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Nadkarni AH, Singh AA, Colaco S, Hariharan P, Colah RB, Ghosh K. Effect of the Hemochromatosis Mutations on Iron Overload among the Indian β Thalassemia Carriers. J Clin Lab Anal 2016; 31. [PMID: 27561698 DOI: 10.1002/jcla.22054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/13/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hereditary hemochromatosis is a disorder of iron metabolism characterized by increased iron absorption.HFE gene mutations C282Y and H63D are responsible for the majority of hereditary hemochromatosis cases. METHODS We tried to look at the effect of HFE mutations on the iron status. A total of 100 β thalassemia traits (BTT) with 100 normal individuals were screened for the C282Y and H63D mutations using PCR-RFLP. The serum ferritin levels were determined using ELISA kit. RESULTS We did not find the C282Y mutation in our study group. The allelic frequencies for H63D mutation did not differ significantly between β-thalassemia traits (8.5%) and normal controls (9%). ΒΤΤ with H63D genotype of H/D (143.16 ± 80.3 ng/ml) and D/D (504 ng/ml) showed higher ferritin levels as against H/H genotype (88.64 ± 92.43 ng/ml). The statistically significant difference was observed in the mean serum ferritin levels among the individuals showing H/H and D/D genotypes (P < 0.002) and H/D and D/D genotype (P < 0.01) in both the groups. CONCLUSION This suggests that iron load in BTT tends to aggravated with the co-inheritance of the H63D mutation. The mutant H63D gene showed the presence of haplotype 6 which is reported in the European population suggesting a common origin.
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Affiliation(s)
- Anita H Nadkarni
- Department of Haematogenetics, National Institute of Immunohaematology (ICMR), Mumbai, India
| | - Aradhana A Singh
- Department of Haematogenetics, National Institute of Immunohaematology (ICMR), Mumbai, India
| | - Stacy Colaco
- Department of Haematogenetics, National Institute of Immunohaematology (ICMR), Mumbai, India
| | - Priya Hariharan
- Department of Haematogenetics, National Institute of Immunohaematology (ICMR), Mumbai, India
| | - Roshan B Colah
- Department of Haematogenetics, National Institute of Immunohaematology (ICMR), Mumbai, India
| | - Kanjaksha Ghosh
- Surat Raktadan Kendra and Research Center, Udhana - Magdalla Road, Surat, India
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Panigrahi I, Mahapatra M, Kumar R, Kumar G, Choudhry Ved P, Saxena R. Jaundice and alpha gene triplication in beta-thalassemia: Association or causation? Hematology 2013; 11:109-12. [PMID: 16753851 DOI: 10.1080/1024533050069882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
There are few studies investigating alpha globin gene triplications in beta-thalassemia in Asian Indians and its effect on phenotype, which was the primary aim of this study. Gap-PCR was performed in order to detect common alpha thalassemia determinants (-alpha(3.7), -alpha(4.2) and alpha alpha alpha(anti 3.7) triplication). Alpha-triplication was detected in 15.4% (10/65) of patients with thalassemia intermedia, 8.8% (4/45) of those with thalassemia minor and in 2.7% (2/74) of healthy controls. The severity of jaundice was higher in thalassemia intermedia cases with alpha-triplication and two of the alpha-triplication cases had a marked increase in serum bilirubin following intercurrent illness. Thus, alpha globin gene triplication is important genetic determinant underlying thalassemia intermedia in North Indians. Patients with alpha-triplication may develop prominent jaundice with marked increase in serum bilirubin following antecedent aggravating factors.
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Affiliation(s)
- Inusha Panigrahi
- All India Institute of Medical Sciences, Department of Hematology, Ansari Nagar, New Delhi, 110029, India.
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Jain S, Agarwal S, Tamhankar P, Verma P, Choudhuri G. Lack of association of primary iron overload and common HFE gene mutations with liver cirrhosis in adult Indian population. Indian J Gastroenterol 2011; 30:161-5. [PMID: 21822737 DOI: 10.1007/s12664-011-0109-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 07/02/2011] [Indexed: 02/04/2023]
Abstract
AIM To find out the association of common HFE mutations (viz., C282Y and H63D) with primary iron overload (PIL) in liver cirrhosis (CLD) patients of Indian origin. METHODS Polymerase chain reaction-restriction fragment length polymorphism method was used for screening C282Y and H63D mutation in 496 CLD patients (hepatitis B virus associated cirrhosis (HBVc) = 74, hepatitis C virus associated cirrhosis (HCV) = 50, alcoholic cirrhosis with hepatitis (ALcW) = 38, alcoholic cirrhosis without hepatitis (ALc) = 92, cryptogenic cirrhosis (CC) = 242) and 502 healthy controls. Transferrin saturation of >45 or serum ferritin of >300 ng/mL (males)/>200 ng/mL (females) with normal total exogenous iron intake was suggestive of PIL. Histological liver iron grading was done by Perl's Prussian blue stain. RESULTS Of 496 patients, 13 (2.6; 9 CC, 2 ALc, 1 HBVc, 1 AlcW) had PIL. However, only two (15.3) of 13 patients (1 CC and 1 HBVc) were positive for H63D heterozygous mutation. All the subjects were found to be C282Y wild type, except a single case of double heterozygous (C282Y/H63D) who however, did not have PIL. Overall frequency of H63D allele in patients and controls was not significantly different (5.95 and 4.58 respectively, p = 0.17). A highly significant H63D allele frequency (p < 0.005) was observed in HBVc (10.82) and ALcW (11.84) groups but they were not associated with PIL. CONCLUSION The frequency of PIL, and the HFE gene mutaion (C282Y) are both rare in Indian patients and explain why hemochromatosis is a rare cause of liver cirrhosis in India. A highly significant H63D allele frequency in HBV and alcohol-related cirrhosis suggest a possible predisposing role for liver fibrosis of this allele.
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Affiliation(s)
- Shalu Jain
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Das R, Chandak GR. Obscure pathogenesis of primary iron overload in Indians warrants more focused research. Indian J Gastroenterol 2011; 30:154-5. [PMID: 21847604 DOI: 10.1007/s12664-011-0119-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 07/22/2011] [Indexed: 02/04/2023]
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Bukvic N, Sportelli F, Sessa F, Longo V, Roberti MG, Santacroce R, Margaglione M. Coexistence of β-Thalassemia and Hereditary Hemochromatosis in Homozygosity: A Possible Synergic Effect? Hemoglobin 2009; 33:155-7. [DOI: 10.1080/03630260902817354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Olivieri NF, Muraca GM, O'Donnell A, Premawardhena A, Fisher C, Weatherall DJ. Studies in haemoglobin E beta-thalassaemia. Br J Haematol 2008; 141:388-97. [PMID: 18410572 DOI: 10.1111/j.1365-2141.2008.07126.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Haemoglobin E beta-thalassaemia is the commonest form of severe thalassaemia in many Asian countries, but little is known about its natural history, the reasons for its clinical diversity, or its optimal management. Despite its frequency, haemoglobin E beta-thalassaemia is often managed in an ill-defined and haphazard way, usually by demand transfusion. We studied a cohort of Sri Lankan patients with haemoglobin E beta-thalassaemia over 5 years, and identified several genetic and environmental factors possibly contributing to the phenotypic diversity of the disorder. These included modifiers of haemoglobin F production, malaria and age-related changes in adaptation to anaemia. Our findings suggest that in many patients, haemoglobin E beta-thalassaemia can be managed without transfusion, even with low haemoglobin levels. Age-related changes in the pattern of adaptation to anaemia suggest that more cost-effective approaches to management should be explored.
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Affiliation(s)
- Nancy F Olivieri
- Hemoglobinopathy Research Program, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
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Abstract
Thalassemias are the most common monogenic gene disorders in the world. Patients present with a wide variability of clinical phenotypes ranging from severe phenotype (β-thalassemia major) to a very mild, almost symptomless, condition. This variability is owing to the presence of a large number of genetic modifiers affecting the disease. Patients are treated with blood transfusions and iron chelation therapy. Pharmacological therapies have varying degrees of success depending on the genetic modifiers of the disease present in the patients. Studies undertaken to identify all the modifiers that affect β-thalassemia will lead to more appropriate genetic counseling during prenatal diagnosis and enable targeted and personalized treatment regimens for patients in the future.
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Affiliation(s)
- Marina Kleanthous
- Cyprus Institute of Neurology and Genetics, 6 International Airport Avenue, Agios Dometios, PO Box 23462, 1683 Nicosia, Cyprus.
| | - Marios Phylactides
- Cyprus Institute of Neurology and Genetics, 6 International Airport Avenue, Agios Dometios, PO Box 23462, 1683 Nicosia, Cyprus.
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Farina M, Rotta LN, Soares FAA, Jardim F, Jacques R, Souza DO, Rocha JBT. Hematological changes in rats chronically exposed to oral aluminum. Toxicology 2005; 209:29-37. [PMID: 15725511 DOI: 10.1016/j.tox.2004.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 11/24/2004] [Accepted: 12/02/2004] [Indexed: 11/22/2022]
Abstract
This study was aimed to investigate the effects of the long-term oral exposure to aluminum sulfate on hematological parameters in rats. For this purpose, 24 adult female Wistar rats were divided in three groups with 8 animals each (control, citrate, and citrate plus aluminum groups). Rats from control and citrate groups had free access to tap water and to a sodium citrate solution (35 mM), respectively. Rats from citrate plus aluminum group received, as unique source of liquid, an aluminum sulfate solution (30 mM) diluted in the above-mentioned sodium citrate solution, ad libitum. After the treatment period (18 months), aluminum-exposed rats showed a significant decrease in the number of red blood cells, blood hemoglobin concentration and hematocrit when compared to rats from the control group. Serum iron levels were also significantly lower in citrate plus aluminum group, whereas total iron binding capacity did not change after citrate plus aluminum exposure. Erythrocyte thiobarbituric acid-reactive substances (TBARS) and nonprotein thiols (NPSH) levels, erythrocyte osmotic fragility and hepatic delta-aminolevulinic acid dehydratase (delta-ALA-D) activity did not change after treatment with citrate plus aluminum. Conversely, aluminum exposure increased delta-ALA-D activity in bone marrow. The present results indicate that long-term oral exposure to low doses of aluminum sulfate promotes alterations on erythrocyte parameters in rats, probably as a consequence of alterations in the iron status. In addition, although the details of the underlying mechanism remain unclear, our study reports, for the first time, a stimulatory effect of chronic aluminum exposure on bone marrow delta-ALA-D activity.
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Affiliation(s)
- M Farina
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040-900 Florianópolis, SC, Brazil.
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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: 1.3] [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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Farina M, Lara FS, Brandão R, Jacques R, Rocha JBT. Effects of aluminum sulfate on erythropoiesis in rats. Toxicol Lett 2002; 132:131-9. [PMID: 12044547 DOI: 10.1016/s0378-4274(02)00077-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to investigate the effects of chronically administered aluminum on erythropoiesis in rats. After treatment (i.p. injections of Al(2)(SO(4))(3), 50 micromol/kg body weight, five times a week) for 3 months, the treated (Al) group showed significantly decreased hemoglobin concentration (32%) and hematocrit (24%) compared with the control group. Serum iron decreased significantly in the Al group, whereas total iron binding capacity did not change. Treatment did not alter the activity of hepatic, renal or cerebral delta-ALA-D. Biochemical measurements related to 2-thiobarbituric acid-reactive substance (TBARS) levels from serum and hepatic, renal and cerebral homogenates also did not change after treatment. Hepatic concentrations of aluminum were higher in the Al group than in the control group. Renal and cerebral aluminum concentrations did not vary between groups. The present results indicate that exposure to aluminum sulfate promotes signs of anemia in rats as a consequence of alterations in iron status.
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Affiliation(s)
- M Farina
- Curso de Farmácia, Centro de Ciências da Saúde, Universidade Regional Integrada-Campus de Erechim, 99700-000 Erechim, RS, Brazil.
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Weatherall DJ. Phenotype-genotype relationships in monogenic disease: lessons from the thalassaemias. Nat Rev Genet 2001; 2:245-55. [PMID: 11283697 DOI: 10.1038/35066048] [Citation(s) in RCA: 439] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The remarkable phenotypic diversity of the beta-thalassaemias reflects the heterogeneity of mutations at the beta-globin locus, the action of many secondary and tertiary modifiers, and a wide range of environmental factors. It is likely that phenotype-genotype relationships will be equally complex in the case of many monogenic diseases. These findings highlight the problems that might be encountered in defining the relationship between the genome and the environment in multifactorial disorders, in which the degree of heritability might be relatively low and several environmental agents are involved. They also emphasize the value of an understanding of phenotype-genotype relationships in designing approaches to gene therapy.
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Affiliation(s)
- D J Weatherall
- Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DS, UK
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Arruda VR, Agostinho MF, Cançado R, Costa FF, Saad ST. beta-thalassemia trait might increase the severity of hemochromatosis in subjects with the C282Y mutation in the HFE gene. Am J Hematol 2000; 63:230. [PMID: 10706769 DOI: 10.1002/(sici)1096-8652(200004)63:4<230::aid-ajh12>3.0.co;2-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Weatherall D. From genotype to phenotype: genetics and medical practice in the new millennium. Philos Trans R Soc Lond B Biol Sci 1999; 354:1995-2010. [PMID: 10670020 PMCID: PMC1692700 DOI: 10.1098/rstb.1999.0539] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The completion of the human genome project will provide a vast amount of information about human genetic diversity. One of the major challenges for the medical sciences will be to relate genotype to phenotype. Over recent years considerable progress has been made in relating the molecular pathology of monogenic diseases to the associated clinical phenotypes. Studies of the inherited disorders of haemoglobin, notably the thalassaemias, have shown how even in these, the simplest of monogenic diseases, there is remarkable complexity with respect to their phenotypic expression. Although studies of other monogenic diseases are less far advanced, it is clear that the same level of complexity will exist. This information provides some indication of the difficulties that will be met when trying to define the genes that are involved in common multigenic disorders and, in particular, in trying to relate disease phenotypes to the complex interactions between many genes and multiple environmental factors.
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Affiliation(s)
- D Weatherall
- Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, UK
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