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Molecular heterogeneity underlying the G6PD Mediterranean phenotype.

As part of a study aiming to define the molecular basis of glucose-6-phosphate dehydrogenase (G6PD) deficiency, we analysed a sample from a Portugese boy with a family history of favism. Although the biochemical properties of red-cell G6PD from this subject were similar to those of the common variant G6PD Mediterranean, the corresponding mutation (563 C----T) was not present. Instead, polymerase chain reaction (PCR) amplification and sequencing of the entire gene detected a C----T transition at nucleotide 592 in exon VI, changing an arginine residue to a cysteine residue only 10 amino acids downstream from the Mediterranean mutation. Single-strand conformation polymorphism analysis of a PCR-amplified DNA fragment spanning exons VI and VII of the G6PD gene has detected the same mutation, confirmed by sequencing, in a G6PD-deficient patient from Southern Italy. We name this new variant G6PD Coimbra.

Base Sequence↗

Positive regulation of the Drosophila melanogaster G6PD gene by an insertion sequence.

In a previous study, we have shown that the three high-G6PD activity mutants are characterized by insertion of the Ins1 sequence consisting of a core sequence flanked by two defective P elements (KP and KP'; the 32nd base of the KP was replaced by guanine in the KP') in front of exonI of the G6PD gene and that the sequence responsible for positive regulation of the G6PD gene expression might be the core sequence but not the flanking KP and KP' elements. The core sequence is composed of either one or two identical units in each mutant. In this report we present evidence (1) that insertion of the Ins1 sequence gives rise to overproduction of G6PD mRNA, (2) that the length and the 5' end of G6PD mRNA do not differ in wild-type and three mutants, (3) that the insertion site of the Ins1 sequence is the same in the mutants, and (4) that each unit of the core sequence has the same in the mutants, and (4) that each unit of the core sequence has a pair of DNase I-hypersensitive sites. The possibility exists that the binding of some regulatory proteins to the DNase I-hypersensitive sites might accelerate the transcription rate of the G6PD gene.

Animals↗

G6PD molecules devoid of catalytic activity are present in the nucleus of the rat lens.

The specific activity of glucoso-6-phosphate dehydrogenase (G6PD) in the rat lens declines as a function of animal age. G6PD activity could be found only in the cortex of the lens. Previous work showed that antibodies against the 'native' form of G6PD could not recognize any cross-reacting material (CRM) in the lens. It was speculated that this could be due either to disappearance of G6PD from the nucleus by degradation or by alterations of the molecules which resulted in the loss of their antigenic determinants. In order to investigate this question, an antibody was prepared against denatured G6PD. This antibody did not interact with 'native' (active) forms of the enzyme; it was shown, however, to recognize antigenically cross-reactive but catalytically inactive intact G6PD molecules in the nucleus of the lens. This finding suggests that altered enzyme molecules are at least partially denatured and accumulate in the lens without being further cleaved proteolytically.

Aging↗

Molecular characterization of G6PD deficiency in Cyprus.

In the present study, we determined the frequency of glucose-6-phosphate dehydrogenase (G6PD) deficiency in Cyprus using two different procedures in two separate adult population groups: a semiquantitative fluorescence test on blood spotted on filter paper and a quantitative spectrophotometric test on liquid blood. The frequency of G6PD deficiency among healthy adult males was found to be 5.1% using the semiquantitative procedure and 6.4% using the quantitative procedure. Neither method was able to detect all the expected female heterozygotes (5.3% and 47.1% of the expected number, respectively). A total of 21 male hemizygotes, 1 female homozygote and 9 female heterozygotes that tested positive for G6PD deficiency were studied at the molecular level. All 32 chromosomes were genotyped and five different mutations were identified. The Mediterranean mutation in exon 6 (563C-->T) (Ser188Phe) was found to be the most common variant in the Cypriot population, accounting for 52.6% of the deficient alleles. In the remaining chromosomes, four different mutations were identified: three known mutations, Kaiping 1388G-->A (Arg463His), Chatham 1003G-->A (Ala335Thr) and Acrokorinthos 463C-->G (His155Asp), and one previously undescribed mutation in exon 3, 148C-->T (Pro50Ser), which we called G6PD Kambos. We conclude that the frequency of G6PD deficiency in Cypriot males is 6.4%, and that this deficiency is the result of several different mutations. Although all the individuals carrying the Mediterranean variant can be detected using a semiquantitative screening method, a quantitative enzyme measurement is required to detect the G6PD variants with less severe enzyme deficiencies, while the most appropriate method for heterozygote detection is DNA analysis.

Clinical Laboratory Techniques↗

Reliability of quantitative and qualitative tests to identify heterozygotes carrying severe or mild G6PD deficiency.

OBJECTIVES: To determine if the qualitative test (cytochemical) is more reliable than the quantitative test (differential pH-metry) in identifying heterozygous G6PD- subjects. DESIGN AND METHODS: Identification of heterozygous G6PD- subjects was done by the measurement of G6PD activity and by a cytochemical test. RESULTS: A cytochemical test is more sensitive than differential pH-metry to identify heterozygous G6PD- subjects. CONCLUSIONS: A cytochemical test is a reliable method for mass screening for G6PD deficiency to identify G6PD- heterozygotes.

Adult↗

Green tea polyphenol epigallocatechin-3-gallate protects cells against peroxynitrite-induced cytotoxicity: modulatory effect of cellular G6PD status.

Glucose-6-phosphate dehydrogenase (G6PD) plays important roles in the maintenance of cellular redox balance. It was not until recently that the importance of G6PD in regulation of cellular growth and apoptosis emerged. In the present study, we found that G6PD-deficient fibroblasts were more susceptible to peroxynitrite-induced cytotoxicity. Treatment with peroxynitrite generator 3-morpholinosydnonimine (SIN-1) hydrochloride caused apoptosis in human fibroblast in a dose-dependent manner. This was preceded by a decrease in the intracellular level of glutathione (GSH) as well as accumulation of p53. The extent of apoptosis and glutathione depletion were greater in G6PD-deficient fibroblasts than in the normal counterpart. Pretreatment with green tea polyphenol epigallocatechin-3-gallate (EGCG) effectively blocked peroxynitrite-induced glutathione depletion, p53 accumulation, and apoptosis in both normal and G6PD-deficient cells. EGCG, administered to cells alone or as pretreatment, caused activation of Akt. The protective effect was abolished by phosphatidylinositol 3-kinase (PI3K) inhibitors, wortmannin, and LY294002. Our findings suggest that G6PD deficiency enhances the toxicity of peroxynitrite and that EGCG initiates cell survival signaling via the PI3K/akt pathway.

Apoptosis↗

A randomized, triple-blind, placebo-controlled trial of prophylactic oral phenobarbital to reduce the need for phototherapy in G6PD-deficient neonates.

OBJECTIVE: Decreased conjugation is probably more important than hemolysis for causing jaundice in G6PD-deficient neonates. The role of enzyme inducers, like phenobarbital, in G6PD deficiency is unclear. This randomized controlled trial was performed to evaluate Phenobarbital's role in reducing the need for phototherapy among G6PD-deficient neonates. STUDY DESIGN: This stratified, randomized, triple-blinded, placebo-controlled trial was conducted in a level III NICU. Consecutive babies with gestation >/=34 weeks and birth weight >/=1800 g were screened from cord blood. G6PD-deficient neonates, who were otherwise healthy, were enrolled. Rh isoimmunization, maternal Phenobarbital use and lack of parental consent were exclusion criteria. Subjects were randomly allocated to receive 5 mg/kg day of oral phenobarbital/ placebo for first 3 days. They were monitored daily for total serum bilirubin (TSB) until declining TSB was documented twice. The primary outcome was requirement for phototherapy and secondary outcomes were duration of phototherapy, need for exchange transfusion, peak TSB and adverse effects. Sample size of 56 could detect a decline in phototherapy requirement from 40 to 5% with 80% power and 5% error. RESULTS: Of 2370 babies screened, 63 were G6PD-deficient. Of them, 56 eligible babies were allocated to phenobarbital (n=27) or placebo (n=29). The mean age of administration of the first dose was 18.55+/-7.3 h. In total, 44% in phenobarbital group and 41% in placebo group required phototherapy (p=1.0). There was no significant difference in exchange transfusion rates (18.5 vs 10%, p=0.46). No baby had adverse reactions. CONCLUSION: Prophylactic oral phenobarbital does not decrease the need for phototherapy or exchange transfusions in G6PD-deficient neonates.

Administration, Oral↗

Molecular basis of haemoglobinopathies and G6PD deficiency in the Comorian population.

INTRODUCTION: The Comoro archipelago is characterised by a high prevalence of red cell genetic disorders such as G6PD deficiency and haemoglobinopathies, being a region endemic for malaria. Over the last 15 years, the city of Marseilles in France has become the main destination for Comorian immigrants. This Comorian community includes patients with sickle cell disease, sickle cell/beta-thalassaemia trait, thalassaemias and G6PD deficiency. MATERIALS AND METHODS: Allele frequencies for haemoglobin S, beta-thalassaemia and G6PD deficiency were determined from neonatal and prenatal screenings of the Comorian community. Haemoglobin fractions were detected by isoelectrofocalisation, and the quantitation of HbS, HbA, HbA(2) and HbF was performed by cation exchange high performance liquid chromatography. The molecular study involved 31 alleles carrying the betaS mutation (Cd 6 [A-->T]), six beta-thalassaemic alleles and 17 G6PD-deficient alleles, selected from a group of carriers or affected subjects. RESULTS: Allele frequencies were 3% for haemoglobin S, 1% for beta-thalassaemia trait and 9.5% for G6PD deficiency. Molecular analysis had revealed that the African alleles are predominant, being present in almost all the subjects studied. Mediterranean alleles were found for all the beta-thalassaemia mutations and for three G6PD chromosomes out of 17. CONCLUSION: These data are consistent with the mixed Arab and African origin of the population of the Comoro Islands, and are of clinical interest in prenatal and newborn screening plans.

Alleles↗

Oxidation of cellular thiols by hydroxyethyldisulphide inhibits DNA double-strand-break rejoining in G6PD deficient mammalian cells.

PURPOSE: We investigated the effect of protein- and non protein-thiol oxidation on DNA double-strand-break (DSB) rejoining after irradiation and its relevance in the survival of CHO cells. MATERIALS AND METHODS: We used mutant cells null for glucose 6 phosphate dehydrogenase (G6PD) activity since reducing equivalents, required for reduction of oxidized thiols, are typically generated through G6PD regulated production of NADPH. Cellular thiols were oxidized by pre-incubating the cells with hydroxyethyldisulphide (HEDS), the oxidized form of mercaptoethanol (ME). The concentrations of the intracellular and extracellular non-protein thiols (NPSH), glutathione, cysteine and mercaptoethanol were quantitated by HPLC. Protein thiols (PSH) were estimated using Ellman's reagent. Cell survival was determined by clonogenic assay. The induction and rejoining of DSB in cells was quantitated by Pulse Field Gel Electrophoresis after exposure to ionizing radiation. RESULTS: Much lower bioreduction of HEDS was found in the G6PD deficient mutants (E89) than in the wild-type cells (K1). A 1 h treatment of E89 cells with HEDS produced almost complete depletion of non-protein thiol (NPSH) and a 26% decrease in protein thiols. Only minor changes were found under similar conditions with K1 cells. When exposed to gamma radiation in the presence of HEDS, the G6PD null mutants exhibited a higher cell killing and decreased rate and extent of rejoining of DSB than were observed in K1 cells. Moreover, when the G6PD deficient cells were transfected with the gene encoding wild-type G6PD (A1A), they recovered close to wild-type cellular thiol status, cell survival and DSB rejoining. CONCLUSIONS: These results suggest that a functioning oxidative pentose phosphate pathway is required for DSB rejoining in cells exposed to a mild thiol oxidant.

Animals↗

Evidence for balancing selection from nucleotide sequence analyses of human G6PD.

Glucose-6-phosphate dehydrogenase (G6PD) mutations that result in reduced enzyme activity have been implicated in malarial resistance and constitute one of the best examples of selection in the human genome. In the present study, we characterize the nucleotide diversity across a 5.2-kb region of G6PD in a sample of 160 Africans and 56 non-Africans, to determine how selection has shaped patterns of DNA variation at this gene. Our global sample of enzymatically normal B alleles and A, A-, and Med alleles with reduced enzyme activities reveals many previously uncharacterized silent-site polymorphisms. In comparison with the absence of amino acid divergence between human and chimpanzee G6PD sequences, we find that the number of G6PD amino acid polymorphisms in human populations is significantly high. Unlike many other G6PD-activity alleles with reduced activity, we find that the age of the A variant, which is common in Africa, may not be consistent with the recent emergence of severe malaria and therefore may have originally had a historically different adaptive function. Overall, our observations strongly support previous genotype-phenotype association studies that proposed that balancing selection maintains G6PD deficiencies within human populations. The present study demonstrates that nucleotide sequence analyses can reveal signatures of both historical and recent selection in the genome and may elucidate the impact that infectious disease has had during human evolution.

Africa South of the Sahara↗

Nucleotide variability at G6pd and the signature of malarial selection in humans.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathy in humans. Deficiency alleles for this X-linked disorder are geographically correlated with historical patterns of malaria, and the most common deficiency allele in Africa (G6PD A-) has been shown to confer some resistance to malaria in both hemizygous males and heterozygous females. We studied DNA sequence variation in 5.1 kb of G6pd from 47 individuals representing a worldwide sample to examine the impact of selection on patterns of human nucleotide diversity and to infer the evolutionary history of the G6PD A- allele. We also sequenced 3.7 kb of a neighboring locus, L1cam, from the same set of individuals to study the effect of selection on patterns of linkage disequilibrium. Despite strong clinical evidence for malarial selection maintaining G6PD deficiency alleles in human populations, the overall level of nucleotide heterozygosity at G6pd is typical of other genes on the X chromosome. However, the signature of selection is evident in the absence of genetic variation among A- alleles from different parts of Africa and in the unusually high levels of linkage disequilibrium over a considerable distance of the X chromosome. In spite of a long-term association between Plasmodium falciparum and the ancestors of modern humans, patterns of nucleotide variability and linkage disequilibrium suggest that the A- allele arose in Africa only within the last 10,000 years and spread due to selection.

Alleles↗

Alcoholic liver disease in black men with G6PD deficiency.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency of the type commonly encountered in Afro-American blacks has been associated with an increased severity of viral hepatitis. Decreased activity of the enzyme has been demonstrated in liver tissue of affected individuals. We studied 21 patients with alcoholic liver disease and G6PD deficiency who were identified through the VA Cooperative Study of Sickle Trait and G6PD Deficiency and compared them with 21 black patients with alcoholic liver disease and normal G6PD levels. A trend suggested the severity of liver disease might be less in G6PD-deficient patients. We conclude that G6PD deficiency is not associated with increased severity of alcoholic liver disease.

Adult↗

Membrane glycoprotein modifications of G6PD deficient red blood cells.

In this study, the composition and the role of membrane glycoproteins in phagocytosis were determined in G6PD deficient RBCs. G6PD deficient RBCs were recognized and significantly phagocytosed by murine macrophages, without pre-exposure to oxidants in vivo. Phagocytosis was partially (60%) inhibited by incubating macrophages with either galactose or mannose, or by incubating RBCs with beta-galactosidase, indicating the involvement of lectin-like receptors in the recognition of G6PD deficient RBCs. Membrane glycoproteins on G6PD deficient cells were detected by binding of Con A to both intact RBCs and to purified membrane proteins. The results demonstrated modifications in the glycoprotein pattern of G6PD deficient RBCs compared to untreated controls. These included reduction in the amounts of several high molecular weight glycoproteins and appearance of lower molecular weight bands. These results suggest that G6PD deficient RBCs undergo glycoprotein modifications, which may lead to premature removal from circulation, even in non-acute hemolysis.

Animals↗

A new glucose 6-phosphate dehydrogenase variant (G6PD Thessaloniki) in a patient with idiopathic myelofibrosis.

A new deficient glucose 6-phosphate dehydrogenase (G6PD) variant, G6PD Thessaloniki, which was found in the red blood cells of a 70-year-old woman who had idiopathic myelofibrosis, is described. G6PD Thessaloniki had a low Michaelis constant (Km) for G6P (20 microM), high Km for NADP (10.1 microM), normal pH optimum, reduced heat stability, decreased electrophoretic mobility (96-98% of the normal), increased 2-deoxy-G6P and decreased galactose 6-phosphate utilization. Several other enzymatic activities measured in the patient's red blood cells were normal. Studies of red blood cell survival and glucose utilization gave evidence of haemolysis caused by defective glucose utilization by the pentose phosphate pathway. The only son of the patient had normal G6PD in his red blood cells. In an attempt to investigate the origin of G6PD Thessaloniki, heat stability tests of G6PD extracted from the patient's skin have been performed.

Aged↗

[The preliminary study on the gene mutations of sixty patients with G6PD deficiency in Yunnan province].

OBJECTIVE: To analyze the types and distribution of glucose-6-phosphate dehydrogenase (G6PD) gene mutations in Yunnan province. METHODS: By using the natural primers or mis-matched primers mediated polymerase chain reaction (PCR) followed by endonuclease digestion methods, six types of G6PD gene mutations, G1388A, G1376T, C1024T, G392T, C592T and A95G were in sixty patients with G6PD deficiency. RESULT: Six types of mutation were revealed: 28.3% (17 of 60) were G1388A, 11.7% (7 of 60) G1376T, 6.7% (4 of 60) C1024T, 1.7% (1 of 60) G392T, 1.7% (1 of 60) C592T, 1.7% (1 of 60) A95G and 48.3% (29 of 60) unidentified. C592T mutation is the first report in Yunnan people. CONCLUSIONS: The G6PD gene in Yunnan people is heterogeneous. Research of G6PD gene mutation types may provide some useful data for clinical diagnosis and prevention of G6PD deficiency, and for human genetic study.

Amino Acid Substitution↗

[Identification of G6PD gene variants from Hakka population in Guangdong province].

OBJECTIVE: Studying on G6PD polymorphism from Hakka population in Guangdong province. METHODS: Identifying the variants of G6PD gene and determining the frequencies respectively with the use of amplified refractory mutation system(ARMS), polymerase chain reaction-single strand conformation polymorphism(PCR-SSCP) and ABI 3100 DNA sequencing technologies. RESULTS: Mutations of G6PD gene in cDNA 1388 (G-->A), 1376 (G-->T), 95 (A-->G), 392 (G-->T), 1024 (C-->T), 1311 (C-->T) have been found. CONCLUSION: G6PD cDNA 1388 (G-->A), 1376 (G-->T), 95(A--> G), 392 (G-->T), 1024 (C-->T) and 1311 (C-->T) accompanied with intron 11 (93 T-->C) are the common mutations in Chinese population. cDNA 1388 (G-->A), cDNA 1376 (G-->T) are the most popular G6PD gene variants in Hakka population. In this study, no new type of G6PD gene mutation was found in the Hakkas of Guangdong.

Asian People↗

[Changes of erythrocyte membrane lipid in hereditary G6PD deficiency].

OBJECTIVE: To explore the biochemical mechanism of G6PD deficiency. METHODS: A fluorescence polarization technique with 1,6-dipheny 1,1,3,5-heratciene (DPH) as a fluorescent probe was used to determine the fluidity of erythrocyte membrane lipid from G6PD deficient patients and normal controls. The polarization of fluorescence was measured between 0 degrees and 90 degrees. RESULTS: The fluorescence polarization parameter (rho) was high in G6PD deficient erythrocytes as compared with normal controls, indicating a decrease in erythrocyte membrane lipid fluidity. The determination of lipoperoxidation of erythrocyte membrane by fluorescence spectrometry also showed that the content of MDA was significantly higher in G6PD deficient erythrocytes than in normal controls. The percentage of unsaturated fatty acid C18:1 and C18:2 in total phosphalipids and phosphatidyl serine was decreased in G6PD deficient erythrocytes. CONCLUSION: The decrease of erythrocyte membrane lipid fluidity is related to the lipid peroxidant, and the oxidative damage of erythrocyte membrane phosphalipids in G6PD deficient patients might be an important factor of hemolysis.

Case-Control Studies↗

Glucose-6-phosphate dehydrogenase (G6PD) deficiency in Yogyakarta and its surrounding areas.

Glucose-6-phosphate dehydrogenase (G6PD) is one of the enzymes needed by the erythrocyte to generate ATP from ADP. Deficiency of this enzyme can lead to hemolysis of red blood cells. Being a malaria endemic area, Indonesia possibly has a high incidence of G6PD deficiency. It is estimated that 2-6% of the population are carriers. In 1996, we detected 145 neonates with G6PD deficiency using the formazan ring method. Among the males, 6.2% had moderate and 1.4% had low enzyme activity; females had enzyme activity in the normal range. Using the Sigma kit, Tashimi et al in 1995 examined 111 neonates in Yogyakarta, none of which was identified as "deficient". There was no correlation between erythrocyte hemolysis and G6PD enzyme content. Interestingly, using the same Sigma kit. Soro et al in 1994 found that among 134 individuals of Batak descent, 10 males (43.48%) and 9 females (8.11%) were G6PD deficient. These were similar to the results reported by Pramuji et al in 1995 for the people around Palembang. Since the G6PD gene is located on the X chromosome, this is a peculiar result thus further studies need to be done. In cooperation with Harvard University, Sumantri et al in 1995 described 14% as carriers. Molecular analysis among these 16 Javanese males showed the following mutations--nt563 (C->T) in 5 cases, nt1376 (G->T) in 3 cases, nt487 (G->A) in 2 cases, nt1311 (C->T) in 1 case with the remaining variants unknown.

Endemic Diseases↗