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Diamantidis MD, Pitsava S, Zayed O, Argyrakouli I, Karapiperis K, Chatzoulis C, Alexiou E, Manafas A, Tsangalas E, Karakoussis K. Concomitant Presence of Hb Agrinio and - -Med Deletion in a Greek Male Patient with Hemoglobinopathy H: More Severe Phenotype and Literature Review. Hematol Rep 2023; 15:483-490. [PMID: 37606495 PMCID: PMC10443284 DOI: 10.3390/hematolrep15030050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/17/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023] Open
Abstract
Hemoglobin (Hb) Agrinio is a rare non-deletional a-globin mutation observed almost exclusively in Greek, Spanish or other Mediterranean families. The clinical manifestations of a carrier of a single Hb Agrinio mutation (single heterozygosity) depend on the concomitant presence or absence of other mutations or variants in the beta, alpha or other modifying genes. We present a Greek patient harboring a Hb Agrinio variant plus the - -Med alpha deletional allele, having an infrequent severe form of alpha thalassemia, in contrast to the typical alpha thalassemic patient and requiring regular red blood cell (RBC) transfusions and chelation treatment. We also provide a concise literature review regarding alpha thalassemic hemoglobin variants and their molecular and clinical combinations. A phase 2, double-blind, randomized, placebo-controlled, multicenter clinical trial to determine the efficacy and safety of luspatercept (BMS-986346/ACE-536) for the treatment of anemia in adults with alpha thalassemia with the participation of our center is currently recruiting patients (NCT05664737).
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Affiliation(s)
- Michael D. Diamantidis
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Stefania Pitsava
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Omar Zayed
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Ioanna Argyrakouli
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Konstantinos Karapiperis
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Christos Chatzoulis
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Evangelos Alexiou
- Radiology Department, General Hospital of Larissa, 41221 Larissa, Greece;
| | - Achilles Manafas
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
| | - Evangelos Tsangalas
- Thalassemia and Sickle Cell Disease Unit, Department of Hematology, General Hospital of Larissa, 41221 Larissa, Greece; (S.P.); (O.Z.); (I.A.); (K.K.); (C.C.); (A.M.); (E.T.)
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Szepetowski S, Berger C, Joly P, Baron-Joly S, Huguenin Y, Cantais A, Brun S, Ged C, Badens C, Thuret I, Giansily-Blaizot M, Pissard S, Aguilar-Martinez P. Homozygosity for the hyperunstable hemoglobin variant Hb Agrinio (HBA2:c.89T>C) leads to severe antenatal anemia: Eight new cases in three families. Am J Hematol 2022; 97:E393-E395. [PMID: 36052950 DOI: 10.1002/ajh.26687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Sarah Szepetowski
- Pediatric Onco-Hematology Department, Reference Center on Rare Red Cell Disorders, La Timone Children's Hospital, APHM, Marseille, France
| | - Claire Berger
- Pediatric Onco-Hematology Department, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Philippe Joly
- Biology Center "Biochimie des pathologies érythrocytaires", Lyon Est Hospital Group, Bron, France
| | | | - Yoann Huguenin
- Pediatric Onco-Hematology Department, Bordeaux University Hospital, Bordeaux, France
| | - Aurélie Cantais
- Neonatal Pediatric Care unit, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Sophie Brun
- Department of Hematological biology, Nîmes University Hospital, Nîmes, France
| | - Cécile Ged
- Biochemistry Department, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Badens
- INSERM, Marseille Medical Genetics, Aix Marseille University, Marseille, France
| | - Isabelle Thuret
- Pediatric Onco-Hematology Department, Reference Center on Rare Red Cell Disorders, La Timone Children's Hospital, APHM, Marseille, France
| | - Muriel Giansily-Blaizot
- Department of Hematological biology, Reference Center on Rare Red Cell Disorders, Montpellier University Hospital, Montpellier, France
| | - Serge Pissard
- Molecular Genetic Laboratory, Henri Mondor University Hospital, Créteil, France
| | - Patricia Aguilar-Martinez
- Department of Hematological biology, Reference Center on Rare Red Cell Disorders, Montpellier University Hospital, Montpellier, France
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Dimishkovska M, Kuzmanovska M, Kocheva S, Martinova K, Karanfilski O, Stojanoski Z, Plaseska-Karanfilska D. First Cases of Hb Agrinio Described in Patients from the Republic of Macedonia. Hemoglobin 2017; 41:308-310. [PMID: 29219637 DOI: 10.1080/03630269.2017.1397016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Previous molecular analyses of α-thalassemia (α-thal) in the Republic of Macedonia have identified the following genetic defects: -α3.7 (rightward), -(α)20.5 and - -MED I deletions and Hb Icaria [α142, Term→Lys (α2), HBA2: c.427T>A] and polyadenylation signal (polyA) [AATAAA>AATGAA (α2), HBA2: c.*92A>G] point mutations. Here, we report two unrelated patients from the Romani population in the Republic of Macedonia, homozygotes for the α2-globin gene variant Hb Agrinio [α29(B10)Leu→Pro; HBA2: c.89T>C]. To date, Hb Agrinio has been described only in individuals of Greek, Cypriot and Spanish origin. Both of our patients had early presentation of the disease (3.5 years and 2 months, respectively) with frequent blood transfusions from early infancy. They have a severe intermediate phenotype of thalassemia (Hb H disease) with hemoglobin (Hb) levels of 7.8 and 7.7 g/dL, respectively. Although the HBA2: c.89T>C mutation results in an α+ allele, the severe phenotype of the homozygotes is due to the production of hyperunstable α chains that undergo post translational precipitation. This leads to a greater degree of red cell damage and hemolytic anemia. The detection of Hb Agrinio in two unrelated families of Romani ethnic origin, may suggest it is a founder mutation in this population living in the Republic of Macedonia. Considering the severity of the clinical presentation of the homozygotes or compound heterozygotes for this rare Hb variant, a targeted molecular screening for Hb Agrinio mutation carriers should be considered in all patients of Romani ethnic origin with manifested microcytosis.
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Affiliation(s)
- Marija Dimishkovska
- a Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov , ' Macedonian Academy of Science and Arts , Skopje , Republic of Macedonia
| | - Maja Kuzmanovska
- a Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov , ' Macedonian Academy of Science and Arts , Skopje , Republic of Macedonia
| | - Svetlana Kocheva
- b University Pediatric Clinic, Medical Faculty , Skopje , Republic of Macedonia
| | - Kata Martinova
- b University Pediatric Clinic, Medical Faculty , Skopje , Republic of Macedonia
| | - Oliver Karanfilski
- c University Clinic for Hematology, Medical Faculty , Skopje , Republic of Macedonia
| | - Zlate Stojanoski
- c University Clinic for Hematology, Medical Faculty , Skopje , Republic of Macedonia
| | - Dijana Plaseska-Karanfilska
- a Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov , ' Macedonian Academy of Science and Arts , Skopje , Republic of Macedonia
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Petropoulou M, Poula A, Traeger-Synodinos J, Kanavakis E, Christopoulos TK, Ioannou PC. Multi-allele DNA biosensor for the rapid genotyping of 'nondeletion' alpha thalassaemia mutations in HBA1 and HBA2 genes by means of multiplex primer extension reaction. Clin Chim Acta 2015; 446:241-7. [PMID: 25892676 DOI: 10.1016/j.cca.2015.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alpha-thalassaemia is an autosomal recessive disorder characterized by defective production of the alpha chain of haemoglobin. It is caused mainly by deletions of one or both of the duplicated alpha-globin genes on chromosome 16, and/or by nucleotide variations, known as "nondeletion" mutations. Definition of the alpha globin genotype in carriers supports genetic counselling, and in patients with Hb H disease is useful to predict prognosis and management options. Here, we report a method that facilitates direct detection by naked eye of the 13 most common "nondeletion" alpha-globin gene mutations in populations around the Mediterranean and Middle East. METHODS AND RESULTS The method comprises (i) PCR amplification of a single 1087 bp fragment for each HBA1 and HBA2 gene (separately); (ii) multiplex primer extension reaction of just 10 cycles, using unpurified amplification product as a template, to incorporate biotin into those allele-specific primers that extend and, finally, (iii) visual detection of the reaction products within minutes by the dipstick biosensor. The method was evaluated by analysing 105 samples of known genotypes and the results were found fully concordant with those obtained by the reference methods. CONCLUSIONS The proposed assay is particularly suited for small molecular-diagnostic laboratories with a limited budget and a low-to-medium sample volume. In addition this platform represents a very simple and useful genotyping tool to support gene scanning methods whenever nucleotide variations have to be specified.
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Affiliation(s)
- Margarita Petropoulou
- Laboratory of Analytical Chemistry, Department of Chemistry, Athens University, Athens 15771, Greece
| | - Amalia Poula
- Laboratory of Analytical Chemistry, Department of Chemistry, Athens University, Athens 15771, Greece
| | | | | | - Theodore K Christopoulos
- Department of Chemistry, University of Patras, Patras 26500, Greece; Foundation for Research and Technology Hellas, Institute of Chemical Engineering and High Temperature Chemical Processes (FORTH/ICE-HT), Patras 26504, Greece
| | - Penelope C Ioannou
- Laboratory of Analytical Chemistry, Department of Chemistry, Athens University, Athens 15771, Greece.
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Kattamis A, Delaporta P, Fylaktou I, Vrettou C, Kyriakopoulou D, Stamoulakatou A, Papassotiriou I, Kanavakis E, Traeger-Synodinos J. Hb Souli, a 6 bp in-frame deletion on the HBA2 gene (HBA2: c.[41-46delCCTGGG]) leads to α-thalassemia intermedia, when in trans to a single α-globin gene deletion. Hemoglobin 2014; 39:55-7. [PMID: 25476779 DOI: 10.3109/03630269.2014.981827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report the case of a 5-year-old child with clinical and hematological findings consistent with the diagnosis of α-thalassemia intermedia (α-TI). Molecular analysis disclosed the common 3.7 kb deletion in the α-globin gene cluster in trans to a novel in-frame 6 bp deletion in the HBA2 gene. It removes the sequence CCTGGG (or GCCTGG) that normally encodes for alanine (codon 13) and tryptophan (codon 14). Even though several hemoglobin (Hb) variants with mutations affecting codons 13 or 14 have been described, Hb Souli (HBA2: c.[41-46delCCTGGG]) is, to the best of our knowledge, the first variant to be reported where both amino acid residues, α13Ala and α14Trp, are deleted, leading to unstable and rapidly degraded α-globin chains.
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Affiliation(s)
- Antonis Kattamis
- First Department of Pediatrics, Athens University Medical School , Athens , Greece
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de la Fuente-Gonzalo F, Baiget M, Badell I, Ricard P, Vinuesa L, Martínez-Nieto J, Ropero P, Villegas A, González FA, Díaz-Mediavilla J, Erythropathology Spanish Group. Study of three families with Hb Agrinio [α29(B10)Leu→Pro, CTG>CCG (α2)] in the Spanish population: three homozygous cases. Hemoglobin 2012; 36:526-32. [PMID: 23094635 DOI: 10.3109/03630269.2012.733988] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Most α-thalassemia (α-thal) mechanisms are deletions of one or both α-globin genes and less than 5.0-10.0% are point mutations. Hb Agrinio [α29(B10)Leu→Pro, CTG>CCG (α2)] is a hyperunstable α chain structural variant in which the thalassemic phenotype is determined by a post translational precipitation of the structurally anomalous chain in erythroid precursors. This study involved 14 cases with Hb Agrinio from three families. Selective sequencing of the α2 gene showed a CTG(Leu)>CCG(Pro) mutation at codon 29. The mutation was found in a heterozygous state in 11 cases and in a homozygous state in three cases. These are the first cases with Hb Agrinio described in Spain. In all cases where a leucine is exchanged for a proline, an unstable hemoglobin (Hb) will occur both in the α and the β chain. Some of these are as unstable as Hb Agrinio and their presence is difficult to detect except by DNA sequencing.
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Paglietti ME, Sollaino MC, Loi D, Barella S, Desogus MF, Galanello R. First Detection of Hb Taybe [α38(C3) or α39(C4) Thr→0 (α1)] in An Italian Child. Hemoglobin 2012; 36:299-304. [DOI: 10.3109/03630269.2012.659780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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