Thalassemia is a recessive monogenic hematological disease associated with reduced amounts of functional hemoglobin caused by mutations/deletions in at least one of the globin genes. This disease has attracted significant attention throughout the years in terms of genetic diagnosis and developments in gene and cell therapy. Here, recent progress is reviewed in the genetic diagnosis and development of therapeutics for thalassemia, particularly β-thalassemia, in China and around the world.
Get full access to this article
View all access options for this article.
References
1.
ModellB, DarlisonM. Global epidemiology of haemoglobin disorders and derived service indicators. Bull World Health Organ, 2008; 86:480–487.
2.
ZengYT, HuangSZ. Disorders of haemoglobin in China. J Med Genet, 1987; 24:578–583.
3.
XuXM, ZhouYQ, LuoGX, et al.The prevalence and spectrum of α and β thalassaemia in Guangdong Province: implications for the future health burden and population screening. J Clin Pathol, 2004; 57:517–522.
4.
XiongF, SunM, ZhangX, et al.Molecular epidemiological survey of haemoglobinopathies in the Guangxi Zhuang Autonomous Region of southern China. Clin Genet, 2010; 78:139–148.
5.
ZhengCG, LiuM, DuJ, et al.Molecular spectrum of α- and β-globin gene mutations detected in the population of Guangxi Zhuang Autonomous Region, People's Republic of China. Hemoglobin, 2011; 35:28–39.
6.
YaoXY, YuJ, ChenSP, et al.Prevalence and genetic analysis of α-thalassemia and β-thalassemia in Chongqing area of China. Gene, 2013; 532:120–124.
7.
YinA, LiB, LuoM, et al.The prevalence and molecular spectrum of α- and β-globin gene mutations in 14,332 families of Guangdong Province, China. PLoS One, 2014; 9:e89855.
8.
HeS, QinQ, YiS, et al.Prevalence and genetic analysis of α- and β-thalassemia in Baise region, a multi-ethnic region in southern China. Gene, 2017; 619:71–75.
9.
HeJ, ZengH, ZhuL, et al.Prevalence and spectrum of thalassemia in Changsha, Hunan province, China: discussion of an innovative screening strategy. J Genet, 2017; 96:327–332.
10.
MahdiehN, RabbaniB. Beta thalassemia in 31,734 cases with HBB gene mutations: pathogenic and structural analysis of the common mutations; Iran as the crossroads of the Middle East. Blood Rev, 2016; 30:493–508.
11.
KanYW, GolbusMS, DozyAM. Prenatal diagnosis of α-thalassemia. Clinical application of molecular hybridization. N Engl J Med, 1976; 295:1165–1167.
12.
ZengYT, HuangSZ. Alpha-globin gene organisation and prenatal diagnosis of alpha-thalassaemia in Chinese. Lancet, 1985; 1:304–307.
13.
ZengYT, HuangSZ, ChenMJ. The types and distribution of α-thalassemia in China. Hemoglobin, 1988; 12:455–458.
14.
ZhangJ, XuX, WangL, et al.[Organization of α-globin genes in Chinese with HbH diseases in Guangdong Province]. Zhongquo Yi Xue Ke Xue Yuan Xue Bao, 1984; 6:79–83.
15.
HuangSZ, ZengYT, QiuXK, et al.Prenatal diagnosis of β thalassemia. Shanghai Med J, 1985; 8:565–567.
16.
ZhangJ, ZuoJ, WuG, et al.Early prenatal gene diagnosis of β-thalassemia (Presentation). Acta Acad Med Sci, 1985; 7:180.
17.
MullisKB, FaloonaFA, ScharfSJ, et al.Specific enzymatic amplification of DNA in vitro: the polymerase chain reaction. Cold Spring Harbor Symp Quant Biol, 1986; 51:263–273.
18.
ZengYT, HuangSZ, RenZR, et al.Identification of HbD-Punjab gene: application of DNA amplification in the study of abnormal hemoglobins. Am J Hum Genet, 1989; 44:886–889.
19.
MaoYH, ShengM, ChenMJ, et al.Prenatal diagnosis of β-thalassemia using multiplex allele-specific amplification M ASPCR in Chinese families. Hematology, 1996; 1:253–257.
20.
MorinPA, SaizR, MonjazebA. High-throughput single nucleotide polymorphism genotyping by fluorescent 5′ exonuclease assay. Biotechniques, 1999; 27:538–540, 542, 544 (passim).
21.
LivakKJ. Allelic discrimination using fluorogenic probes and the 5′ nuclease assay. Genet Anal, 1999; 14:143–149.
22.
HuangQ, LiuZ, LiaoY, et al.Multiplex fluorescence melting curve analysis for mutation detection with dual-labeled, self-quenched probes. PLoS One, 2011; 6:e19206.
23.
HuangQ, WangX, TangN, et al.Simultaneous genotyping of α-thalassemia deletional and nondeletional mutations by real-time PCR-based multicolor melting curve analysis. J Mol Diagn, 2017; 19:567–574.
24.
XiongF, HuangQ, ChenX, et al.A melting curve analysis-based PCR assay for one-step genotyping of β-thalassemia mutations a multicenter validation. J Mol Diagn, 2011; 13:427–435.
25.
HeX, ShengM, XuM, et al.Rapid identification of common β-thalassemia mutations in the Chinese population using duplex or triplex amplicon genotyping by high-resolution melting analysis. Genet Test Mol Biomarkers, 2010; 14:851–856.
26.
LiR, LiaoC, LiD, et al.High-resolution melting analysis of the three common nondeletional α-thalassemia mutations in the Chinese population: Hbs Constant Spring, Quong Sze and Westmead. Hemoglobin, 2010; 34:587–593.
27.
LiuYN, LiR, ZhouJY, et al.Screening for mutations in the α-globin genes leading to abnormal hemoglobin variants with high resolution melting analysis. Clin Chem Lab Med, 2011; 50:273–277.
28.
LinM, JiaoJW, ZhanXH, et al.High resolution melting analysis: a rapid screening and typing tool for common β-thalassemia mutation in Chinese population. PLoS One, 2014; 9:e102243.
29.
AnsorgeWJ. Next-generation DNA sequencing techniques. N Biotechnol, 2009; 25:195–203.
30.
ShangX, PengZ, YeY, et al.Rapid targeted next-generation sequencing platform for molecular screening and clinical genotyping in subjects with hemoglobinopathies. EBioMedicine, 2017; 23:150–159.
31.
LoYM, CorbettaN, ChamberlainPF, et al.Presence of fetal DNA in maternal plasma and serum. Lancet, 1997; 350:485–487.
32.
XiongL, BarrettAN, HuaR, et al.Non-invasive prenatal diagnostic testing for β-thalassaemia using cell-free fetal DNA and next generation sequencing. Prenat Diagn, 2015; 35:258–265.
33.
GongL, GuXF, ChenYD, et al.Reversal of aberrant splicing of β-thalassemia allele (IVS-2-654 C→T) by antisense RNA expression vector in cultured human erythroid cells. Br J Haematol, 2000; 111:351–358.
34.
XieSY, RenZR, ZhangJZ, et al.Restoration of the balanced α/β-globin gene expression in β654-thalassemia mice using combined RNAi and antisense RNA approach. Hum Mol Genet, 2007; 16:2616–2625.
35.
MayC, RivellaS, CallegariJ, et al.Therapeutic haemoglobin synthesis in β-thalassaemic mice expressing lentivirus-encoded human β-globin. Nature, 2000; 406:82–86.
36.
LiW, XieSY, GuoXB, et al.A novel transgenic mouse model produced from lentiviral germline integration for the study of β-thalassemia gene therapy. Haematologica, 2008; 93:356–362.
37.
YangGH, ShiWS, HuXY, et al.Therapeutic effects of induced pluripotent stem cells in chimeric mice with β-thalassemia. Haematologica, 2014; 99:1304–1311.
38.
ZengYT, HuangSZ, RenZR, et al.Hydroxyurea therapy in β-thalassaemia intermedia: improvement in haematological parameters due to enhanced β-globin synthesis. Br J Haematol, 1995; 90:557–563.
39.
HuangSZ, FiabchE, GuXF, et al.Hydroxyurea enhances β-globin expression and decreases aberrant splicing in cultured β+- thalassemia cells. Blood, 1995; 86(suppl):482a.
40.
SankaranVG, XuJ, RagoczyT, et al.Developmental and species-divergent globin switching are driven by BCL11A. Nature, 2009; 460:1093–1097.
41.
WienertB, MartynGE, KuritaR, et al.KLF1 drives the expression of fetal hemoglobin in British HPFH. Blood, 2017; 130:803–807.
42.
ShangX, PengZY, YeYH, et al.Rapid targeted next-generation sequencing platform for molecular screening and clinical genotyping in subjects with hemoglobinopathies. EBioMedicine, 2017; 23:150–159.
43.
ChenDY, ZuoYJ, ZhangXH, et al.A genetic variant ameliorates β-thalassemia severity by epigenetic-mediated elevation of human fetal hemoglobin expression. Am J Hum Genet, 2017; 101:130–138.
44.
XieF, YeL, ChangJC, et al.Seamless gene correction of β-thalassemia mutations in patient-specific iPSCs using CRISPR/Cas9 and piggyBac. Genome Res, 2014; 24:1526–1533.
45.
LiangPP, XuYW, ZhangXY, et al.CRISPR/Cas9-mediated gene editing in human tripronuclear zygotes. Protein Cell, 2015; 6:363–372.
46.
LiangPP, DingCH, SunHW, et al.Correction of β-thalassemia mutant by base editor in human embryos. Protein Cell, 2017; 8:811–822.
47.
NiuXH, HeWY, SongB, et al.Combining single strand oligodeoxynucleotides and CRISPR/Cas9 to correct gene mutations in β-thalassemia-induced pluripotent stem cells. J Biol Chem, 2016; 291:16576–16585.
48.
HannaJ, WernigM, MarkoulakiS, et al.Treatment of sickle cell anemia mouse model with iPS cells generated from autologous skin. Science, 2007; 318:1920–1923.
49.
DitadiA, SturgeonCM, ToberJ, et al.Human definitive haemogenic endothelium and arterial vascular endothelium represent distinct lineages. Nat Cell Biol, 2015; 17:580–591.
50.
SugimuraR, JhaDK, HanA, et al.Haematopoietic stem and progenitor cells from human pluripotent stem cells. Nature, 2017; 545:432–438.
51.
TorikaiH, ReikA, SoldnerF, et al.Toward eliminating HLA class I expression to generate universal cells from allogeneic donors. Blood, 2013; 122:1341–1349.
52.
Cavazzana-CalvoM, PayenE, NegreO, et al.Transfusion independence and HMGA2 activation after gene therapy of human β-thalassaemia. Nature, 2010; 467:318–322.
53.
Mansilla-SotoJ, RiviereI, BouladF, et al.Cell and gene therapy for the β-thalassemias: advances and prospects. Hum Gene Ther, 2016; 27:295–304.
54.
GinnSL, AlexanderIE, EdelsteinML, et al.Gene therapy clinical trials worldwide to 2012 – an update. J Gene Med, 2013; 15:65–77.
55.
HannaE, RémuzatC, AuquierP, ToumiM. Gene therapies development: slow progress and promising prospect. J Mark Access Health Policy, 2016; 5:1265293.