hemoglobin E disease

disease
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Summary

hemoglobin E disease (MONDO:0016243) is a disease with 9 cohort genes (3 GWAS associations across 1 studies). The dominant Reactome pathway is Factors involved in megakaryocyte development and platelet production (5 cohort genes).

At a glance

  • Prevalence: Unknown (Worldwide)
  • Cohort genes: 9
  • GWAS associations: 3
  • ClinVar variants: 1
  • Phenotypes (HPO): 13

Clinical features

Signs & symptoms

Clinical features (HPO)

13 HPO clinical features (Orphanet curated; top 13 by frequency):

HPO IDTermFrequency
HP:0004840Hypochromic microcytic anemiaVery frequent (80-99%)
HP:0010972Anemia of inadequate productionVery frequent (80-99%)
HP:0011902Abnormal hemoglobinVery frequent (80-99%)
HP:0020059Increased red blood cell countVery frequent (80-99%)
HP:0025066Decreased mean corpuscular volumeVery frequent (80-99%)
HP:0032231HypochromiaVery frequent (80-99%)
HP:0011905Reduced hemoglobin AFrequent (30-79%)
HP:0001511Intrauterine growth retardationOccasional (5-29%)
HP:0001622Premature birthOccasional (5-29%)
HP:0001744SplenomegalyOccasional (5-29%)
HP:0004817Drug-sensitive hemolytic anemiaOccasional (5-29%)
HP:0005546Increased red cell osmotic resistanceOccasional (5-29%)
HP:0005268Spontaneous abortionVery rare (<1-4%)

Identifiers

Disease identifiers

FieldValue
Canonical namehemoglobin E disease
Mondo IDMONDO:0016243
Orphanet2133
DOIDDOID:5379
ICD-111898135714
NCITC35287
SNOMED CT25065001
UMLSC0238159
MedGen68658
GARD0002641
MedDRA10053215
Is cancer (heuristic)no

Also known as: hemoglobin E disease

Data availability: 1 ClinVar variant · 3 GWAS associations (1 study) · 1 GenCC gene-disease record.

Disease family

Classification path: disease › human disease › disease by body system or component › hematologic disorderanemiahemoglobin E disease

Related subtypes (18): congenital anemia, neonatal anemia, microcytic anemia, hypochromic anemia, pancytopenia, deficiency anemia, pure red-cell aplasia, macrocytic anemia, normocytic anemia, sideroblastic anemia, aplastic anemia, hemoglobin C disease, beta-thalassemia and related diseases, hemoglobinopathy Toms River, hereditary methemoglobinemia, hemoglobin D disease, anemia due to enzyme disorder, anemia due to chronic disorder

Genetics & variants

GWAS landscape

3 GWAS associations across 1 studies. Top hits map to 3 distinct genes (as reported by GWAS).

Top associations by p-value

rsIDp-valueGeneRisk alleleOdds ratio
rs20713483e-15HBD, HBBP1?4.05
rs93760922e-11HBS1L - MYB?2.91
rs7664321e-10BCL11A?2.8

Top studies (by case count)

StudyLead authorYearCasesControlsTitle
GCST000532Nuinoon M20092350A genome-wide association identified the common genetic variants influence disease severity in beta0-thalassemia/hemoglobin E.

Variant details and genetic-evidence tiers

Tier distribution (top 50 variants)

TierVariants
Tier 1: coding0
Tier 2: splice/UTR0
Tier 3: regulatory0
Tier 4: intronic/intergenic3

MAF distribution

BucketVariants
common (>=0.05)3
low_freq (0.01-0.05)0
rare (<0.01)0
unknown0

Functional consequences

ConsequenceCount
intron_variant2
intergenic_variant1

Top variants

rsIDChrPosAllelesMAFConsequenceGenep-valueTier
rs2071348115242916T>A,C,G0.5intron_variantHBD, HBBP13e-15Tier 4: intronic/intergenic
rs93760926135106006C>A0.23intergenic_variantHBS1L - MYB2e-11Tier 4: intronic/intergenic
rs766432260492835C>A,G,T0.24intron_variantBCL11A1e-10Tier 4: intronic/intergenic

ClinVar germline variants

1 retrieved; paginated sample, class counts are floors:

1 pathogenic

ClinVarVariant (HGVS)GeneClassificationReview
15161NM_000518.5(HBB):c.79G>A (p.Glu27Lys)HBBPathogeniccriteria provided, multiple submitters, no conflicts

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 33 · Orphanet: 41 · OMIM-shared: 0 · Dual-evidence (GWAS+Mendelian): 3

Dual-evidence genes (GWAS + Mendelian — highest-confidence targets)

GeneHGNCEvidence routes
BCL11ABCL11AGWAS, Orphanet
HBDHBDGWAS, Orphanet
HBG2HBG2GWAS, Orphanet

GenCC gene–disease validity (cohort genes)

the Disease column is the GenCC-asserted condition — a cohort gene’s strongest validity may be for a related predisposition syndrome.

GeneClassificationInheritanceDiseaseRecords
HBBStrongAutosomal dominanthereditary persistence of fetal hemoglobin33

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
HBBOrphanet:2132Hemoglobin C disease
HBBOrphanet:2133Hemoglobin E disease
HBBOrphanet:231214Beta-thalassemia major
HBBOrphanet:231222Beta-thalassemia intermedia
HBBOrphanet:231226Unstable beta globin chain variant disease
HBBOrphanet:231237Delta-beta-thalassemia
HBBOrphanet:231242Hemoglobin C-beta-thalassemia syndrome
HBBOrphanet:231249Hemoglobin E-beta-thalassemia syndrome
HBBOrphanet:232Sickle cell anemia
HBBOrphanet:247511Autosomal dominant secondary polycythemia
HBBOrphanet:251365Sickle cell S-C disease
HBBOrphanet:251370Sickle cell S-D Punjab disease
HBBOrphanet:251375Sickle cell S-E disease
HBBOrphanet:251380Hereditary persistence of fetal hemoglobin-sickle cell disease syndrome
HBBOrphanet:330041Hemoglobin M disease
HBBOrphanet:46532Hereditary persistence of fetal hemoglobin-beta-thalassemia syndrome
HBBOrphanet:695140Sickle cell-beta zero-thalassemia
HBBOrphanet:695147Sickle cell-beta plus-thalassemia
HBBOrphanet:699822Sickle cell S-Lepore disease
HBBOrphanet:700090Sickle cell S-O Arab disease
HBBOrphanet:700107Sickle cell S-other specified hemoglobin variant
HBBOrphanet:700111Homozygous hemoglobin O Arab disease
HBBOrphanet:715125Hemoglobin E-beta-thalassemia intermedia
HBBOrphanet:715128Hemoglobin E-beta-thalassemia major
HBBOrphanet:715135Hemoglobin Lepore-beta-thalassemia intermedia
HBBOrphanet:715140Hemoglobin Lepore-beta-thalassemia major
HBBOrphanet:715143Heterozygous beta-thalassemia intermedia with supernumerary alpha-globin gene
HBBOrphanet:715157Low oxygen affinity beta chain hemoglobin disease
HBBOrphanet:90039Hemoglobin D disease
BCL11AOrphanet:251380Hereditary persistence of fetal hemoglobin-sickle cell disease syndrome
BCL11AOrphanet:619233Hereditary persistence of fetal hemoglobin-intellectual disability syndrome
HBDOrphanet:231237Delta-beta-thalassemia
HBDOrphanet:330032Hemoglobin Lepore-beta-thalassemia syndrome
HBDOrphanet:699822Sickle cell S-Lepore disease
HBG2Orphanet:251380Hereditary persistence of fetal hemoglobin-sickle cell disease syndrome
HBG2Orphanet:280615Low oxygen affinity gamma chain hemoglobin disease
HBG2Orphanet:46532Hereditary persistence of fetal hemoglobin-beta-thalassemia syndrome
HBG2Orphanet:707792Unstable gamma globin chain variant disease
MYBOrphanet:251671Angiocentric glioma
MYBOrphanet:86849Acute basophilic leukemia
MYBOrphanet:99861Precursor T-cell acute lymphoblastic leukemia

Cohort genes → proteins

9 cohort genes, 8 distinct canonical proteins.

Evidence partition

SubsetGenes
gwas_only8
multi_evidence1

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
HBBHGNC:4827ENSG00000244734P68871Hemoglobin subunit betagencc,clinvar
BCL11AHGNC:13221ENSG00000119866Q9H165BCL11 transcription factor Agwas
ACSBG1HGNC:29567ENSG00000103740Q96GR2Long-chain-fatty-acid–CoA ligase ACSBG1gwas
HBBP1HGNC:4828ENSG00000229988hemoglobin subunit beta pseudogene 1gwas
HBDHGNC:4829ENSG00000223609P02042Hemoglobin subunit deltagwas
HBE1HGNC:4830ENSG00000213931P02100Hemoglobin subunit epsilongwas
HBG2HGNC:4832ENSG00000196565P69892Hemoglobin subunit gamma-2gwas
HBS1LHGNC:4834ENSG00000112339Q9Y450HBS1-like proteingwas
MYBHGNC:7545ENSG00000118513P10242Transcriptional activator Mybgwas

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
HBBHemoglobin subunit betaInvolved in oxygen transport from the lung to the various peripheral tissues.
BCL11ABCL11 transcription factor ATranscription factor.
ACSBG1Long-chain-fatty-acid–CoA ligase ACSBG1Catalyzes the conversion of fatty acids such as long-chain and very long-chain fatty acids to their active form acyl-CoAs for both synthesis of cellular lipids, and degradation via beta-oxidation.
HBDHemoglobin subunit deltaInvolved in oxygen transport from the lung to the various peripheral tissues.
HBE1Hemoglobin subunit epsilonThe epsilon chain is a beta-type chain of early mammalian embryonic hemoglobin.
HBG2Hemoglobin subunit gamma-2Gamma chains make up the fetal hemoglobin F, in combination with alpha chains.
HBS1LHBS1-like proteinGTPase component of the Pelota-HBS1L complex, a complex that recognizes stalled ribosomes and triggers the No-Go Decay (NGD) pathway.
MYBTranscriptional activator MybTranscriptional activator; DNA-binding protein that specifically recognize the sequence 5’-YAAC[GT]G-3'.

Protein-family classification

Druggable: 0 · Difficult: 2 · Unknown: 7 · Druggable fraction: 0.0

Family distribution

Cohort families vs a genome-wide background (hypergeometric, BH-FDR; fold = observed/expected). Counts kept; sorted by enrichment, so the catch-all Other/Unknown bucket no longer leads.

FamilyGenesFoldFDR
Transcription factor21.8×0.299
Other/Unknown71.4×0.299

Per-gene assignment

SymbolFamilyDruggable?ECInterPro (top 3)
HBBOther/UnknownnoGlobin, Hemoglobin_b, Globin-like_sf
BCL11ATranscription factornoZnf_C2H2_type, Znf_C2H2_sf, Dev/Hematopoietic_TF
ACSBG1Other/UnknownnoAMP-dep_synth/lig_dom, AMP-binding_CS, ANL_N_sf
HBBP1Other/Unknownno
HBDOther/UnknownnoGlobin, Hemoglobin_b, Globin-like_sf
HBE1Other/UnknownnoGlobin, Hemoglobin_b, Globin-like_sf
HBG2Other/UnknownnoGlobin, Hemoglobin_b, Globin-like_sf
HBS1LOther/UnknownnoT_Tr_GTP-bd_dom, EFTu-like_2, Transl_B-barrel_sf
MYBTranscription factornoSANT/Myb, Homeodomain-like_sf, Tscrpt_reg_Wos2-domain

Expression context

Cohort genes with no expression data: 0.

9 cohort genes are a single-cell marker in ≥1 SCXA experiment.

Breadth distribution (Bgee present_calls)

BucketGenes
narrow (1-5 tissues)0
moderate (6-20)0
broad (>20)9
unknown0

Top tissues across cohort

TissueCohort genes
trabecular bone tissue2
vena cava2
ganglionic eminence2
male germ line stem cell (sensu Vertebrata) in testis2
adrenal tissue2
monocyte1
cortical plate1
primary visual cortex1
C1 segment of cervical spinal cord1
inferior olivary complex1
upper leg skin1
pancreatic ductal cell1
bone marrow1
bone marrow cell1
primordial germ cell in gonad1
placenta1
calcaneal tendon1
gastrocnemius1
muscle of leg1
bronchial epithelial cell1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
HBB284broadmarkermonocyte, trabecular bone tissue, vena cava
BCL11A247ubiquitousmarkercortical plate, ganglionic eminence, primary visual cortex
ACSBG1207broadmarkerupper leg skin, inferior olivary complex, C1 segment of cervical spinal cord
HBBP155tissue_specificmarkermale germ line stem cell (sensu Vertebrata) in testis, pancreatic ductal cell, vena cava
HBD170tissue_specificmarkertrabecular bone tissue, bone marrow, bone marrow cell
HBE1127tissue_specificmarkermale germ line stem cell (sensu Vertebrata) in testis, primordial germ cell in gonad, adrenal tissue
HBG2129tissue_specificmarkerplacenta, adrenal tissue, ganglionic eminence
HBS1L290ubiquitousmarkercalcaneal tendon, muscle of leg, gastrocnemius
MYB183broadmarkermucosa of sigmoid colon, bronchial epithelial cell, epithelium of bronchus

Protein interactions among cohort

Intra-cohort edges: 5.

Hub genes (top 10 by interactor count)

SymbolInteractor count
MYB3,155
BCL11A2,389
HBS1L2,360
ACSBG11,697
HBD1,206
HBE11,167
HBB454
HBG266
HBBP10

Intra-cohort edges

ABSources
BCL11AHBDstring_interaction
BCL11AHBE1string_interaction
BCL11AHBS1Lstring_interaction
HBBHBE1biogrid_interaction, intact
HBE1HBS1Lstring_interaction

Structural data

PDB: 6 · AlphaFold-only: 2 · No structure: 1

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
HBBP68871350
BCL11AQ9H16517
HBS1LQ9Y45011
HBG2P698924
HBDP020422
HBE1P021001

AlphaFold-only cohort genes (top 30 by pLDDT)

SymbolUniProtpLDDT
ACSBG1Q96GR284.99
MYBP1024259.16

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 38. Enrichment computed across 9 evidence-associated genes (8 with Reactome annotation).

Pathways by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 8 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

PathwayCohort genesFoldFDRSample cohort genes
Factors involved in megakaryocyte development and platelet production541.5×2e-06HBB, HBD, HBE1, HBG2, MYB
Heme assimilation1475.8×0.040HBB
Erythrocytes take up oxygen and release carbon dioxide1158.6×0.053HBB
ALK mutants bind TKIs1119.0×0.053BCL11A
Erythrocytes take up carbon dioxide and release oxygen1109.8×0.053HBB
Scavenging of heme from plasma1109.8×0.053HBB
mRNA decay by 3’ to 5’ exoribonuclease189.2×0.053HBS1L
Specification of the neural plate border179.3×0.053MYB
Formation of the embryonic stem cell BAF (esBAF) complex175.1×0.053BCL11A
Chaperone Mediated Autophagy162.1×0.053HBB
Synthesis of very long-chain fatty acyl-CoAs157.1×0.053ACSBG1
Formation of neuronal progenitor and neuronal BAF (npBAF and nBAF)157.1×0.053BCL11A
Fatty acyl-CoA biosynthesis154.9×0.053ACSBG1
Late endosomal microautophagy140.8×0.066HBB
Signaling by ALK in cancer134.0×0.072BCL11A
Gastrulation132.4×0.072MYB
Heme signaling126.9×0.082HBB
Cytoprotection by HMOX1123.0×0.090HBB
Signaling by ALK fusions and activated point mutants118.8×0.098BCL11A
Transcriptional regulation by RUNX1118.3×0.098MYB
Fatty acid metabolism116.4×0.098ACSBG1
ESR-mediated signaling116.0×0.098MYB
Transcriptional regulation of granulopoiesis115.7×0.098MYB
PELO:HBS1L and ABCE1 dissociate a ribosome on a non-stop mRNA115.7×0.098HBS1L
Signaling by Nuclear Receptors112.8×0.115MYB
RUNX1 regulates transcription of genes involved in differentiation of HSCs111.9×0.118MYB
Estrogen-dependent gene expression19.4×0.142MYB
Diseases of signal transduction by growth factor receptors and second messengers17.1×0.180BCL11A
Hemostasis14.5×0.264MYB
Metabolism of lipids13.9×0.288ACSBG1

GO biological processes by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 8 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

GO termCohort genesFoldFDRSample cohort genes
carbon dioxide transport4648.1×1e-09HBB, HBD, HBE1, HBG2
oxygen transport4526.6×1e-09HBB, HBD, HBE1, HBG2
erythrocyte development4263.3×2e-08HBB, HBD, HBE1, HBG2
negative regulation of neuron remodeling12106.5×0.007BCL11A
negative regulation of branching morphogenesis of a nerve12106.5×0.007BCL11A
negative regulation of protein homooligomerization1702.2×0.013BCL11A
positive regulation of hepatic stellate cell proliferation1702.2×0.013MYB
positive regulation of testosterone secretion1702.2×0.013MYB
myeloid cell development1526.6×0.013MYB
negative regulation of hematopoietic progenitor cell differentiation1526.6×0.013MYB
negative regulation of dendrite extension1526.6×0.013BCL11A
skeletal muscle cell proliferation1421.3×0.014MYB
nitric oxide transport1421.3×0.014HBB
positive regulation of hepatic stellate cell activation1351.1×0.015MYB
nuclear-transcribed mRNA catabolic process, no-go decay1300.9×0.015HBS1L
positive regulation of transforming growth factor beta production1263.3×0.015MYB
negative regulation of dendrite development1263.3×0.015BCL11A
stem cell division1234.1×0.015MYB
T-helper 2 cell differentiation1234.1×0.015MYB
positive regulation of collateral sprouting1234.1×0.015BCL11A
cellular oxidant detoxification1234.1×0.015HBB
renal absorption1210.7×0.015HBB
cellular response to L-glutamate1210.7×0.015BCL11A
negative regulation of collateral sprouting1191.5×0.016BCL11A
ribosome disassembly1123.9×0.022HBS1L
embryonic digestive tract development1123.9×0.022MYB
regulation of dendrite development1123.9×0.022BCL11A
cellular response to interleukin-61123.9×0.022MYB
negative regulation of megakaryocyte differentiation1110.9×0.023MYB
long-chain fatty-acyl-CoA biosynthetic process1105.3×0.024ACSBG1

Therapeutics

Drug target analysis

Approved (phase 4): 1 · Phase ≥3: 1 · Phased (≥1): 1 · Undrugged: 8

Druggability breadth: 5 of 9 evidence-associated genes (56%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Genes with an approved drug

The molecule shown is one approved compound that hits the gene — not necessarily a drug of choice or one indicated for this disease.

SymbolExample approved molecule
HBBCANDESARTAN CILEXETIL

Top cohort targets by molecule count

SymbolMoleculesMax phase
HBB234
BCL11A00
ACSBG100
HBBP100
HBD00
HBE100
HBG200
HBS1L00
MYB00

Drugs targeting cohort genes (top 30)

MoleculeMax phaseTargets in cohort
CANDESARTAN CILEXETIL4HBB
MECHLORETHAMINE HYDROCHLORIDE4HBB
PHENAZOPYRIDINE HYDROCHLORIDE4HBB
MERCAPTOPURINE ANHYDROUS4HBB
AZACITIDINE4HBB
AZATHIOPRINE4HBB
TOPOTECAN HYDROCHLORIDE4HBB
ACYCLOVIR4HBB
FLUOROURACIL4HBB
RAUWOLFIA SERPENTINA4HBB
HYDROQUINONE4HBB
MENADIONE4HBB
THIOTEPA4HBB
THIOGUANINE4HBB
RESERPINE4HBB
CURCUMIN3HBB
HYDROXYCAMPTOTHECIN3HBB
MOLIBRESIB2HBB
FISETIN2HBB
TEROXIRONE2HBB
5-FLUOROURIDINE2HBB
ELLAGIC ACID2HBB
BAICALEIN2HBB

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 0.

Cohort genes with ChEMBL bioactivity (full, sorted by assay count)

SymbolAssaysType breakdown
HBB68Binding:50, Functional:18
MYB7Binding:7
HBG21Binding:1
HBS1L1Binding:1

Pharmacogenomics

Cohort genes with a PharmGKB record: 9; with CPIC/DPWG dosing guidelines: 0.

No cohort gene has a CPIC/DPWG genotype-guided dosing guideline (PharmGKB).

Chemical tractability of cohort targets

23 approved/phased compounds have measured bioactivity against a cohort gene (and aren’t yet in disease-level trials). This is a research / tractability signal, NOT a therapeutic recommendation — a bioactivity row often reflects off-target or screening binding (e.g. promiscuous kinase inhibitors against a cohort kinase), implying no disease mechanism.

CompoundMax phaseCohort target (bioactivity)
CANDESARTAN CILEXETIL4HBB
MECHLORETHAMINE HYDROCHLORIDE4HBB
PHENAZOPYRIDINE HYDROCHLORIDE4HBB
MERCAPTOPURINE ANHYDROUS4HBB
AZACITIDINE4HBB
AZATHIOPRINE4HBB
TOPOTECAN HYDROCHLORIDE4HBB
ACYCLOVIR4HBB
FLUOROURACIL4HBB
RAUWOLFIA SERPENTINA4HBB
HYDROQUINONE4HBB
MENADIONE4HBB
THIOTEPA4HBB
THIOGUANINE4HBB
RESERPINE4HBB
CURCUMIN3HBB
HYDROXYCAMPTOTHECIN3HBB
MOLIBRESIB2HBB
FISETIN2HBB
TEROXIRONE2HBB
5-FLUOROURIDINE2HBB
ELLAGIC ACID2HBB
BAICALEIN2HBB

Druggability pyramid

Cohort genes binned by druggability tier (high → low):

TierDefinitionGenesSymbols
AApproved (phase 4 drug)1HBB
BPhased (≥1) drug, not yet approved0
CDruggable family + PDB, no drug0
DDruggable family + AlphaFold only, no drug0
EDifficult family or no structure, no drug8BCL11A, ACSBG1, HBBP1, HBD, HBE1, HBG2, HBS1L, MYB

Undrugged target profiles

8 cohort genes are undrugged. Ranked by ‘starting-point quality’ (assay depth + drugged-partner adjacency).

SymbolChEMBL assaysDrugged partners (top 3)
BCL11A0
ACSBG10
HBBP10
HBD0
HBE10
HBG21
HBS1L1
MYB7

Clinical trials & evidence

Clinical trials

Clinical trials: 0.