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De La Hoz Polo M, Hudson VE, Adu J, Chakravorty S, Haque S. The many faces of sickle cell disease in children: complications in the appendicular skeleton. Pediatr Radiol 2024; 54:1437-1450. [PMID: 38740606 DOI: 10.1007/s00247-024-05913-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 05/16/2024]
Abstract
Sickle cell disease (SCD) is a hereditary red cell disorder with clinical manifestations secondary to sickling or crescent-shaped distortion of the red blood cells. Musculoskeletal complications of SCD are often the main causes for acute and chronic morbidities in children with manifestations including osteomyelitis, osteoporosis and osteonecrosis. This article aims to familiarise the paediatric radiologist with appendicular skeletal complications of SCD in the paediatric population and their imaging appearance.
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Affiliation(s)
| | - Victoria E Hudson
- Radiology Department, King's College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - John Adu
- Radiology Department, St George's University Hospital, London, UK
| | - Subarna Chakravorty
- Department of Paediatric Haematology, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Saira Haque
- Radiology Department, King's College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
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2
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Bathla T, Lotfollahzadeh S, Quisel M, Mehta M, Malikova M, Chitalia VC. End Organ Affection in Sickle Cell Disease. Cells 2024; 13:934. [PMID: 38891066 PMCID: PMC11174153 DOI: 10.3390/cells13110934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024] Open
Abstract
Sickle cell disease is an orphan disease affecting ethnic minorities and characterized by profound systemic manifestations. Although around 100,000 individuals with SCD are living in the US, the exact number of individuals is unknown, and it is considered an orphan disease. This single-gene disorder leads to red blood cell sickling and the deoxygenation of hemoglobin, resulting in hemolysis. SCD is associated with acute complications such as vaso-occlusive crisis, infections, and chronic target organ complications such as pulmonary disease and renal failure. While genetic therapy holds promise to alter the fundamental disease process, the major challenge in the field remains the target end organ damage and ways to mitigate or reverse it. Here, we provide an overview of the clinical manifestations and pathogenesis with a focus on end-organ damage and current therapeutic options, including recent FDA-approved stem cell and gene editing therapies.
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Affiliation(s)
- Tanvi Bathla
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
| | - Saran Lotfollahzadeh
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
| | - Matthew Quisel
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
| | - Mansi Mehta
- Saint Vincent’s Medical Hospital, Worcester, MA 01608, USA;
| | - Marina Malikova
- Department of Surgery, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Vipul C. Chitalia
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
- Veterans Affairs Boston Healthcare System, Boston, MA 02118, USA
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Center of Cross-Organ Vascular Pathology, Department of Medicine, Boston University Medical Center, Evans Biomedical Research Center, X-530, Boston, MA 02118, USA
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Arcanjo GS, Souza MB, Domingos IF, Pereira-Martins DA, Falcão DA, Batista JV, Hatzlhofer BL, Diniz MV, Silva AP, Guaraná WL, Hazin MF, Araujo AS, Cunha AF, Saad SO, Costa FF, Lucena-Araujo AR, Bezerra MAC. BMP6 and VDR gene polymorphisms are associated with osteonecrosis in a sickle cell anaemia cohort. Br J Haematol 2024; 204:1507-1514. [PMID: 38323352 DOI: 10.1111/bjh.19329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
The occurrence and severity of osteonecrosis in sickle cell anaemia (SCA) vary due to risk factors, including genetic modifiers. Bone morphogenetic proteins (BMPs), particularly BMP6, and the vitamin D receptor (VDR) play key roles in cartilage and bone metabolism, making them potential contributors to orthopaedic outcomes in SCA. Here, we evaluated the association of polymorphisms in BMP6 (rs3812163, rs270393 and rs449853) and VDR (FokI rs2228570 and Cdx2 rs11568820) genes with osteonecrosis risk in a Brazilian SCA cohort. A total of 177 unrelated SCA patients were selected. The AA genotype of BMP6 rs3812163 was independently associated with a lower osteonecrosis risk (p = 0.015; odds ratio (OR): 0.38; 95% confidence interval (CI): 0.18-0.83) and with the long-term cumulative incidence of osteonecrosis (p = 0.029; hazard ratio: 0.56, 95% CI: 0.34-0.94). The VDR rs2228570 TT genotype was independently associated with a lower osteonecrosis risk (p = 0.039; OR: 0.14; 95% CI: 0.02-0.90). In summary, our results provide evidence that BMP6 rs3812163 and the VDR rs2228570 might be implicated in osteonecrosis pathophysiology in SCA and might help identify individuals at high risk.
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Affiliation(s)
- Gabriela S Arcanjo
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Mariana B Souza
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Igor F Domingos
- Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Diego A Pereira-Martins
- Department of Hematology, Cancer Research Centre Groningen, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Diego A Falcão
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Jessica V Batista
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Betania L Hatzlhofer
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Madi V Diniz
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Alexsandro P Silva
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Werbson L Guaraná
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Manuela F Hazin
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Pernambuco, Brazil
| | - Aderson S Araujo
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Pernambuco, Brazil
| | - Anderson F Cunha
- Department of Genetics and Evolution, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Sara O Saad
- Hematology and Hemotherapy Center, State University of Campinas, Campinas, São Paulo, Brazil
| | - Fernando F Costa
- Hematology and Hemotherapy Center, State University of Campinas, Campinas, São Paulo, Brazil
| | | | - Marcos André C Bezerra
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Ekoube CE, Bitsie DM, Njiengwe EF, Ma Linwa EM, Eyoum C, Betoko RM, Massako JD, Nsang EH, Soumaiyatou A, Kuate CT. Exploring Factors Associated with Quality of Life in Caregivers of Children and Adolescents with Sickle Cell Disease and HIV: A Comparative Analysis. Anemia 2024; 2024:4429541. [PMID: 38487039 PMCID: PMC10937083 DOI: 10.1155/2024/4429541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Paediatric HIV and sickle cell disease (SCD) are two stigmatising and potentially fatal illnesses that place a significant burden on families. HIV patients benefit from a longstanding free-service national programme in Cameroon, and this could considerably alleviate burden of care on HIV caregivers, possibly leading to better quality of life (QoL) in HIV caregivers compared to SCD caregivers. Our study aimed to compare the QoL between caregivers of children and adolescents with SCD and HIV and explore factors associated with this QoL in Cameroon. Methods and Materials We conducted a hospital-based cross-sectional analytic study at Douala Laquintinie Hospital from February to May 2023. A questionnaire was administered to caregivers of paediatric patients (≤18 years) with SCD and HIV. The Pediatrics Quality of Life-Family Impact Module (PedsQL FIM), the 7-item Generalized Anxiety Disorder (GAD-7), and the 9-item Patient Health Question (PHQ-9) tools were used as measures of quality of life, anxiety, and depression, respectively. Multivariable linear regression was used to determine factors associated with quality of life. A significance level was set at p < 0.05. Results We included 199 caregivers: SCD = 104 and HIV = 95. The mean age of caregivers in our sample was 40.47 ± 10.18 years. Caregivers of paediatric patients with HIV had a better mean quality of life than SCD (93.01 ± 7.35SD versus 64.86 ± 9.20SD, p < 0.001). PHQ-9 score (B = -1.52, 95% CI = [-2.08; -0.96], p=<0.001), GAD-7 score (B = -1.46, 95% CI = [-2.09; -0.83], p=<0.001), spending less than 75 000 FCFA on medications monthly (B = 12.13, 95% CI = [5.73; 18.94], p=<0.001), and being a SCD caregiver (B = -11.62, 95% CI = [-18.46; -4.78], p=0.001) were factors independently associated with quality of life on multivariable analysis. Conclusion Quality of life is lower in caregivers of children and adolescents with SCD than with HIV. Preventing depression and anxiety as well as advocating for the subsidization of medications through a national SCD program may improve quality of life in SCD caregivers.
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Affiliation(s)
- Charlotte Eposse Ekoube
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Laquintinie Hospital of Douala, Douala, Cameroon
| | - Dora Mbonjo Bitsie
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | | | - Christian Eyoum
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Ritha Mbono Betoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Laquintinie Hospital of Douala, Douala, Cameroon
| | | | - Emmanuel Heles Nsang
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Abba Soumaiyatou
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Callixte Tegueu Kuate
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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Khargekar N, Banerjee A, Athalye S, Mahajan N, Kargutkar N, Tapase P, Madkaikar M. Role of hydroxyurea therapy in the prevention of organ damage in sickle cell disease: a systematic review and meta-analysis. Syst Rev 2024; 13:60. [PMID: 38331925 PMCID: PMC10851507 DOI: 10.1186/s13643-024-02461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Hydroxyurea is an affordable drug that reduces vaso-occlusive crises and transfusion requirements in sickle cell disease. However, its effectiveness in preventing chronic organ damage is still unclear. This systematic review and meta-analysis aimed to evaluate the role of hydroxyurea in preventing organ morbidity. METHOD We included original articles published in English from 1st January 1990 to 31st January 2023, reporting hydroxyurea therapy and organ damage from PubMed, Google Scholar, Scopus, and CrossRef databases. A total of 45 studies with 4681 sickle cell disease patients were evaluated for organ damage. RESULTS Our analysis showed that hydroxyurea intervention significantly lowered transcranial Doppler and tricuspid regurgitant velocity, with a standardized mean difference of - 1.03 (- 1.49; - 0.58); I 2 = 96% and - 1.37 (CI - 2.31, - 0.42); I 2 = 94%, respectively. Moreover, the pooled estimate for albuminuria showed a beneficial effect post-hydroxyurea therapy by reducing the risk of albuminuria by 58% (risk ratio of 0.42 (0.28; 0.63); I 2 = 28%). CONCLUSION Our study found that a hydroxyurea dose above 20 mg/kg/day with a mean rise in HbF by 18.46% post-hydroxyurea therapy had a beneficial role in reducing transcranial doppler velocity, tricuspid regurgitant velocity, albuminuria, and splenic abnormality. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023401187.
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Affiliation(s)
- Naveen Khargekar
- Department of Haematogenetics, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India.
| | - Anindita Banerjee
- Department of Transfusion Transmitted Disease, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Shreyasi Athalye
- Department of Transfusion Transmitted Disease, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Namrata Mahajan
- Department of Haematogenetics, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Neha Kargutkar
- Department of Haematogenetics, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Prashant Tapase
- Department of Paediatric Immunology & Leukocyte Biology, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400 012, India
| | - Manisha Madkaikar
- Department of Paediatric Immunology & Leukocyte Biology, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400 012, India
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Ge H, Wang Z, Zhang J. X-ray, digital tomographic fusion, CT, and MRI in early ischemic necrosis of the femoral head. Medicine (Baltimore) 2024; 103:e36281. [PMID: 38215113 PMCID: PMC10783393 DOI: 10.1097/md.0000000000036281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/02/2023] [Indexed: 01/14/2024] Open
Abstract
To investigate the imaging performance of radiography, digital tomographic fusion (DTS), computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis of early avascular necrosis of the femoral head (ANFH). A total of 220 patients with ANFH who visited our hospital from January 2020 to January 2022 were included in the study. X-ray, DTS, CT, and MRI examinations of both hips were performed for all patients. The trabecular structure, bone density changes, femoral head morphology, and joint space changes were observed using the aforementioned imaging modalities. The staging was performed according to the Association Research Circulation Osseous (ARCO) criteria. The diagnostic detection rate of each imaging modality, and the sensitivity, specificity, positive predictive value, and negative predictive value of each examination for diagnosing early ANFH were calculated and compared. Patients were diagnosed with stage I (n = 65), stage II (n = 85), stage III (n = 32), and stage IV (n = 38) ANFH. For MRI, the detection rate (97.7%), sensitivity (94.7%), specificity (88.6%), positive predictive value (95.9%), and negative predictive value (92.5%), for diagnosing early ANFH, were significantly higher than those of other imaging methods (P < .05). MRI is the most accurate and sensitive imaging method for diagnosing early ANFH and has important clinical applications.
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Affiliation(s)
- Hong Ge
- Radiology Department, The Third Hospital of Hebei Medical University, Qiaoxi District, Shijiazhuang, China
| | - Zhuhai Wang
- Radiology Department, The Third Hospital of Hebei Medical University, Qiaoxi District, Shijiazhuang, China
| | - Jiangang Zhang
- Radiology Department, The Third Hospital of Hebei Medical University, Qiaoxi District, Shijiazhuang, China
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Ouederni M, Rouag H, Ben Fraj I, Rekaya S, Kouki R, Lamouchi T, Zaiter I, Mellouli F, Bejaoui M, Ben Khaled M. Incidence and risk factors for osteonecrosis of the femoral head in five hundred and ten sickle cell disease paediatric patients. INTERNATIONAL ORTHOPAEDICS 2023; 47:2941-2952. [PMID: 37452863 DOI: 10.1007/s00264-023-05886-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Osteonecrosis of the femoral head (ONFH) is a degenerative and progressive disorder that mainly affects people with sickle cell disease (SCD). Herein, we aimed to search for a better understanding of markers that can act as risk factors for ONFH in patients with SCD. METHODS We conducted a retrospective study including 510 SCD patients followed over 23 years. Patients were divided into the ONFH group and the no-ONHF control group. Univariate and multivariate logistic regression analyses were performed to identify risk factors. RESULTS Among 510 SCD patients, 41(8%) were diagnosed with ONFH at a mean age of 167 months ± 64 (72-288). The cumulative incidence of ONHF increased from 2.3% at ten years to 18.3% at 20 years of age. The radiological grade 3 ONHF was predominant. No significant differences in sex, age at diagnosis of SCD, and Hb genotype were found between groups. The patient age and the time since diagnosis of SCD were statistically higher in patients with ONHF in univariate and multivariate analysis. ONHF was also associated with higher creatinine level (p = 0.001) lower LDH level (p = 0.006), and higher number of vaso-occlusive crisis (VOC)/patient/year (p < 0.001). The cumulative incidence of ONHF in patients having more than 3 VOC/year was significantly higher (43% versus 18.9% at 20 years, p < 0.001). In addition, infections, gallstones, growth delay, delayed initiation of hydroxyurea, and a higher transfusion rate were significantly associated with ONFH. CONCLUSION These findings confirm that ONFH is closely related to the age, severity, and duration of SCD. Better management of this disease prevents acute and chronic complications, and early screening of the ONFH as soon as the first signs of the severity of the disease are detected provides a better functional prognosis.
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Affiliation(s)
- Monia Ouederni
- Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia.
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Hatem Rouag
- Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia
| | - Ilhem Ben Fraj
- Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Samia Rekaya
- Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Ridha Kouki
- Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia
| | - Takwa Lamouchi
- Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Ikram Zaiter
- Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Mellouli
- Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Bejaoui
- Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Monia Ben Khaled
- Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
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Chan SS, Coblentz A, Bhatia A, Kaste SC, Mhlanga J, Parisi MT, Thacker P, Voss SD, Weidman EK, Siegel MJ. Imaging of pediatric hematopoietic stem cell transplant recipients: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30013. [PMID: 36546505 PMCID: PMC10644273 DOI: 10.1002/pbc.30013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/28/2022] [Accepted: 09/05/2022] [Indexed: 12/24/2022]
Abstract
Imaging in hematopoietic stem cell transplantation patients is not targeted at evaluating the transplant per se. Rather, imaging is largely confined to evaluating peri-procedural and post-procedural complications. Alternatively, imaging may be performed to establish a baseline study for comparison should the patient develop certain post-procedural complications. This article looks to describe the various imaging modalities available with recommendations for which imaging study should be performed in specific complications. We also provide select imaging protocols for different indications and modalities for the purpose of establishing a set minimal standard for imaging in these complex patients.
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Affiliation(s)
- Sherwin S Chan
- Department of Radiology, Children’s Mercy Kansas City, Kansas City, MO; Department of Radiology, University of Missouri at Kansas City School of Medicine, Kansas City, MO
| | - Ailish Coblentz
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aashim Bhatia
- Department of Radiology, Division of Neuroradiology Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sue C. Kaste
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - Joyce Mhlanga
- Department of Radiology, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA
| | | | - Stephan D. Voss
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA. 02115
| | - Elizabeth K. Weidman
- Department of Radiology, Weill Cornell Medicine – New York Presbyterian Hospital, New York, NY
| | - Marilyn J Siegel
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
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9
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Voi V, Turrini S, Mattavelli M, Vigliani V, Margarita G, Ferrero GB. Occult ischemic bone lesions in children with sickle cell disease: A study of prevalence. Eur J Haematol 2023; 110:236-242. [PMID: 36367374 DOI: 10.1111/ejh.13898] [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: 09/23/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Avascular necrosis (AVN) is a severe complication of sickle cell disease (SCD) and involves principally the femoral head. Few data exist about the prevalence of lesions in other segments. METHODS In this cross-sectional study, 42 children (20 males and 22 females) underwent a magnetic resonance imaging (MRI) of the spine, upper arms, and femurs. The primary outcome was to define the prevalence and locations of bone infarcts. RESULTS Forty-two patients completed the study; the total median age was 11.9 years (interquartile range = 9.5-13.9). Eleven patients (26.2%) were positive for altered bone findings for a total of 32 lesions. Most of the lesions were in the humerus 17 (53.1%), 11 (34.4%) in the femurs, and 4 (12.5%) in the vertebrae. The median number of vaso-occlusive crises (VOCs) was two and four for patients without and with bone lesions, respectively (p = .01). The annual rate of VOC is the best marker for the positive MRI (odds ratio = 82.6; p = .03), and it is correlated with the number of sites involved (p = .02). CONCLUSIONS Our study highlights that the prevalence of skeletal lesions could be underestimated, and it provides the basis for clinical reasoning and tailored therapy in SCD children.
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Affiliation(s)
- Vincenzo Voi
- Department of Clinical and Biological Science, School of Medicine, Centre for Hemoglobinopathies, AOU San Luigi Gonzaga, University of Turin, Turin, Italy
| | - Silvia Turrini
- Post-graduating School, Pneumology, Città della Salute e della Scienza, AOU Molinette, University of Turin, Turin, Italy
| | | | - Valentina Vigliani
- Department of Clinical and Biological Science, School of Medicine, Centre for Hemoglobinopathies, AOU San Luigi Gonzaga, University of Turin, Turin, Italy
| | - Giuseppe Margarita
- C.D.C. S.P.A.-Affidea Group, Magnetic Resonance Imaging Unit, Turin, Italy
| | - Giovanni Battista Ferrero
- Department of Clinical and Biological Science, School of Medicine, Centre for Hemoglobinopathies, AOU San Luigi Gonzaga, University of Turin, Turin, Italy
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Yousif NG, Al Kilabi AEK, Hatem KK, Al-Albaseesee HH, Al-Fatlawy WAY, Alhamadani M, Nöth UA, Altmimi A. Autologous hematopoietic bone marrow and concentrated growth factor transplantation combined with core decompression in patients with avascular necrosis of the femoral head. J Med Life 2023; 16:76-90. [PMID: 36873113 PMCID: PMC9979168 DOI: 10.25122/jml-2022-0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/09/2023] [Indexed: 03/07/2023] Open
Abstract
The study aimed to assess the effectiveness of autologous hematopoietic bone marrow and concentrated growth factor (CGF) transplantation and core decompression in patients with avascular necrosis of the femoral head (ANFH). We performed a single-center prospective study on 31 patients with non-traumatic early-stage (stage I to III) ANFH based on the 1994 classification of the Association Research Circulation Osseous (ARCO). The patients were subjected to bone marrow aspiration from the posterior iliac crest, separation, and concentration of growth factors from the bone marrow aspirate, core decompression of the femoral head, and injection of hematopoietic bone marrow and CGFs into the necrotic lesion. Patients were evaluated using the visual analogue scale, the WOMAC questionnaire, and X-ray and MRI examinations of the hip joints before, at 2, 4, and 6 months after the intervention. Patients had a mean age of 33 years (range 20-44 years), 19 (61%) of them being male and 12 (39%) females. The presentation of the disease was bilateral in 21 patients and unilateral in 10 patients. The main cause of ANFH was steroid treatment. The mean VAS and WOMAC scores were 48.37 (SD: 14.67) out of 100, and the mean VAS pain score was 50.83 out of 100 (SD: 20.46), respectively, before transplant. This value significantly improved to 22.31 (SD 12.12) of 100, and the mean VAS pain score was 21.31 of 100 (SD: 20.46) (P=0.04). MRI showed a significant improvement (P=0.012). Our results suggest that autologous hematopoietic bone marrow and CGFs transplantation with core decompression have a beneficial effect in early-stage ANFH.
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Affiliation(s)
- Nasser Ghaly Yousif
- Department of Medicine, Medical College, Al Muthanna University, Samawah, Iraq
| | | | - Karrar Kareem Hatem
- Department of Surgery, Medical College, Jabir Ibn Hayyan Medical University, Najaf, Iraq
| | | | | | | | - Ulrich Aran Nöth
- Department of Regenerative Research, College of Medicine, Colorado University, Boulder, Colorado
| | - Ahmed Altmimi
- Department of Biology, Ministry of Health, Al Muthanna, Iraq
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11
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Grimbly C, Escagedo PD, Jaremko JL, Bruce A, Alos N, Robinson ME, Konji VN, Page M, Scharke M, Simpson E, Pastore YD, Girgis R, Alexander RT, Ward LM. Sickle cell bone disease and response to intravenous bisphosphonates in children. Osteoporos Int 2022; 33:2397-2408. [PMID: 35904681 PMCID: PMC9568449 DOI: 10.1007/s00198-022-06455-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/28/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED Children with sickle cell disease (SCD) have the potential for extensive and early-onset bone morbidity. This study reports on the diversity of bone morbidity seen in children with SCD followed at three tertiary centers. IV bisphosphonates were effective for bone pain analgesia and did not trigger sickle cell complications. INTRODUCTION To evaluate bone morbidity and the response to intravenous (IV) bisphosphonate therapy in children with SCD. METHODS We conducted a retrospective review of patient records from 2003 to 2019 at three Canadian pediatric tertiary care centers. Radiographs, magnetic resonance images, and computed tomography scans were reviewed for the presence of avascular necrosis (AVN), bone infarcts, and myositis. IV bisphosphonates were offered for bone pain management. Bone mineral density was assessed by dual-energy X-ray absorptiometry (DXA). RESULTS Forty-six children (20 girls, 43%) had bone morbidity at a mean age of 11.8 years (SD 3.9) including AVN of the femoral (17/46, 37%) and humeral (8/46, 17%) heads, H-shaped vertebral body deformities due to endplate infarcts (35/46, 76%), and non-vertebral body skeletal infarcts (15/46, 32%). Five children (5/26, 19%) had myositis overlying areas of AVN or bone infarcts visualized on magnetic resonance imaging. Twenty-three children (8/23 girls) received IV bisphosphonate therapy. They all reported significant or complete resolution of bone pain. There were no reports of sickle cell hemolytic crises, pain crises, or stroke attributed to IV bisphosphonate therapy. CONCLUSION Children with SCD have the potential for extensive and early-onset bone morbidity. In this series, IV bisphosphonates were effective for bone pain analgesia and did not trigger sickle cell complications.
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Affiliation(s)
- C Grimbly
- Department of Pediatrics, University of Alberta, 4-584 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 2R7, Canada.
- Women's and Children's Health Research Institute, Alberta, Canada.
| | - P Diaz Escagedo
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, QC, Canada
| | - J L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - A Bruce
- Department of Pediatrics, University of Alberta, 4-584 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 2R7, Canada
- Women's and Children's Health Research Institute, Alberta, Canada
| | - N Alos
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, QC, Canada
| | - M E Robinson
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - V N Konji
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - M Page
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - M Scharke
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - E Simpson
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Y D Pastore
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, QC, Canada
| | - R Girgis
- Department of Pediatrics, University of Alberta, 4-584 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 2R7, Canada
- Women's and Children's Health Research Institute, Alberta, Canada
| | - R T Alexander
- Department of Pediatrics, University of Alberta, 4-584 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 2R7, Canada
- Women's and Children's Health Research Institute, Alberta, Canada
| | - L M Ward
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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12
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Multifocal Osteonecrosis in a 3-Year-old Child With Sickle Beta Plus Thalassemia. J Pediatr Hematol Oncol 2022; 44:e428-e430. [PMID: 33974587 DOI: 10.1097/mph.0000000000002155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
Sickle beta+thalassemia is considered to be a mild form of sickle cell disease. However, some patients with mild disease can present with osteonecrosis. Here, we present a rare 3-year-old male who presented with acute pain, a baseline hemoglobin of 13 g/dL, who acutely developed multifocal osteonecrosis, and improved with partial exchange transfusion and hydroxyurea therapy.
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13
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Leandro MP, De Sá CKC, Filho DPS, De Souza LAA, Salles C, Tenório MCC, Paz CLDSL, Matos MAA. Association and Risk Factors of Osteonecrosis of Femoral Head in Sickle Cell Disease: A Systematic Review. Indian J Orthop 2022; 56:216-225. [PMID: 35140852 PMCID: PMC8789990 DOI: 10.1007/s43465-021-00469-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/27/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective was to evaluate the level of evidence about the associated factors and the risk factors of osteonecrosis of femoral head (ONFH) in sickle cell individuals. METHODS The review was based on the search and selection of studies available in the electronic databases PubMed, SCIELO, LILACS, BVS. As descriptors, the terms of Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) corresponding to "Osteonecrosis", "Necrosis avascular" and "Aseptic necrosis" and "Femoral head" and "sickle cell disease" and "risk factor" and "predictor". RESULTS Among clinical and laboratorial factors the most promising risk factors were the severity of sickle cell disease and acute chest syndrome. As a result, from studies of a moderate level of quality, blood pressure, body weight, previous trauma, haemoglobin to haematocrit ratio (Hb/HCT), and number of hospitalizations can be highlighted. Others, such as genetic markers and male gender, have also been positively associated in lower quality studies. CONCLUSION For a better clarification of what the risk factors are for the ONFH, it is necessary to study with populations of different origins, different ages, different profiles of Hb, which present greater methodological rigor and perform a multivariate analysis to control confounding factors. Further study is also needed to understand the genetic determinants of ONFH.
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Affiliation(s)
- Márcio Passos Leandro
- Hospital Geral Ernesto Simões Filho, Praça Conselheiro João Alfredo, s/n – Caixa D’agua, Salvador-Bahia, 40301-155 Brazil
| | - Cloud Kennedy Couto De Sá
- Hospital Geral Ernesto Simões Filho, Praça Conselheiro João Alfredo, s/n – Caixa D’agua, Salvador-Bahia, 40301-155 Brazil
| | - Diógenes Pires Serra Filho
- Hospital Geral Ernesto Simões Filho, Praça Conselheiro João Alfredo, s/n – Caixa D’agua, Salvador-Bahia, 40301-155 Brazil
| | - Lucas Azevedo Alves De Souza
- Hospital Geral Ernesto Simões Filho, Praça Conselheiro João Alfredo, s/n – Caixa D’agua, Salvador-Bahia, 40301-155 Brazil
| | - Cristina Salles
- Bahiana School of Medicine and Public Health, Salvador-Bahia, Brazil
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14
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Alzahrani F, Fallatah AM, Al-Haddad FM, Khayyat ST, AlMehmadi WM, AlQahtani BG, Alamri RS. Risk Factors and Complications Among Pediatric Patients With Sickle Cell Anemia: A Single Tertiary Center Retrospective Study. Cureus 2021; 13:e12440. [PMID: 33552759 PMCID: PMC7851883 DOI: 10.7759/cureus.12440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objective Sickle cell anemia (SCA) is one of the common genetic diseases in the Kingdom of Saudi Arabia (KSA). This disease results from a genetic mutation that causes malformation of the red blood cells (RBCs), leading to various systemic complications, including vaso-occlusive crisis (VOC), acute chest syndrome (ACS), osteomyelitis, avascular necrosis (AVN), and stroke, to name a few. The leading cause of mortality in SCA is these systemic complications rather than the disease itself. Understanding the risk factors of these complications can help reduce mortality in these patients and improve their quality of life. In this study, we aimed to determine the risk factors of SCA complications among pediatric patients with SCA at King Abdulaziz University Hospital (KAUH) in Jeddah, KSA. Methods This retrospective study was carried out from January 2012 till June end 2019. It was conducted among pediatric patients with SCA. Patients were screened for eligibility, and we excluded those with thalassemia and those who had a medical history of chronic diseases. Data were collected from patients' electronic medical records. Results The study included 102 pediatric patients with SCA; their mean age was 7.88 ±4.22 years; almost half of them were females (56%) and 44% were males. The dominant body mass index (BMI) classification among them was normal (49%). Urinary tract infection (UTI) was the most common complication with 38 cases followed by VOC with 32 cases. Other complications observed were ACS (25.5%) followed by stroke (15.7%). HbSS was the most prominent genotype among these patients, and it was associated with a higher rate of complications. However, there was no significant relationship between genotype and patients developing complications. Finally, patients with high white blood cell (WBC) counts, elevated systolic blood pressure (SBP), and hypoxia developed more complications, and there was a significant relationship between these conditions and the development of complications (p<0.05). Conclusion Based on our findings, patients with high WBC count, elevated SBP, and hypoxia are at greater risk of developing complications. Accordingly, healthcare providers should consider putting in place all measures required to provide a good quality of life for these patients, including raising awareness about the risk factors that lead to these complications, appropriate immunizations, and precautionary measures to promote these patients' welfare.
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Affiliation(s)
| | - Anas M Fallatah
- Medicine, College of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Fatimah M Al-Haddad
- Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Shahad T Khayyat
- Medicine, College of Medicine, King Abdulaziz University, Jeddah, SAU
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15
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Hallmark L, Almeida LE, Kamimura S, Smith M, Quezado ZM. Nitric oxide and sickle cell disease-Is there a painful connection? Exp Biol Med (Maywood) 2020; 246:332-341. [PMID: 33517776 DOI: 10.1177/1535370220976397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sickle cell disease is the most common hemoglobinopathy and affects millions worldwide. The disease is associated with severe organ dysfunction, acute and chronic pain, and significantly decreased life expectancy. The large body of work demonstrating that hemolysis results in rapid consumption of the endogenous vasodilator nitric oxide, decreased nitric oxide production, and promotion of vaso-occlusion provides the basis for the hypothesis that nitric oxide bioavailability is reduced in sickle cell disease and that this deficit plays a role in sickle cell disease pain. Despite initial promising results, large clinical trials using strategies to increase nitric oxide bioavailability in sickle cell disease patients yielded no significant change in duration or frequency of acute pain crises. Further, recent investigations showed that sickle cell disease patients and mouse models have elevated baseline levels of blood nitrite, a reservoir for nitric oxide formation and a product of nitric oxide metabolism, regardless of pain phenotype. These conflicting results challenge the hypotheses that nitric oxide bioavailability is decreased and that it plays a significant role in the pathogenesis in sickle cell disease acute pain crises. Conversely, a large body of work demonstrates that nitric oxide, as a neurotransmitter, has a complex role in pain neurobiology, contributes to the development of central sensitization, and can mediate hyperalgesia in inflammatory and neuropathic pain. These results support an alternative hypothesis: one proposing that altered nitric oxide signaling may contribute to the development of neuropathic and/or inflammatory pain in sickle cell disease through its role as a neurotransmitter.
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Affiliation(s)
- Lillian Hallmark
- Department of Perioperative Medicine, 2511National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Luis Ef Almeida
- Department of Perioperative Medicine, 2511National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sayuri Kamimura
- Department of Perioperative Medicine, 2511National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Meghann Smith
- Department of Perioperative Medicine, 2511National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Zenaide Mn Quezado
- Department of Perioperative Medicine, 2511National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
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16
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Kuҫi Z, Jordan C, Wehner S, Sörensen J, Jarisch A, Salzmann-Manrique E, Pfeffermann LM, Klingebiel T, Bader P, Kuҫi S. The Phenotype and Functional Activity of Mesenchymal Stromal Cells in Pediatric Patients with Non-Malignant Hematological Diseases. Cells 2020; 9:cells9020431. [PMID: 32059574 PMCID: PMC7072753 DOI: 10.3390/cells9020431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 12/16/2022] Open
Abstract
As the biology of mesenchymal stromal cells (MSCs) in patients with non-malignant hematological diseases (NMHD) is poorly understood, in the current study we performed a basic characterization of the phenotype and functional activity of NMHD-MSCs. Bone marrow (BM) of patients with thalassemia major (TM) possessed a significantly higher number of nucleated cells (BM-MNCs)/mL BM than healthy donors (P < 0.0001), which however did not result in a higher number of colony forming units-fibroblast (CFU-F) per milliliter BM. In contrast, from 1 × 106 BM-MNCs of patients with sickle cell disease (SCD) were generated significantly more CFU-Fs than from TM-BM-MNCs (P < 0.013) and control group (P < 0.02). In addition, NMHD-MSCs expressed significantly lower levels of CD146 molecule, demonstrated an equal proliferation potential and differentiated along three lineages (osteoblasts, chondrocytes and adipocytes) as healthy donors’ MSCs, with exception of TM-MSCs which differentiated weakly in adipocytes. In contrast to other NMHD-MSCs and healthy donors’ MSCs, TM-MSCs demonstrated an impaired in vitro immunosuppressive potential, either. Noteworthy, the majority of the immunosuppressive effect of NMHD-MSCs was mediated through prostaglandin-E2 (PGE2), because indomethacin (an inhibitor of PGE2 synthesis) was able to significantly reverse this effect. Our results indicate therefore that NMHD-MSCs, except TM-MSCs, may be used as an autologous cell-based therapy for post-transplant complications such as graft failure, graft-versus-host disease (GvHD) and osteonecrosis.
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Affiliation(s)
- Zyrafete Kuҫi
- University Hospital for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Goethe University Frankfurt am Main, 60528 Frankfurt am Main, Germany; (Z.K.); (S.W.); (J.S.); (A.J.); (E.S.-M.); (T.K.); (P.B.)
| | - Christiane Jordan
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen GmbH, Goethe University Hospital, 60528 Frankfurt am Main, Germany; (C.J.); (L.-M.P.)
| | - Sibylle Wehner
- University Hospital for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Goethe University Frankfurt am Main, 60528 Frankfurt am Main, Germany; (Z.K.); (S.W.); (J.S.); (A.J.); (E.S.-M.); (T.K.); (P.B.)
| | - Jan Sörensen
- University Hospital for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Goethe University Frankfurt am Main, 60528 Frankfurt am Main, Germany; (Z.K.); (S.W.); (J.S.); (A.J.); (E.S.-M.); (T.K.); (P.B.)
| | - Andrea Jarisch
- University Hospital for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Goethe University Frankfurt am Main, 60528 Frankfurt am Main, Germany; (Z.K.); (S.W.); (J.S.); (A.J.); (E.S.-M.); (T.K.); (P.B.)
| | - Emilia Salzmann-Manrique
- University Hospital for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Goethe University Frankfurt am Main, 60528 Frankfurt am Main, Germany; (Z.K.); (S.W.); (J.S.); (A.J.); (E.S.-M.); (T.K.); (P.B.)
| | - Lisa-Marie Pfeffermann
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen GmbH, Goethe University Hospital, 60528 Frankfurt am Main, Germany; (C.J.); (L.-M.P.)
| | - Thomas Klingebiel
- University Hospital for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Goethe University Frankfurt am Main, 60528 Frankfurt am Main, Germany; (Z.K.); (S.W.); (J.S.); (A.J.); (E.S.-M.); (T.K.); (P.B.)
| | - Peter Bader
- University Hospital for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Goethe University Frankfurt am Main, 60528 Frankfurt am Main, Germany; (Z.K.); (S.W.); (J.S.); (A.J.); (E.S.-M.); (T.K.); (P.B.)
| | - Selim Kuҫi
- University Hospital for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Goethe University Frankfurt am Main, 60528 Frankfurt am Main, Germany; (Z.K.); (S.W.); (J.S.); (A.J.); (E.S.-M.); (T.K.); (P.B.)
- Correspondence: ; Tel.: +49-6963-0180-656; Fax: +49-6963-0183-539
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17
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Adesina OO, Neumayr LD. Osteonecrosis in sickle cell disease: an update on risk factors, diagnosis, and management. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:351-358. [PMID: 31808856 PMCID: PMC6913430 DOI: 10.1182/hematology.2019000038] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Osteonecrosis, a form of ischemic bone injury that leads to degenerative joint disease, affects ∼30% of people with sickle cell disease. Although osteonecrosis most commonly affects the femoral head (often bilaterally, with asymmetric clinical and radiographic progression), many people with sickle cell disease also present with multifocal joint involvement. We present the case of a young woman with bilateral osteonecrosis of the femoral head at varying stages of progression; we also highlight other important comorbid complications (eg, chronic pain requiring long-term opioids, debility, and social isolation) and postoperative outcomes. In this review, partly based on recommendations on osteonecrosis management from the 2014 evidence-based report on sickle cell disease from the National Heart, Lung and Blood Institutes, we also discuss early signs or symptoms of osteonecrosis of the femoral head, radiographic diagnosis and staging criteria, hydroxyurea effect on progression to femoral head collapse, and surgical outcomes of total hip arthroplasty in the modern era. In summary, we failed to find an association between hydroxyurea use and femoral head osteonecrosis; we also showed that evidence-based perioperative sickle cell disease management resulted in superior postoperative outcomes after cementless total hip arthroplasty in sickle cell-related osteonecrosis of the femoral head.
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Affiliation(s)
- Oyebimpe O Adesina
- Department of Medicine, Division of Hematology, University of Washington School of Medicine, Seattle, WA; and
| | - Lynne D Neumayr
- Department of Hematology, University of California, San Francisco, Benioff Children's Hospital, Oakland, CA
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18
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Martí‐Carvajal AJ, Solà I, Agreda‐Pérez LH. Treatment for avascular necrosis of bone in people with sickle cell disease. Cochrane Database Syst Rev 2019; 12:CD004344. [PMID: 31803937 PMCID: PMC6894369 DOI: 10.1002/14651858.cd004344.pub7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Avascular necrosis of bone is a frequent and severe complication of sickle cell disease and its treatment is not standardised. This is an update of a previously published Cochrane Review. OBJECTIVES To determine the impact of any surgical procedure compared with other surgical interventions or non-surgical procedures, on avascular necrosis of bone in people with sickle cell disease in terms of efficacy and safety. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Additional trials were sought from both ongoing trial registries and the reference lists of papers identified by the search strategy. Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 17 September 2019. SELECTION CRITERIA Randomized clinical trials comparing specific therapies for avascular necrosis of bone in people with sickle cell disease. DATA COLLECTION AND ANALYSIS Each author independently extracted data and assessed trial quality. The quality of the evidence was assessed using GRADE. Given only one trial was identified, meta-analyses were not possible. MAIN RESULTS One trial (46 participants) was eligible for inclusion. After randomization eight participants were withdrawn, mainly because they declined to participate in the trial. Data were analysed for 38 participants at the end of the trial. After a mean follow-up of three years, hip core decompression and physical therapy did not show clinical improvement when compared with physical therapy alone using the score from the original trial (an improvement of 18.1 points for those treated with intervention therapy versus an improvement of 15.7 points with control therapy). We are very uncertain whether there is any difference between groups regarding major complications (hip pain, risk ratio 0.95 (95% confidence interval 0.56 to 1.60; vaso-occlusive crises, risk ratio 1.14 (95% confidence interval 0.72 to 1.80; very low quality of evidence); and acute chest syndrome, risk ratio 1.06 (95% confidence interval 0.44 to 2.56; very low quality of evidence)). This trial did not report results on mortality or quality of life. AUTHORS' CONCLUSIONS We found no evidence that adding hip core decompression to physical therapy achieves clinical improvement in people with sickle cell disease with avascular necrosis of bone compared to physical therapy alone. However, we highlight that our conclusion is based on one trial with high attrition rates. Further randomized controlled trials are necessary to evaluate the role of hip-core depression for this clinical condition. Endpoints should focus on participants' subjective experience (e.g. quality of life and pain) as well as more objective 'time-to-event' measures (e.g. mortality, survival, hip longevity). The availability of participants to allow adequate trial power will be a key consideration for endpoint choice.
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Affiliation(s)
| | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 167Pavilion 18BarcelonaCatalunyaSpain08025
| | - Luis H Agreda‐Pérez
- Hospital "Dr. Adolfo Prince Lara"Medicina InternaAv. SalomPto. CabelloEdo. CaraboboVenezuela
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19
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Houwing ME, de Pagter PJ, van Beers EJ, Biemond BJ, Rettenbacher E, Rijneveld AW, Schols EM, Philipsen JNJ, Tamminga RYJ, van Draat KF, Nur E, Cnossen MH. Sickle cell disease: Clinical presentation and management of a global health challenge. Blood Rev 2019; 37:100580. [PMID: 31128863 DOI: 10.1016/j.blre.2019.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 01/12/2023]
Abstract
Sickle cell disease is an autosomal recessive, multisystem disorder, characterised by chronic haemolytic anaemia, painful episodes of vaso-occlusion, progressive organ failure and a reduced life expectancy. Sickle cell disease is the most common monogenetic disease, with millions affected worldwide. In well-resourced countries, comprehensive care programs have increased life expectancy of sickle cell disease patients, with almost all infants surviving into adulthood. Therapeutic options for sickle cell disease patients are however, still scarce. Predictors of sickle cell disease severity and a better understanding of pathophysiology and (epi)genetic modifiers are warranted and could lead to more precise management and treatment. This review provides an extensive summary of the pathophysiology and management of sickle cell disease and encompasses the characteristics, complications and current and future treatment options of the disease.
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Affiliation(s)
- M E Houwing
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - P J de Pagter
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - E J van Beers
- Department of Internal Medicine and Dermatology, Van Creveldkliniek, University Medical Center Utrecht, Internal mail no C.01.412, 3508, GA, Utrecht, the Netherlands.
| | - B J Biemond
- Department of Internal Medicine and Clinical Haematology, Amsterdam University Medical Centers, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - E Rettenbacher
- Department of Paediatric Haematology, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10, 6500, HB, Nijmegen, the Netherlands.
| | - A W Rijneveld
- Department of Haematology, Erasmus University Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - E M Schols
- Department of Haematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - J N J Philipsen
- Department of Cell Biology, Erasmus University Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - R Y J Tamminga
- Department of Paediatric Oncology and Haematology, University Medical Center Groningen - Beatrix Children's Hospital, Postbus 30001, 9700, RB, Groningen, the Netherlands..
| | - K Fijn van Draat
- Department of Paediatric Haematology, Amsterdam University Medical Centers - Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Plasma Proteins, Sanquin Research, the Netherlands.
| | - E Nur
- Department of Internal Medicine and Clinical Haematology, Amsterdam University Medical Centers, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
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Adekile AD, Gupta R, Al-Khayat A, Mohammed A, Atyani S, Thomas D. Risk of avascular necrosis of the femoral head in children with sickle cell disease on hydroxyurea: MRI evaluation. Pediatr Blood Cancer 2019; 66:e27503. [PMID: 30345708 DOI: 10.1002/pbc.27503] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/03/2018] [Accepted: 09/21/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND There are conflicting reports on the role of hydroxyurea (HU) in the pathogenesis of avascular necrosis of the femoral head (AVNFH) in patients with sickle cell disease (SCD). PROCEDURE The present study is a prospective cohort study of Kuwaiti children with SCD who were treated with HU. They had magnetic resonance imaging of the hips before starting HU and at regular intervals during a follow-up period, ranging from 1 to 15 years. RESULTS There were 40 patients (18 SS, 19 Sβ0-thalassemia, and three SD genotypes), aged 6-20 years. Pre-HU, 11 (27.5%) had varying grades of AVNFH, while post HU, the prevalence was 32.5%. Two patients developed new lesions during the study, while five (45.5%) that had lesions pre-HU remained static, another five (45.5%) progressed, and one (9%) improved radiologically. The older patients who had been on HU the longest were more likely to deteriorate. The only hematological parameter that was consistently associated with AVNFH was the reticulocyte count. CONCLUSIONS The frequency and rate of progression of AVNFH in this study is much less than that previously reported for our patients not treated with HU. There is no evidence that HU therapy is a risk factor for AVNFH. It may, in fact, prevent new lesions and deter the progression of existing AVNFH.
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Affiliation(s)
- Adekunle D Adekile
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait.,Pediatric Hematology Unit, Mubarak Al-Kabeer Hospital, Safat, Kuwait
| | - Renu Gupta
- Department of Radiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.,Department of Radiology, Mubarak Al-Kabeer Hospital, Safat, Kuwait
| | - Abdullah Al-Khayat
- Department of Radiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Ahmed Mohammed
- Center for Medical Education, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Said Atyani
- Department of Radiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Diana Thomas
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait
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21
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Mesleh Shayeb A, Smeltzer MP, Kaste SC, Brown A, Estepp JH, Nottage KA. Vaso-occlusive crisis as a predictor of symptomatic avascular necrosis in children with sickle cell disease. Pediatr Blood Cancer 2018; 65:e27435. [PMID: 30183122 DOI: 10.1002/pbc.27435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/11/2022]
Abstract
Avascular necrosis (AVN) is a chronic bone complication of sickle cell disease (SCD) resulting in significant morbidity. Understanding associated risk factors can facilitate risk-based screening, earlier identification, and prompt intervention. Between 1998 and 2014, 26 symptomatic cases with imaging evidence of AVN were compared 1:5 with age- and SCD genotype-matched controls (n = 128). Patients with 1-5 vaso-occlusive crisis (VOC) (OR 11.9, 95% CI, 1.4-99.9; P = 0.02) and more than 5 VOC (OR 53.6, 95% CI, 5.5-520.2; P = 0.0006) in a 5-year period were more likely to have AVN. Symptomatic patients with more than five VOC in 5 years may benefit from radiologic screening for AVN.
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Affiliation(s)
- Akram Mesleh Shayeb
- Departments of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Departments of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, The University of Memphis School of Public Health, Memphis, Tennessee
| | - Sue C Kaste
- Diagnostic Imaging and Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ashley Brown
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Jeremie H Estepp
- Departments of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Departments of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
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22
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Daltro G, Franco BA, Faleiro TB, Rosário DAV, Daltro PB, Fortuna V. Osteonecrosis in sickle cell disease patients from Bahia, Brazil: a cross-sectional study. INTERNATIONAL ORTHOPAEDICS 2018; 42:1527-1534. [PMID: 29582115 DOI: 10.1007/s00264-018-3905-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to describe the clinical features of osteonecrosis (ON) in sickle cell disease (SCD) patients in Bahia, a Northeast state with the highest prevalence of the disease in Brazil. METHODS Between 2006 and 2017, 283 cases of osteonecrosis in SCD patients were enrolled to analyse the age at diagnosis, genotype, gender, pain, distribution of the lesions and disease staging. MRI and radiograph were obtained at the participation. RESULTS Of the 283 SCD cases, 120 (42.4%) were haemoglobin SS genotype while 163 (57.6%) were SC genotype. Two hundred and forty-six cases were bilateral and 37 were unilateral, with an average age at diagnosis of 33.7 (range 10-67) years. The most frequent identified ON site not only was the hip (74.6%), but also affected shoulder, knee and ankle. Most cases presented at early stage I (172, 60.8%) disease. No significant differences on the features of osteonecrosis were identified between haemoglobin SS and haemoglobin SC cases. CONCLUSIONS Given the relatively high prevalence of bilateral osteonecrosis at early stages, painful symptoms and rather late age at diagnosis, SCD patients should have radiological examination of their joints more often in order to prevent severe functional disability and increase patient's life quality.
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Affiliation(s)
- Gildasio Daltro
- Prof. Edgar Santos Hospital Complex, Federal University of Bahia, R. Doutor Augusto Viana, s/n, Canela, Salvador, BA, 40110-060, Brazil
| | - Bruno Adelmo Franco
- Prof. Edgar Santos Hospital Complex, Federal University of Bahia, R. Doutor Augusto Viana, s/n, Canela, Salvador, BA, 40110-060, Brazil
| | - Thiago Batista Faleiro
- Prof. Edgar Santos Hospital Complex, Federal University of Bahia, R. Doutor Augusto Viana, s/n, Canela, Salvador, BA, 40110-060, Brazil
| | - Davi Araujo Veiga Rosário
- Prof. Edgar Santos Hospital Complex, Federal University of Bahia, R. Doutor Augusto Viana, s/n, Canela, Salvador, BA, 40110-060, Brazil
| | - Paula Braga Daltro
- Health Science Institute, Federal University of Bahia, Av. Reitor Miguel Calmon, s/n, Vale do Canela, Salvador, BA, 40110-100, Brazil
| | - Vitor Fortuna
- Health Science Institute, Federal University of Bahia, Av. Reitor Miguel Calmon, s/n, Vale do Canela, Salvador, BA, 40110-100, Brazil.
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Osteonecrosis of the femoral head in sickle cell disease: prevalence, comorbidities, and surgical outcomes in California. Blood Adv 2017; 1:1287-1295. [PMID: 29296770 DOI: 10.1182/bloodadvances.2017005256] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/07/2017] [Indexed: 01/03/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a prevalent complication of sickle cell disease (SCD) that has not been well described in population-based cohort studies. Using California's Office of Statewide Planning and Development discharge databases (1991-2013), we estimated the cumulative incidence of ONFH after accounting for the competing risk of death and used a multivariable Cox proportional hazards regression to identify factors associated with ONFH diagnosis. We also calculated rates of readmissions to the hospital or emergency department within 30 to 90 days of hip replacement surgery. Of the 6237 patients in our SCD cohort, 22% (n = 1356) developed ONFH at a median age of 27 years, and 23% (n = 308) of the patients with ONFH underwent hip replacement surgery at a median age of 36 years. The cumulative incidence of ONFH to age 30 years was higher among SCD patients with more severe disease (24%; vs 8% in less severe) and those with antecedent acute chest syndrome (ACS) (18%; vs 8% without prior history of ACS). From 2003 to 2013, SCD patients with more severe disease (hazard ratio [HR], 2.77; 95% confidence interval [CI], 2.38-3.23) or with antecedent ACS (HR, 1.61; CI, 1.35-1.91) were more likely to develop ONFH. Twenty-seven percent of post-hip surgery patients were readmitted within 30 days, mostly for painful vaso-occlusive crises. ONFH is a common SCD complication that increases with age; ongoing studies into prevention and effective nonsurgical interventions for SCD-induced osteonecrosis must remain a high research priority.
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24
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AAPT Diagnostic Criteria for Chronic Sickle Cell Disease Pain. THE JOURNAL OF PAIN 2017; 18:490-498. [DOI: 10.1016/j.jpain.2016.12.016] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 12/11/2022]
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25
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Kato GJ, Steinberg MH, Gladwin MT. Intravascular hemolysis and the pathophysiology of sickle cell disease. J Clin Invest 2017; 127:750-760. [PMID: 28248201 DOI: 10.1172/jci89741] [Citation(s) in RCA: 410] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Hemolysis is a fundamental feature of sickle cell anemia that contributes to its pathophysiology and phenotypic variability. Decompartmentalized hemoglobin, arginase 1, asymmetric dimethylarginine, and adenine nucleotides are all products of hemolysis that promote vasomotor dysfunction, proliferative vasculopathy, and a multitude of clinical complications of pulmonary and systemic vasculopathy, including pulmonary hypertension, leg ulcers, priapism, chronic kidney disease, and large-artery ischemic stroke. Nitric oxide (NO) is inactivated by cell-free hemoglobin in a dioxygenation reaction that also oxidizes hemoglobin to methemoglobin, a non-oxygen-binding form of hemoglobin that readily loses heme. Circulating hemoglobin and heme represent erythrocytic danger-associated molecular pattern (eDAMP) molecules, which activate the innate immune system and endothelium to an inflammatory, proadhesive state that promotes sickle vaso-occlusion and acute lung injury in murine models of sickle cell disease. Intravascular hemolysis can impair NO bioavailability and cause oxidative stress, altering redox balance and amplifying physiological processes that govern blood flow, hemostasis, inflammation, and angiogenesis. These pathological responses promote regional vasoconstriction and subsequent blood vessel remodeling. Thus, intravascular hemolysis represents an intrinsic mechanism for human vascular disease that manifests clinical complications in sickle cell disease and other chronic hereditary or acquired hemolytic anemias.
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26
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Martí-Carvajal AJ, Solà I, Agreda-Pérez LH. Treatment for avascular necrosis of bone in people with sickle cell disease. Cochrane Database Syst Rev 2016:CD004344. [PMID: 27502327 DOI: 10.1002/14651858.cd004344.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Avascular necrosis of bone is a frequent and severe complication of sickle cell disease and its treatment is not standardised. This is an update of a previously published Cochrane Review. OBJECTIVES To determine the impact of any surgical procedure compared with other surgical interventions or non-surgical procedures, on avascular necrosis of bone in people with sickle cell disease in terms of efficacy and safety. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Additional trials were sought from the reference lists of papers identified by the search strategy.Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 27 May 2016. SELECTION CRITERIA Randomized clinical trials comparing specific therapies for avascular necrosis of bone in people with sickle cell disease. DATA COLLECTION AND ANALYSIS Each author independently extracted data and assessed trial quality. Since only one trial was identified, meta-analysis was not possible. MAIN RESULTS One trial (46 participants) was eligible for inclusion. After randomization eight participants were withdrawn, mainly because they declined to participate in the trial. Data were analysed for 38 participants at the end of the trial. After a mean follow up of three years, hip core decompression and physical therapy did not show clinical improvement when compared with physical therapy alone using the score from the original trial (an improvement of 18.1 points for those treated with intervention therapy versus an improvement of 15.7 points with control therapy). There was no significant statistical difference between groups regarding major complications (hip pain, risk ratio 0.95 (95% confidence interval 0.56 to 1.60; vaso-occlusive crises, risk ratio 1.14 (95% confidence interval 0.72 to 1.80; very low quality of evidence); and acute chest syndrome, risk ratio 1.06 (95% confidence interval 0.44 to 2.56; very low quality of evidence)). This trial did not report results on mortality or quality of life. AUTHORS' CONCLUSIONS We found no evidence that adding hip core decompression to physical therapy achieves clinical improvement in people with sickle cell disease with avascular necrosis of bone compared to physical therapy alone. However, we highlight that our conclusion is based on one trial with high attrition rates. Further randomized controlled trials are necessary to evaluate the role of hip-core depression for this clinical condition. Endpoints should focus on participants' subjective experience (e.g. quality of life and pain) as well as more objective 'time-to-event' measures (e.g. mortality, survival, hip longevity). The availability of participants to allow adequate trial power will be a key consideration for endpoint choice.
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27
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Noubouossie D, Tayou Tagny C, Chetcha B, Ngo Balogog P, Mbanya DN. Sickle-cell disease in sub-Saharan Africa. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- D. Noubouossie
- Faculty of Medicine & Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
| | - C. Tayou Tagny
- Faculty of Medicine & Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
- Yaoundé University Teaching Hospital; Yaoundé Cameroon
| | - B. Chetcha
- Faculty of Medicine & Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
- Yaoundé Central Hospital; Yaoundé Cameroon
| | | | - D. N. Mbanya
- Faculty of Medicine & Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
- Yaoundé University Teaching Hospital; Yaoundé Cameroon
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Archer N, Galacteros F, Brugnara C. 2015 Clinical trials update in sickle cell anemia. Am J Hematol 2015; 90:934-50. [PMID: 26178236 PMCID: PMC5752136 DOI: 10.1002/ajh.24116] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 02/02/2023]
Abstract
Polymerization of HbS and cell sickling are the prime pathophysiological events in sickle cell disease (SCD). Over the last 30 years, a substantial understanding at the molecular level has been acquired on how a single amino acid change in the structure of the beta chain of hemoglobin leads to the explosive growth of the HbS polymer and the associated changes in red cell morphology. O2 tension and intracellular HbS concentration are the primary molecular drivers of this process, and are obvious targets for developing new therapies. However, polymerization and sickling are driving a complex network of associated cellular changes inside and outside of the erythrocyte, which become essential components of the inflammatory vasculopathy and result in a large range of potential acute and chronic organ damages. In these areas, a multitude of new targets for therapeutic developments have emerged, with several ongoing or planned new therapeutic interventions. This review outlines the key points of SCD pathophysiology as they relate to the development of new therapies, both at the pre-clinical and clinical levels.
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Affiliation(s)
- Natasha Archer
- Pediatric Hematology/Oncology Dana-Farber/Children’s Hospital Blood Disorders and Cancer Center, Boston, Massachusetts
| | - Frédéric Galacteros
- Centre De Référence Des Syndromes Drépanocytaires Majeurs, Hôpital Henri-Mondor, APHP, UPEC, Creteil, France
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children’s Hospital, Harvard Medical School Boston, Massachusetts
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29
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Adekile A, Menzel S, Gupta R, Al-Sharida S, Farag A, Haider M, Akbulut N, Mustafa N, Thein SL. Response to hydroxyurea among Kuwaiti patients with sickle cell disease and elevated baseline HbF levels. Am J Hematol 2015; 90:E138-9. [PMID: 25851995 DOI: 10.1002/ajh.24027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/30/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | - Stephan Menzel
- Faculty of Life Sciences & Medicine; , King's College London; London United Kingdom
| | - Renu Gupta
- Department of Radiology; Kuwait University; Kuwait City Kuwait
- Pediatric Hematology Unit; Mubarak Al-Kabeer Hospital; Kuwait
| | | | | | - Mohammad Haider
- Department of Pediatrics; Kuwait University; Kuwait City Kuwait
| | | | - Nada Mustafa
- Department of Pediatrics; Kuwait University; Kuwait City Kuwait
| | - Swee Lay Thein
- Faculty of Life Sciences & Medicine; , King's College London; London United Kingdom
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30
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Daltro GC, Fortuna V, de Souza ES, Salles MM, Carreira AC, Meyer R, Freire SM, Borojevic R. Efficacy of autologous stem cell-based therapy for osteonecrosis of the femoral head in sickle cell disease: a five-year follow-up study. Stem Cell Res Ther 2015; 6:110. [PMID: 26021713 PMCID: PMC4465459 DOI: 10.1186/s13287-015-0105-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/08/2015] [Accepted: 05/21/2015] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Stem cell therapy with bone marrow-derived mononuclear cells (BMMCs) is an option for improving joint function in osteonecrosis of the femoral head (ONFH). Bone marrow-derived mesenchymal stromal cell (MSC) numbers and their osteogenic differentiation are decreased in patients with ONFH. However, whether this decrease also extends to the early stages of ONFH in sickle cell disease (SCD) is still unclear. METHODS We conducted a phase I/II, non-controlled study to determine efficacy and safety of BMMC implantation using a minimally invasive technique in SCD patients with ONFH. Eighty-nine patients were recruited and followed up for 60 months after surgery. Clinical and radiographic findings were assessed, and data were completed by in vitro analysis. RESULTS At the final follow-up (60 months) there was a significant improvement in clinical joint symptoms and pain relief as measured by the Harris Hip Score (P = 0.0005). In addition, after the BMMC implantation procedure, radiographic assessment showed disease stabilization and only 3.7 % of the treated patients did not achieve a satisfactory clinical result. The amount of fibroblast colony-forming units was 28.2 ± 13.9 per 1 million BMMCs after concentration. Flow cytometry analysis showed a significantly higher number of hematopoietic stem/endothelial progenitor cell markers in concentrated BMMCs when compared with bone marrow aspirate, indicating an enrichment of these cell types. Isolated MSCs from SCD patients with pre-collapse ONFH maintained the replicative capacity without significant loss of their specific biomolecular characteristics, multi-differentiation potential, and osteogenic differentiation activities. Cytokines and growth factors (interleukin-8, transforming growth factor-beta, stromal cell-derived factor-1alpha and vascular endothelial growth factor) that mediate endogenous bone regeneration were also produced by expanded MSCs from SCD patients. CONCLUSION The autologous BMMC implantation with a minimally invasive technique resulted in significant pain relief and halted the progression of early stages of ONFH in SCD patients. MSCs from SCD patients display biological properties that may add to the efficiency of surgical treatment in ONFH. In summary, our results indicate that infusion of BMMCs enriched with stem/progenitor cells is a safe and effective treatment for the early stages of ONFH in SCD patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02448121; registered 15 May 2015.
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Affiliation(s)
| | - Vitor Fortuna
- Health Science Institute, Federal University of Bahia, Reitor Miguel Calmon Avenue, Salvador, BA, 40110-100, Brazil.
| | - Eliane Silva de Souza
- Health Science Institute, Federal University of Bahia, Reitor Miguel Calmon Avenue, Salvador, BA, 40110-100, Brazil.
| | - Marcela Miranda Salles
- Health Science Institute, Federal University of Bahia, Reitor Miguel Calmon Avenue, Salvador, BA, 40110-100, Brazil.
| | - Ana Claudia Carreira
- Cell and Molecular Therapy Center NUCEL-NETCEM, School of Medicine, Internal Medicine Department, and Chemistry Institute, Biochemistry Department, University of São Paulo, São Paulo, SP, 05508-900, Brazil.
| | - Roberto Meyer
- Health Science Institute, Federal University of Bahia, Reitor Miguel Calmon Avenue, Salvador, BA, 40110-100, Brazil.
| | - Songeli Menezes Freire
- Health Science Institute, Federal University of Bahia, Reitor Miguel Calmon Avenue, Salvador, BA, 40110-100, Brazil.
| | - Radovan Borojevic
- Petrópolis School of Medicine/Arthur de Sá Earp Faculties, Petrópolis, RJ, 25680-120, Brazil. .,National Institute of Metrology, Quality and Technology (Inmetro), Xerém, Rio de Janeiro, RJ, 25250-020, Brazil.
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Abstract
Sickle cell disease (SCD) is a single gene disorder causing a debilitating systemic syndrome characterised by chronic anaemia, acute painful episodes, organ infarction and chronic organ damage and by a significant reduction in life expectancy. The origin of SCD lies in the malarial regions of the tropics where carriers are protected against death from malaria and hence enjoy an evolutionary advantage. More recently, population migration has meant that SCD now has a worldwide distribution and that a substantial number of children are born with the condition in higher-income areas, including large parts of Europe and North and South America. Newborn screening, systematic clinical follow-up and prevention of sepsis and organ damage have led to an increased life expectancy among people with SCD in many such countries; however, in resource-limited settings where the majority continue to be born, most affected children continue to die in early childhood, usually undiagnosed, due to the lack of effective programmes for its early detection and treatment. As new therapies emerge, potentially leading to disease amelioration or cure, it is of paramount importance that the significant burden of SCD in resource-poor countries is properly recognised.
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Affiliation(s)
| | - Thomas N Williams
- Department of Medicine, Imperial College, London, UK,KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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32
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Marsh A, Schiffelers R, Kuypers F, Larkin S, Gildengorin G, van Solinge W, Hoppe C. Microparticles as biomarkers of osteonecrosis of the hip in sickle cell disease. Br J Haematol 2014; 168:135-8. [PMID: 25196812 DOI: 10.1111/bjh.13110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/09/2014] [Indexed: 11/28/2022]
Abstract
Osteonecrosis of the femoral head (ONFH) is a common complication of sickle cell disease (SCD). To examine the association between microparticles and ONFH in SCD, we compared plasma microparticle levels in 20 patients with and without ONFH. Microparticles were quantified using nanoparticle tracking analysis and found to be 2·3-fold higher in patients with ONFH compared to patients without ONFH, and 2·5-fold higher than in healthy controls. These results suggest that microparticles may be a clinically useful biomarker of ONFH in SCD. Further investigations are needed to determine the functional relevance of microparticles in the pathogenesis of ONFH in SCD.
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Affiliation(s)
- Anne Marsh
- Department of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA; Children's Hospital Oakland Research Institute, Oakland, CA, USA
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Martí-Carvajal AJ, Solà I, Agreda-Pérez LH. Treatment for avascular necrosis of bone in people with sickle cell disease. Cochrane Database Syst Rev 2014:CD004344. [PMID: 25009086 DOI: 10.1002/14651858.cd004344.pub5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Avascular necrosis of bone is a frequent and severe complication of sickle cell disease and its treatment is not standardised. OBJECTIVES To determine the impact of any surgical procedure compared with other surgical interventions or non-surgical procedures, on avascular necrosis of bone in people with sickle cell disease in terms of efficacy and safety. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Additional trials were sought from the reference lists of papers identified by the search strategy.Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 17 March 2014. SELECTION CRITERIA Randomised clinical trials comparing specific therapies for avascular necrosis of bone in people with sickle cell disease. DATA COLLECTION AND ANALYSIS Each author independently extracted data and assessed trial quality. Since only one trial was identified, meta-analysis was not possible. MAIN RESULTS One trial (46 participants) was eligible for inclusion. After randomisation eight participants were withdrawn, mainly because they declined to participate in the trial. Data were analysed for 38 participants at the end of the trial. After a mean follow up of three years, hip core decompression and physical therapy did not show clinical improvement when compared with physical therapy alone using the score from the original trial (an improvement of 18.1 points for those treated with intervention therapy versus an improvement of 15.7 points with control therapy). There was no significant statistical difference between groups regarding major complications (hip pain, relative risk (RR) 0.95 (95% confidence interval (CI) 0.56 to 1.60; vaso-occlusive crises, RR 1.14 (95% CI 0.72 to 1.80; very low quality of evidence); and acute chest syndrome, RR 1.06 (95% CI 0.44 to 2.56; very low quality of evidence)). This trial did not report results on mortality or quality of life. AUTHORS' CONCLUSIONS We found no evidence that adding hip core decompression to physical therapy achieves clinical improvement in people with sickle cell disease with avascular necrosis of bone compared to physical therapy alone. However, we highlight that our conclusion is based on one trial with high attrition rates. Further randomised controlled trials are necessary to evaluate the role of hip-core depression for this clinical condition. Endpoints should focus on participants' subjective experience (e.g. quality of life and pain) as well as more objective 'time-to-event' measures (e.g. mortality, survival, hip longevity). The availability of participants to allow adequate trial power will be a key consideration for endpoint choice.
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Steinberg MH, Sebastiani P. Genetic modifiers of sickle cell disease. Am J Hematol 2012; 87:795-803. [PMID: 22641398 PMCID: PMC4562292 DOI: 10.1002/ajh.23232] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 03/28/2012] [Accepted: 04/04/2012] [Indexed: 01/19/2023]
Abstract
Sickle cell anemia is associated with unusual clinical heterogeneity for a Mendelian disorder. Fetal hemoglobin concentration and coincident α thalassemia, both which directly affect the sickle erythrocyte, are the major modulators of the phenotype of disease. Understanding the genetics underlying the heritable subphenotypes of sickle cell anemia would be prognostically useful, could inform personalized therapeutics, and might help the discovery of new "druggable" pathophysiologic targets. Genotype-phenotype association studies have been used to identify novel genetic modifiers. In the future, whole genome sequencing with its promise of discovering hitherto unsuspected variants could add to our understanding of the genetic modifiers of this disease.
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Affiliation(s)
- Martin H. Steinberg
- Division of Hematology/Oncology, Department of Medicine, Boston University School of Medicine, Boston MA 02118 USA
| | - Paola Sebastiani
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
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Ballas SK, Kesen MR, Goldberg MF, Lutty GA, Dampier C, Osunkwo I, Wang WC, Hoppe C, Hagar W, Darbari DS, Malik P. Beyond the definitions of the phenotypic complications of sickle cell disease: an update on management. ScientificWorldJournal 2012; 2012:949535. [PMID: 22924029 PMCID: PMC3415156 DOI: 10.1100/2012/949535] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 04/01/2012] [Indexed: 12/25/2022] Open
Abstract
The sickle hemoglobin is an abnormal hemoglobin due to point mutation (GAG → GTG) in exon 1 of the β globin gene resulting in the substitution of glutamic acid by valine at position 6 of the β globin polypeptide chain. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of sickle cell disease in general and sickle cell anemia in particular. The disease itself is chronic in nature but many of its complications are acute such as the recurrent acute painful crises (its hallmark), acute chest syndrome, and priapism. These complications vary considerably among patients, in the same patient with time, among countries and with age and sex. To date, there is no well-established consensus among providers on the management of the complications of sickle cell disease due in part to lack of evidence and in part to differences in the experience of providers. It is the aim of this paper to review available current approaches to manage the major complications of sickle cell disease. We hope that this will establish another preliminary forum among providers that may eventually lead the way to better outcomes.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation and Department of Medicine, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, USA.
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Martí-Carvajal AJ, Solà I, Agreda-Pérez LH. Treatment for avascular necrosis of bone in people with sickle cell disease. Cochrane Database Syst Rev 2012:CD004344. [PMID: 22592696 DOI: 10.1002/14651858.cd004344.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Avascular necrosis of bone is a frequent and severe complication of sickle cell disease and its treatment is not standardised. OBJECTIVES To determine the impact of any surgical procedure compared with other surgical interventions or non-surgical procedures, on avascular necrosis of bone in people with sickle cell disease in terms of efficacy and safety. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Additional trials were sought from the reference lists of papers identified by the search strategy.Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 21 February 2012. SELECTION CRITERIA Randomised clinical trials comparing specific therapies for avascular necrosis of bone in people with sickle cell disease. DATA COLLECTION AND ANALYSIS Each author independently extracted data and assessed trial quality. Since only one trial was identified, meta-analysis was not possible. MAIN RESULTS One trial (46 participants) was eligible for inclusion. After randomisation eight participants were withdrawn, mainly because they declined to participate in the trial. Data were analysed for 38 participants at the end of the trial. After a mean follow up of three years, hip core decompression and physical therapy did not show clinical improvement when compared with physical therapy alone using the score from the original trial (an improvement of 18.1 points for those treated with intervention therapy versus an improvement of 15.7 points with control therapy). There was no significant statistical difference between groups regarding major complications (hip pain, relative risk (RR) 0.95 (95% confidence interval (CI) 0.56 to 1.60; vaso-occlusive crises, RR 1.14 (95% CI 0.72 to 1.80); and acute chest syndrome, RR 1.06 (95% CI 0.44 to 2.56)). This trial did not report results on mortality or quality of life. AUTHORS' CONCLUSIONS We found no evidence that adding hip core decompression to physical therapy achieves clinical improvement in people with sickle cell disease with avascular necrosis of bone compared to physical therapy alone. However, we highlight that our conclusion is based on one trial with high attrition rates. Further randomised controlled trials are necessary to evaluate the role of hip-core depression for this clinical condition. Endpoints should focus on participants' subjective experience (e.g. quality of life and pain) as well as more objective 'time-to-event' measures (e.g. mortality, survival, hip longevity). The availability of participants to allow adequate trial power will be a key consideration for endpoint choice.
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Osteonecrosis in children after allogeneic hematopoietic cell transplantation: study of prevalence, risk factors and longitudinal changes using MR imaging. Bone Marrow Transplant 2011. [PMID: 22158389 DOI: 10.1038/bmt.2011.234;10.1038/bmt.2011.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Osteonecrosis after hematopoietic SCT (HCT) has seldom been addressed in pediatric populations. At our institution, since January 2002, children undergoing allogeneic HCT (alloHCT) receive yearly follow-up magnetic resonance imaging (MR) of hips and knees. To estimate the prevalence, longitudinal changes and associated risk factors for osteonecrosis after alloHCT, we reviewed MRs for children who underwent single alloHCT during the study period. We analyzed 149 of 344 patients who had post-HCT MR imaging performed (84 males; median age 11 years (range, 0.5-21 years)), median follow-up time was 32.6 months (range, 2.8-97.2 months). In all, 44 (29.5%) developed osteonecrosis of hips and/or knees; of those, 20 (45%) had at least 30% epiphyseal involvement. In 23 (52%), osteonecrosis lesions were identified in the first and in 43 (98%) by the third yearly scan. Knees were more frequently involved than hips; severity of osteonecrosis was greater in hips. Those who had pre-alloHCT osteonecrosis, two patients' hips and six patients' knees resolved completely; three patients' osteonecrosis lesions regressed after alloHCT. On risk factor analysis, age at time of alloHCT (P=0.051) and osteonecrosis identified by MRs before alloHCT (P=0.001) were the primary risk factors. This analysis shows that preventive strategies for osteonecrosis in this population should focus on measures to minimize risk factors before alloHCT.
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Osteonecrosis in children after allogeneic hematopoietic cell transplantation: study of prevalence, risk factors and longitudinal changes using MR imaging. Bone Marrow Transplant 2011; 47:1067-74. [PMID: 22158389 PMCID: PMC3310343 DOI: 10.1038/bmt.2011.234] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Osteonecrosis after hematopoietic stem cell transplantation (HCT) has seldom been addressed in pediatric populations. At our institution, since January 2002, children undergoing allogeneic HCT (alloHCT) receive yearly follow-up magnetic resonance imaging (MR) of hips and knees. To estimate the prevalence, longitudinal changes and associated risk factors for osteonecrosis after alloHCT, we reviewed MRs for children who underwent single alloHCT during the study period. We analyzed 149 of 344 patients who had post HCT MRI imaging performed [84 males; median age11 years (range, 0.5–21years)], median follow-up time was 32.6 months (range, 2.8–97.2 months). Forty-four (29.5%) developed osteonecrosis of hips and/or knees; of those, 20 (45%) had at least 30% epiphyseal involvement. In 23 (52%) osteonecrosis lesions were identified in the first, and 43 (98%) by the third yearly scan. Knees were more frequently involved than hips; severity of osteonecrosis was greater in hips. Those who had pre-alloHCT osteonecrosis, two patients’ hips and six patients’ knees resolved completely; three patients’ osteonecrosis lesions regressed after alloHCT. On risk factor analysis, age at time of alloHCT (p=0.051) and osteonecrosis identified by MRs before alloHCT (p=0.001) were the primary risk factors. This analysis shows that preventive strategies for osteonecrosis in this population should focus on measures to minimize risk factors before alloHCT.
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