Alpha-Thalassemia and Protection from Malaria

Fri, 21 Apr 2006 00:36:37 PST

( from http://www.rxpgnews.com ) Over the course of human history, hundreds of thousands of genetic mutations have arisen in the global population. The most harmful ones usually disappearby affecting an individual's fitness, i. e., the ability to reproduce, the mutations are lost before carriers can pass them on to their childrenwhereas most mutations are maintained in the population in low frequencies. Some mutations, however, can give the carrier such a large survival advantage that the mutations become positively selected for, leading to their presence in high frequencies in some populations.

Blood disorders are a good example of this selection process. The sickle cell mutation, for example, is a mutation of the β-globin gene that can cause severe anemia in people who inherit two mutated genes. People with just one mutated hemoglobin (Hb) S gene, however, can be highly protected against malaria. And in Africa, where malaria is one of the biggest killers, up to 40% of people are believed to carry one of the sickle genes.

The thalassemias are also inherited blood disorders that result from mutations in either the α-globin or β-globin genes. α-thalassemias are now the most common genetic disorders of human beings, and this is thought to be because of their protective effect against malaria. People usually have four α-globin genes, two on each Chromosome 16. In Africa, however, a common deletion can remove one of these genes from either chromosome or from both chromosomes; individuals with three or two α-globin genes remaining have anemia, which is more severe the fewer α-globin genes are present but is not life-threatening. This condition, in which at most one α-globin gene is missing from each chromosome, is known as α+-thalassemia (α0-thalassemia occurs when both genes are removed from a chromosome). Despite the well-known beneficial effect of α+-thalassemia against malaria, scientists know little about how exactly the α+-thalassemias result in this protection, and whether they protect against all forms of the disease.

In a new study in PLoS Medicine, Thomas Williams, Sammy Wambua, and colleaguesresearchers from Kenya and Oxfordinvestigated the effect of α+-thalassemia on malaria and other childhood diseases, such as gastroenteritis, in two groups of children in Kenya. The first group comprised children younger than five years old, recruited between September 1998 and August 2001, 301 of whom were analyzed in the study (the mild disease cohort). The second group comprised 2,104 children recruited at birth between May 1992 and April 1995 (the birth cohort). All children analyzed were typed for both HbS and α+-thalassemia.

Williams and colleagues found that α+-thalassemia (either with one or two α-globin genes lost) was associated with significant reductions in the rate of admission to hospital with malaria (with or without signs of severity) and severe malaria. Both homozygous individuals (with two α genes missing in total, one from each chromosome) and heterozygote individuals (with only one α gene missing in total) had much lower rates of severe malaria anemia than normal children.

However, α+-thalassemia had no effect on symptomless parasitemia (defined as the presence of the Plasmodium falciparum malaria parasite in the blood of a child, but without fever or other symptoms). And although the occurrence of uncomplicated malaria was lower in both those heterozygous and those homozygous for α+-thalassemia compared with normal children, this drop in incidence was not statistically significant.

In general, there were no links between α+-thalassemia and the occurrence of nonmalarial illnesses. There were, however, two exceptions. In the birth cohort, fewer heterozygous infants than normal children were admitted to hospital with severe anemia. In the mild disease cohort, both heterozygous and homozygous children had a lower frequency of lower respiratory tract infections than normal childrenalthough, this was not seen in the other cohort.

These findings appear to contradict previous results from a study conducted by the same group in the Pacific islands of Vanuatu that showed α+-thalassemia might increase the frequency of uncomplicated malaria. The authors say this might partly be explained by the fact that, unlike Kenya, in Vanuatu two species of malaria, P. vivax and P. falciparum, both cause disease at similar frequencies. Furthermore, there may be major genetic differences in both human and parasite populations between these regions.

Whether the mutation has a protective effect against other diseases is still unresolved. The authors maintain that such an effect is plausibleindeed, the protection from lower respiratory tract infections in some children was of a similar magnitude to that for malaria. The authors have also previously recorded protection against nonmalarial diseases in Papua New Guinea.

These findings have important implications for researchers looking for antimalarial genes and for those searching for potential vaccine candidates: they will need to use a carefully focused approach that differentiates between uncomplicated, or symptomless, disease and the complicated, or severe, form.

MBD2 Protein mediates silencing of the fetal gamma-globin gene through DNA methylation

Tue, 11 Apr 2006 22:41:37 PST

( from http://www.rxpgnews.com ) Virginia Commonwealth University Massey Cancer Center researchers have identified the role of a protein in hemoglobin gene silencing that may one day be a potential target for the treatment of genetic blood disorders like sickle-cell anemia and beta-thalassemia on the molecular level.

In the April issue of the journal Proceedings of the National Academy of Sciences, researchers reported for the first time that the protein, MBD2, mediates silencing of the fetal gamma-globin gene through DNA methylation, a process that chemically modifies DNA. Researchers used a transgenic mouse model containing the human hemoglobin gene locus to show that MBD2 interprets the DNA methylation signal throughout the genome, which determined how the pattern of methylation effected the expression of specific genes.

Understanding how these epigenetic switches turn specific genes on and off, and identifying the important proteins involved, could lead to more targeted ways to reactivate genes and determine if there is a therapeutic benefit for particular diseases, said Gordon D. Ginder, M.D., director of the VCU Massey Cancer Center and lead author of the study.

Epigenetics refers to the study of the modifications of DNA and the surrounding proteins found in chromosomes that turn genes on and off and that can be passed on after cell division in an individual. Traditionally, researchers have focused their attention on changes to the DNA base code as being responsible for altered gene expression in disease.

Previous clinical studies have shown that increased gamma-globin gene expression has a positive effect in those with sickle-cell anemia or beta-thalassemia. The gamma-globin genes normally become silent in adult hemoglobin expressing red blood cells. If we can find a specific and safe mechanism to reactivate the gamma-globin gene, we may be able to overcome the underlying molecular defect in sickle-cell anemia and beta-thalassemia, Ginder said.

Gene silencing is important for the differentiation of many different types of cells to take place. In humans, there are five beta-type globin genes clustered on chromosome 11 in the order in which they are turned on, or expressed, during development. These genes include the embryonic epsilon-globin gene, two gamma-globin genes and the adult delta- and beta-globin genes. During fetal development, the embryonic epsilon-globin gene is active first, followed by the gamma-globin genes, and finally the major adult form, beta-globin, becomes the dominant expressed gene following birth.

According to Ginder, regulation of many genes and other molecular processes require DNA methylation. He said that DNA methylation is associated with the silencing of many types of genes, including tumor suppressor genes found in cancer cells. Scientists now know that DNA methylation plays a significant role in the development and progression of several forms of cancer.

Currently, the only therapeutic approach to relieving methylation-mediated gene silencing that has been tested in humans is through blocking the methylating enzymes non-specifically throughout the cell. Although this approach may have the desired effect on the specific gene or genes involved, it can also have an undesirable effect by turning on the wrong genes, he said.

The more targeted the approach the better, because there is less likelihood of producing any unintended negative side-effects. For example, there is some specificity of how some proteins, such as MBD2, act to silence only certain sets of methylated genes, Ginder said.

Mutations of hemoglobin genes play a role in genetic blood disorders such as sickle-cell anemia and beta-thalassemia.

RxPG News : Thalassemias

Alpha-Thalassemia and Protection from Malaria

MBD2 Protein mediates silencing of the fetal gamma-globin gene through DNA methylation