Erythrocyte glucose-6-phosphate dehydrogenase (1.1.1.49) deficiency in Antalya province, Turkey: an epidemiologic and biochemical study

Glucose 6 phosphate dehydrogenase deficiency: A single-center experience

Objective

This study aims to evaluate the demographic information, clinical and laboratory findings of patients with glucose 6 phosphate dehydrogenase deficiency.

Material and Methods

We collected data by reviewing files and electronic records of 65 patients with glucose 6 phosphate dehydrogenase deficiency under the age of 18 years who were followed up in our clinic between 2007 and 2019. Demographic, clinical, and laboratory features, family history, complications of the disease, and history of splenectomy and cholecystectomy were evaluated. Mean, standard deviation, and median values were used when descriptive analyses were presented.

Results

The age of diagnosis ranged between 1-192 months and the median age of diagnosis was two months. Fifty-nine patients (90.7%) were boys and six (9.2%) were girls. The mean value of glucose 6 phosphate dehydrogenase enzyme on admission was 1,9±1,4 U/g of hemoglobin (Hb). Family history was pesent in 40% of patients in whom information was avaliable. The most common presentation was prolonged jaundice and the most common physical finding was jaundice. Splenomegaly was detected in none of the patients. Cholelithiasis was present in one of 21 patients who were evaluated with ultrasonography. None of the patients required splenectomy, cholecystectomy, and regular erythrocyte transfusion during follow-up.

Conclusion

As G6PD variants with chronic hemolysis are not usually seen in Turkey, patients who required splenectomy, cholecystectomy, and regular erythrocyte transfusion were not detected. Although glucose 6 phosphate dehydrogenase deficiency is more common in males, it can also be seen in girls. In Turkey, glucose 6 phosphate dehydrogenase deficiency should be considered in patients presenting with prolonged jaundice.

Red cell glucose 6-phosphate dehydrogenase deficiency in the northern region of Turkey: is G6PD deficiency exclusively a male disease?

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive genetic defect that can cause hemolytic crisis. However, this disease affects both males and females. In Turkey, the frequency of this enzyme deficiency was reported to vary, from 0.25 to 18%, by the geographical area. Its prevalence in the northern Black Sea region of Turkey is unknown. The aims of this study were to assess the prevalence of G6PD deficiency in the northern region Turkey in children and adults with hyperbilirubinemia and hemolytic anemia. This report included a total of 976 G6PD enzyme results that were analyzed between May 2005 and January 2014. G6PD deficiency was detected in 5.0% of all patients. G6PD deficiency was significantly less frequent in females (1.9%, 6/323) than in males (6.6%, 43/653). G6PD deficiency was detected in 3.7% of infants with hyperbilirubinemia, 9.2% of children, and 4.5% of adults with hemolytic anemia. In both the newborn group and the group of children, G6PD deficiency was significantly more frequent in males. In the combined group of children (groups I and II), the proportion of males was 74% and 67% in all groups (P = .0008). In conclusion, in northern region of Turkey, G6PD deficiency is an important cause of neonatal hyperbilirubinemia and hemolytic crisis in children and adults. This study suggests that most pediatricians thought that G6PD deficiency is exclusively a male disease. For this reason, some female patients may have been undiagnosed.

Investigation of the Mutation Points and Effects of Some Drugs on Glucose-6-phosphate Dehydrogenase-deficient People in the Erzurum Region

We have carried out a systematic study of the molecular basis of glucose-6-phosphate dehydrogenase (G6PD) deficiency on three samples of 1,183 children aged 0.5-6 years from Erzurum, in eastern Anatolia. Total genomic DNAs were isolated from the blood samples of a healthy person and the three persons determined with G6PD deficiency by examining the enzyme activity and hemoglobin ratio. Then PCR amplification of the entire coding region in eight fragments was carried out followed by Agarose gel electrophoresis. The 540-bp PCR fragment containing exons VI-VII and the 550bp PCR fragment containing exons XI-XIII were digested with EcoRI and with NIaIII, respectively. SSCP techniques for eight fragments (exons II, III-IV, V, VI-VII, VIII, IX, X, and XI-XIII) were employed to determine the mutations on the exons of the G6PD gene. A mutation occurred on the region of the exons 6 and 7 of one person (person-1) and exon 5 of two G6PD-deficient persons (person 2 and 3) examined. The sequential approach described is fast and efficient and could be applied to other populations. Effects of analgesic drugs on G6PD were studied on the purified enzyme (ammonium fractionation, dialysis and 2',5' ADP-Sepharose 4B affinity chromatography) for the healthy person and G6PD-deficient persons 1, 2 and 3. The effects of remifentanil hydrochloride, fentanyl citrate, alfentanil hydrochloride and pethidine hydrochloride, as analgesic drugs, on G6PD activity were tested. Although remifentanil hydrochloride, fentanyl citrate (I50 values; 1.45mM and 6.1 mM, respectively) inhibited the activity of the enzyme belonging to the healthy person, they did not alter enzyme activity on two of the three persons with G6PD deficiency. Other drugs (alfentanil hydrochloride and pethidine hydrochloride) did not effect the enzyme activity of the healthy or G6PD-deficient children.

An unusual syncope cause in the ED: favism

Favism is an acute hemolytic syndrome occurring in glucose-6-phosphate dehydrogenase (G6PD)-deficient individuals after the consumption of fava beans. The highest incidence is in boys aged 2-6 years. We report a 56-year-old man presented to the emergency department (ED) with recurrent syncope attacks due to favism. In our knowledge, this is the first report of favism-caused syncope in an adult patient without a G6PD deficiency diagnosis in the past and diagnosed in ED.

Prevalence of Erythrocyte Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency in the Population of Western Turkey

BACKGROUND

Newborn G6PD deficiency screening has been recognized as an essential component of public health care in most developed and some Mediterranean countries. However, such screening is yet to be widely embraced in Turkey. The aim of the present study was to determine the normal values of G6PD and deficiency prevalence of this enzyme in different age groups of people living in the western region of Turkey and accordingly inform and educate about favism to those asymptomatic carriers who usually are not aware of their G6PD deficient status.

METHODS

A total of 1421 clinically healthy individuals without evidence of leukocytosis or thrombocytosis were included in the study. Activity of G6PD was quantitatively measured.

RESULTS

Normal mean values of G6PD in healthy males were 8.94 +/- 8.65 IU/g Hb (or 231.73 +/- 43.16 IU/10(12) RBC), in females were 9.16 +/- 3.78 IU/g Hb (or 219.9 +/- 43.1 IU/10(12) RBC). The frequencies of severe and mild G6PD deficiencies were 0.44% and 6.07% in females, respectively, whereas in males it was 7.24%. Overall frequency of the G6PD-deficient phenotype was detected as 6.9%.

CONCLUSIONS

There is no significant statistical difference of G6PD activity between males and females, although frequency of the G6PD-deficient phenotype is relatively high in western Turkey. The results emphasize a need for screening for G6PD deficiency before prescribing anti-malarial therapy with drugs like primaquine to patients in this region of Turkey known for its prevalence of malaria.

Biochemical and cytochemical evaluation of heterozygote individuals with glucose-6-phosphate dehydrogenase deficiency

The aim of this study was to diagnose heterozygous glucose-6-phosphate dehydrogenase (G6PD) deficient females by an inexpensive cytochemical G6PD staining method that is easy to perform, allowing diagnosis of G6PD deficiency without cumbersome genetic analysis. Three subject groups were included in the study. The first group consisted of 15 hemizygous deficient males. The second and the third group were composed of 15 heterozygous deficient females and 15 healthy individuals, respectively. Biochemical determination and cytochemical staining of G6PD activity were performed in samples of all subjects. Results obtained with the cytochemical staining method correlated significantly with the biochemical data (p < 0.001), but a only 51-68% of the erythrocytes were stained positively in females with normal biochemical G6PD activity despite their having a G6PD-deficient child. This observation clearly indicates that these individuals are heterozygously deficient. These findings show that the cytochemical staining method to detect G6PD activity in erythrocytes is reliable, sensitive and specific and is superior to the biochemical method. Therefore, this method can be used routinely to detect heterozygous G6PD deficiency.

Antioxidant effect of EGb 761 on hydrogen peroxide-induced lipoperoxidation of G-6-PD deficient erythrocytes

In order to reduce the haemolytic susceptibility of glucose-6-phosphate dehydrogenase (G-6-PD) deficient erythrocytes, Ginkgo biloba extract (EGb 761) and vitamin E (vit E) were used as antioxidant agents and their effects compared. The erythrocyte suspensions from control and G-6-PD deficient patients were subjected to hydrogen peroxide (H2O2) incubation for 1 h. The produced thiobarbituric acid reactive substance (TBARS) levels measured as nmol/g Hb were compared with those of the erythrocytes administered 250 microg/mL EGb 761 or vit E previously or concomitantly with H2O2. Preincubation with EGb 761 reduced the TBARS levels from 317.14 +/- 25.27 to 160.09 +/- 21.97 nmol/g Hb in controls and from 348.24 +/- 7.79 to 205.60 +/- 14.22 nmol/g Hb in deficient erythrocytes. Concomitant application of EGb 761 with H2O2 resulted in similar but less reduction. The antioxidative effects of vitamin E were comparable to those of EGb 761. Contrary to the results obtained from oxidant conditions, the antioxidant characteristics of EGb 761 and vitamin E were not observed when they were applied directly to the erythrocytes without oxidative stress. The findings demonstrate that irrespective of administration time, EGb 761 significantly reduced TBARS levels in the erythrocytes of control and G-6-PD deficient patients subjected to oxidative stress.

Prevalence of G-6-PD deficiency in the Croatian Adriatic Coast population

BACKGROUND

The objective of this study was to determine the prevalence of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency among the population of the Croatian Adriatic Coast, part of the Mediterranean basin.

METHODS

The fluorescent spot test was used to screen 2,726 randomly selected high school students in the Croatian Adriatic coastal area. Fluorescence readings were performed at the beginning and at 3, 6, 10, and 25 min of incubation. Results were classified into the following three groups: bright fluorescence (BF), weak fluorescence (WF), and no fluorescence (NF). All NF and WF samples at 3 min were quantitatively measured using the spectrophotometric method.

RESULTS

Twelve persons, 10 boys and 2 girls, were found to be deficient in G-6-PD, rendering a 0.44% prevalence of G-6-PD deficiency. All NF samples at fluorescent spot test were G-6-PD-deficient. WF at 3 min of the incubation period was present in 33 (1.2%) subjects, and only 2 (6%) were true positive. Fluorescence reading at 10 min of incubation omits five (41%) of the G-6-PD deficient samples.

CONCLUSIONS

Prevalence of G-6-PD deficiency in the Croatian Adriatic coastal population is 0.44%. Fluorescent spot test for moderate enzyme deficiency is reliable in early fluorescence reading.

Antioxidant capacity of G-6-PD-deficient erythrocytes

Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is the most common human enzymopathy. In this research, we studied two groups consisting of 30 male subjects who are G-6-PD deficient and 30 normal male subjects matched with the G-6-PD-deficient patients for age. All 30 assays were performed under normal conditions free of any oxidative attack that may result in haemolytic crisis in G-6-PD-deficient subjects. The erythrocyte glucose-6-phosphate dehydrogenase, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), glutathione-S-transferase (GST) activities, reduced glutathione (GSH) levels and erythrocyte and plasma thiobarbituric acid-reactive substances (TBARS) levels were measured. All parameters in each group did not differ significantly except for G-6-PD levels. These data show that G-6-PD-deficient subjects can survive in normal conditions unless they are exposed to any oxidative stress.

Increased resistance to oxidative stress in normal and glucose-6-phosphate dehydrogenase-deficient hemolysates in the presence of enzyme substrates

Erythrocytes and hemolysates from 10 normal and 10 glucose-6-phosphate dehydrogenase-deficient individuals were incubated with cumene hydroperoxide, and free radical-induced lipid peroxidation was monitored by chemiluminescence. Chemiluminescence intensities in erythrocytes of normal and deficient subjects were similar in the presence or absence of glucose-6-phosphate dehydrogenase substrates. Hemolysates of normal and deficient subjects also showed similar chemiluminescence in the absence of substrates. However, with the addition of substrates to the incubation medium, deficient hemolysates reached maximum chemiluminescence intensity within a shorter period, and maximum values were higher than in normal hemolysates. We believe this offers a new means of detection of glucose-6-phosphate dehydrogenase-deficient patients.