A large number of people are affected by genetic disorders in the Arab region. There are 451 genetic disorders in the combined Arab populations of Bahrain, Oman, and the United Arab Emirates (UAE) according to the catalog for transmission genetics in Arab (CTGA). Among these countries, Oman has the highest Arab population which includes the most number of disorders, followed by the UAE and Bahrain.
Nearly 75 out of 1000 babies born in the UAE have a congenital disability, according to the government reports of UAE and the country ranked sixth among 193 countries in terms of the prevalence of congenital disabilities, primarily due to genetic reasons (Chronic Diseases and Natural Disorders – The Official Portal of the UAE Government, n.d.). According to the other important countries of the MENA region, i.e., Egypt reported about 73.25% had a family history of different genetic disorders.
Some of the most prevalent disorders in the Arab region include blood disorders (thalassemia, sickle cell anemia, and G6PD deficiency), chromosomal defects (Down syndrome), developmental problems and defects (Fragile X Syndrome), and autosomal-recessive disorder (cystic fibrosis).
In context to blood disorders, sickle cell anemia is the most prevalent disorder among people from India, Africa, the Caribbean, the Middle East, and the Mediterranean. Studies show that the incidence and prevalence range from 0.04% to 2.1%. Thalassemia is a major concern of the healthcare sector in many MENA countries.
According to various studies, the Down syndrome prevalence rate among Saudi Arabia nationals reported was 18 per 10,000 live births and the rate in other nations includes Oman (1:500) and Qatar (1:546). The incidence and prevalence of cystic fibrosis in Bahrain were found to be around 1: 5,800 live births, and the prevalence is 3: 100,000 individuals (Cystic Fibrosis – CAGS, n.d.).
Why is the Arab world prone to hereditary disorders?
Genetic and congenital problems are more prevalent in Arab countries than in industrialized nations, and recessive hereditary diseases account for a sizable share of physical and mental disabilities.Reasons that may contribute to the high prevalence of genetically determined disorders include:
Consanguinity is a major cause of genetic disorders in the MENA region.The prevalence of consanguineous marriages in some countries includes Egypt (68%), Saudi Arabia (58%), Jordan (51–58%), Kuwait (54%), and Qatar (52%) (Bener & Mohammad, 2017). Some Arab countries have a higher rate of children with Down Syndrome than the normal industrialized country which ranges from 2 to 1.7 per 1000. Services for the prevention and control of genetic disorders are restricted due to certain cultural, legal, and religious restrictions.The treatment landscape of genetic diseases in the MENA region
The MENA region is lacking in the approved treatment for genetic disorders. Some therapies are approved in the region for treatment of genetic disorders like, in 2022, Emmaus received approval from the UAE Ministry of Health for Endari® (L-glutamine oral powder) for the treatment of sickle cell anemia. In 2019, the company entered into an exclusive agreement with Taiba Healthcare under which Taiba will be able to register, commercialize and distribute endari® in certain regions of the MENA region.
The investigation and approval of therapies is less in the MENA region unlike regions like America and Europe. That's why the emerging players in these regions are also not much. For example, in 2021, Silence Therapeutics announced that the investigation of SLN124 in people with thalassemia had been dosed their first patient in the GEMINI II Phase I clinical study at the Jordan University Hospital, Amman, Jordan, which is one of the locations among 25 trial sites. Phase III drugs such as Crizanlizumab (SEG101) and Inclacumab indicated for sickle cell anemia are under development in multiple study locations, including some countries of the MENA region.
Genetic disease prevention programs
Arab countries have started affordable preventative programs for some common genetic disorders. Following are some of the major prevention programs adapted by the countries.
Premarital screening and genetic counseling (PMSGC): A screening program for genetic carriers is a consultation service offered to people planning to marry involving a premarital screening visit and incorporating a history-taking session, a clinical examination, and laboratory tests to check for hereditary and infectious disorders.Neonatal screening programs: Clinical screening of newborn babies for detecting the spectrum of diseases, including rare genetic and metabolic disorders. The UAE and Oman have set up national or hospital-based registries for congenital abnormalities.Preimplantation genetic diagnosis: In Arab nations, pre-implantation genetic diagnosis is praised since it does not involve the decision to terminate the pregnancy.Future outlook and Conclusion
The growing prevalence of genetic diseases is still a concern in the MENA region. This challenge is due to the various factors involving limited approval of therapies and a lack of education and awareness related to the control of the disease. The Arab family is distinguished by its large size, high maternity and paternity ages at conception, and substantial endogamy, with consanguinity rates between 25 and 60% that are 100 times greater than the 0.2% consanguinity rate in Western countries. Due to which the Arab genomes would have an enormous burden of homozygous regions, increasing the occurrence of recessive diseases.
In conclusion, even though there aren’t many emerging therapies for the genetic disorders in the MENA right now, the final goal of doctors and researchers is to increase awareness and improve diagnosis among people. To increase precise genomic diagnostics and therapeutics, it is promising that national genome projects have begun to emerge in the Gulf region (Kuwait, Qatar, Saudi Arabia), which will hopefully spread to other nations and result in the sharing of more comprehensive and representative genetic data from the Middle East (Abou Tayoun & Rehm, 2020).
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