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Renoux C, Joly P, Faes C, Mury P, Eglenen B, Turkay M, Yavas G, Yalcin O, Bertrand Y, Garnier N, Cuzzubbo D, Gauthier A, Romana M, Möckesch B, Cannas G, Antoine-Jonville S, Pialoux V, Connes P. Association between Oxidative Stress, Genetic Factors, and Clinical Severity in Children with Sickle Cell Anemia. J Pediatr 2018; 195:228-235. [PMID: 29449005 DOI: 10.1016/j.jpeds.2017.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/13/2017] [Accepted: 12/08/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the associations between several sickle cell disease genetic modifiers (beta-globin haplotypes, alpha-thalassemia, and glucose-6-phosphate dehydrogenase deficiency) and the level of oxidative stress and to evaluate the association between oxidative stress and the rates of vaso-occlusive events. STUDY DESIGN Steady-state oxidative and nitrosative stress markers, biological variables, genetic modulators, and vaso-occlusive crisis events requiring emergency admissions were measured during a 2-year period in 62 children with sickle cell anemia (58 SS and 4 Sβ0). Twelve ethnic-matched children without sickle cell anemia also participated as healthy controls (AA) for oxidative and nitrosative stress level measurement. RESULTS Oxidative and nitrosative stress were greater in patients with sickle cell anemia compared with control patients, but the rate of vaso-occlusive crisis events in sickle cell anemia was not associated with the level of oxidative stress. The presence of alpha-thalassemia, but not glucose-6-phosphate dehydrogenase deficiency or beta-globin haplotype, modulated the level of oxidative stress in children with sickle cell anemia. CONCLUSION Mild hemolysis in children with alpha-thalassemia may limit oxidative stress and could explain the protective role of alpha-thalassemia in hemolysis-related sickle cell complications.
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Affiliation(s)
- Céline Renoux
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; Department of Biochemistry on Red Blood Cell Disease, Biologie Est Center, Hospices Civils de Lyon, Lyon, France
| | - Philippe Joly
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; Department of Biochemistry on Red Blood Cell Disease, Biologie Est Center, Hospices Civils de Lyon, Lyon, France
| | - Camille Faes
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Pauline Mury
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Buse Eglenen
- School of Medicine, Koç University, Istanbul, Turkey
| | - Mine Turkay
- School of Medicine, Koç University, Istanbul, Turkey
| | - Gokce Yavas
- School of Medicine, Koç University, Istanbul, Turkey
| | - Ozlem Yalcin
- School of Medicine, Koç University, Istanbul, Turkey
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Nathalie Garnier
- Institute of Pediatric Hematology and Oncology (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Daniela Cuzzubbo
- Institute of Pediatric Hematology and Oncology (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Alexandra Gauthier
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; Institute of Pediatric Hematology and Oncology (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Marc Romana
- Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; UMR Inserm 1134, Ricou Hospital, Academic Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe
| | - Berenike Möckesch
- Laboratory ACTES EA3596, University of French West Indies, Pointe-à-Pitre, Guadeloupe
| | - Giovanna Cannas
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; Internal Medicine, Hématology, Edouard Herriot Hospital, Lyon, France
| | | | - Vincent Pialoux
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; French University Institute (IUF), Paris, France
| | - Philippe Connes
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; French University Institute (IUF), Paris, France.
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De A, Manwani D, Rastogi D. Airway inflammation in sickle cell disease-A translational perspective. Pediatr Pulmonol 2018; 53:400-411. [PMID: 29314737 DOI: 10.1002/ppul.23932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/29/2017] [Indexed: 12/14/2022]
Abstract
Asthma and sickle cell disease (SCD) are common chronic conditions in children of African ancestry that are characterized by cough, wheeze, and obstructive patterns on pulmonary function. Pulmonary function testing in children with SCD has estimated a prevalence of obstructive lung disease ranging from 13% to 57%, and airway hyper-responsiveness of up to 77%, independent of a diagnosis of asthma. Asthma co-existing with SCD is associated with increased risk of acute chest syndrome (ACS), respiratory symptoms, pain episodes, and death. However, there are inherent differences in the pathophysiology of SCD and asthma. While classic allergic asthma in the general population is associated with a T-helper 2 cell (Th-2 cells) pattern of cell inflammation, increased IgE levels and often positive allergy testing, inflammation in SCD is associated with different inflammatory pathways, involving neutrophilic and monocytic pathways, which have been explored to a limited extent in mouse models and with a dearth of human studies. The current review summarizes the existent literature on sickle cell related airway inflammation and its cross roads with allergic asthma-related inflammation, and discusses the importance of further elucidating and understanding these common and divergent inflammatory pathways in human studies to facilitate development of targeted therapy for children with SCD and pulmonary morbidity.
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Affiliation(s)
- Aliva De
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Deepa Manwani
- Division of Hematology/Oncology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Deepa Rastogi
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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103
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Cox SE, Ellins EA, Marealle AI, Newton CR, Soka D, Sasi P, Luca Di Tanna G, Johnson W, Makani J, Prentice AM, Halcox JP, Kirkham FJ. Ready-to-use food supplement, with or without arginine and citrulline, with daily chloroquine in Tanzanian children with sickle-cell disease: a double-blind, random order crossover trial. Lancet Haematol 2018; 5:e147-e160. [PMID: 29548623 PMCID: PMC5871644 DOI: 10.1016/s2352-3026(18)30020-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sickle-cell disease increases the risk of malnutrition. Low arginine and nitric oxide bioavailability are implicated in morbidity related to sickle-cell disease. Simple interventions are required, especially in low-income settings. We aimed to test the hypotheses that: (1) supplementary arginine, citrulline, and daily chloroquine increase bioavailable arginine and flow-mediated dilatation (FMD; maximal diameter change; FMDmax%), a measure of nitric oxide-dependent endothelial function; and (2) protein energy supplementation in the form of ready-to-use supplementary food (RUSF) improves the height-for-age and body-mass index-for-age Z-scores in children with sickle-cell disease. METHODS We performed a double-blind, random order crossover trial with two 4-month intervention periods (each followed by 4-month washout periods) in Muhimbili National Hospital in Dar-es-Salaam, Tanzania. We enrolled 119 children from the Muhimbili Sickle Cohort who were aged 8-12 years, naive to hydroxyurea, and had documented HbSS phenotype. Two formulations of RUSF (providing 500 kcal/day) were tested: basic (RUSF-b), with which children also received weekly chloroquine (150 mg or 225 mg chloroquine base, dependent on bodyweight); and vascular (RUSF-v), which was fortified with arginine and citrulline (designed to achieve mean intakes of 0·2 g/kg per day of arginine and 0·1 g/kg per day of citrulline), and with which children received daily chloroquine (maximum 3 mg chloroquine base/kg per day). Children were randomly allocated to receive either RUSF-b first or RUSF-v first and, after a washout period, were then given the other treatment. The primary outcomes in comparing the two RUSF formulations were mean plasma arginine, arginine to ornithine ratio, and arginine to asymmetric dimethylarginine ratio, and mean FMDmax%. The primary outcomes of the combined effect of both RUSF interventions were mean height-for-age Z-score and body-mass index-for-age Z-score. Analyses were done on the eligible intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01718054; and with ISRCTN74331412. FINDINGS Between Aug 9, 2012, and Feb 26, 2014, 145 children were randomised (71 children to RUSF-v first and 74 children to RUSF-b first) and 119 children were treated, of whom 114 children yielded complete data for all reported endpoints. The ratio of arginine to ornithine (mean of individual differences -8·67%, 95% CI -19·55 to 2·20; p=0·12) and the mean FMDmax% (1·00, -0·47 to 2·47; p=0·18) did not significantly differ between the RUSF-b and RUSF-v treatments. However, the arginine to asymmetric dimethylarginine ratio was significantly increased by RUSF-v compared with RUSF-b (56·26%, 31·13 to 81·38; p<0·0001). In planned analyses that used mixed effects models to estimate the effect of each intervention compared with the participants at baseline or during washout periods, the arginine to asymmetric dimethylarginine ratio increased following both RUSF-v treatment (86%; p<0·0001) and RUSF-b treatment (40%; p<0·0001). However, FMDmax% was higher after treatment with RUSF-v (0·92; p<0·0001) but not RUSF-b (0·39; p=0·22). Following either intervention (RUSF-b and RUSF-v, pooled) body-mass index-for-age Z-score (0·091; p=0·001) and height-for-age Z-score (0·013; p=0·081) increased compared with baseline and washout timepoints. In 83 participants in the treated population, there were 71 adverse events during the intervention, of which 21 (30%) were serious, and 81 adverse events during the washout periods, of which 26 (32%) were serious (p=0·31), including one patient who died in the second washout period. INTERPRETATION RUSF providing 500 kcal/day results in small weight gains in children with sickle-cell disease. However, even without arginine and citrulline fortification, RUSF seems to ameliorate arginine dysregulation and might improve endothelial function. Long-term studies are required to assess whether these physiological effects translate to improved clinical outcomes and better growth and development in patients with sickle-cell disease. FUNDING Wellcome Trust.
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Affiliation(s)
- Sharon E Cox
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Muhimbili Wellcome Programme, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Elizabeth A Ellins
- Institute of Life Sciences, Swansea University Medical School, Swansea University, Swansea, UK
| | - Alphonce I Marealle
- Muhimbili Wellcome Programme, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Charles R Newton
- Muhimbili Wellcome Programme, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deogratias Soka
- Muhimbili Wellcome Programme, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Haematology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Philip Sasi
- Department of Clinical Pharmacology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gian Luca Di Tanna
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK; Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Julie Makani
- Muhimbili Wellcome Programme, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Haematology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, London, UK
| | - Julian P Halcox
- Institute of Life Sciences, Swansea University Medical School, Swansea University, Swansea, UK
| | - Fenella J Kirkham
- Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, London, UK; Clinical and Experimental Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK; University Child Health, University Hospital Southampton, Southampton, UK
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Rankine-Mullings AE, Morrison-Levy N, Soares D, Aldred K, King L, Ali S, Knight-Madden JM, Wisdom-Phipps M, Adams RJ, Ware RE, Reid M. Transcranial Doppler velocity among Jamaican children with sickle cell anaemia: determining the significance of haematological values and nutrition. Br J Haematol 2018; 181:242-251. [PMID: 29504121 DOI: 10.1111/bjh.15162] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Angela E. Rankine-Mullings
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Nadine Morrison-Levy
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Deanne Soares
- Tropical Metabolism Research Unit; Caribbean Institute for Health Research Institute; University of the West Indies; Kingston Jamaica
| | - Karen Aldred
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Lesley King
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Susanna Ali
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Jennifer M. Knight-Madden
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Margaret Wisdom-Phipps
- Sickle Cell Unit; Caribbean Institute for Health Research; University of the West Indies; Kingston Jamaica
| | - Robert J. Adams
- Neurology; College of Medicine; Medical University of South Carolina; Charleston SC USA
| | - Russell E. Ware
- Cincinnati Children's Hospital Medical Centre; Cincinnati OH USA
| | - Marvin Reid
- Tropical Metabolism Research Unit; Caribbean Institute for Health Research Institute; University of the West Indies; Kingston Jamaica
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Donnola SB, Piccone CM, Lu L, Batesole J, Little J, Dell KM, Flask CA. Diffusion tensor imaging MRI of sickle cell kidney disease: initial results and comparison with iron deposition. NMR IN BIOMEDICINE 2018; 31:10.1002/nbm.3883. [PMID: 29350437 PMCID: PMC5822685 DOI: 10.1002/nbm.3883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/19/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
Chronic kidney disease (CKD) occurs in over one-third of patients with sickle cell disease (SCD) and can progress to end-stage renal disease. Unfortunately, current clinical assessments of kidney function are insensitive to early-stage CKD. Previous studies have shown that diffusion magnetic resonance imaging (MRI) can sensitively detect regional renal microstructural changes associated with early-stage CKD. However, previous MRI studies in patients with SCD have been largely limited to the detection of renal iron deposition assessed by T2 * relaxometry. In this pilot imaging study, we compare MRI assessments of renal microstructure (diffusion) and iron deposition (T2 *) in patients with SCD and in non-SCD control subjects. Diffusion tensor imaging (DTI) and T2 * relaxometry MRI data were obtained for pediatric (n = 5) and adult (n = 4) patients with SCD, as well as for non-SCD control subjects (n = 10), on a Siemens Espree 1.5-T MRI scanner. A region-of-interest analysis was used to calculate mean medullary and cortical values for each MRI metric. MRI findings were also compared with clinical assessments of renal function and hemolysis. Patients with SCD showed a significant decrease in medullary fractional anisotropy (FA, p = 0.0001) in comparison with non-SCD subjects, indicative of microstructural alterations in the renal medulla of patients with SCD. Cortical and medullary reductions in T2 * (increased iron deposition, p = ≤0.0001) were also observed. Significant correlations were also observed between kidney T2 * assessments and multiple measures of hemolysis. This is the first DTI MRI study of patients with SCD to demonstrate reductions in medullary FA despite no overt CKD [estimated glomerular filtration rate (eGFR) > 100 mL/min/1.73 m2 ]. These medullary FA changes are consistent with previous studies in patients with CKD, and suggest that DTI MRI can provide a useful measure of kidney injury to complement MRI assessments of iron deposition.
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Affiliation(s)
- Shannon B. Donnola
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Connie M. Piccone
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Divison of Hematology/Oncology, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Lan Lu
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Joshua Batesole
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jane Little
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Division of Hematology and Oncology, University Hospitals - Cleveland Medical Center, Cleveland, Ohio, USA
| | - Katherine M. Dell
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Pediatric Nephrology, Cleveland Clinic Children’s, Cleveland, Ohio, USA
- CWRU Center for Kidney Research, The MetroHealth System, Cleveland, Ohio, USA
| | - Chris A. Flask
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Mwesigwa S, Moulds JM, Chen A, Flanagan J, Sheehan VA, George A, Hanchard NA. Whole-exome sequencing of sickle cell disease patients with hyperhemolysis syndrome suggests a role for rare variation in disease predisposition. Transfusion 2018; 58:726-735. [PMID: 29210071 PMCID: PMC5847445 DOI: 10.1111/trf.14431] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hyperhemolysis syndrome (HHS) is an uncommon, but life-threatening, transfusion-related complication of red blood cell transfusion. HHS has predominantly been described in patients with sickle cell disease (SCD) and is difficult to diagnose and treat. The pathogenesis of HHS, including its occurrence in only a subset of apparently susceptible individuals, is poorly understood. We undertook whole-exome sequencing (WES) of 12 SCD-HHS patients to identify shared genetic variants that might be relevant to the development of HHS. STUDY DESIGN AND METHODS DNA from adults with SCD having at least one previous episode of HHS were subject to WES. High-quality variants were passed through a series of bioinformatics filters to identify variants that were uncommon among African populations represented in public databases. Recurrent, putative loss-of-function variants occurring in biologically plausible genes were prioritized and then genotyped in a larger, ancestry-matched cohort of non-HHS controls. RESULTS A rare, heterozygous stop-gain variant (p.Glu210Ter) in MBL2 was significantly enriched among HHS cases (p = 0.002). This variant is predicted to result in a premature termination codon that escapes nonsense-mediated mRNA decay, potentially leading to a novel phenotype. We also observed a complex insertion-deletion variant in the final exon of KLRC3 that was enriched among cases (p = 0.0019), although neither variant was found among seven pediatric SCD-HHS patients. CONCLUSION Our results suggest a potential role for rare genetic defects in the development of HHS among adult SCD patients. Such enriched variants may ultimately be useful for identifying high-risk individuals and informing therapeutic approaches in HHS.
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Affiliation(s)
- Savannah Mwesigwa
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Collaborative African Genomics Network (CAfGEN), Gaborone, Botswana
- Makerere University, Kampala, Uganda
| | - Joann M Moulds
- Scientific Support Services, LifeShare Blood Centers, Shreveport, Louisiana
| | | | - Jonathan Flanagan
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - Vivien A Sheehan
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | | | - Neil A Hanchard
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Collaborative African Genomics Network (CAfGEN), Gaborone, Botswana
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HO-1 hi patrolling monocytes protect against vaso-occlusion in sickle cell disease. Blood 2018; 131:1600-1610. [PMID: 29437594 DOI: 10.1182/blood-2017-12-819870] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/29/2018] [Indexed: 12/18/2022] Open
Abstract
Patients with sickle cell disease (SCD) suffer from intravascular hemolysis associated with vascular injury and dysfunction in mouse models, and painful vaso-occlusive crisis (VOC) involving increased attachment of sickle erythrocytes and activated leukocytes to damaged vascular endothelium. Patrolling monocytes, which normally scavenge damaged cells and debris from the vasculature, express higher levels of anti-inflammatory heme oxygenase 1 (HO-1), a heme degrading enzyme. Here, we show that HO-1-expressing patrolling monocytes protect SCD vasculature from ongoing hemolytic insult and vaso-occlusion. We found that a mean 37% of patrolling monocytes from SCD patients express very high levels of HO-1 (HO-1hi) vs 6% in healthy controls and demonstrated that HO-1hi expression was dependent on uptake of heme-exposed endothelium. SCD patients with a recent VOC episode had lower numbers of HO-1hi patrolling monocytes. Heme-mediated vaso-occlusion by mouse SCD red blood cells was exacerbated in mice lacking patrolling monocytes, and reversed following transfer of patrolling monocytes. Altogether, these data indicate that SCD patrolling monocytes remove hemolysis-damaged endothelial cells, resulting in HO-1 upregulation and dampening of VOC, and that perturbation in patrolling monocyte numbers resulting in lower numbers of HO-1hi patrolling monocyte may predispose SCD patients to VOC. These data suggest that HO-1hi patrolling monocytes are key players in VOC pathophysiology and have potential as therapeutic targets for VOC.
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Marealle AI, Siervo M, Wassel S, Bluck L, Prentice AM, Minzi O, Sasi P, Kamuhabwa A, Soka D, Makani J, Cox SE. A pilot study of a non-invasive oral nitrate stable isotopic method suggests that arginine and citrulline supplementation increases whole-body NO production in Tanzanian children with sickle cell disease. Nitric Oxide 2018; 74:19-22. [PMID: 29305240 PMCID: PMC5832986 DOI: 10.1016/j.niox.2017.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/25/2017] [Accepted: 12/29/2017] [Indexed: 12/24/2022]
Abstract
Background Low bioavailability of nitric oxide (NO) is implicated in the pathophysiology of sickle cell disease (SCD). We designed a nested pilot study to be conducted within a clinical trial testing the effects of a daily ready-to-use supplementary food (RUSF) fortified with arginine (Arg) and citrulline (Citr) vs. non-fortified RUSF in children with SCD. The pilot study evaluated 1) the feasibility of a non-invasive stable isotope method to measure whole-body NO production and 2) whether Arg+Citr supplementation was associated with increased whole-body NO production. Subjects Twenty-nine children (70% male, 9–11years, weight 16.3–31.3 kg) with SCD. Methods Sixteen children received RUSF+Arg/Citr (Arg, 0.2 g/kg/day; Citr, 0.1 g/kg/day) in combination with daily chloroquine (50 mg) and thirteen received the base RUSF in combination with weekly chloroquine (150 mg). Plasma amino acids were assessed using ion-exchange elution (Biochrom-30, Biochrom, UK) and whole-body NO production was measured using a non-invasive stable isotopic method. Results The RUSF+Arg/Citr intervention increased plasma arginine (P = .02) and ornithine (P = .003) and decreased the ratio of asymmetric dimethylarginine to arginine (P = .01), compared to the base RUSF. A significant increase in whole-body NO production was observed in the RUSF-Arg/Citr group compared to baseline (weight-adjusted systemic NO synthesis 3.38 ± 2.29 μmol/kg/hr vs 2.35 ± 1.13 μmol/kg/hr, P = .04). No significant changes were detected in the base RUSF group (weight-adjusted systemic NO synthesis 2.64 ± 1.14 μmol/kg/hr vs 2.53 ± 1.12 μmol/kg/hr, P = .80). Conclusions The non-invasive stable isotopic method was acceptable and the results provided supporting evidence that Arg/Citr supplementation may increase systemic NO synthesis in children with SCD. This method for measuring whole-body NO synthesis is feasible in young children. The isotopic decay of the stable isotope tracer demonstrated good linear fit. Arginine and citrulline supplementation may increase whole-body NO synthesis.
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Affiliation(s)
- Alphonce I Marealle
- Muhimbili Wellcome Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; School of Pharmacy, Department of Clinical Pharmacy & Pharmacology, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Mario Siervo
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, UK
| | | | - Les Bluck
- MRC Human Nutrition Research, Cambridge, UK
| | - Andrew M Prentice
- MRC Unit, The Gambia and MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Omary Minzi
- School of Pharmacy, Department of Clinical Pharmacy & Pharmacology, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Philip Sasi
- School of Medicine, Department of Clinical Pharmacology, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Appolinary Kamuhabwa
- School of Pharmacy, Department of Clinical Pharmacy & Pharmacology, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Deogratias Soka
- Muhimbili Wellcome Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julie Makani
- Muhimbili Wellcome Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sharon E Cox
- Muhimbili Wellcome Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan; Dept of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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Adekile AD, Azab AF, Owayed A, Khadadah M. Correlates of Pulmonary Function in Children with Sickle Cell Disease and Elevated Fetal Hemoglobin. Med Princ Pract 2018; 27:49-54. [PMID: 29183008 PMCID: PMC5968263 DOI: 10.1159/000485801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/28/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The current study was carried out to compare pulmonary function tests (PFTs) in pediatric Kuwaiti sickle cell disease (SCD) patients to age-matched normal controls and to investigate the association of PFTs with selected clinical and laboratory parameters. Subjects andMethods: There were 38 patients with SCD and 36 controls in the study. The patients were recruited from the Pediatric Hematology Clinics of Mubarak Al-Kabeer and Al-Amiri Hospitals, Kuwait, and were studied in steady state. The controls were healthy, non-sickle cell siblings of the patients. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), total lung capacity, and other PFT parameters were obtained using a constant-volume, variable-pressure, body plethysmograph. Hemoglobin, fetal hemoglobin, serum bilirubin, and lactate dehydrogenase were determined using standard methods. RESULTS The mean ages of the patients and controls were 10.5 ± 3.2 and 10.5 ± 3.5 years, respectively. The FEV1% predicted of 84.1 ± 15.4% among the patients was significantly lower than the 92.1 ± 11.8% in the controls (p = 0.003). The FVC% predicted was also significantly lower (p = 0.022) in the patients than in the controls, although the values were generally within the normal range. There was no association of FEV1 with pain phenotype, acute chest syndrome (ACS), or blood transfusions. Also, there was no significant correlation with reticulocytes, bilirubin, or lactate dehydrogenase. CONCLUSIONS In this study, changes in PFT, especially FEV1, developed early in the SCD patients. There was no demonstrable association with frequent vaso-occlusive crisis, ACS, and other variables. Hence, there is a need for follow-up studies with serial PFTs to identify vulnerable patients, who might need intervention to prevent early mortality.
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Affiliation(s)
- Adekunle D. Adekile
- Department of Pediatrics, Kuwait University, Safat, Kuwait
- Department of Pediatric Hematology Unit, Mubarak Hospital, Safat, Kuwait
- *Prof. Adekunle D. Adekile, Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110 (Kuwait), E-Mail
| | - Asmaa Farag Azab
- Department of Pediatric Hematology Unit, Mubarak Hospital, Safat, Kuwait
| | | | - Mousa Khadadah
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
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110
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Tammara BK, Harnisch LO. Dose Selection Based on Modeling and Simulation for Rivipansel in Pediatric Patients Aged 6 to 11 Years With Sickle Cell Disease. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2017; 6:845-854. [PMID: 29115052 PMCID: PMC5744176 DOI: 10.1002/psp4.12263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This modeling and simulation exercise aimed to provide dosing recommendations for rivipansel phase III studies in children aged 6–11 years with sickle cell disease (SCD). Pharmacokinetic data from 109 patients aged 12–51 years who received rivipansel (2–40 mg/kg) in previous studies (three phase I and one phase II) were integrated to build a three‐compartmental simulation model. Renal clearance simulations across the age range accounted for renal function development and postulated hyperfiltration in SCD. Simulated demographic distributions for the pediatric SCD population were used to predict concentration‐time profiles from three dosing regimens, which were then compared against efficacious average steady‐state concentrations observed in phase II. A dosing regimen comprising a 40‐mg/kg loading dose followed by a 20‐mg/kg maintenance dose every 12 hours was selected, as it will likely provide an efficacious concentration range. Its validity will be confirmed in the ongoing phase III study.
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111
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Reams SG, Messana L, Brown PB, Nanry K, Gunnell AE. Clinical trial conduct in special populations and developing regions: An overview of the DOVE study in pediatric patients with sickle cell disease. Contemp Clin Trials 2017; 64:88-94. [PMID: 29104118 DOI: 10.1016/j.cct.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 09/08/2017] [Accepted: 11/01/2017] [Indexed: 11/16/2022]
Abstract
Clinical trials conducted in unique patient populations or individuals with rare diseases are typically hampered by limitations in availability of qualified patients, requiring sponsors to broaden their global outreach to achieve enrollment. Engaging clinical study centers in developing regions may offer access to a substantially larger patient pool. However, they provide a unique set of challenges based on local cultures and requirements. The DOVE study (Determining effects Of platelet inhibition on Vaso-occlusive Events) was a clinical trial of prasugrel hydrochloride (prasugrel) in pediatric patients (aged 2 to <18years) with sickle cell anemia. The study was conducted at centers located in both well-developed and developing regions, enrolling 341 children. Study planning and execution required careful consideration of cultural requirements in each region and implementation of additional trial initiation and execution processes to address those needs. Innovative strategies were employed to ensure global consistency and quality in study execution. Significant regional- and country-specific differences were observed in site activation and enrollment. Although site activation processes were more complex and slower in developing countries, enrollment rates were much higher, which helped mitigate the site activation delays and allowed significant contribution to complete study enrollment. Data quality and patient retention in developing countries were equivalent to those observed in more developed countries, further supporting the ability to successfully conduct high-quality global registration trials in those countries. This report provides an overview of the experiences in site identification, site qualification, enrollment, patient retention, and data quality assurance in the DOVE study.
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Affiliation(s)
- Stephen G Reams
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - Linda Messana
- Quintiles Inc., Plaza Building, 4820 Emperor Boulevard, Durham, NC 27703, USA
| | - Patricia B Brown
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Kevin Nanry
- Quintiles Inc., Plaza Building, 4820 Emperor Boulevard, Durham, NC 27703, USA
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112
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Carvalho MOS, Souza ALCS, Carvalho MB, Pacheco APAS, Rocha LC, do Nascimento VML, Figueiredo CVB, Guarda CC, Santiago RP, Adekile A, Goncalves MDS. Evaluation of Alpha-1 Antitrypsin Levels and SERPINA1 Gene Polymorphisms in Sickle Cell Disease. Front Immunol 2017; 8:1491. [PMID: 29163550 PMCID: PMC5681845 DOI: 10.3389/fimmu.2017.01491] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/23/2017] [Indexed: 12/11/2022] Open
Abstract
Alpha-1 antitrypsin (AAT) is an inhibitor of neutrophil elastase and a member of the serine proteinase inhibitor (serpin) superfamily, and little is known about its activity in sickle cell disease (SCD). We hypothesize that AAT may undergo changes in SCD because of the high oxidative stress and inflammation associated with the disease. We have found high AAT levels in SCD patients compared to controls, while mutant genotypes of SERPINA1 gene had decreased AAT levels, in both groups. AAT showed negative correlation with red blood cells, hemoglobin (Hb), hematocrit, high-density lipoprotein cholesterol, urea, creatinine, and albumin and was positively correlated with mean corpuscular Hb concentration, white blood cells, neutrophils, Hb S, bilirubin, lactate dehydrogenase, ferritin, and C-reactive protein. Patients with higher levels of AAT had more infection episodes (OR = 1.71, CI: 1.05–2.65, p = 0.02), gallstones (OR = 1.75, CI: 1.03–2.97, p = 0.02), and had more blood transfusions (OR = 2.35, CI: 1.51–3.65, p = 0.0001). Our data on AAT association with laboratory indices of hemolysis and inflammation suggest that it may be positively associated with SCD severity; the negative correlations with renal parameters suggest a cytoprotective mechanism in SCD patients. In summary, AAT may need to be included in studies related to SCD and in the discussion of further therapeutic strategies.
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Affiliation(s)
- Magda Oliveira Seixas Carvalho
- Instituto Gonçalo Moniz-Fiocruz-Bahia (IGM-FIOCRUZ-Ba), Salvador, Brazil.,Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, Brazil
| | | | | | | | | | | | - Camylla Vilas Boas Figueiredo
- Instituto Gonçalo Moniz-Fiocruz-Bahia (IGM-FIOCRUZ-Ba), Salvador, Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Caroline Conceição Guarda
- Instituto Gonçalo Moniz-Fiocruz-Bahia (IGM-FIOCRUZ-Ba), Salvador, Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Rayra Pereira Santiago
- Instituto Gonçalo Moniz-Fiocruz-Bahia (IGM-FIOCRUZ-Ba), Salvador, Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Adekunle Adekile
- Department of Pediatrics, Kuwait University, Kuwait City, Kuwait
| | - Marilda de Souza Goncalves
- Instituto Gonçalo Moniz-Fiocruz-Bahia (IGM-FIOCRUZ-Ba), Salvador, Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Brazil
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113
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Khaleel M, Puliyel M, Shah P, Sunwoo J, Kato RM, Chalacheva P, Thuptimdang W, Detterich J, Wood JC, Tsao J, Zeltzer L, Sposto R, Khoo MCK, Coates TD. Individuals with sickle cell disease have a significantly greater vasoconstriction response to thermal pain than controls and have significant vasoconstriction in response to anticipation of pain. Am J Hematol 2017; 92:1137-1145. [PMID: 28707371 DOI: 10.1002/ajh.24858] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 12/17/2022]
Abstract
The painful vaso-occlusive crises (VOC) that characterize sickle cell disease (SCD) progress over hours from the asymptomatic steady-state. SCD patients report that VOC can be triggered by stress, cold exposure, and, pain itself. We anticipated that pain could cause neural-mediated vasoconstriction, decreasing regional blood flow and promoting entrapment of sickle cells in the microvasculature. Therefore, we measured microvascular blood flow in the fingers of both hands using plethysmography and laser-Doppler flowmetry while applying a series of painful thermal stimuli on the right forearm in 23 SCD patients and 25 controls. Heat pain applied to one arm caused bilateral decrease in microvascular perfusion. The vasoconstriction response started before administration of the thermal pain stimulus in all subjects, suggesting that pain anticipation also causes significant vasoconstriction. The time delay between thermal pain application and global vasoconstriction ranged from 5 to 15.5 seconds and increased with age (P < .01). Although subjective measures, pain threshold and pain tolerance were not different between SCD subjects and controls, but the vaso-reactivity index characterizing the microvascular blood flow response to painful stimuli was significantly higher in SCD patients (P = .0028). This global vasoconstriction increases microvascular transit time, and may promote entrapment of sickle cells in the microvasculature, making vaso-occlusion more likely. The rapidity of the global vasoconstriction response indicates a neural origin that may play a part in the transition from steady-state to VOC, and may also contribute to the variability in VOC frequency observed in SCD patients.
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Affiliation(s)
- Maha Khaleel
- Section of Hematology; Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | - Mammen Puliyel
- Section of Hematology; Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | - Payal Shah
- Section of Hematology; Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | - John Sunwoo
- Biomedical engineering; Viterbi School of Engineering; Los Angeles California
| | - Roberta M. Kato
- Division of Pulmonology; Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | | | - Wanwara Thuptimdang
- Biomedical engineering; Viterbi School of Engineering; Los Angeles California
| | - Jon Detterich
- Division of Cardiology; Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | - John C. Wood
- Biomedical engineering; Viterbi School of Engineering; Los Angeles California
- Division of Cardiology; Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | - Jennie Tsao
- Pediatric Pain Program, University of California Los Angeles; Los Angeles California
| | - Lonnie Zeltzer
- Pediatric Pain Program, University of California Los Angeles; Los Angeles California
| | - Richard Sposto
- Section of Hematology; Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
- Department of Preventive Medicine, Keck School of Medicine; University of Southern California; Los Angeles California
| | - Michael C. K. Khoo
- Biomedical engineering; Viterbi School of Engineering; Los Angeles California
| | - Thomas D. Coates
- Section of Hematology; Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
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114
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Krishnamoorthy S, Pace B, Gupta D, Sturtevant S, Li B, Makala L, Brittain J, Moore N, Vieira BF, Thullen T, Stone I, Li H, Hobbs WE, Light DR. Dimethyl fumarate increases fetal hemoglobin, provides heme detoxification, and corrects anemia in sickle cell disease. JCI Insight 2017; 2:96409. [PMID: 29046485 DOI: 10.1172/jci.insight.96409] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/07/2017] [Indexed: 12/31/2022] Open
Abstract
Sickle cell disease (SCD) results from a point mutation in the β-globin gene forming hemoglobin S (HbS), which polymerizes in deoxygenated erythrocytes, triggering recurrent painful vaso-occlusive crises and chronic hemolytic anemia. Reactivation of fetal Hb (HbF) expression ameliorates these symptoms of SCD. Nuclear factor (erythroid derived-2)-like 2 (Nrf2) is a transcription factor that triggers cytoprotective and antioxidant pathways to limit oxidative damage and inflammation and increases HbF synthesis in CD34+ stem cell-derived erythroid progenitors. We investigated the ability of dimethyl fumarate (DMF), a small-molecule Nrf2 agonist, to activate γ-globin transcription and enhance HbF in tissue culture and in murine and primate models. DMF recruited Nrf2 to the γ-globin promoters and the locus control region of the β-globin locus in erythroleukemia cells, elevated HbF in SCD donor-derived erythroid progenitors, and reduced hypoxia-induced sickling. Chronic DMF administration in SCD mice induced HbF and increased Nrf2-dependent genes to detoxify heme and limit inflammation. This improved hematological parameters, reduced plasma-free Hb, and attenuated inflammatory markers. Chronic DMF administration to nonanemic primates increased γ-globin mRNA in BM and HbF protein in rbc. DMF represents a potential therapy for SCD to induce HbF and augment vasoprotection and heme detoxification.
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Affiliation(s)
| | | | - Dipti Gupta
- Hematology Research, Bioverativ, Waltham, Massachusetts, USA
| | | | | | | | - Julia Brittain
- Vascular Biology Center, Augusta University, Augusta, Georgia, USA
| | - Nancy Moore
- Hematology Research, Bioverativ, Waltham, Massachusetts, USA
| | | | | | | | - Huo Li
- Computational Biology, Biogen, Cambridge, Massachusetts, USA
| | - William E Hobbs
- Hematology Research, Bioverativ, Waltham, Massachusetts, USA
| | - David R Light
- Hematology Research, Bioverativ, Waltham, Massachusetts, USA
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115
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Souza SFC, de Carvalho HLCC, Costa CPS, Thomaz EBAF. Association of sickle cell haemoglobinopathies with dental and jaw bone abnormalities. Oral Dis 2017; 24:393-403. [DOI: 10.1111/odi.12742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 08/10/2017] [Accepted: 08/13/2017] [Indexed: 01/01/2023]
Affiliation(s)
- SFC Souza
- Department of Dentistry; Federal University of Maranhão; São Luıs Brazil
| | - HLCC de Carvalho
- Postgraduate Dentistry Program; Federal University of Maranhão; São Luıs Brazil
| | - CPS Costa
- Postgraduate Dentistry Program; Federal University of Maranhão; São Luıs Brazil
| | - EBAF Thomaz
- Department of Public Health; Federal University of Maranhão; São Luıs Brazil
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116
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Aleluia MM, Fonseca TCC, Souza RQ, Neves FI, da Guarda CC, Santiago RP, Cunha BLA, Figueiredo CVB, Santana SS, da Paz SS, Ferreira JRD, Cerqueira BAV, Gonçalves MDS. Comparative study of sickle cell anemia and hemoglobin SC disease: clinical characterization, laboratory biomarkers and genetic profiles. BMC HEMATOLOGY 2017; 17:15. [PMID: 28932402 PMCID: PMC5602866 DOI: 10.1186/s12878-017-0087-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
Abstract
Background In this study, we evaluate the association of different clinical profiles, laboratory and genetic biomarkers in patients with sickle cell anemia (SCA) and hemoglobin SC disease (HbSC) in attempt to characterize the sickle cell disease (SCD) genotypes. Methods We conducted a cross-sectional study from 2013 to 2014 in 200 SCD individuals (141 with SCA; 59 with HbSC) and analyzed demographic data to characterize the study population. In addition, we determined the association of hematological, biochemical and genetic markers including the βS-globin gene haplotypes and the 3.7 Kb deletion of α-thalassemia (−α3.7Kb-thal), as well as the occurrence of clinical events in both SCD genotypes. Results Laboratory parameters showed a hemolytic profile associated with endothelial dysfunction in SCA individuals; however, the HbSC genotype was more associated with increased blood viscosity and inflammatory conditions. The BEN haplotype was the most frequently observed and was associated with elevated fetal hemoglobin (HbF) and low S hemoglobin (HbS). The -α3.7Kb-thal prevalence was 0.09 (9%), and it was associated with elevated hemoglobin and hematocrit concentrations. Clinical events were more frequent in SCA patients. Conclusions Our data emphasize the differences between SCA and HbSC patients based on laboratory parameters and the clinical and genetic profile of both genotypes.
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Affiliation(s)
- Milena Magalhães Aleluia
- Laboratório de Hematologia e Genética Computacional, Instituto Gonçalo Moniz - IGM, Fundação Oswaldo Cruz (Fiocruz), Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia CEP, 40296-710 Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Teresa Cristina Cardoso Fonseca
- Centro de Referência a Doença Falciforme, Itabuna, Bahia, Brazil.,Universidade Estadual de Santa Cruz (UESC), Ilhéus, Bahia, Brazil
| | - Regiana Quinto Souza
- Centro de Referência a Doença Falciforme, Itabuna, Bahia, Brazil.,Universidade Estadual de Santa Cruz (UESC), Ilhéus, Bahia, Brazil
| | | | - Caroline Conceição da Guarda
- Laboratório de Hematologia e Genética Computacional, Instituto Gonçalo Moniz - IGM, Fundação Oswaldo Cruz (Fiocruz), Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia CEP, 40296-710 Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Rayra Pereira Santiago
- Laboratório de Hematologia e Genética Computacional, Instituto Gonçalo Moniz - IGM, Fundação Oswaldo Cruz (Fiocruz), Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia CEP, 40296-710 Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | | | - Camylla Villas Boas Figueiredo
- Laboratório de Hematologia e Genética Computacional, Instituto Gonçalo Moniz - IGM, Fundação Oswaldo Cruz (Fiocruz), Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia CEP, 40296-710 Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Sânzio Silva Santana
- Laboratório de Hematologia e Genética Computacional, Instituto Gonçalo Moniz - IGM, Fundação Oswaldo Cruz (Fiocruz), Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia CEP, 40296-710 Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Silvana Sousa da Paz
- Laboratório de Hematologia e Genética Computacional, Instituto Gonçalo Moniz - IGM, Fundação Oswaldo Cruz (Fiocruz), Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia CEP, 40296-710 Brazil
| | - Júnia Raquel Dutra Ferreira
- Laboratório de Hematologia e Genética Computacional, Instituto Gonçalo Moniz - IGM, Fundação Oswaldo Cruz (Fiocruz), Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia CEP, 40296-710 Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | | | - Marilda de Souza Gonçalves
- Laboratório de Hematologia e Genética Computacional, Instituto Gonçalo Moniz - IGM, Fundação Oswaldo Cruz (Fiocruz), Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia CEP, 40296-710 Brazil.,Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
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117
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Yeral M, Boga C, Aytan P, Ozdogu H. Corticosteroid-induced vaso-occlusive events may be prevented by lowering hemoglobin S levels in adults with sickle cell disease. Transfus Apher Sci 2017; 56:717-718. [PMID: 28988593 DOI: 10.1016/j.transci.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Mahmut Yeral
- Department of Hematology, Faculty of Medicine, Baskent University, Ankara, Turkey; Baskent University Adana Adult Bone Marrow Transplantation Center, Yuregir, 01250 Adana, Turkey.
| | - Can Boga
- Department of Hematology, Faculty of Medicine, Baskent University, Ankara, Turkey; Baskent University Adana Adult Bone Marrow Transplantation Center, Yuregir, 01250 Adana, Turkey.
| | - Pelin Aytan
- Department of Hematology, Faculty of Medicine, Baskent University, Ankara, Turkey; Baskent University Adana Adult Bone Marrow Transplantation Center, Yuregir, 01250 Adana, Turkey.
| | - Hakan Ozdogu
- Department of Hematology, Faculty of Medicine, Baskent University, Ankara, Turkey; Baskent University Adana Adult Bone Marrow Transplantation Center, Yuregir, 01250 Adana, Turkey.
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118
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Placenta growth factor mediated gene regulation in sickle cell disease. Blood Rev 2017; 32:61-70. [PMID: 28823762 DOI: 10.1016/j.blre.2017.08.008] [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: 06/21/2017] [Revised: 08/08/2017] [Accepted: 08/15/2017] [Indexed: 01/07/2023]
Abstract
Sickle cell anemia (SCA) is an autosomal recessive disorder caused by mutation in the β-globin gene. Pulmonary hypertension (PH), a complication of SCA, results in severe morbidity and mortality. PH is a multifactorial disease: systemic vasculopathy, pulmonary vasoconstriction, and endothelial dysfunction and remodeling. Placenta growth factor (PlGF), an angiogenic growth factor, elaborated from erythroid cells, has been shown to contribute to inflammation, pulmonary vasoconstriction and airway hyper-responsiveness (AH) in mouse models of sickle cell disease. In this review, we summarize the cell-signaling mechanism(s) by which PlGF regulates the expression of genes involved in inflammation, PH and AH in cell culture and corroborate these findings in mouse models of SCA and in individuals with SCA. The role of microRNAs (miRNAs) in the post-transcriptional regulation of these genes is presented and how these miRNAs located in their host genes are transcriptionally regulated. An understanding of the transcriptional regulation of these miRNAs provides a new therapeutic approach to ameliorate the clinical manifestations of SCA.
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119
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Buckley EM, Platt MO, Lam WA. Novel in vivo and in vitro techniques to image and model the cerebral vasculature in sickle cell disease. Blood Cells Mol Dis 2017; 67:114-119. [PMID: 28822622 DOI: 10.1016/j.bcmd.2017.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 08/07/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Erin M Buckley
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, United States; Department of Pediatrics, Emory University, United States.
| | - Manu O Platt
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, United States.
| | - Wilbur A Lam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, United States; Department of Pediatrics, Emory University, United States; Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, United States.
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120
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Martí‐Carvajal AJ, Martí‐Amarista CE. Interventions for treating intrahepatic cholestasis in people with sickle cell disease. Cochrane Database Syst Rev 2017; 7:CD010985. [PMID: 28759700 PMCID: PMC6483462 DOI: 10.1002/14651858.cd010985.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Sickle cell disease is the most common hemoglobinopathy occurring worldwide and sickle cell intrahepatic cholestasis is a complication long recognized in this population. Cholestatic liver diseases are characterized by impaired formation or excretion (or both) of bile from the liver. There is a need to assess the clinical benefits and harms of the interventions used to treat intrahepatic cholestasis in people with sickle cell disease. This is an update of a previously published Cochrane Review. OBJECTIVES To assess the benefits and harms of the interventions for treating intrahepatic cholestasis in people with sickle cell disease. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 23 May 2017), the WHO International Clinical Trials Registry Platform Search Portal (23 May 2017) and ClinicalTrials.gov.Date of last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 12 April 2017. SELECTION CRITERIA We searched for published or unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS Each author intended to independently extract data and assess the risk of bias of the trials by standard Cochrane methodologies; however, no trials were included in the review. MAIN RESULTS There were no randomised controlled trials identified. AUTHORS' CONCLUSIONS This updated Cochrane Review did not identify any randomised controlled trials assessing interventions for treating intrahepatic cholestasis in people with sickle cell disease. Randomised controlled trials are needed to establish the optimum treatment for this condition.
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Erukainure OL, Ajiboye JA, Abbah UA, Asieba GO, Mamuru S, Zaruwa MZ, Manhas N, Singh P, Islam MS. Monodora myristica (African nutmeg) modulates redox homeostasis and alters functional chemistry in sickled erythrocytes. Hum Exp Toxicol 2017; 37:458-467. [DOI: 10.1177/0960327117712385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The antioxidative effect of Monodora myristica seed acetone extract and its effect on chemical functional groups were investigated in sickled erythrocytes as well as molecular modeling of the antisickling potentials of its secondary metabolites. The extract was subjected to gas chromatography–mass spectrometry to identify the compounds present, which were then docked into the allosteric-binding site of deoxy-hemoglobin. The extract was incubated with sickled erythrocytes at 37°C for 6, 12, and 24 h and were subjected to antioxidative analysis for reduced glutathione (GSH), superoxide dismutase (SOD), catalase, and lipid peroxidation (LPO). Chemical functional group of the treated cells was analyzed via Fourier transform infrared spectroscopy (FTIR). The predominant compounds identified were 17-octadecynoic acid; oleic acid, androstan-3-one, 17-hydroxy-2-methyl- (2.beta.,5.beta.,17.beta.)-; estran-3-one, 17-(acetyloxy)-2-methyl-, (2.alpha., 5.alpha., 17.beta.), and (+)-3-carene, 10-(acetylmethyl)-. They all fitted well within the active site of Hb with good binding affinity, as evidenced by the negative CDocker interaction energies of their complexes ranging between −54.4 and −26.7 kcal/mol. Treatment with the extract exacerbated SOD and catalase activities as well as GSH level, while LPO was suppressed. This antioxidative activity was time and/or dose dependent, with 6 and 12 h incubation showing the optimum activity. FTIR analysis of the treated cells showed the presence of hydrophobic functional groups. The synergetic molecular interaction of the major compounds of the extract with the α-dimer of Hb depicts an antisickling effect of M. myristica acetone extract. This is accompanied by exacerbation of endogenous antioxidant enzymes activity and modification of the functional chemistry of the cells.
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Affiliation(s)
- OL Erukainure
- Nutrition and Toxicology Division, Federal Institute of Industrial Research, Lagos, Nigeria
- Department of Biochemistry, School of Life Sciences, University of KwaZulu–Natal, Westville Campus, Durban, South Africa
| | - JA Ajiboye
- Department of Biochemistry, Bells University of Technology, Ota, Nigeria
| | - UA Abbah
- Department of Biochemistry, Bells University of Technology, Ota, Nigeria
| | - GO Asieba
- Analytical Division, Federal Institute of Industrial Research, Lagos, Nigeria
| | - S Mamuru
- Department of Chemistry, Adamawa State University, Mubi, Nigeria
| | - MZ Zaruwa
- Department of Chemistry, Adamawa State University, Mubi, Nigeria
| | - N Manhas
- School of Chemistry and Physics, University of KwaZulu–Natal, Westville Campus, Durban, South Africa
| | - P Singh
- School of Chemistry and Physics, University of KwaZulu–Natal, Westville Campus, Durban, South Africa
| | - MS Islam
- Department of Biochemistry, School of Life Sciences, University of KwaZulu–Natal, Westville Campus, Durban, South Africa
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Möckesch B, Charlot K, Jumet S, Romana M, Divialle-Doumdo L, Hardy-Dessources MD, Petras M, Tressieres B, Tarer V, Hue O, Etienne-Julan M, Connes P, Antoine-Jonville S. Micro- and macrovascular function in children with sickle cell anaemia and sickle cell haemoglobin C disease. Blood Cells Mol Dis 2017; 64:23-29. [DOI: 10.1016/j.bcmd.2017.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 01/25/2023]
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Hoppe C, Jacob E, Styles L, Kuypers F, Larkin S, Vichinsky E. Simvastatin reduces vaso-occlusive pain in sickle cell anaemia: a pilot efficacy trial. Br J Haematol 2017; 177:620-629. [PMID: 28369718 PMCID: PMC5435522 DOI: 10.1111/bjh.14580] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/06/2016] [Indexed: 12/21/2022]
Abstract
Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso-occlusive pain. Despite the broad impact of inflammation on acute and chronic clinical manifestations of SCA, no directed anti-inflammatory therapies currently exist. Statins are cholesterol-lowering agents shown to confer protection from vascular injury by suppressing inflammation. We previously documented a reduction in soluble biomarkers of inflammation in patients with sickle cell disease treated with simvastatin. To determine the potential clinical efficacy of simvastatin, we treated 19 SCA patients with single daily dose simvastatin for 3 months and assessed changes from baseline in the frequency and intensity of diary-reported pain and levels of circulating nitric oxide metabolites (NOx), high sensitivity C-reactive protein (hs-CRP), vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), ICAM-3, E-selectin, and vascular endothelial growth factor (VEGF). Treatment with simvastatin resulted in a significant reduction in the frequency of pain (P = 0·0003), oral analgesic use (P = 0·003) and circulating hs-CRP (P = 0·003), soluble (s)E-selectin (P = 0·01), sICAM-1 (P = 0·02), sICAM-3 (P = 0·02) and sVEGF (P = 0·01). Simvastatin had no effect on pain intensity or levels of NOx, sP-selectin and sVCAM-1. The observed reductions in pain rate and markers of inflammation were greatest in subjects receiving hydroxycarbamide (HC), suggesting a synergistic effect of simvastatin. These results provide preliminary clinical data to support a larger trial of simvastatin in SCA.
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Affiliation(s)
- Carolyn Hoppe
- Department of Hematology-Oncology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA
| | - Eufemia Jacob
- School of Nursing, University of California Los Angeles, CA
| | | | - Frans Kuypers
- Children’s Hospital Oakland Research Institute, Oakland, CA
| | - Sandra Larkin
- Children’s Hospital Oakland Research Institute, Oakland, CA
| | - Elliott Vichinsky
- Department of Hematology-Oncology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA
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124
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Affiliation(s)
- Frédéric B Piel
- From the Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, School of Public Health, Imperial College London (F.B.P.), and the Department of Haematological Medicine, King's College Hospital, King's College London (D.C.R.), London; and the Department of Medicine, Boston University School of Medicine, Boston (M.H.S.)
| | - Martin H Steinberg
- From the Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, School of Public Health, Imperial College London (F.B.P.), and the Department of Haematological Medicine, King's College Hospital, King's College London (D.C.R.), London; and the Department of Medicine, Boston University School of Medicine, Boston (M.H.S.)
| | - David C Rees
- From the Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, School of Public Health, Imperial College London (F.B.P.), and the Department of Haematological Medicine, King's College Hospital, King's College London (D.C.R.), London; and the Department of Medicine, Boston University School of Medicine, Boston (M.H.S.)
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Ferrão TDO, Martins-Filho PR, Aragão C, Santana M, Nascimento A, Cardoso T, Cipolotti R. Doppler velocimetry of the orbital arteries in patients with sickle cell anemia: relationship with biomarkers of hemolysis. Radiol Bras 2017; 50:103-108. [PMID: 28428653 PMCID: PMC5397001 DOI: 10.1590/0100-3984.2015.0180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate orbital vascular resistance by Doppler velocimetry in patients
with steady-state sickle cell anemia, as well as to characterize its
relationship with biomarkers of hemolysis. Materials and Methods This was a cross-sectional study of two groups: 71 outpatients with sickle
cell anemia; and 32 age- and gendermatched, healthy subjects (control
group). All participants underwent Doppler velocimetry of the orbital
arteries and laboratory tests. Results All biochemical laboratory markers were abnormal in the sickle cell anemia
patients (p < 0.0001 vs. controls). In the patient
group, Doppler velocimetry revealed increased flow velocities in the
ophthalmic artery and reduced flow velocities in the central retinal artery,
as well as high values for the resistance index (RI) and pulsatility index
(PI) in both arteries (p < 0.0001 vs. controls).
Biomarkers of hemolysis were found to correlate significantly with the RI
and PI indices. In the ophthalmic artery, the reticulocyte count showed a
moderate direct correlation with RI and with PI. In the central retinal
artery, hemoglobin showed a strong inverse correlation with RI and with
PI. Conclusion Orbital vascular resistance, as evaluated by Doppler velocimetry, is elevated
in patients with steady-state sickle cell anemia and shows a significant
correlation with biomarkers of hemolysis.
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Affiliation(s)
- Thiago de Oliveira Ferrão
- PhD, Radiologist, Assistant Professor in the Department of Medicine at the Universidade Federal de Sergipe (UFS), Aracaju, SE, Brazil
| | - Paulo Ricardo Martins-Filho
- PhD, Adjunct Professor in the Graduate Program in Health Sciences and Head of the Laboratory of Investigative Pathology at the Universidade Federal de Sergipe (UFS), Aracaju, SE, Brazil
| | - Cleverton Aragão
- Medical Student at the Universidade Federal de Sergipe (UFS), Aracaju, SE, Brazil
| | - Marlyson Santana
- Medical Student at the Universidade Federal de Sergipe (UFS), Aracaju, SE, Brazil
| | - Allan Nascimento
- Medical Student at the Universidade Federal de Sergipe (UFS), Aracaju, SE, Brazil
| | - Thayane Cardoso
- Medical Student at the Universidade Federal de Sergipe (UFS), Aracaju, SE, Brazil
| | - Rosana Cipolotti
- PhD, Pediatric Oncologist/Hematologist, Associate Professor in the Department of Medicine at the Universidade Federal de Sergipe (UFS), Aracaju, SE, Brazil
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Belcik JT, Davidson BP, Xie A, Wu MD, Yadava M, Qi Y, Liang S, Chon CR, Ammi AY, Field J, Harmann L, Chilian WM, Linden J, Lindner JR. Augmentation of Muscle Blood Flow by Ultrasound Cavitation Is Mediated by ATP and Purinergic Signaling. Circulation 2017; 135:1240-1252. [PMID: 28174191 DOI: 10.1161/circulationaha.116.024826] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/23/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Augmentation of tissue blood flow by therapeutic ultrasound is thought to rely on convective shear. Microbubble contrast agents that undergo ultrasound-mediated cavitation markedly amplify these effects. We hypothesized that purinergic signaling is responsible for shear-dependent increases in muscle perfusion during therapeutic cavitation. METHODS Unilateral exposure of the proximal hindlimb of mice (with or without ischemia produced by iliac ligation) to therapeutic ultrasound (1.3 MHz, mechanical index 1.3) was performed for 10 minutes after intravenous injection of 2×108 lipid microbubbles. Microvascular perfusion was evaluated by low-power contrast ultrasound perfusion imaging. In vivo muscle ATP release and in vitro ATP release from endothelial cells or erythrocytes were assessed by a luciferin-luciferase assay. Purinergic signaling pathways were assessed by studying interventions that (1) accelerated ATP degradation; (2) inhibited P2Y receptors, adenosine receptors, or KATP channels; or (3) inhibited downstream signaling pathways involving endothelial nitric oxide synthase or prostanoid production (indomethacin). Augmentation in muscle perfusion by ultrasound cavitation was assessed in a proof-of-concept clinical trial in 12 subjects with stable sickle cell disease. RESULTS Therapeutic ultrasound cavitation increased muscle perfusion by 7-fold in normal mice, reversed tissue ischemia for up to 24 hours in the murine model of peripheral artery disease, and doubled muscle perfusion in patients with sickle cell disease. Augmentation in flow extended well beyond the region of ultrasound exposure. Ultrasound cavitation produced an ≈40-fold focal and sustained increase in ATP, the source of which included both endothelial cells and erythrocytes. Inhibitory studies indicated that ATP was a critical mediator of flow augmentation that acts primarily through either P2Y receptors or adenosine produced by ectonucleotidase activity. Combined indomethacin and inhibition of endothelial nitric oxide synthase abolished the effects of therapeutic ultrasound, indicating downstream signaling through both nitric oxide and prostaglandins. CONCLUSIONS Therapeutic ultrasound using microbubble cavitation to increase muscle perfusion relies on shear-dependent increases in ATP, which can act through a diverse portfolio of purinergic signaling pathways. These events can reverse hindlimb ischemia in mice for >24 hours and increase muscle blood flow in patients with sickle cell disease. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT01566890.
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Affiliation(s)
- J Todd Belcik
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Brian P Davidson
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Aris Xie
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Melinda D Wu
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Mrinal Yadava
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Yue Qi
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Sherry Liang
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Chae Ryung Chon
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Azzdine Y Ammi
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Joshua Field
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Leanne Harmann
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - William M Chilian
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Joel Linden
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.)
| | - Jonathan R Lindner
- From Knight Cardiovascular Institute (J.T.B., B.P.D., A.X., M.Y., Y.Q., S.L., C.R.C., A.Y.A., J.R.L.), and Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland; Doernbecher Children's Hospital, Portland, OR; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee (J.F., L.H.); Blood Center of Wisconsin, Madison, WI (J.F., L.H.); Northeast Ohio Medical University, Rootstown (W.M.C.); and Department of Pharmacology, Division of Development Immunology, La Jolla Institute for Allergy and Immunology, University of California San Diego (J.L.).
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Martí‐Carvajal AJ, Agreda‐Pérez LH. Antibiotics for treating osteomyelitis in people with sickle cell disease. Cochrane Database Syst Rev 2016; 11:CD007175. [PMID: 27841931 PMCID: PMC6734123 DOI: 10.1002/14651858.cd007175.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Osteomyelitis (both acute and chronic) is one of the most common infectious complications in people with sickle cell disease. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from osteomyelitis. This is an update of a previously published Cochrane Review. OBJECTIVES To determine whether an empirical antibiotic treatment approach (monotherapy or combination therapy) is effective and safe as compared to pathogen-directed antibiotic treatment and whether this effectiveness and safety is dependent on different treatment regimens, age or setting. SEARCH METHODS We searched The Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 20 October 2016), African Index Medicus (20 October 2016), ISI Web of Knowledge (20 October 2016) and World Health Organization International Clinical Trials Registry Platform (20 October 2016).Date of most recent search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 18 August 2016. SELECTION CRITERIA We searched for published or unpublished randomised and quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS Each author intended to independently extract data and assess trial quality by standard Cochrane methodologies, but no eligible randomised controlled trials were identified. MAIN RESULTS This update was unable to find any randomised or quasi-randomised controlled trials on antibiotic treatment approaches for osteomyelitis in people with sickle cell disease. AUTHORS' CONCLUSIONS We were unable to identify any relevant trials on the efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from osteomyelitis. Randomised controlled trials are needed to establish the optimum antibiotic treatment for this condition.
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Affiliation(s)
| | - Luis H Agreda‐Pérez
- Hospital "Dr. Adolfo Prince Lara"Medicina InternaAv. SalomPto. CabelloVenezuela
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128
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Torres LS, Okumura JV, Silva DGH, Mimura KKO, Belini-Júnior É, Oliveira RG, Lobo CLC, Oliani SM, Bonini-Domingos CR. Inflammation in Sickle Cell Disease: Differential and Down-Expressed Plasma Levels of Annexin A1 Protein. PLoS One 2016; 11:e0165833. [PMID: 27802331 PMCID: PMC5089686 DOI: 10.1371/journal.pone.0165833] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/18/2016] [Indexed: 01/09/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited hemolytic anemia whose pathophysiology is driven by polymerization of the hemoglobin S (Hb S), leading to hemolysis and vaso-occlusive events. Inflammation is a fundamental component in these processes and a continuous inflammatory stimulus can lead to tissue damages. Thus, pro-resolving pathways emerge in order to restore the homeostasis. For example there is the annexin A1 (ANXA1), an endogenous anti-inflammatory protein involved in reducing neutrophil-endothelial interactions, accelerating neutrophil apoptosis and stimulating macrophage efferocytosis. We investigated the expression of ANXA1 in plasma of SCD patients and its relation with anemic, hemolytic and inflammatory parameters of the disease. Three SCD genotypes were considered: the homozygous inheritance for Hb S (Hb SS) and the association between Hb S and the hemoglobin variants D-Punjab (Hb SD) and C (Hb SC). ANXA1 and proinflammatory cytokines were quantified by ELISA in plasma of SCD patients and control individuals without hemoglobinopathies. Hematological and biochemical parameters were analyzed by flow cytometry and spectrophotometer. The plasma levels of ANXA1 were about three-fold lesser in SCD patients compared to the control group, and within the SCD genotypes the most elevated levels were found in Hb SS individuals (approximately three-fold higher). Proinflammatory cytokines were higher in SCD groups than in the control individuals. Anemic and hemolytic markers were higher in Hb SS and Hb SD genotypes compared to Hb SC patients. White blood cells and platelets count were higher in Hb SS genotype and were positively correlated to ANXA1 levels. We found that ANXA1 is down-regulated and differentially expressed within the SCD genotypes. Its expression seems to depend on the inflammatory, hemolytic and vaso-occlusive characteristics of the diseased. These data may lead to new biological targets for therapeutic intervention in SCD.
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Affiliation(s)
- Lidiane S. Torres
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
- * E-mail: (LST); (SMO)
| | - Jéssika V. Okumura
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Danilo G. H. Silva
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Kallyne K. O. Mimura
- Laboratory of Immunomorphology, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Édis Belini-Júnior
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Renan G. Oliveira
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Clarisse L. C. Lobo
- Institute of Hematology Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sonia M. Oliani
- Laboratory of Immunomorphology, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
- * E-mail: (LST); (SMO)
| | - Claudia R. Bonini-Domingos
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
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Mehari A, Thomas AV, Thomas AN, Johnson MS. Review: Hemodynamic Characteristics and Outcomes of Sickle Cell Disease Associated Pulmonary Hypertension. Ethn Dis 2016; 26:545-552. [PMID: 27773982 DOI: 10.18865/ed.26.4.545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pulmonary hypertension (PH) is a leading cause of morbidity and early mortality in adults with sickle cell disease (SCD). However, the prevalence, hemodynamic profile and prognosis of SCD-PH remain controversial and need frequent updates. Pulmonary hypertension determined by right heart catheterization (RHC) occurs in 6% to 10% of adults with SCD. Hemodynamically, SCD-PH may be pre-capillary or post-capillary in nature. The exact etiology is unknown and often multifactorial; hence a thorough diagnostic evaluation following established PH guidelines is essential to determine disease prevalence, etiology and outcomes. Data on the efficacy and safety of pulmonary arterial hypertension (PAH) therapy are limited in SCD; clinical trials in these patients are urgently needed. This review provides an overview of RHC-determined hemodynamic characteristics, current management modality and outcomes; we also highlight recent advances and unmet research needs in SCD-PH.
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Affiliation(s)
- Alem Mehari
- Division of Pulmonary and Critical Care, Howard University College of Medicine, Washington, DC
| | - Alvin V Thomas
- Division of Pulmonary and Critical Care, Howard University College of Medicine, Washington, DC
| | - Alicia N Thomas
- Division of Pulmonary and Critical Care, Howard University College of Medicine, Washington, DC
| | - Mark S Johnson
- Department of Community and Family Medicine, Howard University College of Medicine, Washington, DC
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Whelihan MF, Lim MY, Mooberry MJ, Piegore MG, Ilich A, Wogu A, Cai J, Monroe DM, Ataga KI, Mann KG, Key NS. Thrombin generation and cell-dependent hypercoagulability in sickle cell disease. J Thromb Haemost 2016; 14:1941-1952. [PMID: 27430959 DOI: 10.1111/jth.13416] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Indexed: 02/03/2023]
Abstract
Essentials Sickle cell disease is increasingly being recognized as a chronic hypercoagulable state. Thrombin generation is elevated in the whole blood, but not the plasma of sickle cell patients. Whole blood thrombin generation inversely correlates to erythrocyte phosphatidylserine exposure. Acquired protein S deficiency is likely explained by binding of protein S to sickle red cells. Click to hear Dr Hillery discuss coagulation and vascular pathologies in mouse models of sickle cell disease. SUMMARY Introduction Sickle cell disease (SCD) is a hypercoagulable state with chronic activation of coagulation and an increased incidence of thromboembolic events. However, although plasma pre-thrombotic markers such as thrombin-anithrombin complexes and D-dimer are elevated, there is no consensus on whether global assays of thrombin generation in plasma are abnormal in patients with SCD. Based on our recent observation that normal red blood cells (RBCs) contribute to thrombin generation in whole blood, we hypothesized that the cellular components in blood (notably phosphatidylserine-expressing erythrocytes) contribute to enhanced thrombin generation in SCD. Methods Whole blood and plasma thrombin generation assays were performed on blood samples from 25 SCD patients in a non-crisis 'steady state' and 25 healthy race-matched controls. Results Whole blood thrombin generation was significantly elevated in SCD, whereas plasma thrombin generation was paradoxically reduced compared with controls. Surprisingly, whole blood and plasma thrombin generation were both negatively correlated with phosphatidylserine exposure on RBCs. Plasma thrombin generation in the presence of exogenous activated protein C or soluble thrombomodulin revealed deficiencies in the protein C/S anticoagulant pathway in SCD. These global changes were associated with significantly lower plasma protein S activity in SCD that correlated inversely with RBC phosphatidylserine exposure. Conclusion Increased RBC phosphatidylserine exposure in SCD is associated with acquired protein S deficiency. In addition, these data suggest a cellular contribution to thrombin generation in SCD (other than RBC phosphatidylserine exposure) that explains the elevated thrombin generation in whole blood.
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Affiliation(s)
| | - M Y Lim
- Department of Medicine, Chapel Hill, NC, USA
| | | | - M G Piegore
- Department of Medicine, Chapel Hill, NC, USA
| | - A Ilich
- Department of Medicine, Chapel Hill, NC, USA
| | - A Wogu
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D M Monroe
- Department of Medicine, Chapel Hill, NC, USA
| | - K I Ataga
- Department of Medicine, Chapel Hill, NC, USA
| | - K G Mann
- Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - N S Key
- Department of Medicine, Chapel Hill, NC, USA.
- Department of Pathology and Laboratory Medicine, Chapel Hill, NC, USA.
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Steppan J, Tran HT, Bead VR, Oh YJ, Sikka G, Bivalacqua TJ, Burnett AL, Berkowitz DE, Santhanam L. Arginase Inhibition Reverses Endothelial Dysfunction, Pulmonary Hypertension, and Vascular Stiffness in Transgenic Sickle Cell Mice. Anesth Analg 2016; 123:652-8. [PMID: 27537757 PMCID: PMC5032625 DOI: 10.1213/ane.0000000000001378] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In sickle cell disease (SCD), hemolysis results in the release and activation of arginase, an enzyme that reciprocally regulates nitric oxide (NO) synthase activity and thus, NO production. Simply supplementing the common substrate L-arginine, however, fails to improve NO bioavailability. In this study, we tested the hypothesis that arginase inhibition would improve NO bioavailability and thereby attenuate systemic and pulmonary vascular endothelial dysfunction in transgenic mice with SCD. METHODS We studied 5-month-old transgenic sickle cell (SC) mice and age matched wild-type (WT) controls. SC mice were treated with the arginase inhibitor, 2(S)-amino-6-boronohexanoic acid (ABH; approximately 400 μg/d) for 4 weeks or left untreated. RESULTS Vascular arginase activity was significantly higher at baseline in untreated SC mice compared to WT controls (SC versus WT, 346 ± 69.3 vs 69 ± 17.3 pmol urea/mg protein/minute; P = 0.0043; n = 4-5 animals per group). Treatment with ABH may significantly decrease arginase activity to levels near WT controls (SC + ABH 125.2 ± 17.3 pmol urea/mg protein/minute; P = 0.0213). Aortic strips from untreated SC mice showed decreased NO and increased reactive oxygen species (ROS) production (NO: fluorescence rate 0.76 ± 0.14 vs 1.34 ± 0.17 RFU/s; P = 0.0005 and ROS: fluorescence rate 3.96 ± 1.70 vs 1.63 ± 1.20 RFU/s, P = 0.0039; n = 3- animals per group). SC animals treated with ABH for 4 weeks demonstrated NO (fluorescence rate: 1.16 ± 0.16) and ROS (fluorescence rate: 2.02 ± 0.45) levels comparable with age-matched WT controls (n = 3- animals per group). The maximal endothelial-dependent vasorelaxation response to acetylcholine was impaired in aortic rings from SC mice compared with WT (57.7% ± 8.4% vs 80.3% ± 11.0%; P = 0.02; n = 6 animals per group). The endothelial-independent response was not different between groups. In SC mice, the right ventricular cardiac output index and end-systolic elastance were similar (4.60 ± 0.51 vs 2.9 ± 0.85 mL/min/100 g and 0.89 ± 0.48 vs 0.58 ± 0.11 mm Hg/μL), whereas the pulmonary vascular resistance index and right ventricular end-systolic pressure were greater (2.9 ± 0.28 vs 5.5 ± 2.0 mm Hg × min/μL/100 g and 18.9 ± 1.1 vs 23.1 ± 4.0 mm Hg; n = 8 animals per group). Pulse wave velocity (a measure of arterial stiffness) was greater in SC mice compared with WT (3.74 ± 0.54 vs 3.25 ± 0.21 m/s; n = 20 animals per group), arginase inhibition for 4 weeks significantly reduced the vascular SC phenotype to one similar to WT animals (P = 0.0009). CONCLUSIONS Arginase inhibition improves NO bioavailability and thereby attenuates systemic and pulmonary vascular endothelial dysfunction in transgenic mice with SCD. Therefore, arginase is a potential therapeutic target in the treatment of cardiovascular dysfunction in SCD.
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MESH Headings
- Anemia, Sickle Cell/drug therapy
- Anemia, Sickle Cell/enzymology
- Anemia, Sickle Cell/physiopathology
- Animals
- Arginase/antagonists & inhibitors
- Arginase/metabolism
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/enzymology
- Endothelium, Vascular/physiopathology
- Enzyme Inhibitors/pharmacology
- Enzyme Inhibitors/therapeutic use
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/enzymology
- Hypertension, Pulmonary/physiopathology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Pulse Wave Analysis/methods
- Vascular Stiffness/drug effects
- Vascular Stiffness/physiology
- Vasodilation/drug effects
- Vasodilation/physiology
- Vasodilator Agents/pharmacology
- Vasodilator Agents/therapeutic use
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Affiliation(s)
- Jochen Steppan
- From the *Department of Anesthesiology and Critical Care Medicine and †Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institution, Baltimore, Maryland; ‡Department of Anesthesiology and Pain Medicine, Yonsei University, College of Medicine, Seoul, South Korea; and §Department of Urology, Johns Hopkins Medical Institution, Baltimore, Maryland
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Relationship between Neutrophil-to-Lymphocyte Ratio and Inflammatory Markers in Sickle Cell Anaemia Patients with Proteinuria. Med Sci (Basel) 2016; 4:medsci4030011. [PMID: 29083375 PMCID: PMC5635800 DOI: 10.3390/medsci4030011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/13/2016] [Accepted: 07/19/2016] [Indexed: 12/26/2022] Open
Abstract
The renal functions and structure in sickle cell anaemia (SCA) patients may be affected by chronic haemodynamic changes and consequences of vaso-occlusive events in the renal medulla. Few reports on neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in SCA patients in Africans exist in the literature. This study correlates the values of NLR and PLR with measured traditional inflammatory markers in SCA patients with and without proteinuria and impaired kidney function (defined in this study as estimated glomerular filtration rate (eGFR), less than 60 mL/min/1.73 m2. Full blood count, C-reactive protein (CRP), and fibrinogen were assayed in 150 SCA patients and 50 control subjects using Coulter Haematology analyser (CELL DYE 37000) and ELISA method, respectively. The NLR and PLR were calculated by dividing absolute neutrophil or platelet counts by absolute lymphocyte count. Fibrinogen, CRP, NLR, and PLR increased progressively (p < 0.001) in SCA patients with or without proteinuria, with the highest values seen in those with impaired renal function. NLR correlated positively with CRP and fibrinogen in SCA patients without proteinuria (p < 0.001), with proteinuria (p < 0.001), and impaired renal function (p < 0.05). A positive relationship was also observed between NLR and fibrinogen in the control subjects. The need to determine cut-off values for these leukocyte ratios to be used in identifying those patients at risk and in the general management of SCA patients is suggested.
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133
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Janse van Rensburg J, Thomas J. Paediatric cardiac anaesthesia in sickle cell disease: a case series. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2016. [DOI: 10.1080/22201181.2016.1168611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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134
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Khalyfa A, Khalyfa AA, Akbarpour M, Connes P, Romana M, Lapping-Carr G, Zhang C, Andrade J, Gozal D. Extracellular microvesicle microRNAs in children with sickle cell anaemia with divergent clinical phenotypes. Br J Haematol 2016; 174:786-98. [PMID: 27161653 DOI: 10.1111/bjh.14104] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/25/2016] [Indexed: 12/18/2022]
Abstract
Sickle cell anaemia (SCA) is the most frequent genetic haemoglobinopathy, which exhibits a highly variable clinical course characterized by hyper-coagulable and pro-inflammatory states, as well as endothelial dysfunction. Extracellular microvesicles are released into biological fluids and play a role in modifying the functional phenotype of target cells. We hypothesized that potential differences in plasma-derived extracellular microvesicles (EV) function and cargo from SCA patients may underlie divergent clinical trajectories. Plasma EV from SCA patients with mild, intermediate and severe clinical disease course were isolated, and primary endothelial cell cultures were exposed. Endothelial cell activation, monocyte adhesion, barrier disruption and exosome cargo (microRNA microarrays) were assessed. EV disrupted the endothelial barrier and induced expression of adhesion molecules and monocyte adhesion in a SCA severity-dependent manner compared to healthy children. Microarray approaches identified a restricted signature of exosomal microRNAs that readily distinguished severe from mild SCA, as well as from healthy children. The microRNA candidates were further validated using quantitative real time polymerase chain reaction assays, and revealed putative gene targets. Circulating exosomal microRNAs may play important roles in predicting the clinical course of SCA, and in delineation of individually tailored, mechanistically-based clinical treatment approaches of SCA patients in the near future.
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Affiliation(s)
- Abdelnaby Khalyfa
- Section of Pediatric Sleep Medicine, Department of Paediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Ahamed A Khalyfa
- Section of Pediatric Sleep Medicine, Department of Paediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Mahzad Akbarpour
- Section of Pediatric Sleep Medicine, Department of Paediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Phillippe Connes
- UMR Inserm U1134, French West Indies University, Pointe-à-Pitre, Guadeloupe, France.,Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France.,Institut Universitaire de France (IUF), Paris, France.,Laboratory LIBM, Team "Vascular Biology and Red Blood Cell", University of Lyon 1, Lyon, France
| | - Marc Romana
- UMR Inserm U1134, French West Indies University, Pointe-à-Pitre, Guadeloupe, France.,Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Gabrielle Lapping-Carr
- Pediatric Hematology-Oncology, Department of Paediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Chunling Zhang
- Center for Research Informatics, Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Jorge Andrade
- Center for Research Informatics, Sciences Division, The University of Chicago, Chicago, IL, USA
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Paediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
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Influence of βS-Globin Haplotypes and Hydroxyurea on Arginase I Levels in Sickle Cell Disease. DISEASE MARKERS 2016; 2016:9172726. [PMID: 27274608 PMCID: PMC4870341 DOI: 10.1155/2016/9172726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/17/2016] [Accepted: 02/24/2016] [Indexed: 12/03/2022]
Abstract
Introduction. Sickle cell disease (SCD) is characterized by hemoglobin S homozygosity, leading to hemolysis and vasoocclusion. The hemolysis releases arginase I, an enzyme that decreases the bioavailability of nitric oxide, worsening the symptoms. The different SCD haplotypes are related to clinical symptoms and varied hemoglobin F (HbF) concentration. The aim of this study was to evaluate the impact of the βS gene haplotypes and HbF concentration on arginase I levels in SCD patients. Methods. Fifty SCD adult patients were enrolled in the study and 20 blood donors composed the control group. Arginase I was measured by ELISA. The βS haplotypes were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Statistical analyses were performed with GraphPad Prism program and the significance level was p < 0.05. Results. Significant increase was observed in the arginase I levels in SCD patients compared to the control group (p < 0.0001). The comparison between the levels of arginase I in three haplotypes groups showed a difference between the Bantu/Bantu × Bantu/Benin groups; Bantu/Bantu × Benin/Benin, independent of HU dosage. An inverse correlation with the arginase I levels and HbF concentration was observed. Conclusion. The results support the hypothesis that arginase I is associated with HbF concentration, also measured indirectly by the association with haplotypes.
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Shaver CM, Upchurch CP, Janz DR, Grove BS, Putz ND, Wickersham NE, Dikalov SI, Ware LB, Bastarache JA. Cell-free hemoglobin: a novel mediator of acute lung injury. Am J Physiol Lung Cell Mol Physiol 2016; 310:L532-41. [PMID: 26773065 PMCID: PMC4796260 DOI: 10.1152/ajplung.00155.2015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 01/14/2016] [Indexed: 01/01/2023] Open
Abstract
Patients with the acute respiratory distress syndrome (ARDS) have elevated levels of cell-free hemoglobin (CFH) in the air space, but the contribution of CFH to the pathogenesis of acute lung injury is unknown. In the present study, we demonstrate that levels of CFH in the air space correlate with measures of alveolar-capillary barrier dysfunction in humans with ARDS (r = 0.89, P < 0.001) and in mice with ventilator-induced acute lung injury (r = 0.89, P < 0.001). To investigate the specific contribution of CFH to ARDS, we studied the impact of purified CFH in the mouse lung and on cultured mouse lung epithelial (MLE-12) cells. Intratracheal delivery of CFH in mice causes acute lung injury with air space inflammation and alveolar-capillary barrier disruption. Similarly, in MLE-12 cells, CFH increases proinflammatory cytokine expression and increases paracellular permeability as measured by electrical cell-substrate impedance sensing. Next, to determine whether these effects are mediated by the iron-containing heme moiety of CFH, we treated mice with intratracheal hemin, the chloride salt of heme, and found that hemin was sufficient to increase alveolar permeability but failed to induce proinflammatory cytokine expression or epithelial cell injury. Together, these data identify CFH in the air space as a previously unrecognized driver of lung epithelial injury in human and experimental ARDS and suggest that CFH and hemin may contribute to ARDS through different mechanisms. Interventions targeting CFH and heme in the air space could provide a new therapeutic approach for ARDS.
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Affiliation(s)
- Ciara M Shaver
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Cameron P Upchurch
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David R Janz
- Section of Pulmonary and Critical Care Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Brandon S Grove
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nathan D Putz
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nancy E Wickersham
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sergey I Dikalov
- Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee; and
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Julie A Bastarache
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee;
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138
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Rémy P, Audard V, Galactéros F. [Kidney and hemoglobinopathy]. Nephrol Ther 2016; 12:117-29. [PMID: 26947986 DOI: 10.1016/j.nephro.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sickle-cell disease (SCD), one of the most common severe monogenic disorders into the world, is associated with an increased frequency of chronic kidney disease. SCD is caused by a point mutation in the gene encoding β globin gene which leads to the formation of hemoglobin S that polymerises after deoxygenation. HbS polymerisation is associated with erythrocyte rigidity and vaso-occlusive episodes that play a central role into SCD pathogenesis. The spectrum of renal diseases during SCD is broad and includes various renal manifestations which become more apparent with increasing age. Underlying pathophysiological processes involved in sickle cell nephropathy are multifactorial but endothelial dysfunction related to chronic hemolysis is a key factor contributing to renal involvement. Our review focuses on the pathogenesis and on the spectrum of renal manifestations occurring in SCD patients.
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Affiliation(s)
- Philippe Rémy
- Service de néphrologie-dialyse-transplantation, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - Vincent Audard
- Service de néphrologie-dialyse-transplantation, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - Frédéric Galactéros
- Service de néphrologie-dialyse-transplantation, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
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Torres LDS, Okumura JV, da Silva DGH, Belini Júnior É, de Oliveira RG, Mimura KKO, Lobo CLDC, Oliani SM, Bonini Domingos CR. Plasma levels of TGF-β1 in homeostasis of the inflammation in sickle cell disease. Cytokine 2016; 80:18-25. [PMID: 26928604 DOI: 10.1016/j.cyto.2016.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/20/2016] [Accepted: 02/23/2016] [Indexed: 01/02/2023]
Abstract
Sickle cell disease (SCD) represents a chronic inflammatory condition with complications triggered by the polymerization of hemoglobin S (Hb S), resulting in a series of cellular interactions mediated by inflammatory cytokines, as the transforming growth factor beta (TGF-β), which plays an important role in inflammation resolution. This study assessed the relation between SCD inflammation and the plasma concentration of TGF-β1, and also checked the influence of the presence of -509C/T polymorphism in TGFB1 gene on TGF-β1 plasma values. The plasma levels of TGF-β1 were quantified by ELISA in 115 patients with SCD (genotypes SS, SD-Los Angeles, Sβ-thalassemia and SC) and in 58 individuals with no hemoglobinopathies (Hb AA), as the control group. The -509C/T polymorphism in TGFB1 gene was screened by PCR-RFLP. The correlation between TGF-β1 plasma levels and the inflammation was based on its association with the count of platelets, total white blood cells (WBC) and neutrophils in the peripheral blood. Patients with SCD showed plasma levels of TGF-β1 higher than the control group, especially the Hb SS genotype, followed by the group with Hb SD. Polymorphism investigation showed no interference in the values obtained for the cytokine in the groups evaluated. All SCD groups showed TGF-β1 levels positively correlated to the platelets and WBC counts. The original data obtained in this study for SCD support the involvement of TGF-β1 in regulating of the inflammatory response and suggest that this marker possibly may become a potential therapeutic target in the treatment of the disease.
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Affiliation(s)
- Lidiane de Souza Torres
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil.
| | - Jéssika Viviani Okumura
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Danilo Grünig Humberto da Silva
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Édis Belini Júnior
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Renan Garcia de Oliveira
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Kallyne Kioko Oliveira Mimura
- Laboratory of Imunomorphology, Department of Biology, Sao Paulo State University (Unesp), Rua Cristovão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Clarisse Lopes de Castro Lobo
- Institute of Hematology Arthur de Siqueira Cavalcanti (Hemorio), Rua Frei Caneca, 08, Rio de Janeiro, RJ 20211-030, Brazil
| | - Sonia Maria Oliani
- Laboratory of Imunomorphology, Department of Biology, Sao Paulo State University (Unesp), Rua Cristovão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Claudia Regina Bonini Domingos
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
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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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Noubouossie D, Key NS, Ataga KI. Coagulation abnormalities of sickle cell disease: Relationship with clinical outcomes and the effect of disease modifying therapies. Blood Rev 2015; 30:245-56. [PMID: 26776344 DOI: 10.1016/j.blre.2015.12.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 12/31/2022]
Abstract
Sickle cell disease (SCD) is a hypercoagulable state. Patients exhibit increased platelet activation, high plasma levels of markers of thrombin generation, depletion of natural anticoagulant proteins, abnormal activation of the fibrinolytic system, and increased tissue factor expression, even in the non-crisis "steady state." Furthermore, SCD is characterized by an increased risk of thrombotic complications. The pathogenesis of coagulation activation in SCD appears to be multi-factorial, with contributions from ischemia-reperfusion injury and inflammation, hemolysis and nitric oxide deficiency, and increased sickle RBC phosphatidylserine expression. Recent studies in animal models suggest that activation of coagulation may contribute to the pathogenesis of SCD, but the data on the contribution of coagulation and platelet activation to SCD-related complications in humans are limited. Clinical trials of new generations of anticoagulants and antiplatelet agents, using a variety of clinical endpoints are warranted.
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Affiliation(s)
- Denis Noubouossie
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, USA
| | - Nigel S Key
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, USA
| | - Kenneth I Ataga
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, USA.
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Tsai SL, McDaniel D, Taromina K, Lee MT. Acupuncture for Sickle Cell Pain Management in a Pediatric Emergency Department, Hematology Clinic, and Inpatient Unit. Med Acupunct 2015. [DOI: 10.1089/acu.2015.1146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Shiu-Lin Tsai
- Division of Pediatric Emergency Medicine, Columbia University Medical Center, New York–Presbyterian Morgan Stanley Children's Hospital, New York, NY
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant for Comprehensive Wellness, Department of Pediatrics, Columbia University Medical Center, New York–Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Douglas McDaniel
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant for Comprehensive Wellness, Department of Pediatrics, Columbia University Medical Center, New York–Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Katherine Taromina
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant for Comprehensive Wellness, Department of Pediatrics, Columbia University Medical Center, New York–Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Margaret T. Lee
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant for Comprehensive Wellness, Department of Pediatrics, Columbia University Medical Center, New York–Presbyterian Morgan Stanley Children's Hospital, New York, NY
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143
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Wu MD, Belcik JT, Qi Y, Zhao Y, Benner C, Pei H, Linden J, Lindner JR. Abnormal Regulation of Microvascular Tone in a Murine Model of Sickle Cell Disease Assessed by Contrast Ultrasound. J Am Soc Echocardiogr 2015; 28:1122-8. [PMID: 26123012 PMCID: PMC4567487 DOI: 10.1016/j.echo.2015.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Microvascular dysregulation, abnormal rheology, and vaso-occlusive events play a role in the pathophysiology of sickle cell disease (SCD). The aim of this study was to test the hypothesis that abnormalities in skeletal muscle perfusion in a murine model of SCD could be parametrically assessed by quantitative contrast-enhanced ultrasound perfusion imaging. METHODS A murine model of moderate SCD without anemia produced by homozygous β-globin deletion replaced by human βs-globin transgene (NY1DD-/-; n = 18), heterozygous transgene replacement (NY1DD+/-; n = 19), and C57Bl/6 control mice (n = 14) was studied. Quantitative contrast-enhanced ultrasound of the proximal hindlimb skeletal muscle was performed at rest and during contractile exercise (2 Hz). Time-intensity data were analyzed to measure microvascular blood volume (MBV), microvascular blood transit rate (β), and microvascular blood flow. Erythrocyte deformability was measured by elongation at various rotational shears. RESULTS At rest, muscle MBV was similar between strains, whereas β was significantly (P = .0015, analysis of variance) reduced to a similar degree in NY1DD-/- and NY1DD+/- compared with wild-type mice (0.24 ± 0.10, 0.16 ± 0.07, and 0.34 ± 0.14 sec(-1), respectively), resulting in a reduction in microvascular blood flow. During contractile exercise, there were no groupwise differences in β (1.43 ± 0.67, 1.09 ± 0.42, and 1.36 ± 0.49 sec(-1) for NY1DD-/-, NY1DD+/-, and wild-type mice, respectively) or in microvascular blood flow or MBV. Erythrocyte deformability at high shear stress (≥5 Pa) was mildly reduced in both transgenic groups, although it was not correlated with blood flow or β. CONCLUSIONS Contrast-enhanced ultrasound in skeletal muscle revealed a lower microvascular blood transit rate in the NY1DD model of SCD and sickle trait but no alterations in MBV. The abnormality in microvascular blood transit rate was likely due to vasomotor dysfunction, because it was abrogated by contractile exercise and at rest was only weakly related to erythrocyte deformability.
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Affiliation(s)
- Melinda D Wu
- Division of Pediatric Hematology and Oncology, Oregon Health & Science University, Portland, Oregon
| | - J Todd Belcik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Yue Qi
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Yan Zhao
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Cameron Benner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Hong Pei
- La Jolla Immunology and Allergy Institute, La Jolla, California
| | - Joel Linden
- La Jolla Immunology and Allergy Institute, La Jolla, California
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
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144
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Tewari S, Brousse V, Piel FB, Menzel S, Rees DC. Environmental determinants of severity in sickle cell disease. Haematologica 2015; 100:1108-16. [PMID: 26341524 PMCID: PMC4800688 DOI: 10.3324/haematol.2014.120030] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/05/2015] [Indexed: 12/13/2022] Open
Abstract
Sickle cell disease causes acute and chronic illness, and median life expectancy is reduced by at least 30 years in all countries, with greater reductions in low-income countries. There is a wide spectrum of severity, with some patients having no symptoms and others suffering frequent, life-changing complications. Much of this variability is unexplained, despite increasingly sophisticated genetic studies. Environmental factors, including climate, air quality, socio-economics, exercise and infection, are likely to be important, as demonstrated by the stark differences in outcomes between patients in Africa and USA/Europe. The effects of weather vary with geography, although most studies show that exposure to cold or wind increases hospital attendance with acute pain. Most of the different air pollutants are closely intercorrelated, and increasing overall levels seem to correlate with increased hospital attendance, although higher concentrations of atmospheric carbon monoxide may offer some benefit for patients with sickle cell disease. Exercise causes some adverse physiological changes, although this may be off-set by improvements in cardiovascular health. Most sickle cell disease patients live in low-income countries and socioeconomic factors are undoubtedly important, but little studied beyond documenting that sickle cell disease is associated with decreases in some measures of social status. Infections cause many of the differences in outcomes seen across the world, but again these effects are relatively poorly understood. All the above factors are likely to account for much of the pathology and variability of sickle cell disease, and large prospective studies are needed to understand these effects better.
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Affiliation(s)
- Sanjay Tewari
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
| | - Valentine Brousse
- Reference Centre for Sickle Cell Disease, Pediatric Department, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris; Université Paris Descartes, France
| | | | - Stephan Menzel
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
| | - David C Rees
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
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145
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Chen YG, Lin TY, Chen HJ, Dai MS, Ho CL, Kao CH. Thalassemia and risk of dementia: a nationwide population-based retrospective cohort study. Eur J Intern Med 2015; 26:554-9. [PMID: 26051928 DOI: 10.1016/j.ejim.2015.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 05/21/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study is a nationwide population-based retrospective cohort study to investigate the risk for developing dementia in thalassemia population. METHODS In a longitudinal cohort of 1 million insured people, we identified 871 thalassemia patients who were newly diagnosed between 2000 and 2004 and selected a comparison cohort of 3484 subjects without thalassemia. We analyzed the risks for thalassemia and dementia using Cox proportional hazard regression models to assess the dementia risk in thalassemia patients after adjusting for age, gender, insured amount, urbanization and comorbidities. RESULTS The overall risks for developing dementia were 1.88-fold (95% CI=1.10-3.21) in patients with thalassemia compared with the comparison cohort after adjusting for age, sex, insured amount, urbanization and comorbidities. The combined effects measured for patients afflicted with thalassemia and the comorbidities of diabetes, hypertension, CAD, head injury, depression, CKD, or substance-related disorder exhibited a significant association with hyperlipidemia risk compared with that measured for patients without thalassemia and without any counterpart comorbidities. In subgroup analysis, the HRs of dementia increased, from 1.69 (95% CI=0.93-3.07) for those who had not undergone transfusion to 2.72 (95% CI=1.09-6.78) for those experienced transfusion compared with the no thalassemia cohort (p for trend<0.01). CONCLUSION Our long-term cohort study result showed that thalassemia should be considered a crucial risk factor for developing dementia.
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Affiliation(s)
- Yu-Guang Chen
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Te-Yu Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Shen Dai
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Liang Ho
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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146
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Hyacinth HI, Adams RJ, Greenberg CS, Voeks JH, Hill A, Hibbert JM, Gee BE. Effect of Chronic Blood Transfusion on Biomarkers of Coagulation Activation and Thrombin Generation in Sickle Cell Patients at Risk for Stroke. PLoS One 2015; 10:e0134193. [PMID: 26305570 PMCID: PMC4549306 DOI: 10.1371/journal.pone.0134193] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/06/2015] [Indexed: 01/01/2023] Open
Abstract
Hypercoagulability in sickle cell disease (SCD) is associated with multiple SCD phenotypes, association with stroke risk has not been well described. We hypothesized that serum levels of biomarkers of coagulation activation correlate with high transcranial Doppler ultrasound velocity and decreases with blood transfusion therapy in SCD patients. Stored serum samples from subjects in the Stroke Prevention in Sickle Cell Anemia (STOP) trial were analyzed using ELISA and protein multiplexing techniques. 40 subjects from each treatment arm (Standard Care [SC] and Transfusion [Tx]) at three time points—baseline, study exit and one year post-trial and 10 each of age matched children with SCD but normal TCD (SNTCD) and with normal hemoglobin (HbAA) were analyzed. At baseline, median vWF, TAT and D-dimer levels were significantly higher among STOP subjects than either HbAA or SNTCD. At study exit, median hemoglobin level was significantly higher while median TCD velocity was significantly lower in Tx compared to SC subjects. Median vWF (409.6 vs. 542.9 μg/ml), TAT (24.8 vs. 40.0 ng/ml) and D-dimer (9.2 vs. 19.1 μg/ml) levels were also significantly lower in the Tx compared to the SC group at study exit. Blood levels of biomarkers coagulation activation/thrombin generation correlated positively with TCD velocity and negatively with number of blood transfusions. Biomarkers of coagulation activation/thrombin generation were significantly elevated in children with SCD, at high risk for stroke. Reduction in levels of these biomarkers correlated with reduction in stroke risk (lower TCD velocity), indicating a possible role for hypercoagulation in SCD associated stroke.
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Affiliation(s)
- Hyacinth I. Hyacinth
- Department of Pediatrics Hematology/Oncology, Emory University School of Medicine, Atlanta, GA, United States of America
- Stroke Centre, Department of Neurology, Medical University of South Carolina, Charleston, SC, United States of America
- * E-mail:
| | - Robert J. Adams
- Stroke Centre, Department of Neurology, Medical University of South Carolina, Charleston, SC, United States of America
| | - Charles S. Greenberg
- Department of Hematology, Medical University of South Carolina, Charleston, SC, United States of America
| | - Jenifer H. Voeks
- Stroke Centre, Department of Neurology, Medical University of South Carolina, Charleston, SC, United States of America
| | - Allyson Hill
- Department of Biology, College of Charleston, Charleston, SC, United States of America
| | - Jacqueline M. Hibbert
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, United States of America
| | - Beatrice E. Gee
- Department of Pediatrics and Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
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147
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Das N, Xie L, Ramakrishnan SK, Campbell A, Rivella S, Shah YM. Intestine-specific Disruption of Hypoxia-inducible Factor (HIF)-2α Improves Anemia in Sickle Cell Disease. J Biol Chem 2015; 290:23523-7. [PMID: 26296885 DOI: 10.1074/jbc.c115.681643] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Indexed: 11/06/2022] Open
Abstract
Sickle cell disease (SCD) is caused by genetic defects in the β-globin chain. SCD is a frequently inherited blood disorder, and sickle cell anemia is a common type of hemoglobinopathy. During anemia, the hypoxic response via the transcription factor hypoxia-inducible factor (HIF)-2α is highly activated in the intestine and is essential in iron absorption. Intestinal disruption of HIF-2α protects against tissue iron accumulation in iron overload anemias. However, the role of intestinal HIF-2α in regulating anemia in SCD is currently not known. Here we show that in mouse models of SCD, disruption of intestinal HIF-2α significantly decreased tissue iron accumulation. This was attributed to a decrease in intestinal iron absorptive genes, which were highly induced in a mouse model of SCD. Interestingly, disruption of intestinal HIF-2α led to a robust improvement in anemia with an increase in RBC, hemoglobin, and hematocrit. This was attributed to improvement in RBC survival, hemolysis, and insufficient erythropoiesis, which is evident from a significant decrease in serum bilirubin, reticulocyte counts, and serum erythropoietin following intestinal HIF-2α disruption. These data suggest that targeting intestinal HIF-2α has a significant therapeutic potential in SCD pathophysiology.
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Affiliation(s)
- Nupur Das
- From the Department of Molecular and Integrative Physiology
| | - Liwei Xie
- From the Department of Molecular and Integrative Physiology
| | | | | | - Stefano Rivella
- the Abramson Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104
| | - Yatrik M Shah
- From the Department of Molecular and Integrative Physiology, Department of Internal Medicine, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan 48109 and
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148
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Lamarre Y, Hardy-Dessources MD, Romana M, Lalanne-Mistrih ML, Waltz X, Petras M, Doumdo L, Blanchet-Deverly A, Martino J, Tressières B, Maillard F, Tarer V, Etienne-Julan M, Connes P. Relationships between systemic vascular resistance, blood rheology and nitric oxide in children with sickle cell anemia or sickle cell-hemoglobin C disease. Clin Hemorheol Microcirc 2015; 58:307-16. [PMID: 23302597 DOI: 10.3233/ch-121661] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Vascular function has been found to be impaired in patients with sickle cell disease (SCD). The present study investigated the determinants of systemic vascular resistance in two main SCD syndromes in children: sickle cell anemia (SCA) and sickle cell-hemoglobin C disease (SCC). Nitric oxide metabolites (NOx), hematological, hemorheological, and hemodynamical parameters were investigated in 61 children with SCA and 49 children with SCC. While mean arterial pressure was not different between SCA and SCC children, systemic vascular resistance (SVR) was greater in SCC children. Although SVR and blood viscosity (ηb) were not correlated in SCC children, the increase of ηb (+18%) in SCC children compared to SCA children results in a greater mean SVR in this former group. SVR was positively correlated with ηb, hemoglobin (Hb) level and RBC deformability, and negatively with NOx level in SCA children. Multivariate linear regression model showed that both NOx and Hb levels were independently associated with SVR in SCA children. In SCC children, only NOx level was associated with SVR. In conclusion, vascular function of SCC children seems to better cope with higher ηb compared to SCA children. Since the occurrence of vaso-occlusive like complications are less frequent in SCC than in SCA children, this finding suggests a pathophysiological link between the vascular function alteration and these clinical manifestations. In addition, our results suggested that nitric oxide metabolism plays a key role in the regulation of SVR, both in SCA and SCC.
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Affiliation(s)
- Yann Lamarre
- Inserm U665, Pointe-à-Pitre, F-97159 Guadeloupe, Université des Antilles et de la Guyane, Guadeloupe
| | | | - Marc Romana
- Inserm U665, Pointe-à-Pitre, F-97159 Guadeloupe, Université des Antilles et de la Guyane, Guadeloupe
| | - Marie-Laure Lalanne-Mistrih
- Inserm U665, Pointe-à-Pitre, F-97159 Guadeloupe, Université des Antilles et de la Guyane, Guadeloupe CIC-EC 802 Inserm, pôle Guadeloupe, Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Xavier Waltz
- Inserm U665, Pointe-à-Pitre, F-97159 Guadeloupe, Université des Antilles et de la Guyane, Guadeloupe
| | - Marie Petras
- Unité Transversale de la Drépanocytose du Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France Centre de référence maladies rare pour la drépanocytose aux Antilles-Guyane, Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Lydia Doumdo
- Unité Transversale de la Drépanocytose du Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France Centre de référence maladies rare pour la drépanocytose aux Antilles-Guyane, Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Anne Blanchet-Deverly
- Unité d'explorations cardiovasculaire du Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Jean Martino
- Service de cardiologie du Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Benoît Tressières
- CIC-EC 802 Inserm, pôle Guadeloupe, Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Frederic Maillard
- Unité Transversale de la Drépanocytose du Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France Service de Pédiatrie du Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France Centre de référence maladies rare pour la drépanocytose aux Antilles-Guyane, Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Vanessa Tarer
- Unité Transversale de la Drépanocytose du Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France Centre de référence maladies rare pour la drépanocytose aux Antilles-Guyane, Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Maryse Etienne-Julan
- Inserm U665, Pointe-à-Pitre, F-97159 Guadeloupe, Université des Antilles et de la Guyane, Guadeloupe Unité Transversale de la Drépanocytose du Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France Centre de référence maladies rare pour la drépanocytose aux Antilles-Guyane, Centre Hospitalier et Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Philippe Connes
- Inserm U665, Pointe-à-Pitre, F-97159 Guadeloupe, Université des Antilles et de la Guyane, Guadeloupe
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Anele UA, Burnett AL. Nitrergic Mechanisms for Management of Recurrent Priapism. Sex Med Rev 2015; 3:160-168. [PMID: 26478814 DOI: 10.1002/smrj.56] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Priapism is a condition involving prolonged penile erection unrelated to sexual interest or desire. The ischemic type, including its recurrent variant, is often associated with both physical and psychological complications. As such, management is of critical importance. Ideal therapies for recurrent priapism should address its underlying pathophysiology. AIM To review the available literature on priapism management approaches particularly related to nitrergic mechanisms. METHODS A literature review of the pathophysiology and management of priapism was performed using PubMed. MAIN OUTCOME MEASURE Publications pertaining to mechanisms of the molecular pathophysiology of priapism. RESULTS Nitrergic mechanisms are characterized as major players in the molecular pathophysiology of priapism. PDE5 inhibitors represent an available therapeutic option with demonstrated ability in attenuating these underlying nitrergic derangements. Several additional signaling pathways have been found to play a role in the molecular pathophysiology of priapism and have also been associated with these nitrergic mechanisms. CONCLUSION An increasing understanding of the molecular pathophysiology of priapism has led to the discovery of new potential targets. Several mechanism-based therapeutic approaches may become available in the future.
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Affiliation(s)
- Uzoma A Anele
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 20817
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 20817
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150
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Musicki B, Zhang Y, Chen H, Brown TR, Zirkin BR, Burnett AL. Mechanism of testosterone deficiency in the transgenic sickle cell mouse. PLoS One 2015; 10:e0128694. [PMID: 26023917 PMCID: PMC4449127 DOI: 10.1371/journal.pone.0128694] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/29/2015] [Indexed: 11/28/2022] Open
Abstract
Testosterone deficiency is associated with sickle cell disease (SCD), but its underlying mechanism is not known. We investigated the possible occurrence and mechanism of testosterone deficiency in a mouse model of human SCD. Transgenic sickle male mice (Sickle) exhibited decreased serum and intratesticular testosterone and increased luteinizing hormone (LH) levels compared with wild type (WT) mice, indicating primary hypogonadism in Sickle mice. LH-, dbcAMP-, and pregnenolone- (but not 22-hydroxycholesterol)- stimulated testosterone production by Leydig cells isolated from the Sickle mouse testis was decreased compared to that of WT mice, implying defective Leydig cell steroidogenesis. There also was reduced protein expression of steroidogenic acute regulatory protein (STAR), but not cholesterol side-chain cleavage enzyme (P450scc), in the Sickle mouse testis. These data suggest that the capacity of P450scc to support testosterone production may be limited by the supply of cholesterol to the mitochondria in Sickle mice. The sickle mouse testis exhibited upregulated NADPH oxidase subunit gp91phox and increased oxidative stress, measured as 4-hydroxy-2-nonenal, and unchanged protein expression of an antioxidant glutathione peroxidase-1. Mice heterozygous for the human sickle globin (Hemi) exhibited intermediate hypogonadal changes between those of WT and Sickle mice. These results demonstrate that testosterone deficiency occurs in Sickle mice, mimicking the human condition. The defects in the Leydig cell steroidogenic pathway in Sickle mice, mainly due to reduced availability of cholesterol for testosterone production, may be related to NADPH oxidase-derived oxidative stress. Our findings suggest that targeting testicular oxidative stress or steroidogenesis mechanisms in SCD offers a potential treatment for improving phenotypic changes associated with testosterone deficiency in this disease.
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Affiliation(s)
- Biljana Musicki
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Yuxi Zhang
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Haolin Chen
- Department of Biochemistry and Molecular Biology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Terry R. Brown
- Department of Biochemistry and Molecular Biology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Barry R. Zirkin
- Department of Biochemistry and Molecular Biology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Arthur L. Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
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