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Duca L, Nava I, Tavazzi D, Marcon A, Motta I, Graziadei G. Epidemiological shift of glucose-6-phosphate dehydrogenase mutations in northern Italy in the last 15 years. Ann Hematol 2021; 100:2683-2688. [PMID: 34533603 DOI: 10.1007/s00277-021-04630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive hemolytic anemia caused by mutations in G6PD gene. The distribution and frequency of genetic variants differ depending on ethnicity and geographical areas. Because of new migrations different variants are now present in Europe. This retrospective study aims to identify variants among the G6PD deficient subjects referred since 2004 to IRCCS Ca' Granda Foundation Hospital in Milan. The subjects were divided into 3 groups: group 1 (2004-2008), group 2 (2009-2013), and group 3 (2014-2018). During 15 years a significant decrease of the Mediterranean and an important increase of the African, Asian, and uncommon variants (classified as Others) have been observed. Three new mutations were found: in group 2 heterozygosity for c.[1454G > A] (Gly485Asp) in an adult female with severe anemia, high bilirubin levels and G6PD activity of 0,69 (IU/gHb) and heterozygosity for c.[584A > G] (Gln195Arg) in an elderly woman of Italian origin showing only anemia and enzymatic activity of 1,54 (IU/gHb) were detected. In group 3 hemizygosity for c.[670A > T] (Ile224Phe) in an adult Chinese man without anemia but with total absence of G6PD activity was found. These data reflect the appearance of uncommon G6PD mutations in northern Italy, probably due to new migrations, as consequence G6PD characterization becomes a diagnostic issue.
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Affiliation(s)
- Lorena Duca
- Department of Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Isabella Nava
- Department of Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Tavazzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessia Marcon
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Irene Motta
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanna Graziadei
- Department of Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Di Pierro E, De Canio M, Mercadante R, Savino M, Granata F, Tavazzi D, Nicolli AM, Trevisan A, Marchini S, Fustinoni S. Laboratory Diagnosis of Porphyria. Diagnostics (Basel) 2021; 11:diagnostics11081343. [PMID: 34441276 PMCID: PMC8391404 DOI: 10.3390/diagnostics11081343] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 12/13/2022] Open
Abstract
Porphyrias are a group of diseases that are clinically and genetically heterogeneous and originate mostly from inherited dysfunctions of specific enzymes involved in heme biosynthesis. Such dysfunctions result in the excessive production and excretion of the intermediates of the heme biosynthesis pathway in the blood, urine, or feces, and these intermediates are responsible for specific clinical presentations. Porphyrias continue to be underdiagnosed, although laboratory diagnosis based on the measurement of metabolites could be utilized to support clinical suspicion in all symptomatic patients. Moreover, the measurement of enzymatic activities along with a molecular analysis may confirm the diagnosis and are, therefore, crucial for identifying pre-symptomatic carriers. The present review provides an overview of the laboratory assays used most commonly for establishing the diagnosis of porphyria. This would assist the clinicians in prescribing appropriate diagnostic testing and interpreting the testing results.
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Affiliation(s)
- Elena Di Pierro
- Dipartimento di Medicina Interna, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Correspondence: ; Tel.: +39-0255036155
| | - Michele De Canio
- Porphyria and Rare Diseases Centre, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy;
| | - Rosa Mercadante
- EPIGET-Epidemiology, Epigenetics, and Toxicology Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (R.M.); (D.T.); (S.F.)
| | - Maria Savino
- Servizio di Medicina Trasfusionale e Laboratorio Analisi, Laboratorio di Immunogenetica, IRCCS Ospedale “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Francesca Granata
- Dipartimento di Medicina Interna, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Dario Tavazzi
- EPIGET-Epidemiology, Epigenetics, and Toxicology Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (R.M.); (D.T.); (S.F.)
| | - Anna Maria Nicolli
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università Degli Studi di Padova, 35121 Padova, Italy; (A.M.N.); (A.T.)
| | - Andrea Trevisan
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università Degli Studi di Padova, 35121 Padova, Italy; (A.M.N.); (A.T.)
| | - Stefano Marchini
- Laboratorio Malattie Rare-Settore Porfirie, Dipartimento di Scienze Mediche, Chirurgiche, Materno-Infantili e Dell’Adulto, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41125 Modena, Italy;
| | - Silvia Fustinoni
- EPIGET-Epidemiology, Epigenetics, and Toxicology Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (R.M.); (D.T.); (S.F.)
- Environmental and Industrial Toxicology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Iurlo A, Bucelli C, Cattaneo D, Levati GV, Viani B, Tavazzi D, Consonni D, Baldini L, Cappellini MD. UGT1A1 genotype does not affect tyrosine kinase inhibitors efficacy and safety in chronic myeloid leukemia. Am J Hematol 2019; 94:E283-E285. [PMID: 31364196 DOI: 10.1002/ajh.25596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Alessandra Iurlo
- Hematology DivisionFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan Milan Italy
| | - Cristina Bucelli
- Hematology DivisionFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan Milan Italy
| | - Daniele Cattaneo
- Hematology DivisionFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan Milan Italy
| | - Giorgia Virginia Levati
- Hematology DivisionFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan Milan Italy
| | - Benedetta Viani
- Hematology DivisionFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan Milan Italy
| | - Dario Tavazzi
- Department of Clinical Sciences and Community HealthUniversity of Milan, and Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Dario Consonni
- Epidemiology UnitFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Luca Baldini
- Hematology DivisionFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan Milan Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community HealthUniversity of Milan, and Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
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Tavazzi D, Motta I, Graziadei G, Sampietro M, Duca L, Cappellini MD. Circulating cell-free DNA and ineffective erythropoiesis in nontransfusion-dependent β-thalassemia. Am J Hematol 2018; 93:E365-E368. [PMID: 30105870 DOI: 10.1002/ajh.25248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Dario Tavazzi
- Università degli Studi di Milano, Dip. Scienze Cliniche e di Comunità; Milan Italy
| | - Irene Motta
- Fondazione IRCCS ‘Cà Granda’ Ospedale Maggiore Policlinico, UO Medicina Interna; Milan Italy
| | - Giovanna Graziadei
- Fondazione IRCCS ‘Cà Granda’ Ospedale Maggiore Policlinico, UO Medicina Interna; Milan Italy
| | - Maurizio Sampietro
- Università degli Studi di Milano, Dip. Fisiopatologia Medico-Chirurgica e dei Trapianti; Milan Italy
| | - Lorena Duca
- Fondazione IRCCS ‘Cà Granda’ Ospedale Maggiore Policlinico, UO Medicina Interna; Milan Italy
| | - Maria Domenica Cappellini
- Fondazione IRCCS ‘Cà Granda’ Ospedale Maggiore Policlinico, UO Medicina Interna; Milan Italy
- Università degli Studi di Milano, Dip. Scienze Cliniche e di Comunità; Milan Italy
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Brancaleoni V, Granata F, Colancecco A, Tavazzi D, Cappellini MD, Di Pierro E. Corrigendum to "Seven novel genetic mutations within the 5' UTR and the housekeeping promoter of HMBS gene responsible for the non-erythroid form of acute intermittent porphyria" [Blood Cells Mol. Dis. 49 (2012) 147-151]. Blood Cells Mol Dis 2016; 62:67. [PMID: 27693411 DOI: 10.1016/j.bcmd.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Valentina Brancaleoni
- Dipartimento di Medicina Interna, Fondazione IRCCS "Ca' Granda", Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milano, Italy
| | - Francesca Granata
- Dipartimento di Medicina Interna, Fondazione IRCCS "Ca' Granda", Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milano, Italy
| | - Alessandra Colancecco
- Dipartimento di Medicina Interna, Fondazione IRCCS "Ca' Granda", Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milano, Italy
| | - Dario Tavazzi
- Dipartimento di Medicina Interna, Fondazione IRCCS "Ca' Granda", Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milano, Italy
| | - Maria Domenica Cappellini
- Dipartimento di Medicina Interna, Fondazione IRCCS "Ca' Granda", Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milano, Italy.
| | - Elena Di Pierro
- Dipartimento di Medicina Interna, Fondazione IRCCS "Ca' Granda", Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milano, Italy
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Brancaleoni V, Granata F, Colancecco A, Tavazzi D, Cappellini MD, Di Pierro E. Seven novel genetic mutations within the 5'UTR and the housekeeping promoter of HMBS gene responsible for the non-erythroid form of acute intermittent porphyria. Blood Cells Mol Dis 2012; 49:147-51. [PMID: 22748422 DOI: 10.1016/j.bcmd.2012.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/03/2012] [Indexed: 11/17/2022]
Abstract
Acute intermittent porphyria (AIP) is an autosomal dominant disorder caused by molecular abnormalities in the HMBS gene. This gene is transcribed from two promoters to produce ubiquitous and erythroid specific isoforms of porphobilinogen deaminase (PBGD). In the classical form of AIP, both isoforms are deficient, but about 5% of families have the non-erythroid variant in which only the ubiquitous isoform is affected. Only one mutation sited in the housekeeping promoter has been previously reported as causative for this form of AIP. In this study, we identified one small deletion and six nucleotide substitutions within the 5'UTR and the housekeeping promoter of HMBS gene: c.1-440_-427del14bp; c.1-421G>A; c.1-331C>T; c.1-270G>A; c.1-122T>A; c.1-103C>T; c.1-28A>C. Using luciferase reporter assays and quantitative PCR experiments, we characterized the functional role of these seven novel genetic variants demonstrating that all mutations cause a significant loss of transcriptional activity. Our investigations suggest that these nucleotide substitutions may alter critical binding sites for transcriptional factors, which confirms that these regions represent an important molecular target for pathogenesis of non-erythroid form of acute intermittent porphyria.
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Affiliation(s)
- Valentina Brancaleoni
- Dipartimento di Medicina Interna, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milano, Italy
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Abstract
Porphyrias are a group of eight rare inherited metabolic disorders of heme biosynthesis pathway. Porphyrias are still underdiagnosed, although examinations of urine and plasma are first-line tests for detecting excess of porphyrins or heme precursors in suspected patients. Diagnosis, particularly for the acute forms, is essential to avoid precipitating factors and the use of triggering drugs. Mutation screening of family members is recommended to identify presymptomatic carriers and to prevent acute attacks. The therapeutic approach should be appropriate regarding specific forms of porphyria and treatment should be started promptly.
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Affiliation(s)
- Maria Domenica Cappellini
- Dipartimento di Medicina Interna, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy.
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8
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Ausenda S, Di Pierro E, Brancaleoni V, Tavazzi D, Cappellini MD. Novel human pathological mutations. Gene symbol: CPOX. Disease: Coproporphyria. Hum Genet 2009; 126:342. [PMID: 19694028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Sabrina Ausenda
- Milano, Fondazione Ospedale Maggiore Policlinico MA RE-Università degli Studi di Milano, Milano, Italy
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9
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Di Pierro E, Ventura P, Brancaleoni V, Moriondo V, Marchini S, Tavazzi D, Nascimbeni F, Ferrari MC, Rocchi E, Cappellini MD. Clinical, biochemical and genetic characteristics of Variegate Porphyria in Italy. Cell Mol Biol (Noisy-le-grand) 2009; 55:79-88. [PMID: 19656455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 05/15/2009] [Indexed: 05/28/2023]
Abstract
Variegate Porphyria (VP) is an autosomal dominant disorder found worldwide but is rare in Italy. In this study we provide an overview of clinical, biochemical and genetic background of 33 Italian VP patients diagnosed in the last fifteen years. About 70% of patients had experienced clinical symptoms: 43.4% had photosensivity, 8.7% acute attacks and 47.8% both. Among the 33 patients, 14 different mutations were identified. Of these only 6 defects have been previously described in other countries and 8 are unique having been identified for the first time in Italy. Two of these, the c.851G>T and the c.1013C>G, were found in two and four unrelated families respectively. No mutation has been found in homozygosis and no significant correlation has been observed between specific clinical and biochemical manifestations and the type of mutation. In contrast, normal faecal protoporphyrin excretion was high predictive of silent phenotype. Normal urinary excretion of PBG and ALA, predicted absence of neurovisceral symptoms. This paper represents the first compilation of data on genotype-phenotype relation in Italian patients with VP.
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Affiliation(s)
- E Di Pierro
- Dipartimento di Medicina Interna, Università degli Studi di Milano - Fondazione Ospedale Maggiore Policlinico Mangiagalli e Regina Elena IRCCS Milano, Italy.
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10
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Origa R, Galanello R, Perseu L, Tavazzi D, Domenica Cappellini M, Terenzani L, Forni GL, Quarta G, Boetti T, Piga A. Cholelithiasis in thalassemia major. Eur J Haematol 2008; 82:22-5. [PMID: 19021734 DOI: 10.1111/j.1600-0609.2008.01162.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Aim of this study was to evaluate prevalence and characteristics of cholelithiasis in a large population of patients with thalassemia major (TM). METHODS Data from 858 consecutive patients with transfusion-dependent thalassemia at five major Italian centers were analyzed. In these centers, a complete abdomen ultrasonography is performed yearly after the beginning of the transfusion regimen. The role of co-inheriting Gilbert's syndrome genotype was investigated studying the promoter region of the UGT1-A1 gene by automated sequencing. RESULTS Thirty percent of TM patients had gallstones. The Gilbert's genotype [homozygosity for (TA)(7) motif at UGT1A promoter gene], influenced both the prevalence of cholelithiasis and the age at which it developed. CONCLUSIONS Cholelithiasis has a remarkable frequency and precocity in patients with TM and especially in those with (TA)(7)/(TA)(7) UGT1-A1 genotype. An early biliary ultrasonography is recommended from childhood and a closer follow-up in patients with thalassemia and associated Gilbert's syndrome may be indicated.
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Affiliation(s)
- Raffaella Origa
- Ospedale Regionale per le Microcitemie, ASL Cagliari, Dipartimento di Scienze Biomediche e Biotecnologie, Università di Cagliari, Cagliari, Italy
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Delbini P, Duca L, Nava I, Tavazzi D, Cappellini MD. Gene symbol: G6PD. Disease: Glucose-6-phosphate dehydrogenase deficiency. Hum Genet 2008; 124:312-313. [PMID: 18846656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Paola Delbini
- Department of Internal Medicine, University of Milan, Maggiore Policlinico Foundation IRCCS., Via F. Sforza, 35, 20122 Milan, Italy.
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12
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Affiliation(s)
- Dario Tavazzi
- Department of Internal Medicine, University of Milan, Fondazione IRCCS Policlinico, Mangiagalli, Regina Elena, Milan, Italy
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Valenti L, Valenti G, Como G, Santorelli G, Dongiovanni P, Rametta R, Fracanzani AL, Tavazzi D, Messa PG, Fargion S. HFE genotype influences erythropoiesis support requirement in hemodialysis patients: a prospective study. Am J Nephrol 2007; 28:311-6. [PMID: 18025780 DOI: 10.1159/000111387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 10/04/2007] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS HFE protein controls iron absorption and cycling, and HFE mutations influence iron status. The aim was to evaluate the effect of the HFE genotype on the need for iron and erythropoietin in Italian hemodialysis patients. METHODS Ninety-six prevalent patients were evaluated at the time of enrolment and prospectively followed for 3 years. Patients were given r-HuEPO and Fe3+-gluconate according to guidelines. The HFE genotype was determined by restriction analysis. RESULTS Three patients (3%) carried the C282Y mutation, 4 (4%) were homozygous and 18 (19%) heterozygous for the H63D mutation, and 71 (74%) were negative for both. At enrolment, subjects positive for HFE mutations had higher iron stores (ferritin 617 +/- 663 vs. 423 +/- 386 ng/ml, p = 0.05), were receiving less iron (82.5 +/- 66 vs. 110 +/- 154 mg/month, p = 0.05) and a lower r-HuEPO dosage (98 +/- 83 vs. 142 +/- 138 U/kg/week, p = 0.03). Consistently during the study period, patients positive for HFE mutations received a lower amount of r-HuEPO (94.5 +/- 63 vs. 186 +/- 344 U/kg/week, p = 0.01) and iron (97 +/- 63 vs. 121 +/- 68 mg/month, p = 0.07). Upon Cox regression analysis, after adjustment for confounding variables, the presence of HFE mutations was associated with a reduced risk of death (HR 0.6, 95% CI 0.34-1.03, p = 0.06). CONCLUSION HFE mutations reduce the amount of r-HuEPO and iron necessary to support erythropoiesis in hemodialysis.
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Affiliation(s)
- Luca Valenti
- Department of Internal Medicine, University of Milan, Ospedale Policlinico Mangiagalli e Regina Elena Fondazione IRCCS, Milan, Italy
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14
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Di Pierro E, Besana V, Moriondo V, Brancaleoni V, Tavazzi D, Casalgrandi G, Ventura P, Rocchi E, Cappellini MD. A large deletion on chromosome 11 in acute intermittent porphyria. Blood Cells Mol Dis 2006; 37:50-4. [PMID: 16828319 DOI: 10.1016/j.bcmd.2006.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Revised: 05/24/2006] [Accepted: 05/24/2006] [Indexed: 11/19/2022]
Abstract
Acute intermittent porphyria (AIP) is an autosomal disorder caused by molecular abnormalities in the gene coding for hydroxymethylbilane synthase (HMBS), the third enzyme in the heme biosynthetic pathway. So far, more than 242 different mutations responsible for AIP have been identified in this gene. In an Italian family with typical clinical and biochemical signs of AIP, no mutation was found by direct sequencing of the entire hydroxymethylbilane synthase gene (HMBS). All the symptomatic patients showed apparent homozygosity and absence of mendelian segregation for eleven common polymorphisms along the gene. Excluding interference of polymorphisms in the primer sites, we assumed the presence of a complete HMBS gene deletion. In order to identify the size of this deletion, single nucleotide polymorphisms (SNPs) analysis was extended to flanking genes, H2A Histone Family member X (H2AFX) and Dolichyl-Phosphate N-Acetylglucosamine Phosphotransferase 1 (DPAGT1), downstream and Vacuolar protein sorting 11 (VPS11), upstream. Heterozygous polymorphisms in the VPS11 and DPAGT1 genes were found. Thus, we performed a Long-PCR with primers situated in regions outside the homozygous polymorphisms and we identified a double deletion with inversion on chromosome 11 (g22516974_22524062del7088, g22524062_22524278inv216, g22524278_22531093del6815). Even if the deletions include the entire HMBS and H2AFX genes and 1463 bp of the final portion of DPAGT1 gene, our patients had no other symptoms than AIP.
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Affiliation(s)
- Elena Di Pierro
- Department of Internal Medicine, Maggiore Policlinico, Mangiagalli and Regina Elena, Foundation IRCCS, University of Milan, Italy
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15
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Martinez di Montemuros F, Tavazzi D, Patti E, Cappellini MD. Human gene mutations. Gene symbol: UROD. Disease: Porphyria, cutanea tarda. Hum Genet 2004; 114:221. [PMID: 15046048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- F Martinez di Montemuros
- Dipartimento di Medicina Interna, Centro Anemie Congenite, University of Milan, Ospedale Maggiore Policlinico IRCCS, Via F. Sforza 35, 20122 Milan, Italy.
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16
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Martinez di Montemuros F, Tavazzi D, Patti E, Cappellini MD. Gene symbol: UROD. Disease: Porphyria, cutanea tarda. Hum Genet 2003; 113:368. [PMID: 12974281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- F Martinez di Montemuros
- Dipartimento di Medicina Interna, University of Milan--Centro Anemie Congenite, Ospedale Maggiore Policlinico IRCCS, Milan, Italy.
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Velati C, Marlianici E, Rigamonti D, Barillari G, Chiavilli F, Fugiani P, Garozzo G, Lancieri M, Rinaldi S, Testa D, Sampietro M, Tavazzi D, Delbini P, Fargion S, Fiorelli G. Mutations of the hemochromatosis gene in Italian candidate blood donors with increased transferrin saturation. ACTA ACUST UNITED AC 2003; 4:436-40. [PMID: 14671617 DOI: 10.1038/sj.thj.6200324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this study was to analyze the role of HFE mutations in blood donors with iron parameters suggesting iron overload, taking into account the regional distribution of HFE mutations in Italy. We studied 5880 subjects undergoing evaluation for blood donation eligibility, from different areas of Italy. Abnormal iron parameters were defined as transferrin saturation (TS) >50% or >45% and serum ferritin (SF) >300 or >250 microg/ml in males and females, respectively. Subjects with increased TS and/or SF were re-tested and typed for HFE mutations C282Y and H63D. A total of 548 individuals had increased iron parameters at first testing. In total, 179/548 were available for retesting, and in 109 increased TS and/or SF were confirmed. Increased TS was confirmed in 25 individuals, among whom three were C282Y homozygotes and six were compound heterozygotes for C282Y and H63D. Increased TS was more frequent in northern Italy than in southern regions. In individuals with increased TS and/or SF, the frequency of C282Y and H63D was 0.13 and 0.21 in northern-Italy versus 0.05 and 0.45 in southern Italy (P=0.004 for H63D). Nine out of 10 individuals carrying hemochromatosis-associated genotypes (including compound heterozygosity for C282Y and H63D) originated from northern regions. Among controls, the allelic frequencies of C282Y and H63D were 0.037 and 0.16 in the northern regions and 0.015 and 0.16 in the southern regions. In conclusion, over one-third of individuals with persistently altered TS carried hemochromatosis-associated genotypes, confirming that a diagnostic approach based on TS and genotyping of selected cases may represent a viable screening procedure.
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Affiliation(s)
- Claudio Velati
- Transfusional Centre of Ospedale Civile di Sondrio, Sondrio, Italy
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Martinez di Montemuros F, Di Pierro E, Patti E, Tavazzi D, Danielli MG, Biolcati G, Rocchi E, Cappellini MD. Molecular characterization of porphyrias in Italy: a diagnostic flow-chart. Cell Mol Biol (Noisy-le-grand) 2002; 48:867-76. [PMID: 12699245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The porphyrias are disorders associated with inherited or acquired enzyme deficiencies in the heme biosynthetic pathway. The differential diagnosis is often difficult since the phenotype is very similar in some forms and the biochemical tests are not commonly available. Here we provide an update on the molecular diagnosis of porphyrias in Italy and a flow-chart to facilitate the identification of mutations in heme biosynthetic genes. The molecular analysis has allowed us to identify the molecular defect underlying the disease in 66 probands with different porphyrias [acute intermittent porphyria (AIP), variegate porphyria (VP), porphyria cutanea tarda (PCT), erythropoietic protoporphyria (EPP)]. No Italian patients with defects in coproporphyrinogen oxidise (CPOX) gene, responsible for hereditary coproporphyria (HCP), have been detected. The molecular characterization has been extended to 115 relatives with the identification of 55 asymptomatic mutation carriers and 60 normal subjects. We have so far identified 50 different mutations among 4 genes associated with the most common porphyrias showing a high molecular heterogeneity: 22 in the hydroxymethylbilane synthase (HMBS) gene (AIP), 7 in the protoporphyrinogen oxidase (PPOX) gene (VP), 16 in the uroporphyrinogen decarboxylase (UROD) gene (PCT) and 5 in the ferrochelatase (FECH) gene (EPP). Among the 50 molecular defects, 29 seem to be restricted to the Italian population.
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Affiliation(s)
- F Martinez di Montemuros
- Dipartimento di Medicina Interna, University of Milan, Ospedale Maggiore Policlinico IRCCS, Via F. Sforza 35, 20122 Milan, Italy.
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19
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Abstract
BACKGROUND Iron overload has been reported in alcoholic liver cirrhosis but it remains to be established whether iron is involved in inducing oxidative damage to erythrocytes in alcoholic cirrhosis. The aim of this study was to assess oxidative damage and red cell indicators of antioxidant defences in alcoholics with mild-to-severe liver cirrhosis, taking into account the iron status. MATERIALS AND METHODS Twenty-nine patients with alcoholic liver cirrhosis (AC) and 27 with nonalcoholic cirrhosis (NAC) were studied. Serum lipid peroxides (LPO) were assayed by a colourimetric method. Serum-free malonyldialdehyde (MDA) was assayed by selected ion monitoring in positive chemical ionization; serum 4-hydroxy-2(E)-nonenal (4-HNE) was determined by a colorimetric method. Reduced (GSH) and oxidized glutathione (GSSG), adenine and pyridine cofactors were assayed in whole blood extracts by HPLC. Hexose-monophosphate shunt (HMPS), glycolytic pathway (EMP) and antioxidant enzyme activities were determined by standard methods. Iron status was evaluated by standard clinical chemistry and by histological grading of liver iron. Nontransferrin-bound iron (NTBI) was measured in serum by HPLC. RESULTS GSH progressively decreased with increasing severity of liver involvement in AC and NAC. MDA, 4-HNE and NTBI were significantly higher in AC serum. Stimulation of red cell HMPS and reducing potential, in terms of NADPH production, were more pronounced in AC. CONCLUSIONS These results suggest that NTBI is more important than the decrease of antioxidant defences in inducing lipid peroxidation. NTBI may play a catalytic role in free radical reactions in the presence of cellular reductants such as NADPH.
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Affiliation(s)
- Gemino Fiorelli
- Department of Internal Medicine, Ospedale Maggiore Policlinico IRCCS, Padiglione Granelli, University of Milan, Via F. Sforza 35, 20122 Milan, Italy.
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20
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Tavazzi D, Martinez di Montemuros F, Fargion S, Fracanzani AL, Fiorelli G, Cappellini MD. Levels of uroporphyrinogen decarboxylase (URO-D) in erythrocytes of Italian porphyria cutanea tarda patients. Cell Mol Biol (Noisy-le-grand) 2002; 48:27-32. [PMID: 11929044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Porphyria cutanea tarda (PCT) is a human metabolic disorder due to the acquired or genetic impairment of uroporphyrinogen decarboxylase (URO-D) activity, the fifth enzyme of the heme biosynthetic pathway. A classification of inherited and non-inherited forms is based on the enzyme activity levels in red blood cells (RBC). Clinical manifestations of PCT are often precipitated by triggering factors such as alcohol, drug abuse, estrogens, virus infections, hepatotoxic chemicals and hepatic siderosis. We measured URO-D activity in RBC from a large sample of Italian PCT patients in order to define the enzyme activity distribution and to attempt a correlation among activity, risk factors and clinical outcome. Three classes of patients with low, normal and over-normal URO-D activity were defined according to control values. Low URO-D levels were present in 25.8% of patients, suggesting the familial form of PCT (type II). In this group, the outcome of PCT seems to be less influenced by risk factors. Patients with over-normal URO-D activity in RBC deserve further investigation.
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Affiliation(s)
- Dario Tavazzi
- Centro Anemie Congenite, IRCCS Ospedale Maggiore Policlinico, Padiglione Granelli, Dipartimento di Medicina Intema, Università degli Studi di Milano, Italy
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21
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Martinez di Montemuros F, Di Pierro E, Biolcati G, Rocchi E, Bissolotti E, Tavazzi D, Fiorelli G, Cappellini MD. Acute intermittent porphyria: heterogeneity of mutations in the hydroxymethylbilane synthase gene in Italy. Blood Cells Mol Dis 2001; 27:961-70. [PMID: 11831862 DOI: 10.1006/bcmd.2001.0466] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute intermittent porphyria (AIP) is an autosomal disorder caused by molecular abnormalities in the gene coding for hydroxymethylbilane synthase (HMBS), the third enzyme in the heme biosynthetic pathway. So far, more than 170 different mutations responsible for AIP have been identified worldwide in the HMBS gene. In this study we have performed molecular characterization in 14 patients with suspected diagnosis of AIP and in 29 family members of Italian ancestry. Molecular analysis of the HMBS gene allowed us to identify 13 different mutations among 14 patients with reduced HMBS activity: 5 splicing defects (IVS9+22 G>A, 612 G>T, IVS11-2 delA, IVS12+2 T>C, and IVS13-1 G>A), 1 small insertion (182 insGA), 1 small deletion (730-731 delCT), and 6 missense/nonsense mutations (76 C>T, 295 G>A, 331 G>A, 580 C>T, 673 C>T, and 874 C>T), resulting in single-amino-acid substitutions or protein truncations. Six of these molecular abnormalities had already been described and 7 are new findings. In a previous work on an Italian population we detected 7 different mutations among 8 AIP patients. This study has raised to 18 the number of different mutations so far found among the Italian AIP population, 11 of which are new findings. We can conclude that the mutation screening in the Italian population contributes to improvement of the diagnostic approach of AIP and to establishing possible clustering of mutations in the Mediterranean area.
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Affiliation(s)
- F Martinez di Montemuros
- Centro Anemie Congenite, Ospedale Maggiore Policlinico IRCCS--Dipartimento di Medicina Interna, University of Milan, Milan, Italy
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22
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Martinez di Montemuros F, Tavazzi D, Salsano E, Piepoli T, Pollo B, Fiorelli G, Finocchiaro G. High frequency of the H63D mutation of the hemochromatosis gene (HFE) in malignant gliomas. Neurology 2001; 57:1342. [PMID: 11591868 DOI: 10.1212/wnl.57.7.1342] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F Martinez di Montemuros
- Department of Internal Medicine, University of Milan, Ospedale Maggiore Policlinico IRCCS, Italy
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23
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Fargion S, Mattioli M, Fracanzani AL, Sampietro M, Tavazzi D, Fociani P, Taioli E, Valenti L, Fiorelli G. Hyperferritinemia, iron overload, and multiple metabolic alterations identify patients at risk for nonalcoholic steatohepatitis. Am J Gastroenterol 2001; 96:2448-55. [PMID: 11513189 DOI: 10.1111/j.1572-0241.2001.04052.x] [Citation(s) in RCA: 170] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to define in patients with hyperferritinemia and normal transferrin saturation the relationships among hyperferritinemia, iron overload, HFE gene mutations, the presence of metabolic alterations, and nonalcoholic steatohepatitis (NASH). METHODS Forty patients with increased serum ferritin, resistant to dietary restriction and normal transferrin saturation, 90 with ultrasonographic evidence of hepatic steatosis, and 60 obligate heterozygotes for hemochromatosis, all negative for alcohol abuse, hepatitis virus infections, and inflammation were studied. Transferrin saturation, serum ferritin, uric acid, lipids, glucose tolerance, insulin resistance, HFE gene mutations, liver histology, and hepatic iron concentration were analyzed. RESULTS Of the 40 patients with hyperferritinemia, 29 (72%) had biochemical metabolic abnormalities, 18 of the 26 examined (69%) had insulin resistance, 26 (65%) had the presence of one of the two HFE gene mutations (normal controls, 33 of 128 [26%], p < 0.0001), and all had increased liver iron concentration. Thirty-one patients (77%) had histology compatible with NASH. At univariate analysis, NASH was significantly associated with the presence of metabolic alterations, the C282Y mutation, and severity of fibrosis. At multivariate analysis, NASH was associated with the coexistence of multiple metabolic alterations (odds ratio = 5.2, 95% CI = 0.95-28.7). The risk of having NASH augmented in the presence of higher values of ferritin and liver iron concentration. Among the 90 patients with ultrasonographic evidence of hepatic steatosis, 24 (27%) had increased serum ferritin with normal transferrin saturation, but only six remained hyperferritinemic after dietary restriction. CONCLUSION Increased ferritin with normal transferrin saturation is frequently found in patients with hepatic steatosis, but it reflects iron overload only in those patients in whom it persists despite an appropriate diet. The simultaneous disorder of iron and glucose and/or lipid metabolism, in most of the cases associated with insulin resistance, is responsible for persistent hyperferritinemia and identifies patients at risk for NASH.
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Affiliation(s)
- S Fargion
- Dipartimento di Medicina Interna, Università di Milano, Ospedale Maggiore IRCCS, Milan, Italy
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24
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Zanella A, Bianchi P, Iurlo A, Boschetti C, Taioli E, Vercellati C, Zappa M, Fermo E, Tavazzi D, Sampietro M. Iron status and HFE genotype in erythrocyte pyruvate kinase deficiency: study of Italian cases. Blood Cells Mol Dis 2001; 27:653-61. [PMID: 11482880 DOI: 10.1006/bcmd.2001.0433] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We evaluated the iron status and searched for mutations C282Y and H63D in the hereditary hemochromatosis gene (HFE) in 34 pyruvate kinase (PK)-deficient patients from 29 unrelated families. Nine had received multiple transfusions. Thirteen of the 25 nontransfused patients displayed increased serum ferritin concentration, in the absence of conditions known to raise this parameter. HFE genotype was abnormal in 9 of 34 patients. The allele frequency was 1.8% for mutation 845G--> (C282Y) and 16.1% for mutation 187C-->G (H63D). Nontransfused subjects with abnormal genotype had serum ferritin and transferrin saturation values significantly higher than those with wild-type genotype. Of the 12 adult nontransfused patients with increased iron status parameters, 1 was C282Y homozygous, 1 compound heterozygous for C282Y and H63D, 3 H63D heterozygous, and 7 had a normal HFE genotype. Serum ferritin and transferrin saturation were not related to hemoglobin, reticulocytes, and bilirubin concentration. At multivariate analysis serum ferritin was independently associated with age and gender, but not with splenectomy and HFE genotypes. The retrospective evaluation of the iron status profile of 10 patients (3 with abnormal and 7 with wild-type HFE genotype) with at least 10 years follow-up showed that overt iron accumulation requiring iron chelation had occurred only in the 3 patients (2 of whom were splenectomized) with the mutated HFE gene.
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Affiliation(s)
- A Zanella
- Divisione di Ematologia, IRCCS Ospedale Maggiore, Via F. Sforza 35, 20122 Milan, Italy.
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25
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Cappellini MD, Martinez di Montemuros F, Tavazzi D, Fargion S, Pizzuti A, Comino A, Cainelli T, Fiorelli G. Seven novel point mutations in the uroporphyrinogen decarboxylase (UROD) gene in patients with familial porphyria cutanea tarda (f-PCT). Hum Mutat 2001; 17:350. [PMID: 11295834 DOI: 10.1002/humu.35] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this work, we describe seven novel molecular defects in the uroporphyrinogen decarboxylase gene responsible for familial porphyria cutanea tarda in Italian subjects with reduced erythrocyte URO-D activity. Four of these molecular abnormalities (R142Q, L161Q, S219F, P235S) are missense mutations, one (Q206X) is a nonsense mutation, one (IVS8-1 G>C) is a splicing defect causing the exon 9 deletion and one (1107 G>A) is located in the 3' untranslated region of UROD gene. All the amino acid substitutions fall in conserved regions in several organisms suggesting an important role in catalysis or in the protein structure stabilization. Three of these mutations have been detected in more than one subject. These results suggest a molecular heterogeneity at the UROD locus in Italian PCT patients although recurrent mutations have been identified.
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Affiliation(s)
- M D Cappellini
- Centro Anemie Congenite, Ospedale Maggiore Policlinico IRCCS, Dipartimento di Medicina Interna, University of Milan, Italy.
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26
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Fargion S, Stazi MA, Fracanzani AL, Mattioli M, Sampietro M, Tavazzi D, Bertelli C, Patriarca V, Mariani C, Fiorelli G. Mutations in the HFE gene and their interaction with exogenous risk factors in hepatocellular carcinoma. Blood Cells Mol Dis 2001; 27:505-11. [PMID: 11500061 DOI: 10.1006/bcmd.2001.0411] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The possible role of iron in facilitating the development of liver cancer is still debated. The aims of this study were to define the prevalence of the mutations 845G --> A and 187C --> G (C282Y and H63D) in the HFE gene associated with hereditary hemochromatosis in Italian patients with hepatocellular carcinoma occurring in cirrhosis and to analyze the interaction between these mutations and other established risk factors for hepatocellular carcinoma. The HFE gene mutations, performed by polymerase chain reaction, were analyzed in 81 patients (63 males, 18 females) with hepatocellular carcinoma. None of the patients had a phenotype compatible with homozygous hereditary hemochromatosis. Interaction between HFE mutations and exogenous risk factors was analyzed by collecting information on alcohol consumption, hepatitis B and C virus infections, and iron status at the time of diagnosis of chronic liver disease. This analysis was performed only in males to rule out gender influence on patients' iron status by using the case-only approach specifically designed to estimate departure from multiplicative risk ratios under the assumption of independence between genotype and environmental exposure. The prevalence of the C282Y mutation was significantly higher in patients with hepatocellular carcinoma than in normal controls (8.6% vs 1.6%, P < 0.03). At univariate analysis, iron overload was significantly associated with both HFE mutations (P < 0.0001), whereas ongoing hepatitis B virus infection was associated with the C282Y mutation (P < 0.05). By multivariate analysis, a trend for an increased risk of being positive for hepatitis virus markers (OR 2.9, CI 95% 0.9-9.5) and of having been alcohol abusers (OR 3, CI 95% 0.7-14) was observed in patients heterozygous for the HFE mutations. These data indicate that the prevalence of the main mutation associated with hereditary hemochromatosis is significantly higher in cirrhotic Italian patients with hepatocellular carcinoma compared to a normal population and suggest that heterozygotes for HFE mutations exposed to hepatitis virus infections or who had been alcohol abusers could have an increased risk of developing cirrhosis and later liver cancer than people without the mutations exposed to the same risk factors.
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Affiliation(s)
- S Fargion
- Dipartimento di Medicina Interna, Università di Milano, Ospedale Maggiore IRCCS, Milan, Italy.
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27
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Sampietro M, Tavazzi D, Cerino M, Zatelli S, Lunghi G, Orlandi A, Fargion S, Fiorelli G, Cappellini MD. TT virus infection in adult beta-thalassemia major patients. Haematologica 2001; 86:39-43. [PMID: 11146569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with thalassemia-major are at risk of blood-borne viral infections. TT virus (TTV), a single stranded, circular DNA virus, has recently been found to be associated with acute and chronic hepatitis. The aims of this study were to assess the prevalence of TTV infection in adult patients with transfusion-dependent thalassemia, and to evaluate the clinical significance of TTV. DESIGN AND METHODS We studied 68 adult patients with thalassemia major, 97% of whom were hepatitis C virus (HCV) antibody positive. TTV DNA was amplified from serum by heminested polymerase chain reaction (PCR). Direct sequencing of PCR products was used to establish TTV genotypes. RESULTS TTV DNA was detected in 47 patients (69.1%). Sequence analysis of PCR products identified TTV genotype 1b as the most common viral genotype in this group. Patients co-infected by HCV and TTV had a significantly higher histologic grade score than patients with isolated HCV infection (5.1+/-2.7 vs. 2.8+/-1.7, p=0.02) while the stage score was not significantly different. INTERPRETATION AND CONCLUSIONS TTV is highly prevalent among Italian multiply transfused patients. In these patients TTV viremia appears to affect the necro-inflammatory activity of hepatitis C, though no evidence of an effect on the evolution of fibrosis was found.
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Affiliation(s)
- M Sampietro
- Dipartimento di Medicina Interna, Università di Milano, Milan, Italy.
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Tavazzi D, Duca L, Graziadei G, Comino A, Fiorelli G, Cappellini MD. Membrane-bound iron contributes to oxidative damage of beta-thalassaemia intermedia erythrocytes. Br J Haematol 2001; 112:48-50. [PMID: 11167782 DOI: 10.1046/j.1365-2141.2001.02482.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Iron-dependent oxidative reactions in beta-thalassaemic erythrocyte membranes are involved in premature cell removal and anaemia. We studied 22 beta-thalassaemia intermedia patients (i) to assess if membrane iron accumulation influences the oxidative damage to thalassaemic cells, and (ii) to see whether the mechanisms of haemoglobin destabilization described in vitro have indicators in circulating erythrocytes. Serum non-transferrin-bound iron as potentially toxic iron for erythrocytes was also evaluated. Membrane-bound free iron significantly correlated to bound haemichromes, suggesting a causal relation, but was poorly related to serum non-transferrin iron, which seems to contribute little to damage from outside the cells. The spleen played an important role in the removal of cells with more membrane iron.
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Affiliation(s)
- D Tavazzi
- Centro Anemie Congenite, Ospedale Maggiore Policlinico IRCCS, Dipartimento di Medicina Interna, Università di Milano, Italy
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Domenica Cappellini M, Tavazzi D, Duca L, Marelli S, Fiorelli G. Non-transferrin-bound iron, iron-related oxidative stress and lipid peroxidation in beta-thalassemia intermedia. Transfus Sci 2000; 23:245-6. [PMID: 11099903 DOI: 10.1016/s0955-3886(00)00095-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M Domenica Cappellini
- Dipartimento di Medicina Interna, Centro Anemie Congenite, Ospedale Maggiore Policlinico IRCCS, University of Milan, Milan, Italy.
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30
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Affiliation(s)
- M Meregalli
- University of Milan, Department of Internal Medicine - IRCCS Ospedale Maggiore
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31
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Cappellini MD, Martinez di Montemuros F, Sampietro M, Tavazzi D, Fiorelli G. The interaction between Gilbert's syndrome and G6PD deficiency influences bilirubin levels. Br J Haematol 1999; 104:928-9. [PMID: 10192462 DOI: 10.1111/j.1365-2141.1999.1331a.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Cappellini MD, Tavazzi D, Duca L, Graziadei G, Mannu F, Turrini F, Arese P, Fiorelli G. Metabolic indicators of oxidative stress correlate with haemichrome attachment to membrane, band 3 aggregation and erythrophagocytosis in beta-thalassaemia intermedia. Br J Haematol 1999; 104:504-12. [PMID: 10086787 DOI: 10.1046/j.1365-2141.1999.01217.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Haematological data, genotype, transfusion requirements, metabolic indicators of oxidative stress (flux via hexose-monophosphate shunt (HMPS); steady state level of GSH and GSSG, NADPH and NADP; activity of anti-oxidant enzymes), parameters of membrane damage (aggregated band 3; membrane-bound haemichromes, autologous immunoglobulins (Igs) and C3 complement fragments) and erythrophagocytosis were measured in erythrocytes (RBC) of 15 beta-thalassaemia intermedia patients (nine splenectomized) with low, if any, transfusion requirements. Patients presented increased aggregated band 3, bound haemichromes, Igs and C3 complement fragments, and increased erythrophagocytosis. Bound haemichromes strongly correlated with aggregated band 3. Anti-band 3 Igs were predominantly associated with aggregated band 3. Erythrophagocytosis positively correlated with aggregated band 3, haemichromes and Igs, suggesting the involvement of haemichrome-induced band 3 aggregation in phagocytic removal of beta-thalassaemic RBC. Splenectomized patients showed higher degrees of membrane damage and phagocytosis, significantly higher numbers of circulating RBC precursors, and tendentially higher numbers of reticulocytes. Basal flux via HMPS was increased twofold, but HMPS stimulation by methylene blue was decreased, as was the glucose flux via HMPS. GSH was remarkably decreased, whereas NADPH was increased. Except for unchanged catalase and glutathione reductase, anti-oxidant enzymes had increased activity. Negative correlation between HMPS stimulation by methylene blue and bound haemichromes indicated that the ability to enhance HMPS may counteract haemichrome precipitation and limit consequent membrane damage leading to erythrophagocytosis.
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Affiliation(s)
- M D Cappellini
- Hereditary Anaemia Centre, Ospedale Maggiore IRCCS, Department of Internal Medicine, University of Milano Medical School, Italy.
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Abstract
Analytical protocols for the study of thalassemic erythrocyte membrane alterations are described. Denatured hemoglobin derivatives and aggregated band 3 are separated from detergent membrane extracts by gel-filtration as high-molecular-weight aggregates and quantitated spectrophotometrically. Membrane-bound, low-molecular-weight iron is measured on SDS-solubilized ghosts by a ferrozine-based colorimetric test. We adapted these methods for microscale preparation and analysis of erythrocyte ghosts in order to have suitable tools to estimate oxidative membrane damage in human samples. Data from 11 beta-thalassemia intermedia patients and from 10 normal controls are reported as an example of the application of these methods.
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Affiliation(s)
- D Tavazzi
- Dipartimento di Medicina Interna, Centro Anemie Congenite Ospedale Maggiore Policlinico, IRCCS, Universitá di Milano, Italia
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Martinez di Montemuros F, Dotti C, Tavazzi D, Fiorelli G, Cappellini MD. Molecular heterogeneity of glucose-6-phosphate dehydrogenase (G6PD) variants in Italy. Haematologica 1997; 82:440-5. [PMID: 9299858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase deficiency, one of the most common human enzymatic defects, is characterized by extreme molecular and biochemical heterogeneity. The molecular bases of almost all polymorphic italian variants have now been identified and the overall heterogeneity is lower than expected from biochemical data. METHODS We examined 161 G6PD-deficient subjects (130 males and 31 females) originating from different parts of Italy. G6PD activity and molecular characterization were determined in all the subjects analyzed. RESULTS We found the G6PD Mediterranean genotype in roughly 70%, G6PD Union and G6PD Seattle in about 6% and G6PD A- in 4% of the samples analyzed. G6PD S. Antioco and G6PD Cosenza were less frequent (1.2%), and single cases of G6PD Partenope and G6PD Tokyo were also detected. CONCLUSIONS We report the frequency and distribution of the most common G6PD variants in Italy. Greater molecular heterogeneity than described by others was observed, especially in Sardinia. Among the severe deficient variants, G6PD Mediterranean has a higher prevalence in Sardinia (83%) than in continental Italy (61%), as does G6PD Union (10% and 4%, respectively). G6PD Seattle and A-, associated with mild G6PD deficiency, are by contrast more frequent in continental Italy.
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Fiorelli G, Turrini F, Mannu F, Porro F, Graziadei G, Tavazzi D, Duca L, Cappellini M. Erythrocyte membrane alterations in thalassemia intermedia. Clin Hemorheol Microcirc 1996. [DOI: 10.3233/ch-1996-16607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G. Fiorelli
- Istituto di Medicina Interna e Fisiopatologia Medica, Ospedale Maggiore Policlinico IRCCS, Università di Milano
| | - F. Turrini
- Dipartimento di Genetica, Biologia e Chimica Medica, Università di Torino
| | - F. Mannu
- Dipartimento di Genetica, Biologia e Chimica Medica, Università di Torino
| | | | - G. Graziadei
- Istituto di Medicina Interna e Fisiopatologia Medica, Ospedale Maggiore Policlinico IRCCS, Università di Milano
| | - D. Tavazzi
- Istituto di Medicina Interna e Fisiopatologia Medica, Ospedale Maggiore Policlinico IRCCS, Università di Milano
| | - L. Duca
- Istituto di Medicina Interna e Fisiopatologia Medica, Ospedale Maggiore Policlinico IRCCS, Università di Milano
| | - M.D. Cappellini
- Istituto di Medicina Interna e Fisiopatologia Medica, Ospedale Maggiore Policlinico IRCCS, Università di Milano
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Cappellini MD, Martinez di Montemuros F, Dotti C, Tavazzi D, Fiorelli G. Molecular characterisation of the glucose-6-phosphate dehydrogenase (G6PD) Ferrara II variant. Hum Genet 1995; 95:440-2. [PMID: 7705842 DOI: 10.1007/bf00208972] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
During the last ten years, molecular biological techniques such as cloning and sequencing and, more recently, polymerase chain reaction (PCR) amplification have led to the identification of the molecular defects responsible for more than fifty glucose-6-phosphate dehydrogenase (G6PD) variants. In this paper, we report the identification of the molecular abnormality underlying the G6PD Ferrara II variant, present in the Po delta area of Northern Italy. Biochemical characterisation shows an enzymatic activity of about 15% of normal (WHO class III), slow electrophoretic mobility, low Km for G6P, high percentage substrate analogue utilisation and a biphasic pH optimum curve. After PCR amplification, non-radioisotopic single-strand conformation polymorphism analysis carried out for the entire coding region has revealed a mobility shift in exon 8. Nucleotide sequencing has demonstrated a missense 844 G > C mutation, causing an Asp > His amino-acid replacement, known as being responsible for G6PD Seattle, G6PD Modena and G6PD Lodi.
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Affiliation(s)
- M D Cappellini
- Istituto di Medicina Interna e Fisiopatologia Medica, Pad. Litta, Università di Milano, Ospedale Maggiore Policlinico, IRCCS, Italy
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Martinez di Montemuros F, Cappellini MD, Dotti C, Tavazzi D, De Bellis G, Debernardi S, Fiorelli G. Molecular characterisation of an Italian G6PD variant responsible for chronic non-spherocytic haemolytic anaemia. Clin Genet 1994; 46:357-9. [PMID: 7889645 DOI: 10.1111/j.1399-0004.1994.tb04178.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An Italian deficient G6PD variant associated with chronic non-spherocytic haemolytic anaemia (CNSHA) was biochemically characterised and studied at molecular level. Single-strand conformation polymorphism (SSCP) analysis led to the identification of an abnormal migration pattern of an amplified fragment encompassing exons 10 and 11 of the G6PD gene. Sequence analysis of both strands using an automated fluorescent DNA sequencer revealed a G-->A transition at nt. position 1246 in exon 10. A C-->T substitution at nt. 1311 in exon 11 was also found, which has already been described as a silent mutation common in Caucasians. The 1246 G-->A mutation has been described only in a Japanese subject with CNSHA (G6PD Tokyo) not associated with the 1311T polymorphism, suggesting that this mutation may have arisen independently in Europe and Asia.
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Cappellini MD, Sampietro M, Toniolo D, Carandina G, Pittalis S, Martinez di Montemuros F, Tavazzi D, Fiorelli G. Biochemical and molecular characterization of a new sporadic glucose-6-phosphate dehydrogenase variant described in Italy: G6PD Modena. Br J Haematol 1994; 87:209-11. [PMID: 7947250 DOI: 10.1111/j.1365-2141.1994.tb04896.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A new glucose-6-phosphate dehydrogenase variant detected in an Italian man from the Po delta is described and designated as G6PD Modena. Biochemical characterization of the variant enzyme revealed an activity 21% of normal, a slow electrophoretic mobility, increased Km value for NADP, decreased Km value for G6P and a complete absence of NADPH inhibition, which could account for the apparently nonhaemolytic feature of this variant. The cloning and sequencing of the G6PD Modena allele showed a G-->C transition at nucleotide 844 in exon VIII causing a Asp-->His amino acid substitution. On the basis of biochemical characterization, G6PD Modena is classified as a genuine variant but it has the same mutation as G6PD Seattle-like.
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Affiliation(s)
- M D Cappellini
- Istituto di Medicina Interna e Fisiopatologia Medica, Ospedale Maggiore Policlinico, Milano, Italy
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Cappellini MD, Sampietro M, Toniolo D, Carandina G, Martinez di Montemuros F, Tavazzi D, Fiorelli G. G6PD Ferrara I has the same two mutations as G6PD A(-) but a distinct biochemical phenotype. Hum Genet 1994; 93:139-42. [PMID: 7906668 DOI: 10.1007/bf00210598] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The cloning and sequencing of the normal glucose-6-phosphate dehydrogenase (G6PD) gene has led to the study of the molecular defects that determine enzymatic variants. In this paper, we describe the mutations responsible for the Ferrara I variant in an Italian man with a family history of favism, from the Po delta. Nucleotide sequencing of this variant showed a G-->A mutation at nucleotide 202 in exon IV causing a Val-->Met amino acid exchange, and a second A-->G mutation at nucleotide 376 in exon V causing an Asn-->Asp amino acid substitution. Although on the basis of its biochemical properties this variant was classified as G6PD Ferrara I, it has the same two mutations as G6PD A(-), which is common in American and African blacks, and as the sporadic Italian G6PD Matera. The mutation at nucleotide 202 was confirmed by NlaIII digestion of a polymerase chain reaction amplified DNA fragment spanning 109 bp of exon IV. The 109-bp mutated amplified sequence is not distinguishable from the normal sequence in single strand conformation polymorphism analysis.
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Affiliation(s)
- M D Cappellini
- Istituto di Medicina Interna e Fisiopatologia Medica, Ospedale Maggiore Policlinico, Milano, Italy
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Cappellini MD, Tavazzi D, Martinez di Montemuros F, Sampietro M, Gaviraghi A, Carandini D, Fiorelli G. Alternative splicing of human G6PD messenger RNA in K562 cells but not in cultured erythroblasts. Eur J Clin Invest 1993; 23:188-91. [PMID: 8477794 DOI: 10.1111/j.1365-2362.1993.tb00760.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The biochemical properties of glucose-6-phosphate dehydrogenase (G6PD) vary in different tissues, and different protein isoforms of the enzyme have been described. Alternative splicing of G6PD intron VII has been detected in transformed lymphoblasts, granulocytes and spermatocytes; the function of this mRNA species is still unknown. We developed a PCR for detecting alternatively spliced G6PD mRNA in K562 and in erythroblasts at different stage of maturation obtained from human peripheral BFU-E in order to evaluate a possible physiological role during erythroid maturation. Trace events of alternative splicing of G6PD intron VII sequences were observed in K562 cells but not in BFU-E-derived erythroid precursors; we consider this phenomenon a non-functional activity in the cells analysed.
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Affiliation(s)
- M D Cappellini
- Istituto di Medicina Interna e Fisiopatologia Medica, Ospedale Maggiore Policlinico, Università di Milano, Italy
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Pittalis S, Martinez di Montemuros F, Tavazzi D, Fiorelli G. Rapid isolation of glucose-6-phosphate dehydrogenase from human erythrocytes by combined affinity and anion-exchange chromatography for biochemical characterization of variants. J Chromatogr 1992; 573:29-34. [PMID: 1564103 DOI: 10.1016/0378-4347(92)80470-b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A new method is presented for the purification of human glucose-6-phosphate dehydrogenase (G6PD) using affinity chromatography with 2'5'-ADP-Sepharose 4B followed by automated ion-exchange chromatography with DEAE 5PW. This rapid method allows a high recovery of enzyme activity from even a small amount of blood; the yield is about 90% after the first purification step and 70% at the end of the procedure. There is an excellent reproducibility of the kinetic parameters and optimal biochemical characterization of G6PD is achieved even for variants associated with severe enzyme deficiency (e.g. G6PD Mediterranean).
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Affiliation(s)
- S Pittalis
- Istituto di Scienze Biomediche San Gerardo, Università di Milano, Monza, Italy
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Cappellini MD, Villa S, Gaviraghi A, Martinez di Montemuros F, Tavazzi D, Panzeri D, Fiorelli G. Behaviour of glucose-6-phosphate dehydrogenase during erythroid maturation. Adv Exp Med Biol 1991; 307:37-43. [PMID: 1805600 DOI: 10.1007/978-1-4684-5985-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M D Cappellini
- Istituto di Medicina Interna, Università di Milano, Monza, Italy
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