Combine-ARMS: A Rapid and Cost-Effective Protocol for Molecular Characterization of β-Thalassemia in Malaysia

Abstract

β-Thalassemia major patients have chronic anemia and are dependent on blood transfusions to sustain life. Molecular characterization and prenatal diagnosis of β-thalassemia is essential in Malaysia because about 4.5% of the population are heterozygous carriers for β-thalassemia. The high percentage of compound heterozygosity (47.62%) found in β-thalassemia major patients in the Thalassaemia Registry, University of Malaya Medical Centre (UMMC), Malaysia, also supports a need for rapid, economical, and sensitive protocols for the detection of β-thalassemia mutations. Molecular characterization of β-thalassemia mutations in Malaysia is currently carried out using ARMS, which detects a single β-thalassemia mutation per PCR reaction. We developed and evaluated Combine amplification refractory mutation system (C-ARMS) techniques for efficient molecular detection of two to three β-thalassemia mutations in a single PCR reaction. Three C-ARMS protocols were evaluated and established for molecular characterization of common β-thalassemia mutations in the Malay and Chinese ethnic groups in Malaysia. Two C-ARMS protocols (cd 41-42/IVSII #654 and -29/cd 71-72) detected the β-thalassemia mutations in 74.98% of the Chinese patients studied. The C-ARMS for cd 41-42/IVSII #654 detected β-thalassemia mutations in 72% of the Chinese families. C-ARMS for cd 41-42/IVSI #5/cd 17 allowed detection of β-thalassemia mutations in 36.53% of β-thalassemia in the Malay patients. C-ARMS for cd 41-42/IVSI #5/cd 17 detected β-thalassemia in 45.54% of the Chinese patients. We conclude that C-ARMS with the ability to detect two to three mutations in a single reaction provides more rapid and cost-effective protocols for β-thalassemia prenatal diagnosis and molecular analysis programs in Malaysia.