Epistasis between the haptoglobin common variant and α+thalassemia influences risk of severe malaria in Kenyan children
Open accessAbstract
Haptoglobin (Hp) scavenges free hemoglobin following malaria-induced hemolysis. Few studies have investigated the relationship between the common Hp variants and the risk of severe malaria, and their results are inconclusive. We conducted a case-control study of 996 children with severe Plasmodium falciparum malaria and 1220 community controls and genotyped for Hp, hemoglobin (Hb) S heterozygotes, and α(+)thalassemia. Hb S heterozygotes and α(+)thalassemia homozygotes were protected from severe malaria (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.07-0.18 and OR, 0.69; 95% CI, 0.53-0.91, respectively). The risk of severe malaria also varied by Hp genotype: Hp2-1 was associated with the greatest protection against severe malaria and Hp2-2 with the greatest risk. Meta-analysis of the current and published studies suggests that Hp2-2 is associated with increased risk of severe malaria compared with Hp2-1. We found a significant interaction between Hp genotype and α(+)thalassemia in predicting risk of severe malaria: Hp2-1 in combination with heterozygous or homozygous α(+)thalassemia was associated with protection from severe malaria (OR, 0.73; 95% CI, 0.54-0.99 and OR, 0.48; 95% CI, 0.32-0.73, respectively), but α(+)thalassemia in combination with Hp2-2 was not protective. This epistatic interaction together with varying frequencies of α(+)thalassemia across Africa may explain the inconsistent relationship between Hp genotype and malaria reported in previous studies.
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Human subjects with quantitative or qualitative hemoglobin defects are partially resistant to infections by Plasmodium and Babesia.
“Therefore, it appears counterintuitive that human subjects with quantitative (thalassemic syndromes) or qualitative (hemoglobinopathies) HB defects are partially resistant to these infections (Atkinson et al., 2014;Ndila et al., 2018;Taylor et al., 2012).”
From Iron in infection and immunity (2020) · cites this paper as Atkinson et al., 2014
The Results (page unavailable in our copy) report reduced risk of severe Plasmodium falciparum malaria in Kenyan children with sickle-cell trait or homozygous α+thalassemia. The paper does not address Babesia, and its findings concern severe malaria rather than resistance to infection generally. (LLM, conf=0.89)
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- Authors
- Atkinson, S. H., Uyoga, S. M., Nyatichi, E., Macharia, A. W., Nyutu, G., Ndila, C., Kwiatkowski, D. P., Rockett, K. A., & Williams, T. N.
- Affiliations
- National Health Service (GB)
- Kenya Medical Research Institute (KE)
- Centre for Human Genetics (GB)
- ORCID
- Venue
- Blood
- Publisher
- American Society of Hematology
- Published
- 2014-03-27
- Volume
- 123
- Issue
- 13
- Pages
- 2008-2016
- ISSN
- 0006-4971 (ISSN-L)
- 1528-0020
- PMC
- PMC3968387
- OpenAlex
- W2069207627
- Cited by
- 27
- References
- 59
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 1 · 2021: 1 · 2020: 4 · 2019: 1 · 2018: 4 · 2017: 6 · 2016: 1 · 2015: 3 · 2014: 2
- FWCI
- 3.98
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Blood (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust (090770, 092654, 091758, 090532)
- British Heart Foundation
- Versus Arthritis
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Hemoglobin structure and function
- Keywords
- haptoglobin, severe malaria, Plasmodium falciparum, alpha-thalassemia, sickle cell trait, hemoglobin S, epistasis, genetic susceptibility, malaria prevention, children, Kenya
- MeSH terms
- Child, Child, Preschool, Epistasis, Genetic, Female, Genotype, Haptoglobins, Humans, Infant, Infant, Newborn, Kenya, Male, Risk Factors, Severity of Illness Index, Meta-Analysis as Topic, Case-Control Studies, Malaria, Falciparum, alpha-Thalassemia, Genetic Predisposition to Disease
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