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Comparison of the protein and DNA approaches for the characterization of a beta-globin chain variant, hemoglobin Cocody [beta 21 (B3) Asp--->Asn], in a Caucasian patient.

Over the past few years, the methodologies used for the identification of hemoglobin A variants have been greatly improved. Both the protein- and DNA-based strategies have their own advantages and limitations. In this report we illustrate the use of both assays for the characterization of a hemoglobin Cocody variant in a women of Spanish descent. After evaluating the mobility value matrix of the abnormal hemoglobin, the amino acid transition was determined by HPLC and micro-sequencing of the protein. The beta 21 Asp was shown to be substituted by an Asn. At the DNA level, the only nucleotide replacement responsible for this amino acid substitution is GAT--->AAT at codon 21. The analysis of the beta-globin gene by denaturing gradient gel electrophoresis (DGGE) method showed that the mutation was situated in a fragment including exon 1. The hemoglobin variant was then identified to be hemoglobin Cocody by DNA sequencing of this fragment.

Adult↗

Hemoglobin Fannin-Lubbock [alpha2 beta 2 119 (GH2) Gly replaced by Asp]. A new hemoglobin variant at the alpha1 beta 1 contact.

Hemoglobin Fannin-Lubbock was found in a 9-year-old Mexican-American female. The abnormal hemoglobin was detected as a fast-moving variant by electrophoresis on cellulose acetate at pH 8.4. Structural analysis indicated a substitution in the beta-chain of aspartic acid for glycine at position 119, a position involved in the alpha1beta1 contact of the hemoglobin tetramer. This contact between unlike chains is larger and undergoes a smaller shift during the process of oxygenation and deoxygenation that the alpha1beta2 contact (Perutz, M.F., Muirhead, H., Cox, J.M. and Goaman, L.C.G. (1968) Nature 219, 131-139). Mutations in this contact tend to cause slight or no changes in functional behavior. Apart from a mild anemia, the propositus did not exhibit any obvious clinical symptoms.

Amino Acids↗

Hb Albany-Suma (alpha 11 [A9] Lys----Asn), a hemoglobin variant with slightly elevated oxygen affinity in Japan.

A fast-moving abnormal hemoglobin was detected in a heterozygous condition from a patient with benign goiter. The hemoglobin has a slight but significant high oxygen affinity. The patient does not show any hematologic abnormality. Structural analysis indicated that a lysine residue normally present at alpha 11 was substituted by an asparagine residue. This substitution which has not been described previously was discovered coincidentally by another laboratory (1). The new variant has been named Hb Albany-Suma to denote the origin of the variant in both the United States and Japan.

Aged↗

Hb Kurosaki [alpha7(A5)Lys -->Glu (AAG --> GAG)]: an alpha2-globin gene mutation found in Thailand.

Hb Kurosaki [alpha 7(A5)Lys --> Glu (AAG --> GAG)], has been found for the first time in Thailand. The 30-year-old Thai male had a normal hematological profile at the steady state, but showed an abnormal hemoglobin (Hb) present at a level of 28%. Protein characterization was performed by automated sequencer analysis of the abnormal alpha-globin chain and amino acid analysis of the abnormal alphaT-1,2 peptide. Direct DNA sequence analysis of selectively amplified segments of the alpha1 and alpha2 genes showed that codon 7 of the alpha2-globin gene was heterozygous for AAG (Lys) and GAG (Glu). This was confirmed by restriction endonuclease digestion with Eco31I.

Adult↗

Niemann-Pick disease in association with homozygous hemoglobin E: a case report.

The first case of Niemann-Pick disease Type A in a Thai infant was reported. The patient also had abnormal hemoglobin E. The diagnosis was based on the clinical features, bone marrow findings and sphingomyelinase levels in the culture of skin fibroblasts. The autosomal recessive mode of inheritance was confirmed in this case.

Bone Marrow Examination↗

Three cases of hemoglobin O Arab.

Three new cases of Hb 0 Arab in two families are reported from districts of Bulgaria, where a carrier state of this abnormal hemoglobin has not been established so far. One of the propositi is a double heterozygote for Hb 0 Ar/beta(0)-thalassemia. His father is a simple heterozygote for Hb 0 Ar with clear-cut cytomorphological stigmata, indicating hemoglobinosis. The second propositus, according to clinical and laboratory data is also a double heterozygote for Hb 0 Ar and beta(0)-thalassemia. The carriers investigated are of Bulgarian nationality. Their territorial origin supportsthe thesis that the gene mutation for Hb 0 Arab most probably has taken place out of the present boundaries of Bulgaria.

Adult↗

A pitfall in hemoglobin electrophoresis. Artefactual minor unstable hemoglobin results from improper specimen handling.

Blood specimens are commonly mailed for the purpose of hemoglobin studies, such as identification of abnormal hemoglobins and measurement of hemoglobins A2 and F. In a period of a few months, the author examined eight specimens sent from a referring laboratory, in which cellulose acetate electrophoresis (p H 8.6) revealed a discrete minor band in a position approximately midway between the positions of hemoglobins A and S. For each specimen, tests for hemoglobin instability were positive. In one specimen, marked methemoglobinemia and sulfhemoglobinemia were also demonstrated. Further studies of fresh specimens obtained from the same subjects failed to demonstrate any hemoglobinopathy. The abnormal band in the original eight specimens was an artefact resulting from improper specimen handling--that is, unduly long transit times without refrigeration. The aftefactual band had electrophoretic mobility identical to that of methemoglobin derived from hemoglobin A.

Aged↗

Genetic variants of hemoglobin and other blood proteins in the San Francisco Bay area.

Studies of blood genetics in "normal healthy" persons and patients of different racial groups in the San Francisco Bay Area were carried out from January 1965 to April 1968. They show that diseases due to genetic abnormalities of blood are fairly common in this region. Frequencies for abnormal hemoglobins and erythrocyte enzyme deficiencies and variants were recorded and it was noted that abnormalities in hemoglobin metabolism that may lead to mild or severe clinical and hematological symptoms proved rather common. Accompanying other disease conditions, they may cause difficulties in diagnosis. Several diseases due to or associated with different enzyme abnormalities were encountered.

Blood Protein Disorders↗

Thalassemia and G-6-PD deficiency in Chinese-Canadians: admission screening of a hospital population.

Admission screening was performed on 684 Chinese-Canadian patients for thalassemia, abnormal hemoglobins and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Thirty-six healthy Chinese adults were also studied. The incidence of beta-thalassemia minor (hemoglobin A(2) greater than 3.5%) was 3.8%. Presumptive alpha-thalassemia minor (demonstration of occasional red cells containing hemoglobin H inclusion bodies) was found in 6.7%. Two patients had findings consistent with alpha-beta-thalassemia. The incidence of G-6-PD deficiency (abnormal methemoglobin reduction test) in adult males was 4.7%. In a parallel study the incidence of hemoglobin Bart's in 310 Chinese newborns was 6.8%. Two mutant hemoglobins were found - hemoglobin E and hemoglobin J (Bangkok).

Adult↗

Genetic and biosynthetic studies of families carrying hemoglobin J alpha Mexico: association of alpha-thalassemia with HbJ.

Hemoglobin J Mexico, an alpha chain mutant, was studied in eight unrelated Algerian families. The quantities of the abnormal hemoglobin in 116 subjects are trimodally distributed: 55% in homozygotes, 31% and 38% in heterozygotes. Both hematological data and the alpha/beta chain biosynthetic ratio are normal in heterozygotes with 31% Hb J and in homozygotes. In contrast, the MCV and MCH as well as the alpha/beta biosynthetic ratio are slightly reduced in heterozygotes with 38% Hb J and in their relatives carrying Hb A. The elevated expression of alphaJ chains in heterozygotes with 38% Hb J may be due to an alpha thalassemia gene trans to the alphaJ locus.

Algeria↗

Heterozygous Hb Hope [beta136(H14)Gly --> Asp] in association with heterozygous beta0-thalassemia with apparent homozygous expression, in a Spanish patient.

Hb Hope [beta136(H14)Gly --> Asp (GGT --> GAT)] has been found alone or in combination with other globin gene mutations in several African-American families, as well as in Japanese, Thai, Laotian, Cuban and Mauritanian families. We report the hematological and molecular characteristics of a heterozygous association of Hb Hope with beta0-thalassemia (thal) in a Spanish patient, in whom the level of expression of abnormal hemoglobin (Hb) by cation exchange high performance liquid chromatography (HPLC) and electrophoresis suggested initially a homozygous expression of the abnormal Hb, although sequencing of the polymerase chain reaction (PCR)-amplified beta-globin gene demonstrated a heterozygous genotype for Hb Hope. To the best of our knowledge, this is the first description of a case of Hb Hope in a Spanish family.

Adult↗

Altered erythropoiesis and increased hemolysis in hemoglobin M Akita (M Hyde Park beta92 His replaced by Tyr) disease.

Hb M Akita disease is a cyanotic hemoglobinopathy found in Akita Prefecture, Japan. The abnormal hemoglobin was found to be the same as Hb M Hyde Park (beta92 His replaced by Tyr) by chemical analysis in 1967. In this disease signs of accelerated hemolysis (serum bilirubin, 2.4 mg/dl; splenomegaly, 2 finger breadths; Hb, 10.7 g/dl; reticulocyte index, 2.7) were noted, but the causes of its slight anemia were revealed to be fairly complex by ferrokinetic study, RBC life-span measurement, and 99mTc myeloscintigram. The anemia in this disease is caused not only by shortened erythrocyte survival (T 1/2 = 11.5 days by 51Cr-tagging method) and sequestration of red cells in the spleen (Spleen: liver ratio = 2.5 approximately 3.0 by 51Cr-surface counting), but also by slow supply of erythrocytes to the peripheral blood from the bone marrow, presumably, related to the existence of unstable Hb M Akita and its derivative (Hb Akita) in the erythroid cells. Both Carrell's isopropanol test and Heinz body formation test were positive. In spite of maximally increased total erythropoiesis (8 times as high as the normal level; M:E ratio = 0.22:1.0), supply of red cells from the bone marrow to the peripheral blood was significantly decreased. The distribution of hematopoietic sites throughout the body was reasonably uniform.

Adult↗

The human hemoglobin variants in Canada.

This report summarizes the results of a search for abnormal hemoglobin variants by use of a filter paper electrophoresis technique on 228,300 blood samples obtained from various parts of four Canadian provinces. Abnormal variants were found in 438 samples and were of 27 different varieties, including six new ones. In addition, the characteristics of beta-thalassemia were found in 147 samples. The types of variant found, and their geographical and ethnic origin are presented.

Alberta↗

Hb Suan-Dok [alpha109(G16)Leu-->Arg; CTG-->CGG (alpha2)] described in a patient of African ancestry.

A 58-year-old Black female from Curaçao (West Indies) was recently referred to our Laboratory for a persistent microcytic hypochromic anemia. An analysis 13 years earlier had shown no abnormal hemoglobin (Hb) fractions and a balanced beta/alpha synthetic ratio. The hematological indices were again compatible with thalassemia and no abnormal fractions were observed on electrophoresis or high-performance liquid chromatography (HPLC). None of the seven common alpha-thalassemia (thal) deletion defects were present. Direct sequencing of the alpha2 gene revealed a CTG-->CGG single base substitution at codon 109. This mutation was previously described in a Thai patient (Hb Suan-Dok), inducing Hb H disease in association with a - -(SEA) allele. In contrast with earlier reports we were unable to identify any native Hb fraction. The balanced beta/alpha ratio indicated that alpha2-Suan-Dok is formed but does not form tetramer formation unless alpha-thal is present.

Anemia, Hypochromic↗

Asymmetric hybrids between hemoglobin Alberta (alpha 2 beta 2 101 Glu replaced by Gly) and hemoglobins A, A2 or F1 in different liganded states.

Isoelectric focusing in cylindrical polyacrylamide gels has been used to demonstrate the formation of asymmetric hybrids between an abnormal hemoglobin, Hb Alberta (alpha 2 beta 2 101 Glu replaced by Gly), and Hb A (alpha 2 beta 2), Hb A2 (alpha 2 delta 2) or Hb F1 (alpha 2 gamma 2 Acetyl). There was no discernible difference in the stabilities of the three hybrids (alpha 2 beta A beta Alberta, alpha 2 delta beta Alberta and alpha 2 gamma Acetyl beta Alberta) in the oxy, carboxy or cyanmet hemoglobin forms. Two mixed liganded hybrids, (alpha beta A)oxy (alpha beta Alberta)cyanmet and (alpha beta A)cyanmet (alpha beta Alberta)oxy were also demonstrated and found to have stabilities similar to that of the Hb Alberta hybrids.

Drug Stability↗

A diabetic case of Hb Riyadh with a low HbA1c value.

A 74-year-old male patient with diabetes mellitus and hypertension who had been treated for a long period was admitted to our hospital. Laboratory data on admission revealed high values for fasting blood sugar and fructosamine, 219 mg/dl and 389 mumol/l respectively, while the concentration of glycated hemoglobin (HbA1c) was low (3.0%). High performance liquid chromatography and isoelectric focusing analysis of the patient's Hb disclosed abnormal Hb with the content being 41.3%. The structural analysis indicated that this abnormal Hb was Hb Riyadh [beta 120 (GH3) Lys-->Asn]. The low value of HbA1c despite the high blood glucose level may be attributed to this abnormal hemoglobin.

Aged↗

Hb Marseille [alpha 2 beta 2 N methionyl-2 (NA2) His----Pro]: a new beta chain variant having an extended N-terminus.

A new abnormal hemoglobin was found in a diabetic Maltese woman by citrate agar electrophoresis. This variant was undetectable by isoelectric focusing. No hematological abnormalities were observed. The structural analysis included isolation of the abnormal beta chain, high pressure liquid chromatography of the corresponding tryptic peptides and then microsequencing of the abnormal T1. These procedures revealed a double abnormality: the presence of a methionyl residue extending the NH2 terminus and a histidine to proline substitution in position NA2.

Amino Acid Sequence↗

Enzymatic reduction of hemoglobins M Milwaukee-1 and M Saskatoon by NADH-cytochrome b5 reductase and NADPH-flavin reductase purified from human erythrocytes.

Enzymatic reduction of the hemoglobin (Hb) M group was studied. Hb M Milwaukee-1 and Hb M Saskatoon were reduced by NADH-cytochrome b5 reductase highly purified from human erythrocytes. Hb M Saskatoon was also reduced by another enzyme in red cells, NADPH-flavin reductase. The reduction rates of Hb M Saskatoon by both enzymes were almost the same as those of MetHb A. The reduction of Hb M Milwaukee-1 by NADH-cytochrome b5 reductase progressed much more slowly than that of Hb M Saskatoon and MetHb A. It took 1/2 h and 10 h for the 50% reduction of Hb M Saskatoon and Hb M Milwaukee-1, respectively. These two methemoglobin reductases from erythrocytes did not reduce other hemoglobins M such as Hb M Iwate, Hb M Boston, or Hb M Hyde Park. A possible role of these abnormal hemoglobins as oxygen carriers and the reason for cyanosis in the patients of Hb M Saskatoon and Hb M Milwaukee-1 are discussed.

Cytochrome Reductases↗