Molecular Analysis of Non-Transfusion Dependent Thalassemia Associated with Hemoglobin E-β-Thalassemia Disease without α-Thalassemia

Background: The finding of many Thai Hb E-beta(0) -thalassemia patients with non-transfusion dependent thalassemia (NTDT) phenotype without co-inheritance of alpha-thalassemia has prompted us to investigate the existence of other genetic modifying factors. Methods: Study was done on 122 adult Thai patients with NTDT Hb E-beta-thalassemia patients without co-inheritance of alpha-thalassemia. Multiple single-nucleotide polymorphisms (SNPs) associated with gamma-globin gene expression including the (G)gamma-XmnI of HBG2 gene, rs2297339, rs4895441, and rs9399137 of the HBS1L-MYB gene, rs4671393 in the BCL11A gene, and G176AfsX179, T334R, R238H and -154 (C-T) in the KLF1 gene were investigated using PCR and related techniques. Results: Heterozygous and homozygous for (G)gamma-XnmI of HBG2 gene were detected at 70.5% and 7.4%, respectively. Further DNA analysis identified the rs2297339 (C-T), rs4895441 (A-G), and rs9399137 (T-C) of HBSIL-NIYB gene in 86.9%, 25.4%, and 23.0%, respectively. The rs4671393 (C-A) of the BCL11A gene was found at 31.2%. For the KLF1 gene, only T334R was detected at 9.0%. Conclusions: It was found that these SNPs, when analyzed in combination, could explain the mild phenotypic expression of all cases. These results underline the importance of these informative SNPs on phenotypic expression of Hb E-beta-thalassemia patients.