An Expert Overview on TherTransfusion-Dependent Thalassemia: Classical to Cutting Edge in Treatment
امتیاز:
The thalassemia issue is a growing worldwide health concern that anticipates the number of patients
suffering from the disease will soon increase significantly. Patients with b-thalassemia intermedia (b-TI)
manifest mild to intermediate levels of anemia, which is a reason for it to be clinically located between
thalassemia minor and b-thalassemia major (b-TM). Notably, the determination of the actual rate of
b-TI is more complicated than b-TM. The leading cause of this illness could be partial repression of
b-globin protein production; accordingly, the rate of b-globin gene repression is different in patients,
and the gene repression intensity creates a different clinical status. This review article provides an overview
of functional mechanisms, advantages, and disadvantages of the classic to latest new treatments
for this group of patients, depending on the disease severity divided into the typical management
strategies for patients with b-TI such as fetal hemoglobin (Hb) induction, splenectomy, bone marrow
transplantation (BMT), transfusion therapy, and herbal and chemical iron chelators. Recently, novel
erythropoiesis-stimulating agents have been added. Novel strategies are subclassified into molecular
and cellular interventions. Genome editing is one of the efficient molecular therapies for improving
hemoglobinopathies, especially b-TI. It encompasses high-fidelity DNA repair (HDR), base and prime
editing, clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 procedure, nucleasefree
strategies, and epigenetic modulation. In cellular interventions, we mentioned the approach pattern
to improve erythropoiesis impairments in translational models and patients with b-TI that involve
activin II receptor traps, Janus-associated kinase 2 (JAK2) inhibitors, and iron metabolism regulation.