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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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THE ROLE OF TMPRSS6 GENE VARIANTS IN DIFFERENT TYPES OF IRON DEFICIENCY ANAEMIA - FROM THE RARE SEVERE HEREDITARY IRIDA TO THE COMMON MILD ACQUIRED IDA

Gonçalves L1, Nobre Jesus G2, Afonso C3, Vieira A4, Maia R5, Miranda A6, Correia L7, Faustino P1

  1. Departamento de Genética Humana, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa;
  2. Serviço de Medicina 2A, Hospital de Santa Maria, Centro Hospital Lisboa Norte;
  3. Serviço de Hematologia Clínica, Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental;
  4. Serviço de Imuno-hemoterapia, Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental;
  5. Unidade de Hematologia do Hospital Dona Estefânia, Centro Hospital Lisboa Central;
  6. Departamento de Promoção da Saúde, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa;
  7. Departamento de Bioquímica e Biologia Humana, Faculdade de Farmácia de Lisboa;

Portugal

- 18ª Reunião da Sociedade Portuguesa de Genética Humana, Faculdade de Medicina da Universidade de Lisboa, (Poster) - 19-21 de novembro de 2014
- Reunião do “Anemia Working Group Portugal” (Poster) - 28 e 29 de novembro, Lisboa

Objective: Iron-refractory iron-deficiency anaemia (IRIDA) is a rare autosomal-recessive disease characterized by severe hypochromic microcytic anemia, low serum iron and transferrin saturation, normal-high ferritin and inappropriate high levels of the hormone hepcidin. Patients are unresponsive to iron oral treatment and present a slow persistent response to intravenous iron injections. The disease is caused by loss-of-function mutations in the TMPRSS6 gene which encodes the matriptase-2 (MT2), a negative regulator of hepcidin transcription. In those patients, high hepcidin levels prevent iron absorption in the duodenum and iron recycling by macrophages. Furthermore, it has been suggested that common variants in TMPRSS6 might modulate haematological phenotype and iron status. Therefore, the objective of this work was to search for severe genetic variants in TMPRSS6 in order to elucidate IRIDA-like phenotypes in some patients and to evaluate whether the SNP rs855791 influences iron deficiency anaemia (IDA) susceptibility in women.
Patients and Methods: Sequencing analyses of the TMPRSS6 gene were performed in 6 cases presenting IRIDA-like phenotypes. Additionally, the SNP rs855791 (p.V736A) was characterized, using an allele specific amplification approach, in 25 women presenting IDA and in 89 women normal controls.
Results: Sequencing analyses of TMPRSS6 in the IRIDA-suspected cases revealed the presence of a previously described pathogenic variant (c.757A>G, p.K253E), a novel splicing variant (whose functional effect is under study) and 3 other common variants. Concerning SNPs study, the frequency distribution of the rs8855791 genotypes showed a statistically association with women hemoglobin, serum iron level and transferrin saturation, being the proportion of CC homozygotes significantly lower in IDA patients.
Conclusion: Several degrees of iron deficiency anaemia can be attributed to genetic variants of TMPRSS6 gene and a relation genotype/phenotype can be established. Moreover, SNPs within the gene which give rise to a partial impairment of MT2 are able to modulate susceptibility to IDA. This suggests that TMPRSS6 has a role in iron-related common disorders in which it may act as a gene modifier.

Partially funded by FCT: PEst-OE/SAU/UI0009/2013 and Pest-OE/SAU/UI4013/2011

Palavras Chave: IRIDA, TMPRSS6 gene variants