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{{Thalassemia}} | {{Thalassemia}} | ||
{{CMG}}; {{AE}}{{shyam}}{{NP}} | |||
==Overview== | |||
Our knowledge about the origins of thalassemia date back to more than 6000 years ago. At that time, persons of Mediterranean descent began their migrations to other regions of the world, carrying gene variants that eventually gave rise to thalassemias. The expansion of empires led to further propagation of the defective globin genes throughout the world. It was soon noted that persons with thalassemia were relatively resistant to [[malaria]], it explains high prevalence of Thalassemia in mediterranean basin, south east Asia, sub-Saharan Africa and the middle east. Further molecular studies were done to identify the underlying pathophysiology of thalassemias. The initial treatment approach to thalassemia was supportive care, especially [[red blood cell]] transfusions. In the recent years, [[bone marrow transplant]] and [[gene therapy]] have been exploited as possible treatments to treat thalassemias. These treatment strategies are still being explored. | |||
==Historical Perspective== | ==Historical Perspective== | ||
*In '''4000 B.C.''', persons of eastern Mediterranean descent migrated to Sicily, carrying thalassemia gene variants with them.<ref name="pmid28293406">{{cite journal| author=De Sanctis V, Kattamis C, Canatan D, Soliman AT, Elsedfy H, Karimi M et al.| title=β-Thalassemia Distribution in the Old World: an Ancient Disease Seen from a Historical Standpoint. | journal=Mediterr J Hematol Infect Dis | year= 2017 | volume= 9 | issue= 1 | pages= e2017018 | pmid=28293406 | doi=10.4084/MJHID.2017.018 | pmc=5333734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28293406 }} </ref> | *In '''4000 B.C.''', persons of eastern Mediterranean descent migrated to Sicily, carrying thalassemia gene variants with them.<ref name="pmid28293406">{{cite journal| author=De Sanctis V, Kattamis C, Canatan D, Soliman AT, Elsedfy H, Karimi M et al.| title=β-Thalassemia Distribution in the Old World: an Ancient Disease Seen from a Historical Standpoint. | journal=Mediterr J Hematol Infect Dis | year= 2017 | volume= 9 | issue= 1 | pages= e2017018 | pmid=28293406 | doi=10.4084/MJHID.2017.018 | pmc=5333734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28293406 }} </ref> | ||
*In the '''800s-900s''', there was mass migration of Arabs. | *In the '''800s-900s''', there was mass migration of Arabs, who harbored globin gene mutations. | ||
*In the '''1400s-1500s''', there was further influx of beta-thalassemia mutations with the expansion of the Ottoman Empire.<ref name="pmid28293406">{{cite journal| author=De Sanctis V, Kattamis C, Canatan D, Soliman AT, Elsedfy H, Karimi M et al.| title=β-Thalassemia Distribution in the Old World: an Ancient Disease Seen from a Historical Standpoint. | journal=Mediterr J Hematol Infect Dis | year= 2017 | volume= 9 | issue= 1 | pages= e2017018 | pmid=28293406 | doi=10.4084/MJHID.2017.018 | pmc=5333734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28293406 }} </ref> The Ottoman Expire expanded Eastern Europe, Central Asia, and Northern Africa, leading to additional mutations to develop in the population. | *In the '''1400s-1500s''', there was further influx of beta-thalassemia mutations with the expansion of the Ottoman Empire.<ref name="pmid28293406">{{cite journal| author=De Sanctis V, Kattamis C, Canatan D, Soliman AT, Elsedfy H, Karimi M et al.| title=β-Thalassemia Distribution in the Old World: an Ancient Disease Seen from a Historical Standpoint. | journal=Mediterr J Hematol Infect Dis | year= 2017 | volume= 9 | issue= 1 | pages= e2017018 | pmid=28293406 | doi=10.4084/MJHID.2017.018 | pmc=5333734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28293406 }} </ref> The Ottoman Expire expanded to Eastern Europe, Central Asia, and Northern Africa, leading to additional globin mutations to develop in the population. | ||
*In '''1948''', J.B.S. Haldane hypothesized that a heterozygote advantage existed for patients with beta-thalassemia in the context of malaria infection. This theory was similar to that of the heterozygote advantage conferred by sickle cell trait for malaria resistance. It was thought that thalassemia mutations would be selected for and would propagate in areas of high prevalence of malaria. Microcytic erythrocytes are less susceptible to malaria infection. | *In '''1948''', the biologist J.B.S. Haldane hypothesized that a [[heterozygote]] advantage existed for patients with beta-thalassemia in the context of [[malaria]] infection. This theory was similar to that of the [[heterozygote]] advantage conferred by [[sickle cell trait]] for [[malaria]] resistance. It was thought that thalassemia mutations would be selected for and would propagate in areas of high prevalence of [[malaria]]. Microcytic [[erythrocytes]] are less susceptible to [[malaria]] infection. | ||
*In '''1952''', Silvestroni and colleagues | *In '''1952''', Silvestroni and colleagues noted that beta-thalassemia trait was highly prevalent in the Po River's delta region.<ref name="pmid28293406">{{cite journal| author=De Sanctis V, Kattamis C, Canatan D, Soliman AT, Elsedfy H, Karimi M et al.| title=β-Thalassemia Distribution in the Old World: an Ancient Disease Seen from a Historical Standpoint. | journal=Mediterr J Hematol Infect Dis | year= 2017 | volume= 9 | issue= 1 | pages= e2017018 | pmid=28293406 | doi=10.4084/MJHID.2017.018 | pmc=5333734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28293406 }} </ref> | ||
*In the '''1970s''', the predilection of beta-thalassemia to affect Mediterranean populations was recognized, and pilot prevention programs were established to raise awareness and provide education about thalassemia. During this time, [[red blood cell]] transfusions were a mainstay for therapy. Transfusions were complicated by the risk for infections with hepatitis B, hepatitis C, and HIV. | *In the '''1970s''', the predilection of beta-thalassemia to affect Mediterranean populations was recognized, and pilot prevention programs were established to raise awareness and provide education about thalassemia. During this time, [[red blood cell]] transfusions were a mainstay for therapy. Transfusions were complicated by the risk for infections with [[hepatitis B]], [[hepatitis C]], and [[HIV]]. | ||
*In '''1978''', the concept of the hematopoietic niche in the bone marrow was introduced by Dr. Schofield.<ref name="pmid25093887">{{cite journal| author=Lane SW, Williams DA, Watt FM| title=Modulating the stem cell niche for tissue regeneration. | journal=Nat Biotechnol | year= 2014 | volume= 32 | issue= 8 | pages= 795-803 | pmid=25093887 | doi=10.1038/nbt.2978 | pmc=4422171 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25093887 }} </ref> | *In the '''1970s-1980s''', scientists began to understand the mutational landscape of thalassemias.<ref name="pmid23284078">{{cite journal| author=Higgs DR| title=The molecular basis of α-thalassemia. | journal=Cold Spring Harb Perspect Med | year= 2013 | volume= 3 | issue= 1 | pages= a011718 | pmid=23284078 | doi=10.1101/cshperspect.a011718 | pmc=3530043 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23284078 }} </ref> Further insight into the molecular basis for thalassemia was made as biotechnology developed over the coming years. | ||
*In the '''1980s''', the concept of allogeneic bone marrow transplant was introduced with the goal of correcting the nonfunctional globin chain. | *In '''1978''', the concept of the hematopoietic niche in the bone marrow was introduced by Dr. Schofield.<ref name="pmid25093887">{{cite journal| author=Lane SW, Williams DA, Watt FM| title=Modulating the stem cell niche for tissue regeneration. | journal=Nat Biotechnol | year= 2014 | volume= 32 | issue= 8 | pages= 795-803 | pmid=25093887 | doi=10.1038/nbt.2978 | pmc=4422171 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25093887 }} </ref> This was important because [[hematopoietic stem cells]] in the bone marrow give rise to mature [[red blood cells]] via the [[megakaryocyte-erythrocyte progenitor]]. | ||
*In the '''1980s''', the concept of [[allogeneic]] [[bone marrow transplant]] was introduced with the goal of correcting the nonfunctional globin chain. The donor cells in from a [[bone marrow transplant]] contain the normal globin gene product, and this could reconstitute normal [[erythropoiesis]], or [[red blood cell]] production. | |||
*In '''1989''', Higgs and colleagues reported on the molecular basis of thalassemias.<ref name="pmid23284078">{{cite journal| author=Higgs DR| title=The molecular basis of α-thalassemia. | journal=Cold Spring Harb Perspect Med | year= 2013 | volume= 3 | issue= 1 | pages= a011718 | pmid=23284078 | doi=10.1101/cshperspect.a011718 | pmc=3530043 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23284078 }} </ref> | *In '''1989''', Higgs and colleagues reported on the molecular basis of thalassemias.<ref name="pmid23284078">{{cite journal| author=Higgs DR| title=The molecular basis of α-thalassemia. | journal=Cold Spring Harb Perspect Med | year= 2013 | volume= 3 | issue= 1 | pages= a011718 | pmid=23284078 | doi=10.1101/cshperspect.a011718 | pmc=3530043 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23284078 }} </ref> | ||
*In the '''2000s''', gene therapy was conceptualized for thalassemias. Efforts were made to introduce exogenous wild-type globin genes into patients to restore normal globin function.<ref name="pmid25737641">{{cite journal| author=Finotti A, Breda L, Lederer CW, Bianchi N, Zuccato C, Kleanthous M et al.| title=Recent trends in the gene therapy of β-thalassemia. | journal=J Blood Med | year= 2015 | volume= 6 | issue= | pages= 69-85 | pmid=25737641 | doi=10.2147/JBM.S46256 | pmc=4342371 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25737641 }} </ref> The goal was to achieve highly efficient transduction of hematopoietic stem and progenitor cells ( | *In the '''2000s''', gene therapy was conceptualized for thalassemias. Efforts were made to introduce exogenous wild-type globin genes into patients to restore normal globin function.<ref name="pmid25737641">{{cite journal| author=Finotti A, Breda L, Lederer CW, Bianchi N, Zuccato C, Kleanthous M et al.| title=Recent trends in the gene therapy of β-thalassemia. | journal=J Blood Med | year= 2015 | volume= 6 | issue= | pages= 69-85 | pmid=25737641 | doi=10.2147/JBM.S46256 | pmc=4342371 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25737641 }} </ref> The goal was to achieve highly efficient transduction of [[hematopoietic stem and progenitor cells]] (HSPCs) such that a normal functional globin could be produced.<ref name="pmid25737641">{{cite journal| author=Finotti A, Breda L, Lederer CW, Bianchi N, Zuccato C, Kleanthous M et al.| title=Recent trends in the gene therapy of β-thalassemia. | journal=J Blood Med | year= 2015 | volume= 6 | issue= | pages= 69-85 | pmid=25737641 | doi=10.2147/JBM.S46256 | pmc=4342371 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25737641 }} </ref> | ||
==References== | ==References== | ||
Latest revision as of 12:15, 16 April 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shyam Patel [2]Neel Patel, M.B.B.S[3]
Overview
Our knowledge about the origins of thalassemia date back to more than 6000 years ago. At that time, persons of Mediterranean descent began their migrations to other regions of the world, carrying gene variants that eventually gave rise to thalassemias. The expansion of empires led to further propagation of the defective globin genes throughout the world. It was soon noted that persons with thalassemia were relatively resistant to malaria, it explains high prevalence of Thalassemia in mediterranean basin, south east Asia, sub-Saharan Africa and the middle east. Further molecular studies were done to identify the underlying pathophysiology of thalassemias. The initial treatment approach to thalassemia was supportive care, especially red blood cell transfusions. In the recent years, bone marrow transplant and gene therapy have been exploited as possible treatments to treat thalassemias. These treatment strategies are still being explored.
Historical Perspective
- In 4000 B.C., persons of eastern Mediterranean descent migrated to Sicily, carrying thalassemia gene variants with them.[1]
- In the 800s-900s, there was mass migration of Arabs, who harbored globin gene mutations.
- In the 1400s-1500s, there was further influx of beta-thalassemia mutations with the expansion of the Ottoman Empire.[1] The Ottoman Expire expanded to Eastern Europe, Central Asia, and Northern Africa, leading to additional globin mutations to develop in the population.
- In 1948, the biologist J.B.S. Haldane hypothesized that a heterozygote advantage existed for patients with beta-thalassemia in the context of malaria infection. This theory was similar to that of the heterozygote advantage conferred by sickle cell trait for malaria resistance. It was thought that thalassemia mutations would be selected for and would propagate in areas of high prevalence of malaria. Microcytic erythrocytes are less susceptible to malaria infection.
- In 1952, Silvestroni and colleagues noted that beta-thalassemia trait was highly prevalent in the Po River's delta region.[1]
- In the 1970s, the predilection of beta-thalassemia to affect Mediterranean populations was recognized, and pilot prevention programs were established to raise awareness and provide education about thalassemia. During this time, red blood cell transfusions were a mainstay for therapy. Transfusions were complicated by the risk for infections with hepatitis B, hepatitis C, and HIV.
- In the 1970s-1980s, scientists began to understand the mutational landscape of thalassemias.[2] Further insight into the molecular basis for thalassemia was made as biotechnology developed over the coming years.
- In 1978, the concept of the hematopoietic niche in the bone marrow was introduced by Dr. Schofield.[3] This was important because hematopoietic stem cells in the bone marrow give rise to mature red blood cells via the megakaryocyte-erythrocyte progenitor.
- In the 1980s, the concept of allogeneic bone marrow transplant was introduced with the goal of correcting the nonfunctional globin chain. The donor cells in from a bone marrow transplant contain the normal globin gene product, and this could reconstitute normal erythropoiesis, or red blood cell production.
- In 1989, Higgs and colleagues reported on the molecular basis of thalassemias.[2]
- In the 2000s, gene therapy was conceptualized for thalassemias. Efforts were made to introduce exogenous wild-type globin genes into patients to restore normal globin function.[4] The goal was to achieve highly efficient transduction of hematopoietic stem and progenitor cells (HSPCs) such that a normal functional globin could be produced.[4]
References
- ↑ 1.0 1.1 1.2 De Sanctis V, Kattamis C, Canatan D, Soliman AT, Elsedfy H, Karimi M; et al. (2017). "β-Thalassemia Distribution in the Old World: an Ancient Disease Seen from a Historical Standpoint". Mediterr J Hematol Infect Dis. 9 (1): e2017018. doi:10.4084/MJHID.2017.018. PMC 5333734. PMID 28293406.
- ↑ 2.0 2.1 Higgs DR (2013). "The molecular basis of α-thalassemia". Cold Spring Harb Perspect Med. 3 (1): a011718. doi:10.1101/cshperspect.a011718. PMC 3530043. PMID 23284078.
- ↑ Lane SW, Williams DA, Watt FM (2014). "Modulating the stem cell niche for tissue regeneration". Nat Biotechnol. 32 (8): 795–803. doi:10.1038/nbt.2978. PMC 4422171. PMID 25093887.
- ↑ 4.0 4.1 Finotti A, Breda L, Lederer CW, Bianchi N, Zuccato C, Kleanthous M; et al. (2015). "Recent trends in the gene therapy of β-thalassemia". J Blood Med. 6: 69–85. doi:10.2147/JBM.S46256. PMC 4342371. PMID 25737641.