Genetic heterogeneity of beta thalassemia in Lebanon reflects historic and recent population migration

Beta thalassemia is an autosomal recessive disorder characterized by reduced (ss(+)) or absent (ss(0)) beta-globin chain synthesis. In Lebanon it is the most predominant genetic defect. In this study we investigated the religious and geographic distribution of the ss-thalassemia mutations identified in Lebanon, and traced their precise origins. A total of 520 P-globin chromosomes from patients of different religious and regional backgrounds was studied. Beta thalassemia mutations were identified using Amplification Refractory Mutation System (ARMS) PCR or direct gene sequencing. Six (IVS-I-110, IVS-I-1, IVS-I-6, IVS-II-1, cd 5 and the C>T substitution at cd 29) out of 20 ss-globin defects identified accounted for more than 86% of the total ss-thalassemia chromosomes. Sunni Muslims had the highest ss-thalassemia carrier rate and presented the greatest heterogeneity, with 16 different mutations. Shiite Muslims followed closely with 13 mutations, whereas Maronites represented 11.9% of all ss-thalassemic subjects and carried 7 different mutations. RFLP haplotype analysis showed that the observed genetic diversity originated from both new mutational events and gene flow from population migration. This study provides information about the types and distribution of ss-thalassemia mutations within each religious group and geographic region, which is essential for the implementation of screening and prevention programs.