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Epistasis between the haptoglobin common variant and α+thalassemia influences risk of severe malaria in Kenyan children.
[alpha-thalassemia]
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
:
Hp
2
-
1
was
associated
with
the
greatest
protection
against
severe
malaria
and
Hp
2
-
2
with
the
greatest
risk
.
Meta
-analysis
of
the
current
and
published
studies
suggests
that
Hp
2
-
2
is
associated
with
increased
risk
of
severe
malaria
compared
with
Hp
2
-
1
.
We
found
a
significant
interaction
between
Hp
genotype
and
α
(
+
)
thalassemia
in
predicting
risk
of
severe
malaria
:
Hp
2
-
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
Hp
2
-
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
.
Diseases
Validation
Diseases presenting
"protection from severe malaria"
symptom
alpha-thalassemia
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