017) were independent variables correlating to a high serum ferritin. CONCLUSION C282Y HFE mutation is less frequent in Central Italy than in Northern Italy.
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Affiliation(s)
- A Floreani
- Department of Surgical and Gastroenterological Sciences, University of Padu, Via Giustiniani 2, 35128 Padua, Italy.
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20
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Muro M, Moya-Quiles MR, Botella C, García L, Minguela A, Alvarez-López MR. Genetic relationship between Murcia Region (SE Spain) and other populations in the Iberian Peninsula and Mediterranean area with respect to HFE gene mutations distribution. Ann Hematol 2007; 86:455-7. [PMID: 17235517 DOI: 10.1007/s00277-006-0242-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 12/04/2006] [Indexed: 12/20/2022]
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21
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Muro M, Moya-Quiles MR, Botella C, Alvarez-López MR. Prevalence of C282Y, H63D and S65C mutations of the hemochromatosis (HFE) gene in a population from southeastern Spain (Murcia Region). Clin Genet 2006; 71:97-8. [PMID: 17204056 DOI: 10.1111/j.1399-0004.2006.00730.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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22
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Sarić M, Zamurović L, Keckarević-Marković M, Keckarević D, Stevanović M, Savić-Pavićević D, Jović J, Romac S. Frequency of the hemochromatosis gene mutations in the population of Serbia and Montenegro. Clin Genet 2006; 70:170-2. [PMID: 16879202 DOI: 10.1111/j.1399-0004.2006.00655.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Aranda N, Viteri FE, Fernández-Ballart J, Murphy M, Arija V. Frequency of the hemochromatosis gene (HFE) 282C→Y, 63H→D, and 65S→C mutations in a general Mediterranean population from Tarragona, Spain. Ann Hematol 2006; 86:17-21. [PMID: 17013646 DOI: 10.1007/s00277-006-0179-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 07/12/2006] [Indexed: 12/29/2022]
Abstract
Three mutations have recently been detected in the hereditary hemochromatosis HFE gene (282C-->Y, 63H-->D, and 65S-->C). To determine their prevalence in a northeastern Spanish Mediterranean population, we studied 812 subjects between 18 and 75 years of age, randomly selected from the electoral roll of three villages. There were no homozygotes for the 282C-->Y or S65D mutations in this sample. For the 63H-->D mutation, 4.8% were homozygotes; 4.3, 32.3, and 2% were heterozygotes for the 282C-->Y, 63H-->D, and 65S-->C mutations, respectively. The prevalence of compound heterozygotes was 2% for 282C-->Y/63H-->D and 0.6% for 63H-->D /65S-->C. We found no significant differences between men and women. In conclusion, 46% of this Mediterranean population of Spain are carriers of at least one of the three mutations that can increase iron absorption.
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Affiliation(s)
- Núria Aranda
- Preventive Medicine and Public Health, Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Spain
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24
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Ropero P, Briceño O, Mateo M, Polo M, Mora A, González FA, Villegas A. Frequency of the C282Y and H63D mutations of the hemochromatosis gene (HFE) in a cohort of 1,000 neonates in Madrid (Spain). Ann Hematol 2006; 85:323-6. [PMID: 16520984 DOI: 10.1007/s00277-006-0094-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Accepted: 01/13/2006] [Indexed: 10/24/2022]
Abstract
For centuries in Europe, population movements have contributed to ethnic groups, cultures, and consequently, inheritance mixing. There are certain genetic diseases such as hereditary hemochromatosis whose distribution is directly related to the population movements. The objective of the present investigation was to determine the C282Y and H63D mutation frequency of the HFE gene in a cohort study of 1,000 neonates in the Community of Madrid (Spain), thus contributing to the HFE gene mutations distribution research in Europe and establishing the origin of the mutations in Spain. The allelic frequency of C282Y mutation was 1.7% (CI 95% 1.1-2.3) and the H63D allele was present in 16.4% of chromosomes (CI 95% 14.8-18). In Spain, the presence of C282Y mutation and its distribution could be due more to Celtic than to Viking legacy, whereas it is assumed that the one in relation to the H63D variant occurred in the Basque Country during the Paleolithic Period.
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Affiliation(s)
- Paloma Ropero
- Servicio de Hematología y Hemoterapia, Hospital Clinico San Carlos, Madrid, Spain
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25
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Cruz E, Vieira J, Gonçalves R, Alves H, Almeida S, Rodrigues P, Lacerda R, Porto G. Involvement of the major histocompatibility complex region in the genetic regulation of circulating CD8 T-cell numbers in humans. ACTA ACUST UNITED AC 2004; 64:25-34. [PMID: 15191520 DOI: 10.1111/j.1399-0039.2004.00245.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Variability in T-lymphocyte numbers is partially explained by a genetic regulation. From studies in animal models, it is known that the Major Histocompatibility Complex (MHC) is involved in this regulation. In humans, this has not been shown yet. The objective of the present study was to test the hypothesis that genes in the MHC region influence the regulation of T-lymphocyte numbers. Two approaches were used. Association studies between T-cell counts (CD4(+) and CD8(+)) or total lymphocyte counts and HLA class I alleles (A and B) or mutations in the HFE (C282Y and H63D), the hemochromatosis gene, in an unrelated population (n = 264). A second approach was a sibpair correlation analysis of the same T-cell counts in relation to HLA-HFE haplotypes in subjects belonging to 48 hemochromatosis families (n = 456 sibpairs). In the normal population, results showed a strong statistically significant association of the HLA-A*01 with high numbers of CD8(+) T cells and a less powerful association with the HLA-A*24 with low numbers of CD8(+) T cells. Sibpair correlations revealed the most significant correlation for CD8(+) T-cell numbers for sibpairs with HLA-HFE-identical haplotypes. This was not observed for CD4(+) T cells. These results show that the MHC region is involved in the genetic regulation of CD8(+) T-cell numbers in humans. Identification of genes responsible for this control may have important biological and clinical implications.
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Affiliation(s)
- E Cruz
- Clinical Hematology, Santo António General Hospital, Porto, Portugal
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26
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Altes A, Ruiz A, Barceló MJ, Remacha AF, Puig T, Maya AJ, Castell C, Amate JM, Saz Z, Baiget M. Prevalence of the C282Y, H63D, and S65C Mutations of theHFEGene in 1,146 Newborns from a Region of Northern Spain. ACTA ACUST UNITED AC 2004; 8:407-10. [PMID: 15684872 DOI: 10.1089/gte.2004.8.407] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In Spain, 85% of patients with genetic hemochromatosis (GH) are homozygous for the C282Y mutation of the HFE gene. H63D and S65C mutations of HFE may also play some role in the disease. The aim of this study was to establish the prevalence of C282Y, H63D, and S65C mutations of the HFE gene in newborns in Catalonia, Spain. One thousand one hundred forty-six newborn screening cards were selected randomly. DNA from these cards was extracted and HFE mutations were analyzed with the LightCycler equipment (Roche Diagnostics Gmbh, Mannheim, Germany). Sufficient DNA sample was obtained to screen for the three mutations in 1,043 cases (91%). The allelic frequencies of C282Y, H63D, and S65C mutations were 0.03 (IC 95% 0.022-0.037), 0.2 (IC 95% 0.19-0.22), and 0.01 (95% confidence interval [CI] 0.006-0.015), respectively. The frequency of C282Y homozygous newborns was 0.001 (95% CI 0.0005-0.0014). The frequencies of newborns doubly heterozygous for C282Y/H63D and C282Y/S65C were 0.01 (95% CI 0.005-0.02) and 0.002 (95% CI 0.0002-0.01), respectively. The allelic frequency of C282Y mutation is similar to that observed in Southern France, in the Czech Republic and in some areas of Italy. The allelic frequency of H63D mutation in Catalonia is the highest reported to date. Nevertheless, S65C is infrequent. These data should be kept in mind when designing hemochromatosis genotypic screening programs in Catalonia.
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Affiliation(s)
- Albert Altes
- Hematology Department, Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain 08923.
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27
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Martins R, Picanço I, Fonseca A, Ferreira L, Rodrigues O, Coelho M, Seixas T, Miranda A, Nunes B, Costa L, Romão L, Faustino P. The role of HFE mutations on iron metabolism in beta-thalassemia carriers. J Hum Genet 2004; 49:651-655. [PMID: 15538648 DOI: 10.1007/s10038-004-0202-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 08/25/2004] [Indexed: 11/28/2022]
Abstract
Hereditary hemochromatosis (HH) is an autosomal recessive disorder of iron metabolism characterized by increased iron absorption and progressive storage resulting in organ damage. HFE gene mutations C282Y and H63D are responsible for the majority of HH cases. A third HFE mutation, S65C, has been associated with the development of a mild form of hemochromatosis. The beta-thalassemia trait is characterized by mild, ineffective erythropoiesis that can induce excess iron absorption and ultimately lead to iron overload. The aim of this study was to evaluate the effect of genetic markers (HFE mutations C282Y, H63D, and S65C) on the iron status of beta-thalassemia carriers. A total of 101 individuals heterozygous for beta-thalassemia and 101 normal control individuals were studied. The allelic frequencies of C282Y (1.5 versus 3.5%), H63D (15.3 versus 18.3%), and S65C (1.0 versus 1.5%) did not differ significantly between beta-thalassemia carriers and normal controls. Serum iron (P=0.029) and transferrin saturation (P=0.009) were increased in beta-thalassemia carriers heterozygous for H63D mutation. The number of subjects carrying C282Y or S65C mutations was too low to conclude their effect on the iron status. These results suggest that the beta-thalassemia trait tends to be aggravated with the coinheritance of H63D mutation, even when present in heterozygosity.
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Affiliation(s)
- Rute Martins
- Centro de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal
| | - Isabel Picanço
- Centro de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal
| | - Aidil Fonseca
- Centro de Biopatologia, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - Lídia Ferreira
- Centro de Biopatologia, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - Odete Rodrigues
- Centro de Biopatologia, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - Marília Coelho
- Centro de Biopatologia, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - Teresa Seixas
- Centro de Biopatologia, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - Armandina Miranda
- Centro de Biopatologia, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - Baltazar Nunes
- Observatório Nacional de Saúde, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - Luciana Costa
- Centro de Biopatologia, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - Luísa Romão
- Centro de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal
| | - Paula Faustino
- Centro de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.
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28
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Ristić S, Makuc J, Starcević N, Logar N, Brajenović-Milić B, Stepec S, Plesa I, Kapović M, Milić S, Stimac D, Crnić-Martinović M, Peterlin B. Hemochromatosis gene mutations in the Croatian and Slovenian populations. Clin Genet 2003; 64:444-6. [PMID: 14616770 DOI: 10.1034/j.1399-0004.2003.00169.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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29
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Milman N, Pedersen P. Evidence that the Cys282Tyr mutation of the HFE gene originated from a population in Southern Scandinavia and spread with the Vikings. Clin Genet 2003; 64:36-47. [PMID: 12791037 DOI: 10.1034/j.1399-0004.2003.00083.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Hereditary hemochromatosis has been recognized as a clinical disorder for more than 100 years. The common form of the disorder is caused by the Cys282Tyr mutation (C282Y) of the HFE gene. Hereditary hemochromatosis affects predominantly people of Northern European origin. The C282Y mutation probably occurred on a single chromosome carrying the ancestral hemochromatosis haplotype, which subsequently was spread by emigration and the founder effect. It has been estimated that the C282Y mutation appeared 60-70 generations ago. It was initially suggested that the ancestral C282Y mutation occurred within the Celtic group of peoples. However, we hypothesize that the distribution of the C282Y mutation in Europe is more consistent with an origin among the Germanic Iron Age population in Southern Scandinavia. From this area, the mutation could later be spread by the migratory activities of the Vikings. The aim of the present study was to evaluate the validity of these two hypotheses. Several arguments are in favor of the 'Viking hypothesis': first, the highest frequencies (5.1-9.7%) of the C282Y mutation are observed in populations in the Northern part of Europe, i.e. Denmark, Norway, Sweden, Faeroe Islands, Iceland, Eastern part of England (Danelaw) and the Dublin area, all Viking homelands and settlements. Second, the highest allele frequencies are reported among populations living along the coastlines. Third, the frequencies of the C282Y mutation decline from Northern to Southern Europe. Intermediate allele frequencies (3.1-4.8%) are seen in the populations in Central Europe, which is the original Celtic homeland. Low allele frequencies (0-3.1%) are recognized in populations in Southern Europe and the Mediterranean.
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Affiliation(s)
- N Milman
- Department of Medicine B, Rigshospitalet, University of Copenhagen, Copenhagen and Department of Clinical Biochemistry, Naestved Hospital, Naestved, Denmark.
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