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Usefulness of NGS for Diagnosis of Dominant Beta-Thalassemia and Unstable Hemoglobinopathies in Five Clinical Cases.

ABSTRACT: Unstable hemoglobinopathies (UHs) are rare anemia disorders (RADs) characterized by abnormal hemoglobin (Hb) variants with decreased stability. UHs are therefore easily precipitating, causing hemolysis and, in some cases, leading to dominant beta-thalassemia (dBTHAL). The clinical picture of UHs is highly heterogeneous, inheritance pattern is dominant, instead of recessive as in more prevalent major Hb syndromes, and may occur de novo. Most cases of UHs are not detected by conventional testing, therefore diagnosis requires a high index of suspicion of the treating physician. Here, we highlight the importance of next generation sequencing (NGS) methodologies for the diagnosis of patients with dBTHAL and other less severe UH variants. We present five unrelated clinical cases referred with chronic hemolytic anemia, three of them with severe blood transfusion dependent anemia. Targeted NGS analysis was performed in three cases while whole exome sequencing (WES) analysis was performed in two cases. Five different UH variants were identified correlating with patients' clinical manifestations. Four variants were related to the beta-globin gene (Hb Bristol-Alesha, Hb Debrousse, Hb Zunyi, and the novel Hb Mokum) meanwhile one case was caused by a mutation in the alpha-globin gene leading to Hb Evans. Inclusion of alpha and beta-globin genes in routine NGS approaches for RADs has to be considered to improve diagnosis' efficiency of RAD due to UHs. Reducing misdiagnoses and underdiagnoses of UH variants, especially of the severe forms leading to dBTHAL would also facilitate the early start of intensive or curative treatments for these patients.

SUBMITTER: Rizzuto V

PROVIDER: S-EPMC7893112 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Usefulness of NGS for Diagnosis of Dominant Beta-Thalassemia and Unstable Hemoglobinopathies in Five Clinical Cases.

Rizzuto Valeria V Koopmann Tamara T TT Blanco-Álvarez Adoración A Tazón-Vega Barbara B Idrizovic Amira A Díaz de Heredia Cristina C Del Orbe Rafael R Pampliega Miriam Vara MV Velasco Pablo P Beneitez David D Santen Gijs W E GWE Waisfisz Quinten Q Elting Mariet M Smiers Frans J W FJW de Pagter Anne J AJ Kerkhoffs Jean-Louis H JH Harteveld Cornelis L CL Mañú-Pereira Maria Del Mar MDM

Frontiers in physiology 20210205

Unstable hemoglobinopathies (UHs) are rare anemia disorders (RADs) characterized by abnormal hemoglobin (Hb) variants with decreased stability. UHs are therefore easily precipitating, causing hemolysis and, in some cases, leading to dominant beta-thalassemia (dBTHAL). The clinical picture of UHs is highly heterogeneous, inheritance pattern is dominant, instead of recessive as in more prevalent major Hb syndromes, and may occur <i>de novo</i>. Most cases of UHs are not detected by conventional te ...[more]

PMID: 33613322

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Project description:BackgroundThe frequency of the beta-thalassemia (β-thalassemia) gene in Indonesia ranges from 3 to 10%. However, in the East Java province, there is still limited information on the prevalence of β-thalassemia mutations in clinically diagnosed beta-thalassemia patients of East Java. Therefore, this study aimed to characterize β-thalassemia mutations in selected patients in the East Java province of Indonesia.MethodsThis is an analytical observational study. Diagnosis of β-thalassemia was based on clinical presentation, complete blood count (CBC), and hemoglobin (Hb) electrophoresis. Blood specimens taken from each patient in three ethylenediaminetetraacetic acid (EDTA) tubes were analyzed for CBC and Hb electrophoresis and processed for DNA extraction and subsequent polymerase chain reaction (PCR). Detection of mutations in Hemoglobin Subunit Beta (HBB) gene exons 1-3 of the β-thalassemia gene as the common mutation in Indonesia was done using PCR followed by Sanger sequencing.ResultsIn total, 33 (n = 33) participants were involved in this study with ages ranging from 5 to 17 years comprising 19 women and 14 men. Their ethnic origins were Javanese (n = 30) and Chinese (n = 3). CBC results showed that mean ± standard deviation (SD) for Hb, red blood cell (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW)-CV were 81.2 ± 7.0 g/L; 3.40 ± 0.39 × 109/L; 71.05 ± 5.72 fL; 24.12 ± 2.45 pg; 33.91 ± 1.47 g/dl; 24.38 ± 6.02%, respectively. Hb electrophoresis revealed that 5 out of 33 participants had beta-thalassemia and 28 out of 33 participants had hemoglobinopathy (Hb) E/beta-thalassemia. Results of Sanger sequencing showed the following genotype variations in the samples: 12 (36.4%) with β CD26 /β IVS-I-5; 6 (18.2%) with β CD26 /β CD35; 3 (9.1%) with β CD26 /β IVS-I-2; 2 (6.1%) with β CD27/28 /β CD40; 2 (6.1%) with β IVS-I-1 /β CAP+1; and β CD26 /β IVS-I-1; β IVS-I-5 /β CAP+1; β IVS-I-5 /β CD35; β CD26 /β CD37; β CD26 /β CD15; β CD26 /β CD40; and β IVS-I-5 /β CD19 in 1 (3%) sample, respectively, and 1 (3%) had no abnormality detected in sequencing even though electrophoresis showed abnormality in the migration pattern. The β CD26 /β IVS-I-5 mutation was found in samples that were noted to have Hb E/beta-thalassemia on Hb electrophoresis.ConclusionThe underlying genetic variations are heterogeneous in thalassemia patients in East Java, where 12 variants were found. The most common variant was β CD26 /β IVS-I-5, which all accounted for Hb E/beta-thalassemia on Hb electrophoresis. Furthermore, 28 out of 33 participants had hemoglobinopathy (Hb) E/beta-thalassemia.

Project description:Worldwide, thalassemia represents one of the most common genetic disorders. There is a prevalence of Beta-thalassemia in Kingdom of Saudi Arabia (KSA), however there is a genetic counseling availability and an existence of mandatory premarital testing policy. Few studies detect molecular mutations of thalassemia genes in different KSA governates, including Makkah, Hufuf, Qatif, and Dammam but in our peer knowledge there is no reports on high altitude Taif region. The aim of the present study is to evaluate the molecular mutation analysis of β-thalassemia gene in El Taif province (as a high-altitude area) patients of KSA and to estimate the iron overload toxicity due to thalassemia syndrome on the hotspot noncoding D-loop region (hypervariable, HV2 gene fragment) of mtDNA. Blood samples were collected from total 25 β-thalassemia patients and 25 normal control that were used for HPLC, hematological analysis and different molecular evaluations. Extracted nuclear DNA from blood sample was used to detect known mutations accompanied with β-thalassemia in other countries using PCR-ARMS technique targeting IVSII-1, IVSI-5, Codon 8/9, Cd44 and Cd5 genes' mutations. Moreover, mtDNA was used to detect point of mutation of HV2 fragment in the D-loop region using PCR-SSCP and then sequencing. Results show significant increase in the level of HbA2 and decrease of HbA in comparison to control by using HPLC. PCR-ARMS reports that all β-thalassemia patients have heterozygous alleles of wild and mutated regions with nucleotide transition/transversion of IVSI-5 (AC>AG), Codon 8/9 (CT>CC), and Cd44 (GG>GA), however no point of mutation was detected in IVSII-1 (AC>AT) Cd5 (CT>CG) genes. Moreover, PCR-SSCP shows points of mutations for β-thalassemia HV2 fragment that were confirmed by sequencing in the form of base pairs deletion, insertion and transition/transversion. For the first time, the present study reports the presence of 2 bps found in HV2 region that might be specific to KSA nations and not found in other countries. In conclusion, our results were in concurrent with other studies in the presence of specific genetic mutations in β-thalassemia patients that is accompanied with points of mutations in HV2 region of high altitude Taif governate.

Dataset Information

Usefulness of NGS for Diagnosis of Dominant Beta-Thalassemia and Unstable Hemoglobinopathies in Five Clinical Cases.

Publications

Usefulness of NGS for Diagnosis of Dominant Beta-Thalassemia and Unstable Hemoglobinopathies in Five Clinical Cases.

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