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1.
Article in English | MEDLINE | ID: mdl-28782205

ABSTRACT

BACKGROUND: The diet and microbiome contribute to metabolic disease in part due to increased intestinal inflammation and permeability. Dietary tryptophan is metabolized by both mammalian and bacterial enzymes. Using in vitro, in vivo models, and clinical data, we tested whether bacterial tryptophan indole derivatives underlie the positive benefits of microbiota on inflammation that is associated with metabolic disease. METHODS: In high-fat diet (HFD)-fed mice intestinal permeability and plasma endotoxin levels were measured after indole-3-propionic acid (IPA; 20 mg kg-1 p.o. for 4 days). Tryptophan derivatives effect on permeability and gene expression were assessed in T84 intestinal cell monolayers, in the presence or absence of pro-inflammatory cytokines. Plasma tryptophan metabolites were analyzed from lean, or obese T2D subjects undergoing Roux-en-Y gastric bypass surgery (RYGB). KEY RESULTS: IPA reduced the increased intestinal permeability observed in HFD-fed mice. Of 16 metabolites tested in vitro, only IPA, and tryptamine reduced T84 cell monolayer permeability compromised by pro-inflammatory cytokines. In T84 cells, IPA reversed the IFN-γ induced increase of fructose transporter SLC2A5 (GLUT5) mRNA, but not induction of inflammatory or metabolic genes. In obese subjects, IPA levels were reduced relative to lean counterparts, and these levels were increased by 3 months after RYGB. CONCLUSIONS AND INFERENCES: The novel findings are that obese subjects have lower levels of IPA, a solely bacterially derived tryptophan derivative, and IPA improved intestinal barrier function in vitro and DIO mice. Reduced plasma IPA levels and reversal by surgery may be a consequence of intestinal indole-producing microbiota but underlying mechanisms warrant further investigation.


Subject(s)
Gastric Bypass , Gastrointestinal Microbiome , Intestinal Mucosa/metabolism , Tryptophan/metabolism , Animals , Diabetes Mellitus, Type 2/metabolism , Diet, High-Fat , Epithelial Cells/metabolism , Indoles/metabolism , Interferon-gamma/metabolism , Male , Mice, Inbred C57BL , Obesity/metabolism , Permeability
2.
Bioorg Med Chem Lett ; 23(9): 2595-7, 2013 May 01.
Article in English | MEDLINE | ID: mdl-23528297

ABSTRACT

By screening directed libraries of serine hydrolase inhibitors using the cell surface form of endothelial lipase (EL), we identified a series of carbamate-derived (EL) inhibitors. Compound 3 raised plasma HDL-C levels in the mouse, and a correlation was found between HDL-C and plasma compound levels. Spectroscopic and kinetic studies support a covalent mechanism of inhibition. Our findings represent the first report of EL inhibition as an effective means for increasing HDL-C in an in vivo model.


Subject(s)
Cholesterol, HDL/blood , Endothelium, Vascular/enzymology , Enzyme Inhibitors/chemistry , Lipase/antagonists & inhibitors , Thiocarbamates/chemistry , Animals , Endothelium, Vascular/drug effects , Enzyme Inhibitors/chemical synthesis , Enzyme Inhibitors/pharmacology , Hydrogen-Ion Concentration , Lipase/metabolism , Lipoproteins, HDL/deficiency , Lipoproteins, HDL/genetics , Lipoproteins, HDL/metabolism , Mice , Mice, Inbred C57BL , Mice, Knockout , Thiocarbamates/chemical synthesis , Thiocarbamates/pharmacology
3.
Drug Metab Dispos ; 34(5): 748-55, 2006 May.
Article in English | MEDLINE | ID: mdl-16455802

ABSTRACT

The potential cancer therapeutic agent, 6,7-(dimethoxy-2, 4-dihydroindeno[1,2-c]pyrazol-3-yl)-(3-fluoro-phenyl)-amine (JNJ-10198409), formed three N-glucuronides that were positively identified by liquid chromatography-tandem mass spectrometry and NMR as N-amine-glucuronide (Glu-A), 1-N-pyrazole-glucuronide (Glu-B), and 2-N-pyrazole-glucuronide (Glu-C). All three N-glucuronides were detected in rat liver microsomes, whereas only Glu-A and -B were found in monkey and human liver microsomes. In contrast to common glucuronides, Glu-B was completely resistant to beta-glucuronidase. Kinetic analyses revealed that glucuronidation of JNJ-10198409 in human liver microsomes exhibited atypical kinetics that may be described by a two-site binding model. For the high affinity binding, K(m) values were 1.2 and 5.0 microM, and V(max) values were 2002 and 2,403 nmol min(-1) mg(-1) for Glu-A and Glu-B, respectively. Kinetic constants of low affinity binding were not determined due to low solubility of the drug. Among the human UDP-glucuronosyltransferases (UGTs) tested, UGT1A9, 1A8, 1A7, and 1A4 were the most active isozymes to produce Glu-A; for the formation of Glu-B, UGT1A9 was the most active enzyme, followed by UGT1A3, 1A7, and 1A4. Glucuronidation of JNJ-10198409 by those UGT1A enzymes followed classic Michaelis-Menten kinetics. In contrast, no glucuronides were formed by all UGT2B isozymes tested, including UGT2B4, 2B7, 2B15, and 2B17. Collectively, these results suggested that glucuronidation of JNJ-10198409 in human liver microsomes is catalyzed by multiple UGT1A enzymes. Since UGT1A enzymes are widely expressed in various tissues, it is anticipated that both hepatic and extrahepatic glucuronidation will likely contribute to the elimination of the drug in humans. Additionally, conjugation at the nitrogens of the pyrazole ring represents a new structural moiety for UGT1A-mediated reactions.


Subject(s)
Glucuronosyltransferase/metabolism , Indans/metabolism , Pyrazoles/metabolism , Receptors, Platelet-Derived Growth Factor/antagonists & inhibitors , Animals , Chromatography, High Pressure Liquid , DNA, Complementary/biosynthesis , Glucuronides/metabolism , Glucuronosyltransferase/biosynthesis , Haplorhini , Humans , In Vitro Techniques , Kinetics , Magnetic Resonance Spectroscopy , Mass Spectrometry , Microsomes, Liver/enzymology , Oxidation-Reduction , Propofol/pharmacology , Rats
4.
Eur J Drug Metab Pharmacokinet ; 30(3): 151-64, 2005.
Article in English | MEDLINE | ID: mdl-16250251

ABSTRACT

The metabolism and excretion of 2,3:4,5-bis-O-(1-methylethylidene)-beta-D-fructopyranose sulfamate (TOPAMAX, topiramate, TPM) have been investigated in animals and humans. Radiolabeled [14C] TPM was orally administered to mice, rats, rabbits, dogs and humans. Plasma, urine and fecal samples were collected and analyzed. TPM and a total of 12 metabolites were isolated and identified in these samples. Metabolites were formed by hydroxylation at the 7- or 8-methyl of an isopropylidene of TPM followed by rearrangement, hydroxylation at the 10-methyl of the other isopropylidene, hydrolysis at the 2,3-O-isopropylidene, hydrolysis at the 4,5-O-isopropylidene, cleavage at the sulfamate group, glucuronide conjugation and sulfate conjugation. A large percentage of unchanged TPM was recovered in animal and human urine. The most dominant metabolite of TPM in mice, male rats, rabbits and dogs appeared to be formed by the hydrolysis of the 2,3-O-isopropylidene group.


Subject(s)
Anticonvulsants/metabolism , Fructose/analogs & derivatives , Migraine Disorders/drug therapy , Adult , Animals , Dogs , Female , Fructose/metabolism , Humans , Male , Mice , Rabbits , Rats , Rats, Sprague-Dawley , Sex Characteristics , Species Specificity , Topiramate
5.
J Am Chem Soc ; 123(50): 12664-9, 2001 Dec 19.
Article in English | MEDLINE | ID: mdl-11741432

ABSTRACT

Nicotinic acetylcholine receptors (nAChRs) are membrane-bound, pentameric ligand-gated ion channels associated with a variety of human disorders such as Alzheimer's disease, Parkinson's disease, schizophrenia, and pain. Most known nAChRs contain an unusual eight-membered disulfide-containing cysteinyl-cysteine ring, ox-[Cys-Cys], as does the soluble acetylcholine binding protein (AChBP) found in the snail Lymnaea stagnalis. The cysteinyl-cysteine ring is located in a region implicated in ligand binding, and conformational changes involving this ring may be important for modulation of nAChR function. We have studied the preferred conformations of Ac-ox-[Cys-Cys]-NH2 by NMR in water and computationally by Monte Carlo simulations using the OPLS-AA force field and GB/SA water model. ox-[Cys-Cys] adopts four distinct low-energy conformers at slightly above 0 degrees C in water. Two populations are dependent on the peptide omega2 dihedral angle, with the trans amide favored over the cis amide by a ratio of ca. 60:40. Two ox-[Cys-Cys] conformers with a cis amide bond (C+ and C-) differ from each other primarily by variation of the chi3 dihedral angle, which defines the orientation of the helicity about the S-S bond (+/- 90 degrees ). Two trans amide conformers have the same S-S helicity (chi3 approximately -90 degrees ), but are distinguished by a backbone rotation about phi2 and psi1 (T- and T'-). The ratio of T-/T'-/C+/C- is 47:15:29:9. The orientation of the pendant moieties from the eight-membered ring is more compact for the major trans conformer (T-) than for the extended conformations adopted by T'-, C+, and C-. These conformational preferences are also observed in tetrapeptide and undecapeptide fragments of the human alpha7 subtype of the nAChR that contains the ox-[Cys-Cys] unit. Conformer T- is nearly identical to the conformation seen in the X-ray structure of ox-[Cys(187)-Cys(188)] found in the unliganded AChBP, and is a Type VIII beta-turn.


Subject(s)
Cysteine/chemistry , Peptide Fragments/chemistry , Peptides, Cyclic/chemistry , Receptors, Nicotinic/chemistry , Computer Simulation , Ligands , Models, Molecular , Nuclear Magnetic Resonance, Biomolecular , Oxidation-Reduction , Protein Conformation , Receptors, Nicotinic/metabolism , Thermodynamics
6.
Bioorg Med Chem ; 7(11): 2353-71, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10632045

ABSTRACT

The thrombin receptor (PAR-1) is an unusual transmembrane G-protein coupled receptor in that it is activated by serine protease cleavage of its extracellular N-terminus to expose an agonist peptide ligand, which is tethered to the receptor itself. Synthetic peptides containing the agonist motif, such as SFLLRN for human PAR-1, are capable of causing full receptor activation. We have probed the possible bioactive conformations of thrombin receptor-activating peptides (TRAPs) by systematic introduction of certain conformational perturbations, involving alpha-methyl, ester psi(COO), and reduced-amide psi(CH2N) scans, into the minimum-essential agonist sequence (SFLLR) to probe the importance of the backbone conformation and amide NH hydrogen bonding. We performed extensive conformational searches of representative pentapeptides to derive families of putative bioactive structures. In addition, we employed 1H NMR and circular dichroism (CD) to characterize the conformational disposition of certain pentapeptide analogues experimentally. Activation of platelet aggregation by our pentapeptide analogues afforded a structure-function correlation for PAR-1 agonist activity. This correlation was assisted by PAR-1 receptor binding data, which gauged the affinity of peptide ligands for the thrombin receptor independent of a functional cellular response derived from receptor activation (i.e. a pure molecular recognition event). Series of alanine-, proline-, and N-methyl-scan peptides were also evaluated for comparison. Along with the known structural features for PAR-1 agonist peptides, our work adds to the understanding of peptide topography relative to platelet functional activity and PAR-1 binding. The absolute requirement of a positively charged N-terminus for strong agonist activity was contradicted by the N-terminal hydroxyl peptide psi(HO)S-FLLR-NH2. The amide nitrogen between residues 1 and 2 was found to be a determinant of receptor recognition and the carbonyl groups along the backbone may be involved in hydrogen bonding with the receptor. Position 3 (P3) of TRAP-5 is known to tolerate a wide variety of side chains, but we also found that the amide nitrogen at this position can be substituted by an oxygen, as in SF-psi(COO)-LLR-NH2, without diminishing activity. However, this peptide bond is sensitive to conformational changes in that SFPLR-NH2 was active, whereas SF-NMeL-LR-NH2 was not. Additionally, we found that position 3 does not tolerate rigid spacers, such as 3-aminocyclohexane-1-carboxylic acid and 2-aminocycloalkane-1-carboxylic acid, as analogues 1A, 1B, 2A, 2B, 3, 4, 5A and 5B lack agonist activity. On the basis of our results, we suggest that an extended structure of the agonist peptide is principally responsible for receptor recognition (i.e. binding) and that hydrophobic contact may occur between the side chains of the second (Phe) and fourth (Leu) residues (i.e. P2-P4 interaction).


Subject(s)
Peptide Fragments/chemistry , Peptide Fragments/metabolism , Receptors, Thrombin/metabolism , Circular Dichroism , Humans , Magnetic Resonance Spectroscopy , Models, Molecular , Peptide Fragments/chemical synthesis , Platelet Aggregation Inhibitors/chemistry , Protein Conformation , Structure-Activity Relationship
7.
FEBS Lett ; 439(1-2): 13-20, 1998 Nov 13.
Article in English | MEDLINE | ID: mdl-9849868

ABSTRACT

Endomorphin-1 (Tyr-Pro-Trp-Phe-NH2) is a highly selective and potent agonist of the mu-opioid receptor. To identify structural attributes unique to this opioid peptide and potential sites of recognition, a conformational analysis has been performed using multidimensional NMR and molecular modeling techniques. The spectroscopic results, derived from experiments in both DMSO and water, indicate that endomorphin-1 exists in the cis- and trans-configuration with respect to the Pro-omega bond in approximately 25% and 75% populations, respectively. In DMSO, the cis-configuration adopts a compact sandwich conformation in which the Tyr and Trp aromatic rings pack against the proline ring, whereas the trans-configuration adopts an extended conformation. Although non-random structure was not observed in water, condensed phase molecular dynamics calculations indicate that trans-isomers dominate the population in this higher dielectric medium. Structural comparison of the cis- and trans-configurations with morphine and selective mu-peptide ligands PL-017 and D-TIPP, as well as the delta-selective peptide ligands TIPP (delta-antagonist, mu-agonist) and DPDPE were also performed and suggest the trans-isomer is likely the bioactive form. A hypothesis is proposed to explain mu- and delta-selectivity based on the presence of spatially distinct selectivity pockets among these ligands.


Subject(s)
Oligopeptides/chemistry , Receptors, Opioid, mu/chemistry , Computer Simulation , Magnetic Resonance Spectroscopy , Models, Molecular , Protein Conformation , Receptors, Opioid/metabolism , Structure-Activity Relationship , Temperature
8.
J Med Chem ; 40(21): 3453-5, 1997 Oct 10.
Article in English | MEDLINE | ID: mdl-9341920

ABSTRACT

A practical combination of comparative modeling and NMR spectroscopy was used to generate a three-dimensional structure of the response regulator protein, Spo0F. The backbone structure obtained compares to the Spo0F Y13S mutant X-ray structure with an rmsd of 2.0 A. We provide results which suggest that structures obtained by this method are suitable for drug discovery. The results of the GRID and DOCK methods as applied to the model and X-ray structures of Spo0F are remarkably similar and tend to suggest the same design conclusions. This trend is illustrated by these same techniques applied to two experimentally derived structures of the analogous protein, CheY, which exhibit a pairwise rmsdBB on the same order as that found for the two Spo0F structures.


Subject(s)
Bacterial Proteins/chemistry , Protein Conformation , Amino Acid Sequence , Bacterial Proteins/genetics , Chemotaxis/physiology , Computer Simulation , Crystallography, X-Ray , Magnetic Resonance Spectroscopy , Membrane Proteins/chemistry , Methyl-Accepting Chemotaxis Proteins , Models, Molecular , Molecular Sequence Data , Mutation , Phosphotransferases/chemistry , Protein Folding , Protein Structure, Secondary , Sequence Alignment , Software
9.
J Neurochem ; 61(1): 315-23, 1993 Jul.
Article in English | MEDLINE | ID: mdl-8515279

ABSTRACT

Nuclear magnetic resonance (NMR) was used to study the metabolic pathways involved in the conversion of glucose to glutamate, gamma-aminobutyrate (GABA), glutamine, and aspartate. D-[1-13C]Glucose was administered to rats intraperitoneally, and 6, 15, 30, or 45 min later the rats were killed and extracts from the forebrain were prepared for 13C-NMR analysis and amino acid analysis. The absolute amount of 13C present within each carbonatom pool was determined for C-2, C-3, and C-4 of glutamate, glutamine, and GABA, for C-2 and C-3 of aspartate, and for C-3 of lactate. The natural abundance 13C present in extracts from control rats was also determined for each of these compounds and for N-acetylaspartate and taurine. The pattern of labeling within glutamate and GABA indicates that these amino acids were synthesized primarily within compartments in which glucose was metabolized to pyruvate, followed by decarboxylation to acetyl-CoA for entry into the tricarboxylic acid cycle. In contrast, the labeling pattern for glutamine and aspartate indicates that appreciable amounts of these amino acids were synthesized within a compartment in which glucose was metabolized to pyruvate, followed by carboxylation to oxaloacetate. These results are consistent with the concept that pyruvate carboxylase and glutamine synthetase are glia-specific enzymes, and that this partially accounts for the unusual metabolic compartmentation in CNS tissues. The results of our study also support the concept that there are several pools of glutamate, with different metabolic turnover rates.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Brain/metabolism , Glucose/metabolism , Magnetic Resonance Spectroscopy , Amino Acids/metabolism , Animals , Carbon Isotopes , Lactates/metabolism , Lactic Acid , Male , Osmolar Concentration , Rats , Rats, Wistar
10.
Dev Neurosci ; 15(3-5): 282-8, 1993.
Article in English | MEDLINE | ID: mdl-7805580

ABSTRACT

The metabolism of [1-13C]D-glucose by astrocytes, neurons and mixed astroglial/neuronal cultures derived from the striatum of fetal rats was studied using NMR. Metabolic activity was studied in resting and depolarized cells (55 mM K+), with dibutyryl cyclic-AMP added to the medium to promote cell differentiation, and with glutamate (0.1 mM) included in the medium. Due to sample limitations the accumulation of 13C label in metabolites within the cells was not sufficient to quantitate. Of the metabolites released into the medium by the astrocyte cultures and the mixed astroglial/neuronal cultures, measurable amounts of label were present in lactate C-3 and C-2, glutamine C-2, C-3 and C-4, acetate C-2, citrate C-2 or C-4 and C-3, glycerol C-1 or C-3, succinate C-2 or C-3 and several unidentified metabolites. Of the labeled metabolites released into the medium, only succinate was markedly affected by K(+)-induced depolarization, dBcAMP, or glutamate. The label in succinate was increased, especially in the K(+)-depolarized astrocyte cultures (3- to 6-fold). The neuronal cultures consumed [1-13C]D-glucose much more slowly than the astrocyte cultures or the mixed cultures. Except for lactate C-3, there was no measurable 13C in metabolites in the medium of the neuronal cultures.


Subject(s)
Astrocytes/metabolism , Glucose/metabolism , Neurons/metabolism , Acetates/metabolism , Animals , Bucladesine/metabolism , Cells, Cultured , Citrates/metabolism , Glycerol/metabolism , Ketoglutaric Acids/metabolism , Magnetic Resonance Spectroscopy , Malates/metabolism , Prosencephalon/cytology , Prosencephalon/metabolism , Rats , Rats, Sprague-Dawley , Succinates/metabolism
12.
Biochemistry ; 29(6): 1460-5, 1990 Feb 13.
Article in English | MEDLINE | ID: mdl-2334707

ABSTRACT

Direct observation of the tetrahedral intermediate in the EPSP synthase reaction pathway was provided by 13C NMR by examining the species bound to the enzyme active site under internal equilibrium conditions and using [2-13C]PEP as a spectroscopic probe. The tetrahedral center of the intermediate bound to the enzyme gave a unique signal appearing at 104 ppm. Separate signals were observed for free EPSP (152 ppm) and EPSP bound to the enzyme in a ternary complex with phosphate (161 ppm). These peak assignments account for our quantitation of the species bound to the enzyme and liberated upon quenching with either triethylamine or base. A comparison of quenching with acid, base, or triethylamine was conducted; the intermediate could be isolated by quenching with either triethylamine or 0.2 N KOH, allowing direct quantitation of the species bound to the enzyme. After long times of incubation during the NMR measurement, a signal at 107 ppm appeared. The compound giving rise to this resonance was isolated and identified as an EPSP ketal [Leo et al. (1990) J. Am. Chem. Soc. (in press)]. The rate of formation of the EPSP ketal was very slow, 3.3 X 10(-5) s-1, establishing that it is a side product of the normal enzymatic reaction, probably arising as a breakdown product of the tetrahedral intermediate. A slow formation of pyruvate was also observed and is attributable to the enzymatic hydrolysis of EPSP, with 5% of the enzyme sites occupied by EPSP and hydrolyzing EPSP at a rate of 4.7 X 10(-4) s-1. To look for additional signals that might arise from a covalent adduct which has been postulated to arise from reaction of enzyme with PEP, an NMR experiment was performed with an analogue of S3P lacking the 4- and 5-hydroxyl groups.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Alkyl and Aryl Transferases , Transferases/metabolism , 3-Phosphoshikimate 1-Carboxyvinyltransferase , Binding Sites , Chemical Phenomena , Chemistry , Chromatography, High Pressure Liquid , Magnetic Resonance Spectroscopy , Molecular Structure , Phosphoenolpyruvate/metabolism , Shikimic Acid/analogs & derivatives , Shikimic Acid/metabolism
13.
Proteins ; 4(2): 123-30, 1988.
Article in English | MEDLINE | ID: mdl-3227013

ABSTRACT

Solid-state and solution 15N nuclear magnetic resonance experiments on uniformly and specifically 15N labeled coat protein in phospholipid bilayers and in detergent micelles are used to describe the dynamics of the membrane-bound form of the protein. The residues in the N- and C-terminal portions of the coat protein in both phospholipid bilayers and in detergent micelles are mobile, while those in the hydrophobic midsection are immobile. There is evidence for a gradient of mobility in the C-terminal region of the coat protein in micelles; at 25 degrees C only the last two residues are mobile on the 10(9)-Hz timescale, while the last six to eight residues appear to be mobile on slower timescales and highly mobile at higher temperatures. Since all of the C-terminal residues are immobile in the virus particles, the mobility of these residues in the membrane-bound form of the protein may be important for the formation of protein-DNA interactions in the assembly process.


Subject(s)
1,2-Dipalmitoylphosphatidylcholine , Colloids , DNA-Binding Proteins , Dimyristoylphosphatidylcholine , Lipid Bilayers , Micelles , Viral Proteins , Magnetic Resonance Spectroscopy/methods , Nitrogen Isotopes , Protein Conformation
14.
Biochemistry ; 26(3): 854-62, 1987 Feb 10.
Article in English | MEDLINE | ID: mdl-3552034

ABSTRACT

The dynamics of backbone and side-chain sites of the membrane-bound form of fd coat protein are described with solid-state 2H and 15N NMR experiments. The samples were isotopically labeled coat protein in phospholipid bilayers in excess water. The protein itself is immobile and does not undergo rapid rotation within the bilayer. Like the structural form of the protein, the membrane-bound form has four mobile residues at the N-terminus. The membrane-bound form differs from the structural form in having several mobile residues at the C-terminus. Many of the side chains of residues with immobile backbone sites undergo large amplitude jump motions. The dynamics are generally similar in both the structural and membrane-bound forms of the protein.


Subject(s)
1,2-Dipalmitoylphosphatidylcholine , Capsid , Coliphages , Dimyristoylphosphatidylcholine , Escherichia coli , Lipid Bilayers , Chymotrypsin , Magnetic Resonance Spectroscopy/methods , Peptide Fragments/analysis , Protein Conformation
15.
Biophys J ; 49(1): 36-8, 1986 Jan.
Article in English | MEDLINE | ID: mdl-19431639
16.
Minerva Med ; 68(19): 1293-300, 1977 Apr 21.
Article in Italian | MEDLINE | ID: mdl-854229

ABSTRACT

Clinical and laboratory data for three patients are presented. Electrophoretic separation of the freshly obtained haemolysate showed a fast beta-chain fraction on each occasion. This is typical of Hb H disease. The test for erythrocyte inclusion bodies was also positive. The main clinical and haematological features of the disease are illustrated.


Subject(s)
Hemoglobin H , Hemoglobinopathies/diagnosis , Hemoglobins, Abnormal , Thalassemia/diagnosis , Adolescent , Adult , Alleles , Child , Diagnosis, Differential , Erythrocyte Inclusions , Female , Hemoglobin H/analysis , Hemoglobinopathies/genetics , Hemoglobins, Abnormal/analysis , Heterozygote , Humans , Thalassemia/genetics
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