Assessment of cardiac iron by MRI susceptometry and R2* in patients with thalassemia

A magnetic resonance imaging cardiac magnetic susceptometry (MRI-CS) technique for assessing cardiac tissue iron concentration based on phase mapping was developed. Normal control subjects (n=9) and thalassemia patients (n=13) receiving long-term blood transfusion therapy underwent MRI-CS and MRI measurements of the cardiac relaxation rate R2*. Using MRI-CS, subepicardium and subendocardium iron concentrations were quantified exploiting the hemosiderin/ferritin iron specific magnetic susceptibility. The average of subepicardium and subendocardium iron concentrations and R2* of the septum were found to be strongly correlated (r=0.96, P<.0001), and linear regression analysis yielded CIC (μg Fe/g_{wet tissue})=(6.4±0.4)·R2* _septum (s⁻¹) − (120±40). The results demonstrated that septal R2* indeed measures cardiac iron level.     

Review on screening and analysis techniques for hemoglobin variants and thalassemia

Thalassemia involves gene mutation that causes the production of an insufficient amount of normal structure globin chains while Hb variant involves gene mutation that causes the change in type or number of amino acid of the globin chain. It has been reported that some 200 million people worldwide had hemoglobinopathies of some sort. Attempts to develop effective and economical techniques for screening and analysis of thalassemia and Hb variants have become very important. In this review, we report the different techniques available, ranging from initial screening to extensive analysis, comparing advantages and disadvantages. Some indirect studies related to thalassemia indication and treatment follow-up are also included. We hope that information on these various techniques would be useful for some scientists who are working on development of a new technique or improving the existing ones.     

Fast and sensitive diagnosis of thalassemia by capillary electrophoresis

This paper demonstrates the diagnosis of -thalassemia by capillary electrophoresis in conjunction with laser-induced fluorescence using poly(ethylene oxide) (PEO) solutions in the presence of electroosmotic flow (EOF). During the electrophoretic separation, PEO solution entered a capillary from the anodic vial by EOF. The separation of a mixture of the polymerase chain reaction (PCR) products (330 and 334 base pairs) from a healthy person and a -thalassemia patient was accomplished within 15 min at 15 kV using 1.5% PEO containing 2 M urea at 30 °C. The electropherogram patterns instead of migration times were used to diagnose -thalassemia, with an accuracy of 100% for the analyses of 11 blood samples from suspected patients. After injecting a large volume of the mixture to the capillary filled with 800 mM Tris-borate buffer (pH 10.0), the DNA fragments stacked due to increases in viscosity and sieving when migrating into 1.5% PEO solution. As a result of improved sensitivity, only 15 PCR cycles were required when using 500 ng of DNA templates. The results shown in this study indicate the potential of this simple, rapid, and cost-effective method for the diagnosis of -thalassemia.Abbreviations CE Capillary electrophoresis - EOF Electroosmotic flow - EtBr Ethidium bromide - LIF Laser-induced fluorescence - PCR Polymerase chain reaction - PEO Poly(ethylene oxide) - TRIS Tris(hydroxymethyl)aminomethane - TB TRIS-borate     

Simplified hemoglobin chain detection by capillary electrophoresis

Hemoglobin (Hb) chains have been analyzed traditionally by cellulose acetate electrophoresis after sample extraction with acetone and denaturation with concentrated urea in order to detect thalassemia (Thal). A few capillary electrophoresis (CE) methods have been also described for separation of Hb chains also after sample extraction. We describe a CE method for analysis of Hb chains without sample preparation. Red blood cells were diluted (hemolyzed) in water and injected directly onto the capillary. The separation was performed in concentrated phosphate buffer at pH 12.6 and 2.15. Under these conditions of pH and buffer concentration, the chains were denatured and separated from the heme during electrophoresis. The common variants of the beta-chains, such as beta(S), beta(C), and beta(E), are also separated from each other. The intact Hb molecule is analyzed using the same sample and CE conditions but in an arginine-Tris buffer, pH 8.6. The data from the three separations are used to complement each other for interpretation of the presence of Hb variants and for thalassemia. The main advantages of this method are simplicity and speed. This method illustrates the flexibility and simplicity of the CE for analysis of the hemoglobinopathies.     

Therapeutic deferoxamine and deferiprone monitoring in β‐thalassemia patients’ plasma by field‐amplified sample injection and sweeping in capillary electrophoresis

One CE method was established for detecting deferoxamine (DFO) and deferiprone (DFR) in plasma. For β‐thalassemia patients, DFO and DFR are major medicines to treat the iron overload caused by blood transfusion. Field‐amplified sample injection combined with sweeping was used for sensitivity enhancement in CE. This method was performed on an uncoated fused‐silica capillary. After liquid–liquid extraction, the plasma samples were electrokinetically injected into capillary at +10 kV for 180 s. The phosphate buffer (100 mM) containing 50 mM triethanolamine was used as the BGE (pH 6.6). Separation buffer was phosphate buffer (100 mM, pH 3.0) containing 150 mM SDS. This method showed good linearity (r ≥ 0.9960). Precision and accuracy were evaluated by the results of RSD and relative error of intrabatch and interbatch analyses, and all of the absolute values were less than 6.12%. The LODs (S/N = 3) were 200 ng/mL for DFO, and 25 ng/mL for DFR. The LOQ (S/N = 10) of DFO and DFR were 600 and 75 ng/mL, respectively. This method was applied for clinical applications of five β‐thalassemia patients.     

Improved T2* assessment in liver iron overload by magnetic resonance imaging

In the clinical MRI practice, it is common to assess liver iron overload by T2* multi-echo gradient-echo images. However, there is no full consensus about the best image analysis approach for the T2* measurements. The currently used methods involve manual drawing of a region of interest (ROI) within MR images of the liver. Evaluation of a representative liver T2* value is done by fitting an appropriate model to the signal decay within the ROIs vs. the echo time. The resulting T2* value may depend on both ROI placement and choice of the signal decay model. The aim of this study was to understand how the choice of the analysis methodology may affect the accuracy of T2* measurements. A software model of the iron overloaded liver was inferred from MR images acquired from 40 thalassemia major patients. Different image analysis methods were compared exploiting the developed software model. Moreover, a method for global semiautomatic T2* measurement involving the whole liver was developed. The global method included automatic segmentation of parenchyma by an adaptive fuzzy-clustering algorithm able to compensate for signal inhomogeneities. Global liver T2* value was evaluated using a pixel-wise technique and an optimized signal decay model. The global approach was compared with the ROI-based approach used in the clinical practice. For the ROI-based approach, the intra-observer and inter-observer coefficients of variation (CoVs) were 3.7% and 5.6%, respectively. For the global analysis, the CoVs for intra-observers and inter-observers reproducibility were 0.85% and 2.87%, respectively. The variability shown by the ROI-based approach was acceptable for use in the clinical practice; however, the developed global method increased the accuracy in T2* assessment and significantly reduced the operator dependence and sampling errors. This global approach could be useful in the clinical arena for patients with borderline liver iron overload and/or requiring follow-up studies.     

FTIR-HATR诊断β-地中海贫血及其机理研究

为建立简单快速的地中海贫血(简称地贫)诊断方法,探讨了傅里叶红外光谱结合水平衰减全反射(FTIR-HATR)技术用于β-地贫患者的检测及其分子机制.检测了68份正常与3Z份β-重型地贫患者样品,并在群体水平上分析了两者光谱差异变化规律.结果显示:(1)由于血红蛋白量的减少,β-地贫组的光谱强度显著低于正常组;(2)在1 750～1 500 cm-1区间,表征蛋白二级结构的1 652,1 638和1 628 cm-1在β-地贫中有明显降低,而在1 682cm-1处略微增强;(3)在1 350 1 500 cm-1区间,表征磷脂CH3/CH2的1 440,1 453,1 479 cm-1及CO-O-C的1 172和1 161cm-1吸收峰在β-地贫中显著减少;而在1 000～1 200 cm-1区间,表征碳水化合物C-O的1 150 cm-1,2,3-二磷酸甘油酸(DPG)或ATP中0-P=0的1 081和1 053cm-1吸收峰显著升高.统计表明DPG/脂类比在β-重型地贫组中显著高于正常组,并可作为诊断指标,将两者完全区分,避免了复杂数据处理过程,为地贫的光谱诊断提供了坚实的实验基础与理论依据.     

Use of fat suppression in R₂ relaxometry with MRI for the quantification of tissue iron overload in beta-thalassemic patients

Purpose

To assess the performance and results of R₂ relaxometry using a fat-suppressed (FS) multiecho sequence and compare these to conventional R₂ relaxometry in estimating tissue iron overload.

Materials and Methods

Relaxation rate values (R₂=1/T2) of the liver, spleen, pancreas and vertebral bone marrow (VBM) were estimated in 21 patients with β-thalassemia major, using a respiratory-triggered 16-echo Carr-Purcell-Meiboom-Gill (CPMG) spin-echo sequence before (R₂) and after (R₂ FS) the application of chemically selective fat suppression.

Results

Hepatic and splenic R₂ FS values correlated with respective R₂ values (r=0.98 and r=0.96, P<.001), whereas correlations between R₂ FS and R₂ values for pancreas and VBM were not statistically significant. Bland–Altman plots show disagreement between R₂ and R₂ FS values, particularly for pancreas and VBM. Hepatic, pancreatic and VBM R₂ FS values correlated with serum ferritin (r=0.88, P<.001; r=0.51, P<.003; and r=0.75, P<.002, respectively). Hepatic R₂ FS values correlated with splenic R₂ FS (r=0.77, P<.03), pancreatic R₂ FS (r=0.61, P<.006) and VBM R₂ FS values (r=0.70, P<.001), whereas pancreatic R₂ FS values correlated also with VMB R₂ FS values. On the contrary, among the R₂ values of the above tissues, obtained without fat suppression, only hepatic R₂ values correlated with serum ferritin, whereas no correlation was documented between hepatic and pancreatic or VBM R₂ values. The application of fat suppression did not improve breathing or flow artifacts.

Conclusion

Application of fat suppression in the standard CPMG sequence improved the capability of MRI in noninvasive quantification of iron, particularly in lipid-rich tissues, such as vertebral bone marrow (VBM) and pancreas.     

非正常形态红细胞对拉曼光谱判别的影响

血红细胞对环境敏感,细胞形态很容易发生改变,皱缩甚至形成棘形。文章应用光镊拉曼光谱技术俘获、收集来自健康个体和地中海贫血患者的正常形态、一般皱缩和棘形红细胞的拉曼光谱,从平均光谱、主成分分析等方法分析不同形态红细胞的光谱差异与胞内Hb的变化,及其对光谱诊断分析的影响。结果发现,在正常的生理环境下,红细胞发生皱缩甚至形成棘形细胞并不影响光谱判别分析。     

pH值对多类人地贫红细胞作用的拉曼光谱研究

地中海贫血是一种发病率高,影响大的血液疾病。以往对地中海贫血的检测方法繁琐,耗时较长。通过对酸、碱pH环境下不同种类地贫红细胞和正常红细胞拉曼光谱的对照,发现在酸性条件下,α-地贫和β-地贫的拉曼谱具有不同的特征：表征氧合血红蛋白的特征峰谱带在β-地贫下强度升高甚至完全取代脱氧血红蛋白的特征峰;β-地贫红细胞膜的链间侧向相互作用序参数较正常红细胞膜的小,且其S_lat值与正常相比减小的比例随贫血程度的不同而不同,而α-地贫的S_lat值与正常红细胞膜的值相当。结果显示,可以基于pH作用的拉曼光谱测定方法,用于协助对地中海贫血的快速诊断。