Search Results (260)

Background: Hemoglobinopathies, including thalassemia and structural hemoglobin variants, are among the most prevalent inherited disorders worldwide and represent a major public health concern in southern China. Accurate characterization of both common and rare variants is essential for carrier screening, genetic counseling, and prevention. However, routine molecular screening is generally restricted to common pathogenic variants, potentially overlooking rare hemoglobinopathy subtypes. This study aimed to characterize the spectrum of hemoglobinopathies in a large hospital-based cohort of reproductive-age individuals from Guangdong, China, and to evaluate a genotype–phenotype discordance-guided secondary testing strategy. Methods: A retrospective hospital-based study was conducted in 71,676 reproductive-age individuals who underwent hemoglobinopathy screening at our hospital in Guangdong, China, between 2018 and 2024. Hematological and routine genetic analyses were performed in parallel. Cases exhibiting genotype–phenotype discordance were further investigated using tailored secondary molecular approaches selected according to specific hematological findings. Results: In this cohort, 10,412 hemoglobinopathies were identified. Thalassemia accounted for 10,217 cases (98.13%), including α-thalassemia (8026), β-thalassemia (2561), δβ-thalassemia (17), γ-thalassemia (10), and δ-thalassemia (4). Structural hemoglobin variants comprised 195 cases (1.91%). Among the 788 genotype–phenotype discordant cases, secondary analysis yielded a positive detection rate of 36.80% (290/788). Conclusions: This study provides large-scale hospital-based data on the distribution of hemoglobinopathies among reproductive-age individuals in Guangdong. Review of genotype–phenotype discordance improved the detection of rare variants beyond routine screening and may facilitate the development of tailored secondary testing strategies. Further studies are warranted to validate its clinical utility and applicability. Full article

This review focuses on the analysis of hemoglobin in the clinical laboratory with an emphasis on the structure–function relationships of hemoglobin and the various methodologies used for its measurement. In clinical laboratories, hemoglobin analysis may take on many forms. These include measuring the concentration of hemoglobin, as well as determining the percentage of oxyhemoglobin, deoxyhemoglobin and dyshemoglobins such as carboxyhemoglobin. There are also techniques available to estimate the oxygen affinity of hemoglobin. Hemoglobin separation techniques by means of electrophoresis or chromatography are essential in the diagnosis of hemoglobinopathies (such as sickle cell anemia) and thalassemias, where there is an imbalance in globin chain synthesis. Hemoglobin contains four globin subunits, which create a unique quaternary structure in which the oxygen affinity can be changed by allosteric modifiers, including oxygen itself. The heme iron-containing tetrapyrrole ring not only carries oxygen; it also controls the binding of oxygen to the other globin subunits. The organization and regulation of the globin genes are discussed to provide essential biological context for informed interpretation of clinical test results. Building on this foundation, selected hemoglobinopathies and thalassemias are highlighted to further illustrate structure–function relationships and their implications for diagnostic testing. However, an exhaustive analysis of hemoglobinopathies is beyond the intended scope of this review, which is not meant to be all-encompassing, as these subjects are extensively addressed in many textbooks and published articles and reviews. Full article

(1) Background: Integrated bioarchaeological approaches combining osteological and ancient DNA analyses provide powerful insights into health, disease, and population history in past societies. However, the relationship between rare skeletal variations, genetic disorders, and ancestry remains insufficiently explored within single individuals. This study aimed to investigate the combined osteological, paleopathological, and genetic characteristics of a Roman-period individual from southwestern Anatolia. (2) Methods: A multidisciplinary approach was applied to the skeletal remains of an adult male recovered from the Sekköy excavation site. Osteological analysis was conducted to assess cranial morphology, pathological lesions, and dental status. Ancient DNA was extracted from petrous bone under strict contamination control. The hemoglobin beta (HBB) gene was analyzed using Next Generation Sequencing and validated by Sanger sequencing. Y-chromosomal STR analysis was performed to determine paternal lineage. (3) Results: Osteological examination revealed a rare craniovertebral anomaly consistent with a third occipital condyle, along with porotic hyperostosis and extensive antemortem dental pathology, indicating prolonged physiological stress. Genetic analysis identified a heterozygous hemoglobin S mutation (HbAS; rs334), confirmed by both next-generation sequencing and Sanger sequencing, providing direct molecular evidence of hereditary hemoglobinopathy. Y-STR profiling assigned the individual to haplogroup R1b (predicted based on Y-STR data), indicating affiliation with Western Eurasian paternal lineages. (4) Conclusions: Despite the presence of comparable skeletal stress indicators, the integration of osteological and genetic data revealed a complex interaction between anatomical variation, chronic physiological stress, and inherited disease. The co-occurrence of a rare cranial anomaly, HbS mutation, and a defined paternal lineage represents a unique bioarchaeological case. These findings highlight the value of integrating skeletal and molecular approaches to reconstruct individual health profiles in archaeological contexts and demonstrate the methodological potential of interdisciplinary bioarcheological analysis. Full article

Sickle cell disease (SCD) is a monogenic disorder responsible for recurrent vaso-occlusive crises, progressive organ damage, and shortened life expectancy. For decades, allogeneic hematopoietic stem cell transplantation from a matched sibling donor has been the only established cure, but its reach remains limited by donor availability and transplant-related toxicity. The approval of two autologous gene therapy products in 2023, exagamglogene autotemcel (exa-cel) and lovotibeglogene autotemcel (lovo-cel), marked a turning point for the SCD population and the gene therapy field in general. This review proposes a molecular rationale for fetal hemoglobin reactivation and β-globin gene addition, describes the engineering of lentiviral and CRISPR-based platforms, and highlights the clinical evidence accumulated to date that demonstrated durable disease modification with acceptable short-term toxicity. We then assess the clinical positioning of gene therapy within the broader spectrum of curative options compared to current available treatments and address the financial, ethical and psychosocial barriers that limit access to gene therapy both within high-income countries and globally. Critical research priorities include long-term safety surveillance, comparative effectiveness studies, pediatric trials below 12 years, and validated patient-reported outcome instruments. Base editing, non-genotoxic conditioning, and in vivo delivery represent the most promising avenues to broaden access and reduce treatment burden. Full article

β-thalassemia minor, often referred to as the β-thalassemia trait, is among the most prevalent hemoglobinopathies globally, impacting around 80–90 million carriers, with a prevalence of up to 15% among Mediterranean, Middle Eastern, and Asian populations. Although traditionally regarded as clinically benign, pregnancy imposes hematologic and metabolic stressors that may unmask latent vulnerabilities. This review combines the latest data and findings about the pathophysiology of β-thalassemia minor during pregnancy, its short-term outcomes on the mother and fetus, and its long-term impact on the child, as well as management techniques. A narrative review of PubMed-indexed studies (2000–2025) was conducted, including cohort and case–control studies, systematic reviews, meta-analyses, and international guidelines. Outcomes were organized by theme, and quantitative findings (prevalence, relative risks, odds ratios) were combined when available. Anemia is a common health issue for mothers. Literature mentions that the pooled incidence is between 30% and 40% during the third trimester, with ~5%of carriers needing a blood transfusion (mainly in iron-deficient or baseline Hb 6–8 g/dL cases). Meta-analyses have shown elevated risks of pre-eclampsia (odds ratio (OR) ~ 1.4, 95% confidence interval (CI) 1.1–1.8) and postpartum hemorrhage (PPH); however, estimates differ by region. The odds of preterm delivery (OR ~ 1.4), small-for-gestational-age (SGA) (OR ~ 1.5), and low birth weight (LBW) are slightly increased for carriers, and neonatal intensive care unit (NICU) admission rates are also higher for carriers. However, the risk of stillbirth is not always increased. The usual approach is iron supplementation guided by ferritin levels to prevent overload, personalized transfusion thresholds, and regular folate support. There is not much evidence for long-term consequences for children of carrier mothers since no research has followed more than 200 children born to carrier mothers into adulthood. However, maternal anemia is linked to slower growth, neurodevelopmental issues, and a higher risk of cardiometabolic problems in larger groups of pregnant women. However, maternal anemia is associated with slower growth, neurodevelopment, and higher cardiometabolic risk in larger groups of pregnant women. β-thalassemia minor during pregnancy usually has a mild, though significant, impact. While most pregnancies proceed without complications, this condition is associated with a significantly higher prevalence of anemia and other adverse postnatal outcomes. Consequently, the implementation of risk-stratified monitoring, smart supplementation, and standardized management protocols is essential. Prospective registries, mechanistic placental research, and long-term offspring cohorts are necessary to better understand long-term trends. Full article

Sickle cell anemia (SCA) is a genetic disorder characterized by chronic hemolysis, primarily driven by red blood cell lysis. Its pathophysiology is centered, though not exclusively, on the increased release of intracellular components, such as hemoglobin degradation products, which are known to stimulate innate immune responses and promote prothrombotic states. Current therapies alleviate symptoms, yet patients remain exposed to a chronic inflammatory milieu punctuated by episodes of acute pain. The recurrence of these crises can be life-threatening due to ischemia–reperfusion injury, hypercoagulability, and respiratory complications. Central mechanisms are marked by elevated hemolysis, heightened inflammatory signaling, and increased procoagulant activity, largely driven by soluble molecules released into the plasma, such as hemoglobin, nuclear molecules and other products. These compounds are recognized from sensors on immune and endothelial cells, named Pattern Recognition Receptors (PRRs), and constitute canonical pathways for intracellular activation. Four main types have been extensively studied in the literature over recent years in both infectious and sterile inflammatory contexts; still, only a few have elucidated the mechanisms underlying acute and chronic inflammation in patients with SCA. Although Toll receptors were shown to be major in triggering immunity, other receptors were found to be important regarding this function, which suggested a multifactorial mechanism for this triggering. Therefore, here, we propose a comprehensive review of previously published findings regarding the expression, activation, and dynamics of Toll-like, NOD-like, and RIG-I–like receptors in the progression of SCA and its associated inflammatory features. Full article

Thalassemia is a hereditary hemoglobinopathy characterized by ineffective erythropoiesis, chronic hemolysis, and transfusion-related iron overload, which collectively contribute to oxidative stress and organ dysfunction. The present study aimed to investigate the relationships between iron metabolism, oxidative stress biomarkers, and immune cell function across different clinical conditions. Peripheral blood samples were obtained from healthy individuals and patients with iron deficiency anemia, obesity, thalassemia trait (TT), β-thalassemia HbE (BTE), and β-thalassemia major (BTM). Hematological parameters were measured using automated hematology analyzers, while biochemical indicators, including liver enzymes and bilirubin, were determined using clinical chemistry assays. Iron overload was evaluated using serum iron parameters and T2*-weighted magnetic resonance imaging. Oxidative stress biomarkers, including reduced glutathione, thiobarbituric acid-reactive substances, and total antioxidant capacity, were assessed spectrophotometrically. Flow cytometric analysis was used to measure reactive oxygen species, redox-active iron, and lipid peroxide levels in granulocytes and lymphocytes. Thalassemia patients exhibited severe anemia, elevated liver enzymes, increased bilirubin levels, and significant alterations in iron metabolism compared with healthy controls. Hepatic iron accumulation was more common than cardiac iron deposition, particularly in BTE patients. Granulocyte oxidative burst activity was significantly reduced in thalassemia patients, whereas lymphocyte responses remained relatively preserved. Increased variability in glutathione levels suggested activation of intracellular antioxidant defense mechanisms in response to chronic oxidative stress. These findings highlight the complex interplay between iron overload, oxidative stress, and the immune cell dysfunction associated with thalassemia, thereby providing insights into improved monitoring and therapeutic strategies. Full article

Allogeneic hematopoietic cell transplantation (HCT) has been used for decades to treat certain malignant and non-malignant hematological conditions, but challenges remain. Increased understanding of disease mechanisms and recent developments in genome editing have enabled alternative strategies utilizing gene-edited autologous HCT and many of these have progressed to the clinic. We present here a comprehensive review of clinical trials of gene-edited autologous hematopoietic stem cells for the treatment of hemoglobinopathies and immunodeficiencies. Searches of major international clinical trial registries were carried out using specific key words. In total, 44 interventional clinical trials investigating gene-edited autologous stem cell therapies were identified, with CASGEVY (exagamglogene autotemcel) being the only product approved to date. Hemoglobinopathies were the most common indication (n = 37) followed by immunodeficiencies (n = 4), with single trials in HIV-1 infection, pyruvate kinase deficiency and limb–girdle muscular dystrophy. Gene-editing strategies fall into three categories: disruption of the BCL11A erythroid enhancer, editing of the γ-globin promoter and direct correction or disruption of disease-relevant genes. CD34⁺ hematopoietic stem and progenitor cells are the most common cell types edited, and CRISPR-Cas9 is the most widely used gene-editing modality. While results are encouraging, efficient intracellular delivery of gene-editing tools, editing efficiencies and off-target editing remain challenges for the field. Full article

Executive function (EF) impairments are common in children with intellectual and developmental disabilities and have a significant impact on learning and daily life. Cognitive training programs aimed at strengthening EFs may show limited feasibility and generalization. However, recent studies suggest that ecological, curriculum-embedded problem-solving activities may be more promising. This multiple-baseline single-case study tested the feasibility and efficacy of a short computational thinking and coding intervention based on problem-solving for children with sickle cell disease, a hemoglobinopathy associated with cognitive decline and EF deficits. The trial followed the What Works Clearinghouse (WWC) Version 5 guidelines for single-case research. Three 7–8-year-old children with lower-range IQ (71–82) and EF impairments completed 11 coding sessions over 5–6 weeks using code.org, with pre/post assessments of non-verbal EF (planning, inhibition, and switching), and verbal EF skills (verbal working memory, phonological fluency and semantic fluency). Results showed 100% adherence to the intervention, significant improvement in coding (IRD range = 0.69–0.79), with positive transfer effects on nonverbal planning skills (gains > 2 z-scores) and also verbal fluency (z-score gains ranging from 0.47 to 1.04). Inter-individual variability in effects was related to the child’s individual cognitive profile. Findings suggest that problem-solving, coding-based activities can be feasible and potentially beneficial for children with significant EF impairments. Full article

β-thalassaemia (β-thal) is part of a group of diseases, the β-hemoglobinopathies, affecting the levels or functionality of the β-globin subunit of hemoglobin, which are the most widespread monogenic diseases throughout the world. The severity of β-thal is determined by different genetic factors, but in the gravest form, affected patients are constrained to a program of blood transfusion and iron chelation regimens for their entire life. Although definitive cures, such as bone marrow transplantation or gene therapy, are now available, they are still far from being applied worldwide. Therefore, there is growing attention towards the use of drugs to cure or ameliorate β-thal disorder. Among all the strategies, pharmacological increase of fetal HbF and/or adult HbA2 can represent an advantageous approach as high levels of both hemoglobins are effective against β-thal. Therefore, the identification of therapeutic targets that can modulate, by the use of drugs, these hemoglobins is increasingly urgent. In this paper, we analyze the effects of the absence of the CCND3 gene, a druggable target associated with HbF and HbA2 levels, in a humanized mouse model of β-thal to assess the impact against the disorder. Upregulation of γ- and δ-globin levels in mice lacking Ccnd3 expression contributes to partial restoration of the α/β balance, with a consequent increase in hemoglobin levels, improvement of iron levels, and reduction of splenomegaly. Moreover, we present data supporting the enhancement of erythropoiesis. Our data indicate the CCND3 gene as a possible target for drugs against β-thal. Full article

Background and aim: Hemoglobinopathies have become an important public health problem due to global migration. The aim of this project was to address the problem of hemoglobinopathy among immigrants living in Türkiye, Spain, and Italy, in addition to training health managers and Syrian family physicians at immigrant health centers in the southeastern provinces of Türkiye. Material and methods: A three-year international project, named EQUALITY PLUS, was supported by the European Union Erasmus Project. We planned transnational meetings (TPM), vocational education meetings (VET), and Practical Implementation Meetings (PIEM) for the education program. Results: Four TPMs were held in Türkiye, Spain, and Italy, involving a total of 49 professionals. Two VETs were held in Spain and Italy. A total of 23 professionals attended both VETs. Six PIEMs were held in the southern and southeastern Turkish provinces, such as Adana Mersin, Hatay, Gaziantep, Kilis, and Sanliurfa. A total of 442 people, including 373 Syrian family physicians and 69 provincial health managers, were educated in six provinces in Türkiye. Discussion: While the immigrants to Italy and Spain come mainly from Central and North West African maritime routes, immigrants to Türkiye predominantly come from Syria. Among a total of 4 million Syrian immigrants to Türkiye, 200.000 were found to be carriers of thalassemia. In the refugee camps where Syrian immigrants live, the fertility rate is high and the number of sick newborns is increasing, and birth control, genetic counseling, and prenatal diagnosis methods are not sufficient. This project was intended to serve as a guide to prevent hemoglobinopathy in Syrian immigrants. Further projects are needed to address the fertility rate and increased number of sick newborns in these refugee camps. Family physicians at migrant health centers received training on the prevention of hemoglobinopathies. This training included providing detailed genetic counseling to families and providing prenatal diagnosis and preimplantation genetic diagnosis opportunities. Because of the major earthquake that occurred in this region after the project, the work could not continue and preliminary data could not be obtained. Public health services will follow the results of project and the registered number of sick newborns with hemoglobinopathies. Full article

Reactive oxygen species (ROS) are unavoidable byproducts of cellular metabolism and are normally controlled by tightly regulated antioxidant systems. Red blood cells (RBCs) are particularly susceptible to oxidative stress due to their high oxygen exposure and iron content. In sickle cell disease (SCD), this vulnerability is exacerbated, as sickled RBCs generate chronically elevated ROS that contribute directly to disease pathophysiology. This review examines emerging evidence linking oxidative stress responses to regulation of fetal hemoglobin (HbF) expression through protein arginine methyltransferases (PRMTs). PRMTs catalyze arginine methylation of histone and non-histone substrates, thereby shaping chromatin structure, transcriptional programs, and translational control. We highlight recent findings demonstrating that specific PRMTs regulate γ-globin expression through distinct mechanisms, including transcriptional repression at the β-globin locus and post-transcriptional control of γ-globin mRNA translation. We propose that oxidative stress signaling may modulate PRMT activity, creating a mechanistic link between cellular stress responses and HbF induction. Because HbF inhibits pathological hemoglobin S polymerization, PRMT-dependent pathways represent an attractive therapeutic axis for SCD and related β-hemoglobinopathies. By integrating oxidative stress biology with PRMT-mediated epigenetic and translational regulation, this review outlines a unifying framework for HbF control, identifies critical knowledge gaps, and highlights future directions for the development of targeted epigenetic therapies. Full article

Newborn bloodspot screening (NBS) began in Guthrie’s laboratory in 1961 for phenylketonuria. A federal study the following year formed the basis for expanding NBS as a public health function. Diseases detectable through NBS gradually expanded, eventually including sickle cell anemia, which was included in the screening panel in New York in 1975. Universal inclusion of full population screening for sickle cell anemia was included in all US NBS programs by 2006. Through the years, NBS for sickle cell anemia has expanded to include other clinically significant hemoglobin disorders (both hemoglobinopathies and thalassemias). While NBS programs exist in most high-income countries, their implementation in low- and middle-income settings has been slow, with the inclusion of hemoglobin disorders occurring even more slowly. It is particularly noteworthy that the low-resource settings with the highest incidences of sickle cell diseases (Sub-Saharan Africa, the Caribbean Islands, and India) and therefore the greatest potential for benefitting from NBS, continue to struggle with its implementation. Recent advances in curative treatments further emphasize the importance of NBS in early disease identification. This report reviews some of the history of newborn screening for hemoglobinopathies and thalassemias and provides an update of related activities currently ongoing globally. Full article

β-thalassemia and sickle cell disease are two inherited hematological diseases due to defective hemoglobin synthesis or to the production of hemoglobin with altered properties. These two conditions have prolonged survival with modern support therapies, albeit life-long, complex, expensive and resource-consuming. Studies carried out in the last three decades have shown that allogeneic hematopoietic stem cell transplantation (allo-HSCT) and gene therapy may offer a curative approach for these diseases. Allo-HSCT should be performed early in life to reduce disease-related complications like irreversible tissue damage due to iron overload in patients with transfusion-dependent β-thalassemia (TDT) and systemic vasculopathy in patients with sickle cell disease (SCD). HSCTs from a matched-sibling donor or a matched-unrelated donor represent the best therapeutic option; however, haploidentical HSCT in both TDT and SCD is now increasingly performed as a valuable and viable option for a larger number of these patients. An alternative curative strategy is based on gene therapy. These curative approaches, particularly those of gene therapy, are available only in a part of the world. Gene therapy diffusion is strongly limited by its high technological and infrastructure requirements and its very high cost. Criteria must be defined for the optimal selection of TDT and SCD patients for allo-HSCT or gene therapy. Full article