The epidemiology of abnormal hemoglobins in Mediterranean high-level athletes

The aim of this study was to determine the prevalence and nature of hemoglobin (Hb) defects in a Mediterranean high-level (HL) athlete population. Five hundred and ninety-four HL male and female athletes were recruited during the annual follow-up of the members of Tunisian national teams. Hematological data, Hb electrophoresis, and DNA analysis were assessed using conventional techniques. Sporting discipline, type of sport, and performance levels were assessed using a questionnaire. The results showed that 32 HL athletes had abnormal Hb (5.4%): β-thalassemia (2.2%), α-thalassemia (0.5%), HbAS (1.5%), HbAC (0.5%), and rare Hb variants (0.7%). Of the 32 defect carriers, all but one (a α-thalassemia) were heterozygous. All the detected hemoglobinopathies but one (an Hb Hope) had already been reported in the country. The prevalence of Hb defect in the HL athletes was similar to that described in the general Tunisian population (P > 0.05). The percentage of Hb defect in the athletes was not dependent on gender, or performance level (P > 0.05). Within each type of sport the percentages of athletes with normal and abnormal Hb were similar (P > 0.05). The hematological data revealed the diversity of anemia, microcytosis, and hypochromia in thalassemic HL athletes. We concluded that HL athletes in Tunisia were a representative sample of the general Tunisian population regarding the prevalence and nature of benign abnormal Hb. The hematological data of the thalassemia carriers exhibited high variability and raised the question of genetic and sporting counseling, as well as biological follow-up for these carriers.     

Interference of hemoglobin Hope on beta-thalassemia diagnosis by the capillary electrophoresis Method

The β-chain hemoglobin (Hb) variants interfere with the diagnosis of β-thalassemia trait using high-performance liquid chromatography (HPLC) and capillary electrophoresis (CE). We analyzed the effect of Hb Hope, a β-chain Hb variant frequently found in the Thai population, on β-thalassemia trait diagnosis. HPLC and CE were used to quantify the level of HbA(2) in 11 whole blood samples containing Hb Hope. The levels of Hb Hope detected by both methods were similar. An elevated HbA(2) level was found in all samples analyzed by the CE method, while 1 was increased when analyzed by HPLC, which was a compound heterozygous of Hb Hope and α-thalassemia-1 SEA-type deletion. Of 11 samples, 6 had mean corpuscular volumes within the reference range. All samples showed negative results for molecular analysis of β(0)-thalassemia codon 17, 41/42, and 71/72 mutations and β-thalassemia 3.5-kb deletion. Therefore, Hb Hope interfered with the diagnosis of β-thalassemia trait analyzed by CE but not by HPLC.     

Hemoglobin Hope found in a patient with basal cell carcinoma of the genial region

Hemoglobinopathy was detected in a 72-year-old female with basal cell carcinoma of the genial region during high-performance liquid chromatography of hemolysate for the assay of HbA1c. Structural analysis demonstrated that this abnormal hemoglobin was identical to Hb Hope [beta 136(H14)Gly----Asp]. No clinical or hematological abnormality was observed. A study of the family revealed that a younger sister and two sons of the propositus had the same hemoglobin variant. This is the second observation of Hb Hope in a Japanese family.     

The Tunisian population history through the Crigler-Najjar type I syndrome

Crigler-Najjar syndrome type I (CN-I) is a rare and severe metabolic disorder. A recurrent mutation - c.1070A>G in exon 3 - was identified in the Tunisian population, suggesting a founder effect. In 2004, the detection of this mutation in two Kuwaiti Bedouin families has called the Tunisian founder effect in question again. To determine the origin of this mutation, 21 Tunisian and 2 Kuwaiti Bedouin CN-I patients were screened using nine genetic markers. Haplotype analysis confirmed the founder effect hypothesis and dated the appearance of this mutation some 32 generations ago in the Tunisian population. Using the same genetic analysis, the ancestor haplotype was identified in these two families. This result genetically confirms the blending of the Bedouin nomads within today's Tunisian population. After population migration from east to west, this mutation was introduced into the Tunisian population, and then perpetuated, probably because of marriages in isolated communities.     

Adoptively transferred human lung tumor specific cytotoxic T cells can control autologous tumor growth and shape tumor phenotype in a SCID mouse xenograft model

The high prevalence of nasopharyngeal cancer (NPC) in Southern Asia and Mediterranean Northern Africa suggests genetic predisposition among other factors. While Human Leukocyte Antigen (HLA) haplotypes have been conclusively associated with NPC predisposition in Asians, Northern African Maghrebians have been less intensely studied. However, low resolution serological methods identified weak positive associations with HLA-B5, B13 and B18 and a negative with HLA-B14. Using sequence based typing (SBT), we performed a direct comparison of HLA class I frequencies in a cohort of 136 Tunisian patients with NPC matched for gender, age and geographical residence to 148 normal Tunisians. The bimodal age distribution of NPC in Maghrebians was also taken into account. HLA frequencies in normal Tunisians were also compared with those of Northern Moroccan Berbers (ME) to evaluate whether the Tunisian population in this study could be considered representative of other Maghrebian populations. HLA-B14 and -Cw08 were negatively associated with NPC (odd ratio = 0.09 and 0.18 respectively, Fisher p₂-value = 0.0001 and = 0.003). Moreover, positive associations were observed for HLA-B-18, -B51 (split of -B5) and -B57 (p₂-value < 0.025 in all) confirming previous findings in Maghrebs. The HLA-B14/Cw*08 haplotype frequency (HF) was 0.007 in NPC patients compared to 0.057 in both Tunisian (OR = 0.12; p₂-value = 0.001) and Moroccan controls. This study confirms several previous associations noted by serologic typing between HLA class I alleles and the prevalence of NPC in Maghrebians populations. In addition, we identified a putative haplotype rare in Tunisian patients with NPC that may serve as a genetic marker for further susceptibility studies.     

Hemoglobin S/hemoglobin City of Hope compound heterozygote with a SubSaharan genetic background and severe bone marrow hypoplasia

Hemoglobin City of Hope (Hb CH) (HBB: c.208G>A, beta 69 (E13)Gly>Ser) is a rare, anomalous change. Seven independent carriers reported so far, had not displayed any hematological manifestations. The ethnic origin of the known instances is presumably heterogeneous, although they are mainly Mediterraneans or equatorial West Africans. We describe the case of a compound heterozygote in trans for Hb S (Glu6Val) and Hb City of Hope (Gly69Ser) in an anemic two year-old boy with a severe immune-deficient phenotype and fatal chronic parvovirus B19 infection. Haplotype with the Hb S was Bantu; while it was a mixed atypical Benin/Cameroon for Hb CH. Remote ancestral origin of the City of Hope mutation in this family seems to be SubSaharan African. The compound heterozygosis in trans for hemoglobins S and City of Hope, jointly with an unfavorable HBB control region background and a viral chronic infection, seemed the cause of the fatal outcome in the patient. When accompanied by other Hb deleterious mutations in trans, Hb CH should not be considered any longer as an innocuous or functionally silent variant.     

Restriction mapping of βS locus among Tunisian sickle-cell patients

Objectives : The polymorphism of the β‐globin gene haplotypes and frameworks is useful in the determination of the unicentric and multicentric origin of a mutational event. In our study, the haplotypes linked to the Tunisian β^S mutation are determined to improve our knowledge of the chromosomal background of the β‐globin gene in sickle‐cell anemia in Tunisia. Methods : The authors have investigated 242 unrelated individuals. Haplotype analysis was carried out by polymerase chain reaction‐restriction fragment length polymorphism‐based methods. Seven polymorphic sites in the β‐globin gene cluster were examined. The correlation of these various haplotypes with Hb F expression was studied. Results : The Benin haplotype (Ben) was largely predominant (60.54%) followed by the Atypical haplotype A (8.43%) and Bantu (Ban) (2.71%) haplotypes. A total of 94 chromosomes had atypical haplotypes, 78 (23.49%) had A1 [?????++], 11 (3.31%) had A2 [???????], and five (1.5%) had B1 [??+??++]. The Benin haplotype is associated with a fairly low HbF levels. Conclusion : The very high frequency of the Benin haplotype in our study suggests that the β^S mutation present in Tunisia may have originated from the Benin region and was brought to Tunisia along the slave trade routes. However, another atypical haplotype observed a new emergence in our population and could be considered as specific to Tunisian chromosome β^S. Am. J. Hum. Biol., 2011. © 2011 Wiley‐Liss, Inc.     

Molecular analysis of haemoglobin E in Southeast Asian populations

Haemoglobin (Hb) E is the most common Hb variant in Asia where its gene frequency approaches 0.3 in some areas. We studied genetic background of Hb E genes among Southeast Asian populations. This study examined β-globin gene haplotypes linked to haemoglobin E (Hb E) in diverse groups of Southeast Asian populations. The study was conducted on southern Thai (22 alleles), Cambodian (84 alleles), Laotian (120 alleles), Vietnamese (87 alleles) and Burmese (one allele) subjects. Results were compared with those of previous studies in northeast Thailand, the Yunnan of China, West India and Europe. Ten different haplotypes were observed. The four most common haplotypes were haplotypes 1 (–?+?–?+?+?+?–) and 2 (+?–?–?–?–?+?–) on chromosomes with framework 2 and haplotypes 6 (–?+?–?+?+?–?+) and 7 (+?– – – – –?+) on chromosomes with framework 3 variety. Phylogenetic analysis indicated that haplotype 1 is a relatively recent haplotype found in all populations, whereas haplotype 6 is found predominately in Cambodians. The results indicate that at least two genetic origins of Hb E are responsible for the high prevalence and spread of Hb E among Southeast Asian populations.     

Antioxidant activities of green and black teas determined by the cumene hydroperoxide/hemoglobin.methylene blue method

Antioxidant activity in tea was measured by the new cumene hydroperoxide/hemoglobin.methylene blue(CHP/Hb.MB) method developed in our laboratory. Using the CHP/Hb.MB method, we investigated the activities of polyphenols(11 varieties) in order to determine their reactivity on CHP. According to the CHP/Hb.MB method, an increase in the number of hydroxyl groups in polyphenols induced high antioxidant activity. We found that this method was capable of measuring the antioxidant activity of polyphenols. Consequently, we were able to measure the antioxidant activities of heated, green, powdered and black teas by this method. The average of antioxidant activities of heated green tea was 207 nmol/ml, while that of green tea was 280 nmol/ml, powdered green tea was 481 nmol/ml and black tea was 215 nmol/ml respectively.     

Preparation and characterization of SNO-PEG-hemoglobin as a candidate for oxygen transporting material.

Acellular hemoglobin (Hb) derivates developed as oxygen carriers are known to cause hypertensive reactions due to their nitric oxide (NO) scavenging action. To modulate this undesired activity, we have developed a new Hb derivative, s-nitrosylated polyethylene glycol (PEG)-modified hemoglobin (SNO-PEG-Hb), which can deliver oxygen and NO. After human Hb was modified with PEG to increase its molecular weight, the free sulfhydryl groups of Hb were s-nitrosylated with s-nitrosoglutathione. Administration of unmodified Hb into anesthetized rats caused a hypertensive reaction, while s-nitrosylated Hb derivatives such as SNO-Hb and SNO-PEG-Hb did not raise blood pressure. The plasma half-lives of heme and NO bound to SNO-PEG-Hb were 11.5 and 2.4 hours respectively, indicating that the s-nitrosylated Hb derivative may act as a slow-releasing agent for NO. Based on these findings, SNO-PEG-Hb is a useful candidate for a blood substitute and tool for oxygen therapeutics.     

HLA class I and class II polymorphisms in Tunisian Berbers

Background: The HLA polymorphism is a powerful genetic tool to study population origins. By analysing allele frequencies and haplotypes in different populations, it is possible to identify ethnic groups and establish the genetic relationships among them.

Aim: The Berber (endogenous Tunisians) HLA class I and class II genotypes were analysed and compared with those of Mediterranean and Sub-Saharan African communities using genetic distances, Neighbour-Joining dendrograms, correspondence and haplotype analysis.

Subjects and methods: One hundred and five unrelated Berbers were typed for HLA class I (A, B) and class II (DRB1, DQB1) gene alleles using reverse dot-blot hybridization.

Results: High frequencies of A*0201 (24.76%), A*3402 (22.38%) and B*44 (32.85%) alleles were recorded for Berbers, the highest recorded for Mediterranean and North African populations. This study shows a close relatedness of Tunisian Berbers to other Tunisians, North Africans and Iberians.

Conclusion: The apparent relatedness of Tunisian Berbers to present-day (North African) Tunisians, Algerians and Moroccans suggests that the Arab invasion of North Africa (7^th–11^th centuries AD) did not significantly impact the genetic makeup of North Africans. Furthermore, Tunisian Berbers appear to be closely related to Iberians (Spaniards and Basques), indicating that the 7^th century AD gene flow of invaders was low in Iberians and that the main part of their genetic pool came after the Northward Saharan migration, when hyper-arid conditions were established in Sahara (before 6000 BC). Other studied populations belong to the old Mediterranean substratum, which has been present in the area since pre-Neolithic times. This study indicates a higher proportion of Iberian than Arab ancestry in Tunisian Berbers, which is of value in evaluating the evolutionary history of present-day Tunisians. Greeks seem to share genetic HLA features (Chr 6) with Sub-Saharans. The relatedness of Greeks to Sub-Saharans has been confirmed by other studies based on chromosome 7 genetic markers.     

Nitric oxide-mediated suppression of 2,3-bisphosphoglycerate synthesis: Therapeutic relevance for environmental hypoxia and sickle cell disease

Though hemoglobin (Hb) is best known for transporting oxygen and metabolic wastes throughout the circulatory system, this erythrocyte protein also acts as a hypoxic sensor, its oxygen saturation dependent on the oxygen partial pressure (pO(2)) which varies throughout the vasculature. The production and transport of the endogenous vasodilator nitric oxide (NO) by Hb is dependent on Hb's oxygen saturation, thereby allowing the protein to auto-regulate blood flow efficiency to meet the relative demands of respiring tissues. Erythrocyte concentrations of 2,3-bisphosphoglycerate (BPG), an enhancer of oxygen off-loading from Hb, is very sensitive to changes in glycolytic rates because its synthesis by BPG synthase is dependent on the availability of the glycolytic intermediate 1,3-bisphosphoglycerate. BPG synthase, as well as some glycolytic enzymes, are also very sensitive to pH changes, and variations in BPG levels have direct consequences on the oxygen off-loading function of Hb. I hypothesize that NO may suppress BPG production by (1) inhibiting glyceraldehyde-3-phosphate dehydrogenase (G3PDH), the most critical glycolytic enzyme for the bioavailability of 1,3-bisphosphoglycerate; and to a lesser extent by (2) associated pH changes in the deoxy-Hb-catalyzed depletion of nitrite, a metabolic reservoir of NO. Both mechanisms are favored in low pO(2) environments where BPG is most needed to maximize oxygen off-loading, indicating that the auto-regulatory link between NO and Hb may have inadvertently linked Hb and BPG synthesis in an unfavorable manner. However, for reasons discussed, NO-mediated suppression of BPG may be advantageous in some circumstances; namely, for individuals living at high altitudes and those with the blood disorder sickle cell anemia. This hypothesis is thus relevant to respiratory health under both normative conditions as well as under hypoxic stress. The potential relevance of the hypothesis to comparative animal physiology and evolutionary biology is also briefly described.     

Genetic heterogeneity of megaloblastic anaemia type 1 in Tunisian patients

Megaloblastic anaemia 1 (MGA1) is a rare autosomal recessive condition characterized by selective intestinal vitamin B12 malabsorption and proteinuria. More than 200 MGA1 patients have been identified worldwide, but the disease is relatively prevalent in Finland, Norway and several Eastern Mediterranean regions. MGA1 is genetically heterogeneous and can be caused by mutations in either the cubilin (CUBN) or the amnionless (AMN) gene. In the present study we investigated the molecular defect underlying MGA1 in nine Tunisian patients belonging to six unrelated consanguineous families. Haplotype and linkage analyses, using microsatellite markers surrounding both CUBN and AMN genes, indicated that four out of the six families were likely to be linked to the CUBN gene. Patients from these families were screened for the Finnish, Mediterranean and Arabian mutations already published. None of the screened mutations could be detected in our population. One family showed a linkage to AMN gene. Direct screening of the AMN gene allowed the identification of the c.208-2A>G mutation, previously described in a Jewish Israeli patient of Tunisian origin and in Turkish patients. This suggests that the c.208-2A>G mutation may derive from a single Mediterranean founder ancestor. For the last family, haplotype analysis excluded both CUBN and AMN genes, suggesting the existence of a third locus that may cause MGA1.     

Extraerythrocytic hemoglobin--a possible oxygen transporter in human malignant tumors

We hypothesize that extraerythrocytic hemoglobin (Hb) serves as an oxygen transporter for human malignant tumors. According to our hypothesis, oxygen transport via intraerythrocytic hemoglobin (Hb), meaning Hb found within erythrocytes, is complemented by oxygen transport via extraerythrocytic Hb, meaning Hb found outside erythrocytes, which circulates in intercellular channels of the tumor. The channels may be derived from processes, including vasculogenic mimicry or endothelial cell retraction. We propose the following scenario: Firstly, hemolysis is caused by the irregular and disruptive endothelial cell-lined tumor vasculature, thus generating extraerythrocytic Hb-O₂. Secondly, this Hb-O₂ is transported together with plasma through the intercellular channels of the tumor. Thirdly, extra-erythrocytic Hb-O₂ delivers oxygen to the hypoxic tumor cells. Finally, oxygen passes from the intraerythrocytic Hb-O₂ in endothelial cell-lined tumor vessels to extraerythrocytic Hb due to the higher affinity of extraerythrocytic Hb for oxygen, thus starting a new cycle of oxygen delivery to the tumor tissue. Based on this hypothesis, we predict that inhibiting oxygen binding to extraerythrocytic Hb inhibits malignant tumor growth.     

血红蛋白为基础的红细胞代用品以[p（O_2）]_（50）测定方法的研究

目的对血红蛋白（Hb）为基础的红细胞代用品以人脐带血Hb及其聚合Hb氧合曲线的测定方法进行研究。方法 Hb与氧结合的能力通常用氧分压[p（O2）]和Hb氧饱和度（Y）构成的氧合曲线来表示。制备人脐带血纯化Hb、聚合Hb,测定高铁Hb浓度,用高效液相色谱（HPLC）测定各种Hb浓度,做氧合曲线。结果改进检测方法和装置后,得到S形的氧合曲线,测得人脐带血纯化Hb样品的[p（O2）]50为（0.934±0.009）kPa[（7.17±0.07）mmHg],5′-磷酸吡哆醛（PLP）修饰的聚合Hb[p（O2）]50为（2.727±0.033）kPa[（20.50±0.25）mmHg]。结论该方法设备简单、操作方便、结果可靠、重复性和重现性较好。     

Muscle microvascular hemoglobin concentration and oxygenation within the contraction-relaxation cycle

Inability to directly measure microvascular oxygen distribution and extraction in striated muscle during a contraction/relaxation cycle limits our understanding of oxygen transport to and utilization by contracting muscle. We examined muscle microvascular hemoglobin concentration (total [Hb/Mb]) and oxygenation within the contraction-relaxation cycle to determine if microvascular RBC volume would be preserved and if oxygen extraction continued during the actual contraction phase. Eight subjects performed dynamic knee extension exercise (40 contractions/min) at moderate ( approximately 30% of peak work rate) and heavy ( approximately 80% of peak) work rates. Total hemoglobin/myoglobin (total [Hb/Mb]) and deoxy-hemoglobin/myoglobin (deoxy-[Hb/Mb]) were measured in the rectus femoris using NIRS to determine if microvascular total [Hb/Mb] would be preserved during the contraction, and to estimate microvascular oxygen extraction, respectively. Mean values during the relaxation (RP) and contractile phases and the peak values during the contractile phase for both moderate and heavy exercise were calculated. Total [Hb/Mb] increased from rest to steady-state exercise (6.36+/-5.08 microM moderate; 5.72+/-4.46 microM heavy exercise, both P<0.05), but did not change significantly within the contraction/relaxation cycle. Muscle contractions were associated with a significant (1.29+/-0.98 microM moderate; 2.16+/-2.12 microM heavy exercise, P<0.05) increase in deoxy-[Hb/Mb] relative to RP. We conclude that (a) microvascular RBC volume is preserved during muscle contractions (i.e., RBCs are present in the capillaries), and (b) the cyclical pattern of deoxygenation/oxygenation during the respective contraction/relaxation phases of the contraction cycle suggests that oxygen extraction is not restricted to the relaxation phase but continues to occur during muscle contractions.     

Changes in the functional properties of bovine hemoglobin induced by covalent modification with polyethylene glycol

Polyethylene glycol conjugation to proteins and peptides (PEGylation) has been shown to promote increased retention time in the circulation as well as to blunt immune or allergic reactions. PEGylated bovine hemoglobin (PEG-Hb) is being explored in human clinical trials as an oxygen delivering agent for the sensitization of solid tumors to radiation therapy. In this study the functional properties of PEG-Hb were compared to those of bovine hemoglobin (Hb), the mutant human hemoglobin Rothchild and bovine hemoglobin crosslinked between the beta chains. The rate of heme transfer from Hb to serum albumin at pH 9.0 was greatly increased by PEGylation, suggesting destabilization of the heme-globin linkage and of the bonds between alpha beta dimers. Measurement of oxygen binding equilibrium showed that the oxygen affinity of Hb became unusually dependent on temperature and Hb concentration after PEGylation. Evidence is presented to suggest that PEGylation of lysine beta-81 at the entrance to the central cavity of the Hb tetramer might be responsible for these observations. The alterations of the functional properties of Hb induced by PEGylation are consistent with the beneficial effects of PEG-Hb in exchange transfusion and radiation sensitization models of human conditions.     

A method for purification and viral inactivation of human placenta hemoglobin

For pilot-scale manufacturing of hemoglobin-based oxygen carrying drugs, we should get highly pure and viral inactivated hemoglobin (Hb) at high recovery. In our method, placenta hemoglobin (PHb) solutions were purified by heating in the presence of reducing agent and deoxygenating conditions so that heat-sensitive proteins were selectively precipitated and virus was inactivated. The optimum preparative condition resulted in highly purified PHb solution (>99% pure) with approximate 90% recovery and less than 2% of MetHb content, maintained oxygen carrying capacity, residual phospholipids less than 1 ppm, free of endotoxin, bacteria, type A&B antigens and virus. Finally, we compared the efficacy of blood exchange on rat with poly-PHb and poly-Hb from adult blood. The results showed no significant difference between two products. Therefore, the placenta Hb obtained from this method could be supplied as materials for oxygen carrying drugs.     

Sudden infant death syndrome: a preconditioning approach to acute arterial hypoxemia

The blood hemoglobin F (HbF) concentration increases in response to chronic arterial hypoxemia and is abnormally elevated in sudden infant death syndrome (SIDS) post-mortem indicating a need for greater oxygen affinity of hemoglobin (Hb) or diminished oxygen usage by tissues or both.Modifying Hb oxygen affinity in rats revealed that increased, rather than decreased, hemoglobin-oxygen affinity permitted survival at greatly reduced environmental oxygen pressures equivalent to high altitude. Decreased Hb-oxygen affinity resulted in bradycardia 5-10 minutes before death. Cardiorespiratory recordings from infants dying suddenly and unexpectedly at home demonstrated cardiovascular failure with hypotension and bradycardia, rather than a cessation of breathing.A fall in blood pressure and acidosis due to hypoxemia in combination with reduced arterial oxygen saturation leads to circulatory failure, heart failure and death.It is speculated that the final mechanism of SIDS mimics failure to survive at high altitudes and very low environmental oxygen pressures when low arterial oxygen pressures combine with decreased Hb-oxygen affinity lead to severe hypoxemia and death.     

Newborn screening for hemoglobin abnormalities. A comparison of methods

Peripheral blood from 1,000 newborn infants of black (641) and Southeast Asian (359) ancestry were screened for hemoglobin variants. Results obtained from the combination of cellulose acetate (CAC) and citrate agar (CAG) electrophoresis were compared with isoelectric focusing (IEF) electrophoresis. There was complete agreement between the two methods on assignment of Hb S trait, Hb C trait, Hb E trait, and homozygous Hb E. IEF identified small amounts of Hb A in two newborn infants with Hb S-beta + thalassemia; the CAC and CAG electrophoretic patterns were indistinguishable from sickle cell anemia. One hundred twenty newborn infants with Hb Bart's were detected by IEF; 51 of these were found on CAC. Although IEF was more sensitive in detecting small amounts of hemoglobin, it is not clear if the improvement in detection warrants adopting this form of electrophoresis for routine screening of newborn infants.