Abstract
One hundred and twenty patients with homozygous beta thalassaemia were selected to determine the clinical effects of certain genetic factors which may modify disease severity. Genetic analysis defined specific beta thalassaemia mutations, the alpha thalassaemia genotype, and the presence of an XmnI restriction enzyme site, associated with increased fetal haemoglobin (HbF) production under certain conditions. Genotypic data with globin chain synthesis were related to the age when regular transfusions began and subsequent pubertal development. This study showed that the major determinants of disease severity in beta thalassaemia were the beta thalassaemia mutations, with co-inheritance of alpha thalassaemia trait and coinheritance of a high HbF determinant acting as ameliorating factors. The presence of an alpha thalassaemia deletion significantly reduced initial disease severity, although the effect on pubertal development was less clear. It is concluded that detailed genetic analysis should be performed in all newly diagnosed patients with thalassaemia. This, in conjunction with clinical assessment, will help to predict disease severity and prognosis.
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- Clegg J. B., Naughton M. A., Weatherall D. J. Separation of the alpha and beta-chains of human hemoglobin. Nature. 1968 Jul 6;219(5149):69–70. doi: 10.1038/219069a0. [DOI] [PubMed] [Google Scholar]
- De Virgiliis S., Congia M., Frau F., Argiolu F., Diana G., Cucca F., Varsi A., Sanna G., Podda G., Fodde M. Deferoxamine-induced growth retardation in patients with thalassemia major. J Pediatr. 1988 Oct;113(4):661–669. doi: 10.1016/s0022-3476(88)80375-5. [DOI] [PubMed] [Google Scholar]
- Gilman J. G., Huisman T. H. Two independent genetic factors in the beta-globin gene cluster are associated with high G gamma-levels in the HbF of SS patients. Blood. 1984 Aug;64(2):452–457. [PubMed] [Google Scholar]
- Gonzalez-Redondo J. M., Stoming T. A., Kutlar A., Kutlar F., Lanclos K. D., Howard E. F., Fei Y. J., Aksoy M., Altay C., Gurgey A. A C----T substitution at nt--101 in a conserved DNA sequence of the promotor region of the beta-globin gene is associated with "silent" beta-thalassemia. Blood. 1989 May 1;73(6):1705–1711. [PubMed] [Google Scholar]
- Orkin S. H., Kazazian H. H., Jr, Antonarakis S. E., Goff S. C., Boehm C. D., Sexton J. P., Waber P. G., Giardina P. J. Linkage of beta-thalassaemia mutations and beta-globin gene polymorphisms with DNA polymorphisms in human beta-globin gene cluster. Nature. 1982 Apr 15;296(5858):627–631. doi: 10.1038/296627a0. [DOI] [PubMed] [Google Scholar]
- Rosatelli M. C., Oggiano L., Battista Leoni G., Tuveri T., Di Tucci A., Scalas M. T., Dore F., Pistidda P., Massa A., Longinotti M. Thalassemia intermedia resulting from a mild beta-thalassemia mutation. Blood. 1989 Feb;73(2):601–605. [PubMed] [Google Scholar]
- Sutton M., Bouhassira E. E., Nagel R. L. Polymerase chain reaction amplification applied to the determination of beta-like globin gene cluster haplotypes. Am J Hematol. 1989 Sep;32(1):66–69. doi: 10.1002/ajh.2830320113. [DOI] [PubMed] [Google Scholar]
- Tamagnini G. P., Lopes M. C., Castanheira M. E., Wainscoat J. S., Wood W. G. Beta + thalassemia--Portuguese type: clinical, haematological and molecular studies of a newly defined form of beta thalassaemia. Br J Haematol. 1983 Jun;54(2):189–200. doi: 10.1111/j.1365-2141.1983.tb02087.x. [DOI] [PubMed] [Google Scholar]
- Tanner J. M., Whitehouse R. H., Takaishi M. Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. I. Arch Dis Child. 1966 Oct;41(219):454–471. doi: 10.1136/adc.41.219.454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thein S. L., Al-Hakim I., Hoffbrand A. V. Thalassaemia intermedia: a new molecular basis. Br J Haematol. 1984 Feb;56(2):333–337. doi: 10.1111/j.1365-2141.1984.tb03960.x. [DOI] [PubMed] [Google Scholar]
- Thein S. L., Wainscoat J. S., Sampietro M., Old J. M., Cappellini D., Fiorelli G., Modell B., Weatherall D. J. Association of thalassaemia intermedia with a beta-globin gene haplotype. Br J Haematol. 1987 Mar;65(3):367–373. doi: 10.1111/j.1365-2141.1987.tb06870.x. [DOI] [PubMed] [Google Scholar]
- Thein S. L. beta-Thalassaemia. Baillieres Clin Haematol. 1993 Mar;6(1):151–175. doi: 10.1016/s0950-3536(05)80069-1. [DOI] [PubMed] [Google Scholar]
- Varawalla N. Y., Old J. M., Weatherall D. J. Rare beta-thalassaemia mutations in Asian indians. Br J Haematol. 1991 Dec;79(4):640–644. doi: 10.1111/j.1365-2141.1991.tb08094.x. [DOI] [PubMed] [Google Scholar]
- Wainscoat J. S., Old J. M., Weatherall D. J., Orkin S. H. The molecular basis for the clinical diversity of beta thalassaemia in Cypriots. Lancet. 1983 Jun 4;1(8336):1235–1237. doi: 10.1016/s0140-6736(83)92694-6. [DOI] [PubMed] [Google Scholar]
- Winichagoon P., Thonglairoam V., Fucharoen S., Wilairat P., Fukumaki Y., Wasi P. Severity differences in beta-thalassaemia/haemoglobin E syndromes: implication of genetic factors. Br J Haematol. 1993 Apr;83(4):633–639. doi: 10.1111/j.1365-2141.1993.tb04702.x. [DOI] [PubMed] [Google Scholar]