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Soya E, Makowski C, Blaise S. Leg ulcer induced by hydroxycarbamide in sickle cell disease: What is the therapeutic impact? Int Wound J 2019; 16:897-902. [PMID: 30916480 PMCID: PMC7949276 DOI: 10.1111/iwj.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/28/2019] [Indexed: 11/27/2022] Open
Abstract
Major sickle cell disease syndrome (SCD) is a set of potentially serious and disabling constitutional haemoglobin pathologies characterised by chronic haemolysis and vaso-occlusion phenomena. If expression takes the form of acute vaso-occlusive crisis, SCD is currently considered to be a chronic systemic pathology, primarily associated with vasculopathy and ischaemia-reperfusion phenomena. The haemolytic aspect of the disease may be associated with endothelial dysfunctional complications, including leg ulcers, which are a classic spontaneous complication of major SCD. Their frequency, all aetiologies combined, varies considerably according to the series under consideration. Hydroxycarbamide has become the standard treatment for some SCD phenotypes, but has classically been described as one of the causes of leg ulcer. This causality is widely debated and is still difficult to establish because it is a specific complication of the disease. Comorbidity factors (eg, iron deficiency) are also often implicated as causal or aggravating factors so research into all the potential aetiologies of leg ulcers in a sickle cell patient must be exhaustive. We discuss the aetiologies of a leg ulcer in a patient treated by hydrocarbamide for major SCD. The imputation of the drug was established, followed by a marrow allograft in this patient.
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Affiliation(s)
- Esaie Soya
- Department of Vascular MedicineGrenoble University HospitalGrenobleFrance
| | | | - Sophie Blaise
- Department of Vascular MedicineGrenoble University HospitalGrenobleFrance
- UMR 1042–HP2INSERM and University Grenoble‐AlpesGrenobleFrance
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Appleby N, Angelov D. Clinical and laboratory assessment of a patient with thrombocytosis. Br J Hosp Med (Lond) 2019; 78:558-564. [PMID: 29019736 DOI: 10.12968/hmed.2017.78.10.558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Elevated platelet counts are frequently encountered in hospital medicine and arise from both physiological and pathological mechanisms. Thrombocytosis may be secondary, reflecting an inflammatory state, iron deficiency, recent surgery or point towards an underlying neoplasm. Thrombocytosis may be the presenting sign of solid tumours and haematological conditions. The discovery of the activating mutations affecting thrombopoiesis led to greater understanding of the pathobiology of essential thrombocythaemia and other myeloproliferative neoplasms. The investigation of suspected primary thrombocytosis has evolved to include testing for these disease-associated mutations. Therapy for patients with essential thrombocythaemia aims to reduce their risk of thrombotic complications by addressing cardiovascular risk factors, and using antiplatelet agents and, in selected patients, cytoreductive therapy. This article provides a logical approach to distinguishing reactive or secondary thrombocytosis from thrombocytosis associated with an underlying myeloproliferative neoplasm and gives an overview of the management of essential thrombocythaemia.
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Affiliation(s)
- Niamh Appleby
- Molecular Haematology Fellow, Molecular Haematology Laboratory, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU
| | - Daniel Angelov
- Core Medical Trainee, Department of Haematology, Mater Misercordiae University Hospital, Dublin
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Jose J, Elsadek RA, Jimmy B, George P. Hydroxyurea: Pattern of Use, Patient Adherence, and Safety Profile in Patients with Sickle Cell Disease in Oman. Oman Med J 2019; 34:327-335. [PMID: 31360322 PMCID: PMC6642718 DOI: 10.5001/omj.2019.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Many barriers contribute to the underutilization of hydroxyurea (HU) in the treatment of sickle cell disease (SCD), and adherence to its use is often reported to be suboptimal. It is important to have information on the safety of HU in patients with SCD. Our study assessed the pattern of use, patients' adherence to medication, discontinuation of use, and safety of HU in patients with SCD. METHODS This cross-sectional study was conducted in the department of medicine of a referral hospital in Oman over five months and included a review of patient files and patient interview. Approval was obtained from the Regional Research and Ethics Committee of the A'Dakhiliyah Governorate and the hospital administration. The parameters were compared between groups using the chi-square test. RESULTS Of 298 patients studied, 128 (43.0%) had used HU at some points. The difference in the prevalence of HU use was statistically significant based only on age (p = 0.014), with younger patients more likely to be currently using HU or used HU in the past. The majority of patients were adherent (82.5%) based on self-reported adherence. The prevalence of discontinuation (temporary or permanent) of HU use was high (57.0%), and suspected adverse drug reaction (ADR) was the most common reason. Among those who had never used HU, 33.7% of patients had an indication for the initiation of HU. A quarter of patients who used HU developed a suspected ADR, with blood abnormalities being the commonest. The duration of HU use influenced ADR prevalence (p = 0.015). CONCLUSIONS Among the current users of HU, the majority of the patients were adherent based on self-reported medication adherence. The prevalence of discontinuation of HU use and instances of non-initiation of HU among those indicated were high. A larger study, ideally of a prospective nature, in various governorates of Oman, would provide a wider picture at the national level.
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Affiliation(s)
- Jimmy Jose
- School of Pharmacy, University of Nizwa, Nizwa, Oman
| | | | - Beena Jimmy
- School of Pharmacy, University of Nizwa, Nizwa, Oman
| | - Prasad George
- Department of General Medicine, Nizwa Hospital, Nizwa, Oman
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Preliminary evidence that hydroxyurea is associated with attenuated peripheral sensitization in adults with sickle cell disease. Pain Rep 2019; 4:e724. [PMID: 31041423 PMCID: PMC6455681 DOI: 10.1097/pr9.0000000000000724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction: Hydroxyurea (HU) is a drug that targets the underlying pathophysiology of sickle cell disease (SCD); however, it continues to be an underutilized treatment for adults. Previous research suggests that HU treatment can result in fewer hospital contacts for acute vaso-occlusive pain crises (VOC). Hydroxyurea's impact on non-VOC pain, however, is not well established. Objectives: This study examined whether HU moderated patterns of static and dynamic pain processing and clinical pain in SCD individuals. Methods: Fifty-eight patients with SCD (N taking HU = 17) underwent quantitative sensory testing (QST) and completed twice daily symptom diaries for 12 weeks. Quantitative sensory testing established thermal threshold and tolerance, mechanical thresholds, and thermal and mechanical temporal summation of pain. Results: Groups did not differ in age, sex, or opioid use. After controlling for morphine use, QST results showed that participants taking HU had higher heat and mechanical pain thresholds (static QST measures) but not thermal and mechanical temporal summation (dynamic QST measures). Participants taking HU also reported lower VOC pain compared with SCD participants not taking HU; however, HU did not moderate non-VOC clinical pain ratings. Conclusion: Findings cautiously suggest that HU acts on pain hypersensitivity and VOC pain, rather than inhibiting pain facilitation and non-VOC pain. These differences may reflect HU's influence on peripheral rather than central sensitization. Future research is warranted to replicate these findings in a larger sample and determine whether early HU administration can prevent peripheral sensitization in SCD individuals.
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Therapy-associated leukemic transformation in myeloproliferative neoplasms – What do we know? Best Pract Res Clin Haematol 2019; 32:65-73. [DOI: 10.1016/j.beha.2019.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 12/22/2022]
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Pecker LH, Maher JY, Law JY, Beach MC, Lanzkron S, Christianson MS. Risks associated with fertility preservation for women with sickle cell anemia. Fertil Steril 2019; 110:720-731. [PMID: 30196969 DOI: 10.1016/j.fertnstert.2018.05.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To highlight the risk of complications among women with sickle cell anemia (SCA) receiving fertility preservation treatment (FPT) before hematopoietic stem cell transplant (HSCT). DESIGN Single-center case series. SETTING Academic fertility center. PATIENT(S) Women aged 15-32 years with SCA undergoing FPT before HSCT. INTERVENTION(S) Retrospective, systematic review. MAIN OUTCOME MEASURE(S) FPT modality, SCA complications during FPT. RESULT(S) Over an 8-year period (2009-2017), seven women with SCA ages 15-32 years (mean 28.5 years) underwent FPT with embryo cryopreservation (n = 1), oocyte cryopreservation (n = 4), and ovarian tissue cryopreservation (n = 2). The five women subjects who underwent oocyte or embryo cryopreservation were treated with an antagonist controlled ovarian hyperstimulation protocol and individualized gonadotropin dosing. The trigger medications included leuprolide acetate (n = 2), and human chorionic gonadotropin (n = 3). Most patients (n = 5) received a disease-modifying therapy for SCA (hydroxyurea or chronic transfusions) before FPT. Three patients experienced periprocedural SCA complications that included life-threatening respiratory failure, painful crisis requiring interruption of a stimulation cycle, and severe postharvest painful crisis. CONCLUSION(S) Women with SCA may choose to undergo diverse FPT strategies before HSCT and are at risk for serious SCA-related complications. Evidence-based strategies to mitigate SCA-related morbidity and to optimize fertility preservation outcomes are needed.
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Affiliation(s)
- Lydia H Pecker
- Division of Pediatric Hematology, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Jacqueline Y Maher
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jennie Y Law
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sophie Lanzkron
- Division of Adult Hematology, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mindy S Christianson
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Wang Z, Xing G, Zhang L. Glycated albumin level is significantly decreased in patients suffering nephrotic syndrome. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 162:307-319. [DOI: 10.1016/bs.pmbts.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Rodríguez-Vázquez L, Martí J. An Animal Model for Assessing the Effects of Hydroxyurea Exposure Suggests That the Administration of This Agent to Pregnant Women and Young Infants May Not Be as Safe as We Thought. Int J Mol Sci 2018; 19:E3986. [PMID: 30544930 PMCID: PMC6320814 DOI: 10.3390/ijms19123986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 12/30/2022] Open
Abstract
The cytostatic agent hydroxyurea (HU) has proven to be beneficial for a variety of conditions in the disciplines of oncology, hematology, infectious disease and dermatology. It disrupts the S phase of the cell cycle by inhibiting the ribonucleotide reductase enzyme, thus blocking the transformation of ribonucleotides into deoxyribonucleotides, a rate limiting step in DNA synthesis. HU is listed as an essential medicine by the World Health Organization. Several studies have indicated that HU is well tolerated and safe in pregnant women and very young pediatric patients. To our knowledge, only a few controlled studies on the adverse effects of HU therapy have been done in humans. Despite this, the prevalence of central nervous system abnormalities, including ischemic lesions and stenosis have been reported. This review will summarize and present the effects of HU exposure on the prenatal and perinatal development of the rat cerebellar cortex and deep cerebellar nuclei neurons. Our results call for the necessity to better understand HU effects and define the administration of this drug to gestating women and young pediatric patients.
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Affiliation(s)
- Lucía Rodríguez-Vázquez
- Unidad de Citología e Histología, Facultad de Biociencias, Universidad Autónoma de Barcelona, Bellaterra, 08193 Barcelona, Spain.
| | - Joaquín Martí
- Unidad de Citología e Histología, Facultad de Biociencias, Universidad Autónoma de Barcelona, Bellaterra, 08193 Barcelona, Spain.
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Kapoor S, Little JA, Pecker LH. Advances in the Treatment of Sickle Cell Disease. Mayo Clin Proc 2018; 93:1810-1824. [PMID: 30414734 DOI: 10.1016/j.mayocp.2018.08.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/08/2018] [Accepted: 08/07/2018] [Indexed: 12/26/2022]
Abstract
Sickle cell disease (SCD) is a monogenic disorder that afflicts approximately 100,000 Americans and millions of people worldwide. It is characterized by hemolytic anemia, vaso-occlusive crises, relentless end-organ injury, and premature death. Currently, red blood cell transfusion and hydroxyurea are the major disease-modifying therapies available for SCD. Hematopoetic stem cell transplant is curative, but barriers to treatment are substantial and include a lack of suitable donors, immunologic transplant rejection, long-term adverse effects, prognostic uncertainty, and poor end-organ function, which is especially problematic for older patients. Gene therapy to correct the βs point mutation is under investigation as another curative modality. Deeper insights into the pathophysiology of SCD have led to the development of novel agents that target cellular adhesion, inflammation, oxidant injury, platelets and/or coagulation, vascular tone, and hemoglobin polymerization. These agents are in preclinical and clinical trials. One such agent, L-glutamine, decreases red blood cell oxidant injury and is recently US Food and Drug Administration approved to prevent acute pain episodes of SCD in patients 5 years of age or older. The purpose of this review is to describe the currently established therapies, barriers to curative therapies, and novel therapeutic agents that can target sickle cell hemoglobin polymerization and/or its downstream sequelae. A PubMed search was conducted for articles published up to May 15, 2018, using the search terms sickle cell disease, novel treatments, hematopoietic stem cell transplantation, and gene therapy. Studies cited include case series, retrospective studies, prospective clinical trials, meta-analyses, online abstracts, and original reviews.
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Affiliation(s)
- Sargam Kapoor
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Hematology/Oncology, Case Western Reserve University, Cleveland, OH
| | - Jane A Little
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Hematology/Oncology, Case Western Reserve University, Cleveland, OH
| | - Lydia H Pecker
- Division of Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, MD.
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Barbui T, Finazzi G, Vannucchi AM, De Stefano V. Targeting myeloid cells to prevent recurrent stroke in general population: the lesson of hydroxyurea in myeloproliferative neoplasms. Blood Cancer J 2018; 8:103. [PMID: 30405115 PMCID: PMC6221886 DOI: 10.1038/s41408-018-0143-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Guido Finazzi
- Hematology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alessandro M Vannucchi
- CRIMM-Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, and Department Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Valerio De Stefano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, and Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
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Smith AW, Bodas P, Sidebotham L, Weilnau J, Wildman B. Improving Uptake of Hydroxyurea in Patients with Sickle Cell Disease: A Retrospective Study of a Clinic-based Change in Consenting Practices. J Natl Med Assoc 2018; 111:169-175. [PMID: 30314826 DOI: 10.1016/j.jnma.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 08/21/2018] [Accepted: 09/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) can shorten lives and may result in severe clinical complications. Hydroxyurea (HU) is inexpensive, widely available, and National Institutes of Health (NIH) recommends HU for SCD. Despite these benefits, utilization of HU is low. Barriers to taking HU include inaccurate perceptions of serious side effects such as hair loss, a significant barrier in the African American community. However, at doses for treating SCD, the incidence of side effects is extremely low. Using a retrospective medical record review, the impact of a revised consent procedure for HU that addressed these barriers was evaluated. METHODS SCD patients 2-20yo eligible for HU were examined. Patients prescribed HU versus those not prescribed HU were compared one year before and one year after revising consent procedures. RESULTS Change in clinic practice (including revised consent procedures) resulted in 158% more patients agreeing to HU therapy (p<.001). DISCUSSION The revised consent procedures are not resource intensive and easy to implement. Future research should address treatment acceptability, intimidation, and cultural sensitivity.
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Affiliation(s)
- Aimee W Smith
- Kent State University, 144 Kent Hall, Kent, OH 44242, USA.
| | - Prasad Bodas
- Akron Children's Hospital, 1 Perkins Square, Akron, OH 44308, USA
| | - Lisa Sidebotham
- Akron Children's Hospital, 1 Perkins Square, Akron, OH 44308, USA
| | - JoEllen Weilnau
- Akron Children's Hospital, 1 Perkins Square, Akron, OH 44308, USA
| | - Beth Wildman
- Kent State University, 144 Kent Hall, Kent, OH 44242, USA
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63
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Ikuta T, Sellak H, Liu SY, Odo N. Serum of sickle cell disease patients contains fetal hemoglobin silencing factors secreted from leukocytes. J Blood Med 2018; 9:95-104. [PMID: 29950916 PMCID: PMC6018840 DOI: 10.2147/jbm.s156999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The mechanisms that regulate fetal hemoglobin (HbF) expression in sickle cell disease (SCD) remain elusive. We previously showed that steady-state SCD patients with high HbF levels due to a γ-globin gene mutation demonstrate strong inverse correlations between HbF levels and leukocyte counts, suggesting that leukocytes play a role in regulating HbF in SCD. MATERIALS AND METHODS To further investigate the role of leukocytes in HbF expression in SCD, we examined the presence of HbF silencing factors in the serum of 82 SCD patients who received hydroxyurea (HU) therapy. RESULTS HU-mediated HbF induction was associated with elevated total hemoglobin levels and improved red blood cell parameters, but there was no correlation with reticulocyte or platelet counts. Importantly, we again found that HU-induced HbF levels correlated with reductions in both neutrophils and lymphocytes/monocytes, indicating that these cell lineages may have a role in regulating HU-mediated HbF expression. Our in vitro studies using CD34+-derived primary erythroblasts found that patient serum preparations include HbF silencing factors that are distinct from granulocyte-macrophage colony-stimulating factor, and the activity of such factors decreases upon HU therapy. CONCLUSION Together, these results demonstrate the importance of leukocyte numbers in the regulation of HbF levels for SCD patients both in steady state and under HU therapy, and that leukocytes secrete HbF silencing factors that negatively affect HbF expression in erythroid-lineage cells in SCD.
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Affiliation(s)
- Tohru Ikuta
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Hassan Sellak
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Si-Yang Liu
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nadine Odo
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Tivnan P, Billett HH, Freeman LM, Haramati LB. Imaging for Pulmonary Embolism in Sickle Cell Disease: A 17-Year Experience. J Nucl Med 2018; 59:1255-1259. [PMID: 29419477 DOI: 10.2967/jnumed.117.205641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 12/30/2017] [Indexed: 11/16/2022] Open
Abstract
Sickle cell disease, a complex disorder with known pulmonary complications, has the potential to confound the diagnosis of pulmonary embolism. We hypothesized that when the choice of imaging is guided by chest radiographic results, CT pulmonary angiography (CTPA) and ventilation-perfusion (V/Q) scintigraphy have comparable diagnostic performance in sickle cell disease. Methods: A retrospective cohort of adults with sickle cell disease who were imaged for suspected pulmonary embolism with either CTPA or V/Q, from 2000 to 2016 at our institution, was established. To reduce radiation exposure, our practice recommends V/Q for stable patients with normal chest radiographs. Results of index pulmonary embolism imaging, 90-d follow-up, and results of chest radiography were recorded. Results: Two hundred forty-five adults with sickle cell disease comprised the cohort. The mean age (±SD) was 33 ± 10.5 y, and 58% (141) were men. Index imaging was V/Q in 62.9% (n = 154) and CTPA in 37.1% (n = 91). Chest radiographs, performed in 96.3% (n = 236), were normal in 72.9% (n = 172). Imaging results for pulmonary embolism were negative in 88.2% (n = 216), positive in 4.1% (n = 10), and indeterminate in 7.8% (n = 19) with no difference between V/Q and CTPA (P = 0.63). Reimaging within 90 d occurred in 9.8% (n = 24), 14.7% (20/136) after initial V/Q, and 5% (4/109) after initial CTPA (P = 0.08). Reimaging revealed a pulmonary embolism diagnosis after negative/indeterminate results in 0.7% (1/149) of V/Qs and 1.2% of (1/86) CTPAs (P = 0.69). Over the 17-y study period, 47% (114/245) underwent repeated imaging, and 11% (27/245) were diagnosed with pulmonary embolism at least once. Conclusion: In sickle cell disease patients with suspected pulmonary embolism, positive imaging rates were low for any given clinical presentation, but 11% of the cohort was diagnosed with pulmonary embolism over the 17-y study period. CTPA and V/Q performed comparably for pulmonary embolism diagnosis when the choice of imaging was guided by results of chest radiography. Hence, V/Q is a reasonable first choice for sickle cell disease patients with normal chest radiographs.
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Affiliation(s)
- Patrick Tivnan
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Henny H Billett
- Division of Hematology, Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; and
| | - Leonard M Freeman
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Linda B Haramati
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York .,Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Abou-Elew HH, Youssry I, Hefny S, Hashem RH, Fouad N, Zayed RA. β S globin gene haplotype and the stroke risk among Egyptian children with sickle cell disease. ACTA ACUST UNITED AC 2017; 23:362-367. [PMID: 29157167 DOI: 10.1080/10245332.2017.1403736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIM OF WORK Sickle cell disease (SCD) is an inherited disease of the beta globin gene. The βS globin gene haplotypes are Senegal, Benin, Bantu, Cameroon, Arab-Indian and atypical haplotypes. In SCD, stroke is a life-threatening event in both adults and children. In light of paucity of studies on βS globin gene haplotypes in Egypt, we aimed to determine βS globin gene haplotypes in children with SCD and study their impact on stroke risk. METHODS Fifty-two SCD patients were included in the study, they were 26 males and 26 females with age range from 3 to 18 years old. The PCR-RFLP technique was used for the determination of βS globin gene haplotypes. Transcranial Doppler (TCD) was done to identify patients at risk of stroke. RESULTS Benin/Benin was the most prevalent haplotype detected in 50% followed by Benin/Bantu in 30.8% of studied patients. TCD study showed that 14/52 (26.9%) patients had abnormally high TCD flow velocities (TCD velocities ≥170 cm/s) and thus considered high stroke risk group, whereas 38/52 (73.1%) patients had TCD flow velocities <170 cm/s and are considered low stroke risk group. Stroke risk was not found to be associated with βS globin gene haplotype (p = .532). CONCLUSION This study provides a relevant contribution to our understanding of the anthropological and historical background of the population in Egypt where Benin haplotype is the commonest βS globin gene haplotype and homozygous Benin/Benin is associated with higher stroke risk than other haplotypes.
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Affiliation(s)
- Heba H Abou-Elew
- a Clinical and Chemical Pathology Department, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Ilham Youssry
- b Pediatric Department, Faculty of Medicine , Cairo University , Cairo , Egypt
| | | | - Rania H Hashem
- d Radiology Department Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Nevine Fouad
- a Clinical and Chemical Pathology Department, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Rania A Zayed
- a Clinical and Chemical Pathology Department, Faculty of Medicine , Cairo University , Cairo , Egypt
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Jonassaint CR, Kang C, Abrams DM, Li JJ, Mao J, Jia Y, Long Q, Sanger M, Jonassaint JC, De Castro L, Shah N. Understanding patterns and correlates of daily pain using the Sickle cell disease Mobile Application to Record Symptoms via Technology (SMART). Br J Haematol 2017; 183:306-308. [PMID: 29076140 DOI: 10.1111/bjh.14956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Charles R Jonassaint
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel M Abrams
- Department of Engineering Sciences and Applied Mathematics, Northwestern University, Chicago, IL, USA
| | - Jingyi J Li
- Department of Statistics, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jason Mao
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yimeng Jia
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Qi Long
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Maureen Sanger
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Jude C Jonassaint
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laura De Castro
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nirmish Shah
- Division of Hematology, Duke University, Durham, NC, USA
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Khan M, Siddiqi R, Gangat N. Therapeutic options for leukemic transformation in patients with myeloproliferative neoplasms. Leuk Res 2017; 63:78-84. [PMID: 29121538 DOI: 10.1016/j.leukres.2017.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/12/2017] [Accepted: 10/25/2017] [Indexed: 12/12/2022]
Abstract
Approximately 5-10% of patients with Philadelphia chromosome negative myeloproliferative neoplasms (MPN) comprising of essential thrombocythemia, polycythemia vera and primary myelofibrosis) experience transformation to acute myeloid leukemia (AML, ≥20% blasts). Treatment options for post-MPN AML patients are limited, as conventional approaches like standard chemotherapy, fail to offer long-term benefit. Median survival for secondary AML is ∼2.4 months. Post-MPN AML therefore represents an area of urgent clinical need. At present, allogeneic stem cell transplant (ASCT) following induction therapy is the best therapeutic option. Patients ineligible for ASCT are treated with hypomethylating agents. New agents under investigation include histone deacetylase inhibitors, JAKinhibitors and agents targeting the BRD4 protein. Combined treatment strategies involving these novel agents are being tested. In this review we present the current evidence regarding treatment options for post-MPN AML patients.
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Affiliation(s)
- Maliha Khan
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rabbia Siddiqi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, MN, United States.
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Real-life experience with hydroxyurea in sickle cell disease: A multicenter study in a cohort of patients with heterogeneous descent. Blood Cells Mol Dis 2017; 69:82-89. [PMID: 29107441 DOI: 10.1016/j.bcmd.2017.08.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022]
Abstract
We conducted the first nation-wide cohort study of sickle cell disease (SCD) in Italy, a Southern European country exposed to intense recent flux migration from endemic areas for SCD. We evaluate the impact of hydroxyurea on a total of 652 pediatric and adult patients from 33 Reference Centers for SCD (mean age 24.5±15years, 51.4% males). Hydroxyurea median treatment duration was 7years (range: <1year to 29years) at a mean therapeutic dose of 18±4.7mg/kg/day. Hydroxyurea was associated with a significant increase in mean total and fetal hemoglobin and a significant decrease in mean hemoglobin S, white blood and platelet counts, and lactate dehydrogenase levels. Hydroxyurea was associated with a significant reduction in the incidence of acute chest syndrome (-29.3%, p<0.001), vaso-occlusive crisis (-34.1%, p<0.001), hospitalization (-53.2%, p<0.001), and bone necrosis (-6.9%, p<0.001). New silent cerebral infarction (SCI) occurred during treatment (+42.4%, p<0.001) but not stroke (+0.5%, p=0.572). These observations were generally consistent upon stratification for age, descent (Caucasian or African), genotype (βS/βS, βS/β0 or βS/β+) and duration of treatment (< or ≥10years). There were no new safety concerns observed compared to those commonly reported in the literature. Our study, conducted on a large population of patients with different descent and compound state supports the benefits of hydroxyurea therapy as a treatment option. Registered at clinical trials.gov (NCT02709681).
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69
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Brunson A, Keegan THM, Bang H, Mahajan A, Paulukonis S, Wun T. Increased risk of leukemia among sickle cell disease patients in California. Blood 2017; 130:1597-1599. [PMID: 28830890 PMCID: PMC5620417 DOI: 10.1182/blood-2017-05-783233] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ann Brunson
- Center for Oncology and Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, School of Medicine
| | - Theresa H M Keegan
- Center for Oncology and Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, School of Medicine
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, and
- Clinical and Translational Science Center, University of California, Davis, Davis, CA
| | - Anjlee Mahajan
- Center for Oncology and Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, School of Medicine
| | - Susan Paulukonis
- California Rare Disease Surveillance Program, Public Health Institute, Richmond, CA; and
| | - Ted Wun
- Center for Oncology and Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, School of Medicine
- Clinical and Translational Science Center, University of California, Davis, Davis, CA
- Section of Hematology Oncology, Veterans Affairs Northern California Health Care System, Mather, CA
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70
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71
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Sins JWR, Mager DJ, Davis SCAT, Biemond BJ, Fijnvandraat K. Pharmacotherapeutical strategies in the prevention of acute, vaso-occlusive pain in sickle cell disease: a systematic review. Blood Adv 2017; 1:1598-1616. [PMID: 29296801 PMCID: PMC5728463 DOI: 10.1182/bloodadvances.2017007211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/03/2017] [Indexed: 12/17/2022] Open
Abstract
Sickle-cell disease (SCD) is characterized by frequent and painful vaso-occlusive crises (VOCs). Various treatments have been evaluated over the years. However, a clear overview is lacking. The objective of this study was to systematically review all pharmacotherapeutical strategies in the prevention of VOCs beyond hydroxyurea. We performed a systematic literature search (MEDLINE, Embase, CENTRAL). Eligible studies were controlled clinical trials evaluating pharmacotherapeutical interventions targeting the reduction of VOCs in patients with SCD. Primary outcomes were the number or duration of SCD-related pain days, VOCs, or hospital admissions for VOCs. Secondary outcomes included time to first VOC or hospital admission for a VOC. A standardized data extraction sheet was used. The methodological quality of studies was assessed using Cochrane's risk-of-bias tool. A total of 36 studies were included in this review, covering 26 different prophylactic interventions. The most promising interventions for reducing the frequency of either VOCs or hospitalizations were the oral antioxidants l-glutamine and ω-3 fatty acids and the IV antiadhesive agent crizanlizumab. Twenty-three studies did not show any beneficial effect of the intervention under investigation, and 6 studies were either too small or methodologically inadequate to draw conclusions. Because of the heterogeneity of interventions, no meta-analysis was performed. In conclusion, this review identified 3 promising pharmacotherapeutical strategies in the prevention of VOCs in SCD. Importantly, this study highlights the discrepancy between the significant burden of SCD worldwide and the low number of adequate trials performed. This review was registered at PROSPERO (CRD42015025250).
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Affiliation(s)
- Joep W R Sins
- Department of Pediatric Hematology, Emma Children's Hospital, and
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Mager
- Department of Pediatric Hematology, Emma Children's Hospital, and
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bart J Biemond
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
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72
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Riordan JD, Nadeau JH. From Peas to Disease: Modifier Genes, Network Resilience, and the Genetics of Health. Am J Hum Genet 2017; 101:177-191. [PMID: 28777930 PMCID: PMC5544383 DOI: 10.1016/j.ajhg.2017.06.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Phenotypes are rarely consistent across genetic backgrounds and environments, but instead vary in many ways depending on allelic variants, unlinked genes, epigenetic factors, and environmental exposures. In the extreme, individuals carrying the same causal DNA sequence variant but on different backgrounds can be classified as having distinct conditions. Similarly, some individuals that carry disease alleles are nevertheless healthy despite affected family members in the same environment. These genetic background effects often result from the action of so-called "modifier genes" that modulate the phenotypic manifestation of target genes in an epistatic manner. While complicating the prospects for gene discovery and the feasibility of mechanistic studies, such effects are opportunities to gain a deeper understanding of gene interaction networks that provide organismal form and function as well as resilience to perturbation. Here, we review the principles of modifier genetics and assess progress in studies of modifier genes and their targets in both simple and complex traits. We propose that modifier effects emerge from gene interaction networks whose structure and function vary with genetic background and argue that these effects can be exploited as safe and effective ways to prevent, stabilize, and reverse disease and dysfunction.
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Affiliation(s)
- Jesse D Riordan
- Pacific Northwest Research Institute, Seattle, WA 98122, USA.
| | - Joseph H Nadeau
- Pacific Northwest Research Institute, Seattle, WA 98122, USA.
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Rodríguez-Vázquez L, Martí J. Effects of Hydroxyurea Exposure on the Rat Cerebellar Neuroepithelium: an Immunohistochemical and Electron Microscopic Study Along the Anteroposterior and Mediolateral Axes. Neurotox Res 2017; 32:671-682. [PMID: 28744838 DOI: 10.1007/s12640-017-9785-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 12/31/2022]
Abstract
We present a histological study of the cell death of cerebellar neuroepithelial neuroblasts following treatment with the cytotoxic agent hydroxyurea (HU) during the embryonic life. Pregnant rats were treated with a single dose of HU (300 mg/kg) at embryonic days 13, 14, or 15 of gestation, and their fetuses were studied from 5 to 35 h after treatment to elucidate the mechanisms of HU-induced fetotoxicity. Quantification of several parameters such as the density of pyknotic, mitotic, and PCNA-immunoreactive cells indicated that HU compromises the survival of the cerebellar neuroepithelium neuroblasts. On the other hand, our light and electron microscopic investigations during the course of prenatal development indicated that HU leads to two types of cell death: apoptosis and cells presenting cytoplasmic vacuolization, altered organelles, and a recognizable cell nucleus. Both modalities of cell death resulted in a substantial loss of cerebellar neuroepithelium cells. Current results suggest that HU exposure during gestation is toxic to the cerebellar neuroepithelium. Moreover, they allow to examine the mechanisms of HU-induced toxicity during the early development of the central nervous system. Our data also suggest that it is essential to avoid underestimating the adverse effects of HU when administered during early prenatal life.
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Affiliation(s)
- Lucía Rodríguez-Vázquez
- Unidad de Citología e Histología, Facultad de Biociencias, Universidad Autónoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - Joaquín Martí
- Unidad de Citología e Histología, Facultad de Biociencias, Universidad Autónoma de Barcelona, 08193 Bellaterra, Barcelona, Spain.
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74
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Conrado FO, Weeden AL, Speas AL, Leissinger MK. Macrocytosis secondary to hydroxyurea therapy. Vet Clin Pathol 2017; 46:451-456. [PMID: 28582589 DOI: 10.1111/vcp.12511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 10-year-old, male neutered Shetland Sheepdog was presented to the University of Florida for evaluation of a well-granulated mast cell tumor. Hydroxyurea therapy was instituted and serial CBCs showed persistent mild anemia and macrocytosis without a corresponding increase in polychromasia. The dog's MCV increased progressively, reaching its highest value of 100.0 fL after 6 months of treatment, and a diagnosis of macrocytosis associated with hydroxyurea therapy was made. The dog's increase in MCV was prominent, and rapidly decreased after the drug was discontinued, consistent with previous observations in human and canine subjects treated with hydroxyurea. Hydroxyurea is a cytotoxic chemotherapeutic agent used in a variety of conditions in human and veterinary medicine, and megaloblastic changes associated with its use have been described in multiple species. This report shows that hydroxyurea treatment is a differential diagnosis for prominent macrocytosis in dogs in the absence of other signs of erythrocyte regeneration.
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Affiliation(s)
- Francisco O Conrado
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Amy L Weeden
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Abbie L Speas
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Mary K Leissinger
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
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75
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Senet P, Blas-Chatelain C, Levy P, Manea E, Peschanski M, Mirault T, Stankovic-Stojanovic K, Debure C, Debbache K, Girot R, Bureau JM, Bachmeyer C, Baldeschi C, Galacteros F, Lionnet F, Gellen-Dautremer J. Factors predictive of leg-ulcer healing in sickle cell disease: a multicentre, prospective cohort study. Br J Dermatol 2017; 177:206-211. [DOI: 10.1111/bjd.15241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 01/01/2023]
Affiliation(s)
- P. Senet
- Service de Dermatologie; Hôpital Tenon; Assistance Publique-Hôpitaux de Paris (APHP); 4 Rue de la Chine Paris CEDEX 20 75970 France
| | - C. Blas-Chatelain
- Service de Rééducation Vasculaire; Hôpital Corentin-Celton; APHP; 4 Parvis Corentin-Celton, BP 66 Issy-les-Moulineaux CEDEX 92133 France
| | - P. Levy
- Service de Santé Publique; Hôpital Tenon; APHP; Université Pierre et Marie Curie and Institut National de la Santé et de la Recherche Médicale; UMR-S 1136; Paris France
| | - E.M. Manea
- Unité des Maladies Génétiques du Globule Rouge; Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Henri-Mondor; APHP and Université Paris-Est Créteil; Créteil France
| | - M. Peschanski
- Inserm/UEVE UMR 861, I-Stem, AFM; Génopôle Campus 1 Évry France
| | - T. Mirault
- Service de Rééducation Vasculaire; Hôpital Corentin-Celton; APHP; 4 Parvis Corentin-Celton, BP 66 Issy-les-Moulineaux CEDEX 92133 France
| | - K. Stankovic-Stojanovic
- Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Tenon; APHP and Université Pierre et Marie Curie; Paris France
| | - C. Debure
- Service de Rééducation Vasculaire; Hôpital Corentin-Celton; APHP; 4 Parvis Corentin-Celton, BP 66 Issy-les-Moulineaux CEDEX 92133 France
| | - K. Debbache
- Unité des Maladies Génétiques du Globule Rouge; Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Henri-Mondor; APHP and Université Paris-Est Créteil; Créteil France
| | - R. Girot
- Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Tenon; APHP and Université Pierre et Marie Curie; Paris France
| | - J.-M. Bureau
- Service de Rééducation Vasculaire; Hôpital Corentin-Celton; APHP; 4 Parvis Corentin-Celton, BP 66 Issy-les-Moulineaux CEDEX 92133 France
| | - C. Bachmeyer
- Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Tenon; APHP and Université Pierre et Marie Curie; Paris France
| | - C. Baldeschi
- Inserm/UEVE UMR 861, I-Stem, AFM; Génopôle Campus 1 Évry France
| | - F. Galacteros
- Unité des Maladies Génétiques du Globule Rouge; Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Henri-Mondor; APHP and Université Paris-Est Créteil; Créteil France
| | - F. Lionnet
- Service de Médecine Interne; Centre de Référence de la Drépanocytose; Hôpital Tenon; APHP and Université Pierre et Marie Curie; Paris France
| | - J. Gellen-Dautremer
- Service de Médecine Interne et Maladies Infectieuses; Centre Hospitalier Universitaire Poitires; 86021 Poitiers France
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76
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Yazdanpanah S, Rabiee M, Tahriri M, Abdolrahim M, Rajab A, Jazayeri HE, Tayebi L. Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: A comprehensive review. Crit Rev Clin Lab Sci 2017; 54:219-232. [PMID: 28393586 DOI: 10.1080/10408363.2017.1299684] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Diabetes Mellitus (DM) is a group of metabolic diseases characterized by chronic high blood glucose concentrations (hyperglycemia). When it is left untreated or improperly managed, it can lead to acute complications including diabetic ketoacidosis and non-ketotic hyperosmolar coma. In addition, possible long-term complications include impotence, nerve damage, stroke, chronic kidney failure, cardiovascular disease, foot ulcers, and retinopathy. Historically, universal methods to measure glycemic control for the diagnosis of diabetes included fasting plasma glucose level (FPG), 2-h plasma glucose (2HP), and random plasma glucose. However, these measurements did not provide information about glycemic control over a long period of time. To address this problem, there has been a switch in the past decade to diagnosing diabetes and its severity through measurement of blood glycated proteins such as Hemoglobin A1c (HbA1c) and glycated albumin (GA). Diagnosis and evaluation of diabetes using glycated proteins has many advantages including high accuracy of glycemic control over a period of time. Currently, common laboratory methods used to measure glycated proteins are high-performance liquid chromatography (HPLC), immunoassay, and electrophoresis. HbA1c is one of the most important diagnostic factors for diabetes. However, some reports indicate that HbA1c is not a suitable marker to determine glycemic control in all diabetic patients. GA, which is not influenced by changes in the lifespan of erythrocytes, is thought to be a good alternative indicator of glycemic control in diabetic patients. Here, we review the literature that has investigated the suitability of HbA1c, GA and GA:HbA1c as indicators of long-term glycemic control and demonstrate the importance of selecting the appropriate glycated protein based on the patient's health status in order to provide useful and modern point-of-care monitoring and treatment.
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Affiliation(s)
- Sara Yazdanpanah
- a Biomaterials Group, Faculty of Biomedical Engineering , Amirkabir University of Technology , Tehran , Iran
| | - Mohammad Rabiee
- a Biomaterials Group, Faculty of Biomedical Engineering , Amirkabir University of Technology , Tehran , Iran
| | - Mohammadreza Tahriri
- a Biomaterials Group, Faculty of Biomedical Engineering , Amirkabir University of Technology , Tehran , Iran.,b Marquette University School of Dentistry , Milwaukee , WI , USA.,c Dental Biomaterials Department , School of Dentistry, Tehran University of Medical Sciences , Tehran , Iran
| | - Mojgan Abdolrahim
- a Biomaterials Group, Faculty of Biomedical Engineering , Amirkabir University of Technology , Tehran , Iran
| | | | | | - Lobat Tayebi
- b Marquette University School of Dentistry , Milwaukee , WI , USA
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77
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Primary and Secondary Stroke Prevention in Children With Sickle Cell Disease. J Pediatr Health Care 2017; 31:145-154. [PMID: 27423528 DOI: 10.1016/j.pedhc.2016.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 01/09/2023]
Abstract
Children with sickle cell disease (SCD) have numerous acute and chronic complications, including central nervous system (CNS) disease, which can be debilitating over their life span. Recognition of risk factors for CNS disease and overt CNS disease should be properly identified by primary care providers, including physicians, physician assistants, and nurse practitioners. Here, we discuss an emerging and important early indicator of CNS disease in the form of silent cerebral infarcts and review overt stroke in patients with SCD. We also discuss transcranial Doppler ultrasonography, when and how often transcranial Doppler ultrasounds should be performed, and management of abnormal results. Lastly, we review the clinical data for the management and prevention of silent cerebral infarcts and overt stroke in children with SCD.
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78
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Adewoyin AS, Oghuvwu OS, Awodu OA. Hydroxyurea therapy in adult Nigerian sickle cell disease: a monocentric survey on pattern of use, clinical effects and patient's compliance. Afr Health Sci 2017; 17:255-261. [PMID: 29026400 DOI: 10.4314/ahs.v17i1.31] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The clinical prospects of hydroxyurea therapy in the management of sickle cell disease (SCD) require evaluation in the Nigerian setting to develop indigenous guidelines. This survey examines the pattern of hydroxyurea therapy, its clinico-haematologic benefits and safety profile in Nigerian SCD subjects. METHODS A cross sectional pilot survey was carried out among 60 adult SCD subjects over 3 months. Data on clinical phenotypes, relevant haematological parameters and details of hydroxyurea therapy were obtained using a structured questionnaire through an interview process and case file review. RESULTS The median age was 30 years. Thirty-four (56.7%) of the subjects are aware of hydroxyurea therapy in SCD. Twenty-four (40%) SCD patients had previously used hydroxyurea. Only 4 subjects were fully compliant. Reasons for non-compliance included poor knowledge and lack of funds. In particular, hydroxyurea reduced leucocyte count and increased mean red cell volume (MCV) in compliant subjects. CONCLUSION Hydroxyurea use is low among Nigerian SCD subjects despite its proven efficacy/clinical prospects in the developed nations. Large scale multicenter studies and clinical trials are needed to form a basis for developing standard local treatment protocol for its use.
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Affiliation(s)
- Ademola Samson Adewoyin
- Department of Haematology and Blood Transfusion, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria
| | - Omokiniovo Sunday Oghuvwu
- Department of Internal Medicine, Clinical Pharmacology and Therapeutics Unit, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria
| | - Omolade Augustina Awodu
- Department of Haematology and Blood Transfusion, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria
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79
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Connor JL, Minniti CP, Tisdale JF, Hsieh MM. Sickle Cell Anemia and Comorbid Leg Ulcer Treated With Curative Peripheral Blood Stem Cell Transplantation. INT J LOW EXTR WOUND 2017; 16:56-59. [PMID: 28682672 DOI: 10.1177/1534734616685636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Allogeneic bone marrow transplantation or peripheral blood stem cell transplantation (PBSCT) are the only curative therapies for patients with sickle cell disease (SCD). Once the patients have successfully undergone transplantation and engrafted, the hallmark of hemolytic anemia resolves, and normal hemoglobin levels are achieved. Some transplant protocols exclude patients with open wounds, including leg ulcers, because of infection risks associated with transplantation and long-term immunosuppression required to prevent graft-versus-host disease. Recalcitrant and recurrent leg ulcers are a serious complication of SCD and a determinant of morbidity. Here, we report the case of a 37-year-old man with sickle cell anemia and a chronic leg ulcer, who underwent PBSCT, engrafted successfully, and then had complete healing of his ulcer 16 months posttransplant.
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Affiliation(s)
- Joseph L Connor
- 1 National Institutes of Health, Bethesda, MD, USA.,2 MedStar Georgetown University Hospital, Washington, DC, USA
| | - Caterina P Minniti
- 1 National Institutes of Health, Bethesda, MD, USA.,3 Yeshiva University, Bronx, NY, USA
| | - John F Tisdale
- 4 National Heart, Lung, and Blood Institute and National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda MD, USA
| | - Matthew M Hsieh
- 4 National Heart, Lung, and Blood Institute and National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda MD, USA
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80
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Carvalho NS, Braga JP, Barbieri M, Torloni MR, Figueiredo MS, Guazzelli CAF. Contraceptive practices in women with sickle-cell disease. J OBSTET GYNAECOL 2016; 37:74-77. [DOI: 10.1080/01443615.2016.1225023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Natália S. Carvalho
- Department of Obstetrics and Gynaecology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil
| | | | - Márcia Barbieri
- Department of Obstetrics and Gynaecology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil
| | - Maria R. Torloni
- Department of Obstetrics and Gynaecology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil
| | | | - Cristina A. F. Guazzelli
- Department of Obstetrics and Gynaecology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil
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81
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Ferrone FA. Sickle cell disease: Its molecular mechanism and the one drug that treats it. Int J Biol Macromol 2016; 93:1168-1173. [DOI: 10.1016/j.ijbiomac.2016.09.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 09/20/2016] [Indexed: 10/21/2022]
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82
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Alapan Y, Fraiwan A, Kucukal E, Hasan MN, Ung R, Kim M, Odame I, Little JA, Gurkan UA. Emerging point-of-care technologies for sickle cell disease screening and monitoring. Expert Rev Med Devices 2016; 13:1073-1093. [PMID: 27785945 PMCID: PMC5166583 DOI: 10.1080/17434440.2016.1254038] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Sickle Cell Disease (SCD) affects 100,000 Americans and more than 14 million people globally, mostly in economically disadvantaged populations, and requires early diagnosis after birth and constant monitoring throughout the life-span of the patient. Areas covered: Early diagnosis of SCD still remains a challenge in preventing childhood mortality in the developing world due to requirements of skilled personnel and high-cost of currently available modalities. On the other hand, SCD monitoring presents insurmountable challenges due to heterogeneities among patient populations, as well as in the same individual longitudinally. Here, we describe emerging point-of-care micro/nano platform technologies for SCD screening and monitoring, and critically discuss current state of the art, potential challenges associated with these technologies, and future directions. Expert commentary: Recently developed microtechnologies offer simple, rapid, and affordable screening of SCD and have the potential to facilitate universal screening in resource-limited settings and developing countries. On the other hand, monitoring of SCD is more complicated compared to diagnosis and requires comprehensive validation of efficacy. Early use of novel microdevices for patient monitoring might come in especially handy in new clinical trial designs of emerging therapies.
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Affiliation(s)
- Yunus Alapan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Arwa Fraiwan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Erdem Kucukal
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - M. Noman Hasan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Ryan Ung
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Myeongseop Kim
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Isaac Odame
- Division of Haematology/Oncology, The Hospital for Sick Children; Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jane A. Little
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Seidman Cancer Center at University Hospitals, Case Medical Center, Cleveland, OH, USA
| | - Umut A. Gurkan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
- Department of Orthopedics, Case Western Reserve University, Cleveland, OH, USA
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Shook LM, Farrell CB, Kalinyak KA, Nelson SC, Hardesty BM, Rampersad AG, Saving KL, Whitten-Shurney WJ, Panepinto JA, Ware RE, Crosby LE. Translating sickle cell guidelines into practice for primary care providers with Project ECHO. MEDICAL EDUCATION ONLINE 2016; 21:33616. [PMID: 27887664 PMCID: PMC5124118 DOI: 10.3402/meo.v21.33616] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Approximately 100,000 persons with sickle cell disease (SCD) live in the United States, including 15,000 in the Midwest. Unfortunately, many patients experience poor health outcomes due to limited access to primary care providers (PCPs) who are prepared to deliver evidence-based SCD care. Sickle Treatment and Outcomes Research in the Midwest (STORM) is a regional network established to improve care and outcomes for individuals with SCD living in Indiana, Illinois, Michigan, Minnesota, Ohio, and Wisconsin. METHODS STORM investigators hypothesized that Project ECHO® methodology could be replicated to create a low-cost, high-impact intervention to train PCPs in evidence-based care for pediatric and young adult patients with SCD in the Midwest, called STORM TeleECHO. This approach utilizes video technology for monthly telementoring clinics consisting of didactic and case-based presentations focused on the National Heart, Lung and Blood Institute (NHLBI) evidence-based guidelines for SCD. RESULTS Network leads in each of the STORM states assisted with developing the curriculum and are recruiting providers for monthly clinics. To assess STORM TeleECHO feasibility and acceptability, monthly attendance and satisfaction data are collected. Changes in self-reported knowledge, comfort, and practice patterns will be compared with pre-participation, and 6 and 12 months after participation. CONCLUSIONS STORM TeleECHO has the potential to increase implementation of the NHLBI evidence-based guidelines, especially increased use of hydroxyurea, resulting in improvements in the quality of care and outcomes for children and young adults with SCD. This model could be replicated in other pediatric chronic illness conditions to improve PCP knowledge and confidence in delivering evidence-based care.
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Affiliation(s)
- Lisa M Shook
- Department of Pediatrics, Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA;
| | - Christina B Farrell
- Department of Pediatrics, Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karen A Kalinyak
- Department of Pediatrics, Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Kay L Saving
- Children's Hospital of Illinois, OSF Saint Francis Medical Center, University of Illinois College of Medicine, Peoria, IL, USA
| | | | - Julie A Panepinto
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Russell E Ware
- Department of Pediatrics, Cincinnati Comprehensive Sickle Cell Center, Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lori E Crosby
- Division of Behavioral Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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84
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Misra H, Bainbridge J, Berryman J, Abuchowski A, Galvez KM, Uribe LF, Hernandez AL, Sosa NR. A Phase Ib open label, randomized, safety study of SANGUINATE™ in patients with sickle cell anemia. Rev Bras Hematol Hemoter 2016; 39:20-27. [PMID: 28270341 PMCID: PMC5339363 DOI: 10.1016/j.bjhh.2016.08.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/03/2016] [Accepted: 08/22/2016] [Indexed: 02/05/2023] Open
Abstract
Background Treatment of sickle cell anemia is a challenging task and despite the well understood genetic and biochemical pathway of sickle hemoglobin, current therapy continues to be limited to the symptomatic treatment of pain, supplemental oxygen, antibiotics, red blood cell transfusions and hydroxyurea. SANGUINATE is a carbon monoxide releasing molecule and oxygen transfer agent under clinical development for the treatment of sickle cell anemia and comorbidities. Methods An open-label randomized Phase Ib study was performed in adult sickle cell anemia patients. Two dose levels of SANGUINATE were compared to hydroxyurea in 24 homozygotes for Hb SS. Twelve subjects received either a low dose (160 mg/kg) of SANGUINATE or 15 mg/kg hydroxyurea. Another 12 subjects received either a high dose (320 mg/kg) of SANGUINATE or 15 mg/kg hydroxyurea. The primary endpoint was the safety of SANGUINATE versus hydroxyurea in sickle cell anemia patients. Secondary endpoints included determination of the plasma pharmacokinetics and assessment of hematologic measurements. Results Musculoskeletal related adverse events were the most common. Transient troponin I levels increased in three patients, one of whom had an increase in tricuspid regurgitant velocity; however, no clinical signs were noted. Following an assessment of vital signs, tricuspid regurgitant velocity, electrocardiogram, serum biochemistry, hematology, urinalysis, and analysis of reported adverse events, SANGUINATE was found to be safe in stable sickle cell anemia patients. Conclusions The clinical trial met its primary objective of demonstrating an acceptable safety profile for SANGUINATE in patients with sickle cell anemia. This trial established the safety of SANGUINATE at both dose levels and permitted its advance to Phase II trials.
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Affiliation(s)
- Hemant Misra
- Prolong Pharmaceuticals, South Plainfield, United States.
| | | | - John Berryman
- Prolong Pharmaceuticals, South Plainfield, United States
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85
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Makubi A, Sasi P, Ngaeje M, Novelli EM, Mmbando BP, Gladwin MT, Makani J. Rationale and design of mDOT-HuA study: a randomized trial to assess the effect of mobile-directly observed therapy on adherence to hydroxyurea in adults with sickle cell anemia in Tanzania. BMC Med Res Methodol 2016; 16:140. [PMID: 27756209 PMCID: PMC5069827 DOI: 10.1186/s12874-016-0245-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background Hydroxyurea (HU) has been demonstrated to be efficacious in reducing complications in individuals with sickle cell anemia (SCA) but poor adherence is a barrier. Directly Observed Therapy (DOT) has been shown to improve adherence in various chronic diseases but there is limited data in adults with SCA. Methods and design To examine the effect of mobile-directly observed therapy (mDOT) on adherence to HU (mDOT-HuA) in adults with SCA at Muhimbili National Hospital in Tanzania. The mDOT-HuA study is a single centre, prospective, randomized, open label clinical trial. One-hundred individuals with SCA with haemoglobin SS genotype, aged ≥18 years, living in Dar es Salaam, able and willing to record and submit videos electronically will be included. Participants will be divided into two treatment arms; 50 in the standard monitoring (SM) arm will receive mobile phones and fixed dose HU therapy with standard monitoring; 50 in the mDOT arm will receive mobile phones, fixed dose HU therapy with standard monitoring and a mobile directly observed web based medication adherence monitoring system. The primary outcome is the proportion of participants achieving ≥80 % HU adherence compared between the two arms as assessed through medication possession ratio at the end of 3 months of treatment. REDCap, an open source software application will be used to collect data using clinical research forms. The proportions of adherence in the two arms will be compared by Fisher’s exact test. Analysis of outcomes will have performed by both the intention-to treat and per-protocol methods. Discussion Should this study become sucessful, it will have the potential for the development of novel strategies for improving HU adherence in SCA. Trial registration ClinicalTrials.gov Identifier: NCT02844673, registered on 25tht July 2016 (retrospectively registered).
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Affiliation(s)
- Abel Makubi
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Muhimbili Sickle cell Programme, Dar es Salaam, Tanzania. .,Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Philip Sasi
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mariam Ngaeje
- Muhimbili Sickle cell Programme, Dar es Salaam, Tanzania
| | - Enrico M Novelli
- Department of Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Mark T Gladwin
- Department of Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie Makani
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Muhimbili Sickle cell Programme, Dar es Salaam, Tanzania.,Muhimbili National Hospital, Dar es Salaam, Tanzania.,Nuffield Department of Clinical Medicine, University of Oxford, London, UK
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86
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Tasan I, Jain S, Zhao H. Use of genome-editing tools to treat sickle cell disease. Hum Genet 2016; 135:1011-28. [PMID: 27250347 PMCID: PMC5002234 DOI: 10.1007/s00439-016-1688-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/11/2016] [Indexed: 12/26/2022]
Abstract
Recent advances in genome-editing techniques have made it possible to modify any desired DNA sequence by employing programmable nucleases. These next-generation genome-modifying tools are the ideal candidates for therapeutic applications, especially for the treatment of genetic disorders like sickle cell disease (SCD). SCD is an inheritable monogenic disorder which is caused by a point mutation in the β-globin gene. Substantial success has been achieved in the development of supportive therapeutic strategies for SCD, but unfortunately there is still a lack of long-term universal cure. The only existing curative treatment is based on allogeneic stem cell transplantation from healthy donors; however, this treatment is applicable to a limited number of patients only. Hence, a universally applicable therapy is highly desirable. In this review, we will discuss the three programmable nucleases that are commonly used for genome-editing purposes: zinc finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs) and clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9 (CRISPR/Cas9). We will continue by exemplifying uses of these methods to correct the sickle cell mutation. Additionally, we will present induction of fetal globin expression as an alternative approach to cure sickle cell disease. We will conclude by comparing the three methods and explaining the concerns about their use in therapy.
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Affiliation(s)
- Ipek Tasan
- Department of Biochemistry, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Surbhi Jain
- Department of Biochemistry, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Huimin Zhao
- Department of Biochemistry, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Center for Biophysics and Quantitative Biology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
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87
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Fox BM, Kasztan M. Endothelin receptor antagonists in sickle cell disease: A promising new therapeutic approach. Life Sci 2016; 159:15-19. [PMID: 27049871 PMCID: PMC4992628 DOI: 10.1016/j.lfs.2016.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/11/2016] [Accepted: 04/01/2016] [Indexed: 01/12/2023]
Abstract
Sickle cell disease (SCD) is a genetic hematologic disorder that is characterized by a variety of potentially life threatening acute and chronic complications. Currently, hydroxyurea is the only clinically approved pharmacological therapy for the treatment of SCD, and the continued prevalence of severe disease complications underscores the desperate need for the development of new therapeutic agents. Central features of the sickle cell disease milieu, including hypoxia, oxidative stress, and thrombosis, are established enhancers of endothelin-1 (ET-1) synthesis. This conceptual connection between ET-1 and SCD was confirmed by multiple studies that demonstrated markedly elevated plasma and urinary levels of ET-1 in SCD patients. Direct evidence for the involvement of ET-1 signaling in the development of SCD pathologies has come from studies using endothelin receptor antagonists in SCD mice. This review summarizes recent studies that have implicated ET-1 signaling as a mechanistic contributor to renal, vascular, pulmonary, and nociceptive complications of sickle cell disease and discusses the potential for the use of ET receptor antagonists in the treatment of SCD.
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Affiliation(s)
- Brandon M Fox
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Malgorzata Kasztan
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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88
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Isotope-dilution gas chromatography-mass spectrometry method for the analysis of hydroxyurea. Ther Drug Monit 2016; 37:325-30. [PMID: 25970508 DOI: 10.1097/ftd.0000000000000145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hydroxyurea is used in the treatment of various malignancies and sickle cell disease. There are limited studies on the pharmacokinetics of hydroxyurea, particularly in pediatric patients. An accurate, precise, and sensitive method is needed to support such studies and to monitor therapeutic adherence. We describe a novel gas chromatography-mass spectrometry (GC-MS) method for the determination of hydroxyurea concentration in plasma using stable labeled hydroxyurea C N2 as an internal standard. METHODS The method involved an organic extraction followed by the preparation of trimethylsilyl (TMS) derivatives of hydroxyurea for GC-MS selected ion-monitoring analysis. The following mass-to-charge (m/z) ratio ions for silated hydroxyurea and hydroxyurea C N2 were monitored: hydroxyurea-quantitative ion 277, qualifier ions 292 and 249; hydroxyurea C N2-quantitative ion 280, qualifier ion 295. This method was evaluated for reportable range, accuracy, within-run and between-run imprecisions, and limits of quantification. RESULTS The reportable range for the method was 0.1-100 mcg/mL. All results were accurate within an allowable error of 15%. Within-run and between-run imprecisions were <15%. Samples were stable for at least 4 hours at room temperature, 2 months at -20°C, and 6 months at -70°C, and after 3 freeze/thaw cycles. Extraction efficiency for 1-, 5-, 10-, and 50-mcg/mL samples averaged 2.2%, 1.8%, 1.6%, and 1.4%, respectively. CONCLUSIONS The isotope-dilution GC-MS method for analysis of hydroxyurea described here is accurate, sensitive, precise, and robust. Its characteristics make the method suitable for supporting pharmacokinetic studies and/or clinical therapeutic monitoring.
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89
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High-performance liquid chromatographic enantioseparation of cyclic β-aminohydroxamic acids on zwitterionic chiral stationary phases based on Cinchona alkaloids. Anal Chim Acta 2016; 921:84-94. [DOI: 10.1016/j.aca.2016.03.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/22/2016] [Accepted: 03/26/2016] [Indexed: 11/24/2022]
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90
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Badawy SM, Thompson AA, Liem RI. Technology Access and Smartphone App Preferences for Medication Adherence in Adolescents and Young Adults With Sickle Cell Disease. Pediatr Blood Cancer 2016; 63:848-52. [PMID: 26844685 DOI: 10.1002/pbc.25905] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/21/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hydroxyurea is the only Food and Drug Administration approved medication for sickle cell disease (SCD) with short- and long-term benefits for both morbidity and mortality. However, hydroxyurea underutilization and adherence remain challenges for patients with SCD. The objectives of this study were to determine access to technology among adolescents and young adults (AYA) with SCD and to identify their preferred technology-based strategies for improving medication adherence. PROCEDURE A cross-sectional survey was administered in a variety of clinical settings from October 2014 through May 2015 to AYA (12-22 years) with SCD (all genotypes) followed in a Comprehensive Sickle Cell Program. RESULTS Eighty of 107 eligible participants completed the survey for a 75% response rate. Participants (51% female, 94% Black) had a mean age of 15.3 ± 2.8 years. Most participants (75%) were on a daily medication with about half on hydroxyurea. Forgetfulness (67%) was the most common barrier to medication adherence. The majority of participants (85%) owned smartphones and either owned or had access to electronic tablets (83%), laptops (72%), or desktops (70%). Of the proposed smartphone app features, daily medication reminders were ranked first most frequently, followed by education about SCD, adherence text prompts, education about SCD medications, and medication log. CONCLUSIONS The majority of our AYA with SCD owned smartphones and had access to other electronic devices. Our survey results provided valuable insight into the preferred app features and optimal strategies for developing technology-based interventions, such as a multicomponent app, to increase medication adherence for AYA with SCD or other chronic conditions.
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Affiliation(s)
- Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine at Northwestern University, Chicago, Illinois.,Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine at Zagazig University, Zagazig, Egypt
| | - Alexis A Thompson
- Division of Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine at Northwestern University, Chicago, Illinois.,Pediatric Hematology/Oncology, Robert H. Lurie Cancer Center at Northwestern, Chicago, Illinois
| | - Robert I Liem
- Division of Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine at Northwestern University, Chicago, Illinois.,Pediatric Hematology/Oncology, Robert H. Lurie Cancer Center at Northwestern, Chicago, Illinois
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91
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Wang J, Tran J, Wang H, Guo C, Harro D, Campbell AD, Eitzman DT. mTOR Inhibition improves anaemia and reduces organ damage in a murine model of sickle cell disease. Br J Haematol 2016; 174:461-9. [PMID: 27030515 DOI: 10.1111/bjh.14057] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/19/2016] [Indexed: 12/14/2022]
Abstract
Mechanistic target of rapamycin (mTOR) has been shown to play an important role in red blood cell physiology, with inhibition of mTOR signalling leading to alterations in erythropoiesis. To determine if mTOR inhibition would improve anaemia in sickle cell disease (SCD), mice with SCD were treated with the dual mTORC1/2 inhibitor, INK128. One week after daily oral drug treatment, erythrocyte count, haemoglobin, and haematocrit were all significantly increased while reticulocyte counts were reduced. These parameters remained stable during 3 weeks of treatment. Similar effects were observed following oral treatment with the mTORC1 inhibitor, sirolimus. Sirolimus treatment prolonged the lifespan of sickle cell erythrocytes in circulation, reduced spleen size, and reduced renal and hepatic iron accumulation in SCD mice. Following middle cerebral artery occlusion, stroke size was reduced in SCD mice treated with sirolimus. In conclusion, mTOR inhibition is protective against anaemia and organ damage in a murine model of SCD.
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Affiliation(s)
- Jintao Wang
- Department of Internal Medicine, University of Michigan, Cardiovascular Research Center, Ann Arbor, MI, USA
| | - Jennifer Tran
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Hui Wang
- Department of Internal Medicine, University of Michigan, Cardiovascular Research Center, Ann Arbor, MI, USA
| | - Chiao Guo
- Department of Internal Medicine, University of Michigan, Cardiovascular Research Center, Ann Arbor, MI, USA
| | - David Harro
- Chemical Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Andrew D Campbell
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Daniel T Eitzman
- Department of Internal Medicine, University of Michigan, Cardiovascular Research Center, Ann Arbor, MI, USA
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FERREIRA SBP, TAVARES WLF, ROSA MACD, BRITO LCND, VIEIRA LQ, MARTELLI JÚNIOR H, RIBEIRO SOBRINHO AP. Sickle cell anemia in Brazil: personal, medical and endodontic patterns. Braz Oral Res 2016; 30:S1806-83242016000100255. [DOI: 10.1590/1807-3107bor-2016.vol30.0060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 11/22/2015] [Indexed: 12/15/2022] Open
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93
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Shearier E, Cheng P, Bao J, Hu YH, Zhao F. Surface Defection Reduces Cytotoxicity of Zn(2-methylimidazole) 2 (ZIF-8) without Compromising its Drug Delivery Capacity. RSC Adv 2016; 6:4128-4135. [PMID: 26998256 PMCID: PMC4792300 DOI: 10.1039/c5ra24336j] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Zn(2-methylimidazole)2 (ZIF-8), as one of the most important metal-organic framework (MOF) molecules, is a promising candidate for drug delivery due to its low-density structure, high surface area, and tunable frameworks. However, ZIF-8 exhibits a high cytotoxicity associated with its external hydrophobic surface, which significantly restricts its application in drug delivery and other biomedical applications. Commonly used chemical functionalization methods would convert the hydrophobic surface of ZIF-8 to hydrophilic, but the generated functional groups on its internal surface may reduce its pore sizes or even block its pores. Herein, a surface defection strategy was applied on the external surface of ZIF-8 to enhance its hydrophilicity without reducing or blocking the internal pores. In this approach, mechanical ball-milling was used to incur defects on the external surface of ZIF-8, leading to unsaturated Zn-sites and N-sites which subsequently bound H2O molecules in an aqueous environment. Furthermore, hydroxyurea delivery and cell cytotoxicity of ZIF-8 with and without the external surface treatment were evaluated. It was found that 5-min ball milling changed the hydrophobic-hydrophilic balance of ZIF-8, resulting in significantly higher cell viability without compromising its hydroxyurea loading and release capacity. Such a simple mechanical ball-milling followed by water-treatment provides a general technique for surface-modification of other MOF molecules, which will undoubtedly magnify their biomedical applications.
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Affiliation(s)
- Emily Shearier
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Peifu Cheng
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI 49931
| | - Jiming Bao
- Department of Electrical & Computer Engineering, University of Houston, Houston TX 77204
| | - Yun Hang Hu
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI 49931
| | - Feng Zhao
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
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94
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Dahhan A. Coronary artery ectasia in atherosclerotic coronary artery disease, inflammatory disorders, and sickle cell disease. Cardiovasc Ther 2015; 33:79-88. [PMID: 25677643 DOI: 10.1111/1755-5922.12106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Coronary artery ectasia (CAE) or aneurysm is usually defined as dilation ≥1.5-fold the normal vessel diameter. It has an incidence of 1.4-5.3% and is associated with a wide variety of etiologies-mainly congenital, atherosclerotic, and inflammatory ones. CAE is very common in sickle cell disease, and possibly sickle cell trait, with an incidence of 17.7%. It is likely related to the inflammatory process associated with hemoglobin S. Prognosis depends mainly on the underlying etiology. Atherosclerotic CAE does not carry additional risks compared to atherosclerotic coronary artery disease (ACAD) without ectasia. However, isolated CAE in the absence of ACAD carries an increased risk of myocardial infarction (MI) due to vasospasm, slower coronary blood flow, and thrombosis, typically within the dilated segments. Due to lack of studies and guidelines, management recommendations are based on personal experiences. Therapy should be tailored to each individual case after assessment of severity, history of complications, underlying etiology, and comorbidities. Treatment of underlying condition and avoidance of exacerbating factors are essential. Medical therapy in general may include antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors statins, and dihydropyridine calcium channel blockers. In severe CAE or history of MI, the addition of anticoagulation therapy after assessing bleeding risk may be warranted. In acute MI, the large thrombus burden in the dilated segment makes the percutaneous approach very challenging. Aspiration attempts can result in distal thromboembolization. Survival is better in bypass grafting than with medical therapy. Nonetheless, bypass grafting does not improve survival in atherosclerotic CAE. Depending on the physical characteristics of aneurysm, different surgical approaches can be sought; however, the ideal one is unclear.
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Affiliation(s)
- Ali Dahhan
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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95
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Jasinovic T, Kozak FK, Moxham JP, Chilvers M, Wensley D, Seear M, Campbell A, Ludemann JP. Casting a look at pediatric plastic bronchitis. Int J Pediatr Otorhinolaryngol 2015; 79:1658-61. [PMID: 26250441 DOI: 10.1016/j.ijporl.2015.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/03/2015] [Accepted: 07/04/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To review clinical presentations and management strategies for children with plastic bronchitis. METHODS Retrospective chart review. RESULTS Seven patients required rigid bronchoscopy to remove bronchial casts over a 17-year study period. Mean age at presentation was 60 months. Mean follow-up was 53 months. Co-morbidities included: congenital heart disease (n=3), chronic pulmonary disorders (n=2) and sickle cell disease (n=1). 4 patients required multiple bronchoscopies for recurrent casts. Adjunctive topical therapies were administered in all 7 patients, without complication. Rigid bronchoscopy for cast removal was performed in 2 patients who were on extra-corporal membrane oxygenation (ECMO), using special precautions to safeguard the ECMO catheters. CONCLUSIONS Bronchial casts in children may present acutely or sub-acutely. Recurrent casts are unusual; however, in combination with severe cardiac disease may lead to mortality. Adjunctive topical therapies are still under investigation. Special safeguards for ECMO catheters are imperative. This case series complements and adds to the International Plastic Bronchitis Registry.
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Affiliation(s)
- Tin Jasinovic
- Division of Pediatric Otolaryngology, British Columbia's Children's Hospital, Vancouver, BC, Canada.
| | - Frederick K Kozak
- Division of Pediatric Otolaryngology, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - J Paul Moxham
- Division of Pediatric Otolaryngology, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - Mark Chilvers
- Division of Pediatric Respirology, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - David Wensley
- Division of Pediatric Respirology, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - Michael Seear
- Division of Pediatric Respirology, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - Andrew Campbell
- Division of Pediatric Cardiac Surgery, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - Jeffrey P Ludemann
- Division of Pediatric Otolaryngology, British Columbia's Children's Hospital, Vancouver, BC, Canada
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96
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Alimam S, Wilkins BS, Harrison CN. How we diagnose and treat essential thrombocythaemia. Br J Haematol 2015; 171:306-21. [DOI: 10.1111/bjh.13605] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Samah Alimam
- Department of Haematology; Guy's & St Thomas’ Hospitals NHS Foundation Trust; Guy's Hospital; London UK
| | - Bridget S. Wilkins
- Department of Cellular Pathology; Guy's & St Thomas’ Hospitals NHS Foundation Trust; St Thomas’ Hospital; London UK
| | - Claire N. Harrison
- Department of Haematology; Guy's & St Thomas’ Hospitals NHS Foundation Trust; Guy's Hospital; London UK
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97
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Abstract
Major hemoglobinopathies, including sickle cell anemia, are becoming a global health issue. Leg ulcers are the most common cutaneous manifestation of sickle cell disease and an important contributor to morbidity burden in this population. Leg ulcers following sickling disorders are extremely painful, and hard to heal. The clinical evidence for the optimal management of these ulcers is limited. Treating the cause and the strategies to prevent sickling are the mainstay of treatment. The basic principles of wound bed preparation and compression therapy is beneficial in these patients.
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98
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Lin RJ, Evans AT, Wakeman K, Unterbrink M. A Mixed-Methods Study of Pain-related Quality of Life in Sickle Cell Vaso-Occlusive Crises. Hemoglobin 2015; 39:305-9. [PMID: 26114739 DOI: 10.3109/03630269.2015.1055576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The quality of care for sickle cell disease patients hospitalized with a vaso-occlusive crisis (VOC) is poor, resulting in staggeringly high healthcare resource utilization. To evaluate in-patient care for VOC, we conducted a mixed-methods study of all adult sickle cell disease patients admitted with a VOC from 2010-2012. We quantitatively assessed the quality of care for all patients, and qualitatively studied a subset of frequently admitted patients. In total, there were 182 admissions from 57 unique patients. The median length of stay was 6 days and the 30-day readmission rate was 34.0%. We identified red blood cell transfusion and patient controlled analgesia use as predictors of increased length of stay. Interestingly, unlike prior findings, younger patients (18-30 years old) did not have increased healthcare resource utilization. Moreover, older age appeared to increase readmission rate and enhance the effect of patient controlled analgesia use on length of stay. Interviews of high healthcare resource utilizers revealed significant deficiencies in pain management and a strong desire for individualized care. This is the first study to examine in-patient predictors of acute healthcare resource utilization in sickle cell disease patients and to correlate them with qualitative perspectives of high healthcare resource utilizers.
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Affiliation(s)
- Richard J Lin
- a Department of Medicine , New York University Langone Medical Center , New York , USA
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99
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Grieco AJ, Billett HH, Green NS, Driscoll MC, Bouhassira EE. Variation in Gamma-Globin Expression before and after Induction with Hydroxyurea Associated with BCL11A, KLF1 and TAL1. PLoS One 2015; 10:e0129431. [PMID: 26053062 PMCID: PMC4459969 DOI: 10.1371/journal.pone.0129431] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/10/2015] [Indexed: 12/31/2022] Open
Abstract
The molecular mechanisms governing γ-globin expression in a subset of fetal hemoglobin (α2γ2: HbF) expressing red blood cells (F-cells) and the mechanisms underlying the variability of response to hydroxyurea induced γ-globin expression in the treatment of sickle cell disease are not completely understood. Here we analyzed intra-person clonal populations of basophilic erythroblasts (baso-Es) derived from bone marrow common myeloid progenitors in serum free cultures and report the level of fetal hemoglobin production in F-cells negatively correlates with expression of BCL11A, KLF1 and TAL1. We then examined the effects of hydroxyurea on these three transcription factors and conclude that a successful induction of γ-globin includes a reduction in BCL11A, KLF1 and TAL1 expression. These data suggests that expression changes in this transcription factor network modulate γ-globin expression in F-cells during steady state erythropoiesis and after induction with hydroxyurea.
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Affiliation(s)
- Amanda J. Grieco
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Henny H. Billett
- Division of Hematology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Nancy S. Green
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Columbia University, New York, New York, United States of America
| | - M. Catherine Driscoll
- Department of Pediatrics, Division of Hematology-Oncology, AECOM, Bronx, New York, United States of America
| | - Eric E. Bouhassira
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, New York, United States of America
- * E-mail:
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100
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Matsebatlela TM, Anderson AL, Gallicchio VS, Elford H, Rice CD. 3,4-Dihydroxy-benzohydroxamic acid (Didox) suppresses pro-inflammatory profiles and oxidative stress in TLR4-activated RAW264.7 murine macrophages. Chem Biol Interact 2015; 233:95-105. [PMID: 25843059 PMCID: PMC4408267 DOI: 10.1016/j.cbi.2015.03.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/18/2015] [Accepted: 03/25/2015] [Indexed: 12/29/2022]
Abstract
Didox (3,4-dihydroxy-benzohydroxamic acid), is a synthetic ribonucleotide reductase (RR) inhibitor derived from polyhydroxy-substituted benzohydroxamic acid, and originally developed as an anti-cancer agent. Some studies indicate that didox may have anti-oxidative stress-like properties, while other studies hint that didox may have anti-inflammatory properties. Using nitric oxide production in response to LPS treatment as a sensitive screening assay for anti-inflammatory compounds, we show that didox is very potent at levels as low as 6.25 μM, with maximal inhibition at 100 μM. A qRT-PCR array was then employed to screen didox for other potential anti-inflammatory and anti-oxidative stress-related properties. Didox was very potent in suppressing the expression of these arrayed mRNA in response to LPS, and in some cases didox alone suppressed expression. Using qRT-PCR as a follow up to the array, we demonstrated that didox suppresses LPS-induced mRNA levels of iNOS, IL-6, IL-1, TNF-α, NF-κβ (p65), and p38-α, after 24h of treatment. Treatment with didox also suppresses the secretion of nitric oxide, IL-6, and IL-10. Furthermore, oxidative stress, as quantified by intracellular ROS levels in response to macrophage activators LPS and phorbol ester (PMA), and the glutathione depleting agent BSO, is reduced by treatment with didox. Moreover, we demonstrate that nuclear translocation of NF-κβ (p65) in response to LPS is inhibited by didox. These findings were supported by qRT-PCR for oxidative stress genes SOD1 and catalase. Overall, this study supports the conclusion that didox may have a future role in managing acute and chronic inflammatory diseases and oxidative stress due to high production of ROS.
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Affiliation(s)
- Thabe M Matsebatlela
- Department of Biochemistry, Microbiology and Biotechnology, University of Limpopo, South Africa
| | - Amy L Anderson
- Department of Biological Sciences, Clemson University, SC, USA
| | | | | | - Charles D Rice
- Department of Biological Sciences, Clemson University, SC, USA.
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