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Saraf SL, Hagar R, Idowu M, Osunkwo I, Cruz K, Kuypers FA, Brown RC, Geib J, Ribadeneira M, Schroeder P, Wu E, Forsyth S, Kelly PF, Kalfa TA, Telen MJ. Multicenter, phase 1 study of etavopivat (FT-4202) treatment for up to 12 weeks in patients with sickle cell disease. Blood Adv 2024; 8:4459-4475. [PMID: 38640200 DOI: 10.1182/bloodadvances.2023012467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/11/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
ABSTRACT Etavopivat is an investigational, once daily, oral, selective erythrocyte pyruvate kinase (PKR) activator. A multicenter, randomized, placebo-controlled, double-blind, 3-part, phase 1 study was conducted to characterize the safety and clinical activity of etavopivat. Thirty-six patients with sickle cell disease (SCD) were enrolled into 4 cohorts: 1 single-dose, 2 multiple ascending doses, and 1 open-label (OL). In the OL cohort, 15 patients (median age 33.0 years [range, 17-55]) received 400 mg etavopivat once daily for 12 weeks; 14 patients completed treatment. Consistent with the mechanism of PKR activation, increases in adenosine triphosphate and decreases in 2,3-diphosphoglycerate were observed and sustained over 12 weeks' treatment. This translated clinically to an increase in hemoglobin (Hb; mean maximal increase 1.6 g/dL [range, 0.8-2.8]), with >1 g/dL increase in 11 (73%) patients during treatment. In addition, the oxygen tension at which Hb is 50% saturated was reduced (P = .0007) with a concomitant shift in point of sickling (P = .0034) to lower oxygen tension in oxygen-gradient ektacytometry. Hemolysis markers (absolute reticulocyte count, indirect bilirubin, and lactate dehydrogenase) decreased from baseline, along with matrix metalloproteinase-9 and erythropoietin. In the OL cohort, adverse events (AEs) were mostly grade 1/2, consistent with underlying SCD; 5 patients had serious AEs. Vaso-occlusive pain episode was the most common treatment-emergent AE (n = 7) in the OL cohort. In this, to our knowledge, the first study of etavopivat in SCD, 400 mg once daily for 12 weeks was well tolerated, resulting in rapid and sustained increases in Hb, improved red blood cell physiology, and decreased hemolysis. This trial was registered at www.ClinicalTrials.gov as #NCT03815695.
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Affiliation(s)
- Santosh L Saraf
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Robert Hagar
- University of California, San Francisco, Benioff Children's Hospital San Francisco, Oakland, CA
| | - Modupe Idowu
- Department of Internal Medicine, University of Texas, McGovern Medical School, Houston, TX
| | - Ifeyinwa Osunkwo
- Levine Cancer Institute, Atrium Health, Charlotte, NC
- Novo Nordisk Rare Disease, Zurich, Switzerland
| | | | - Frans A Kuypers
- Department of Pediatrics, University of California, San Francisco, Oakland, CA
| | | | - James Geib
- Forma Therapeutics, a part of Novo Nordisk, Watertown, MA
| | | | | | - Eric Wu
- Novo Nordisk, Plainsboro, NJ
| | | | | | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Marilyn J Telen
- Department of Medicine and Duke Comprehensive Sickle Cell Center, Duke University Medical Center, Durham, NC
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2
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Houwing ME, Bos J, van Wijk R, van Beers EJ, Cnossen MH, Rab MAE. Use of the oxygen gradient ektacytometry in the dose titration of hydroxyurea therapy in children with sickle cell disease. Int J Lab Hematol 2024; 46:390-394. [PMID: 38105480 DOI: 10.1111/ijlh.14208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Maite E Houwing
- Department of Pediatric Hematology and Oncology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jennifer Bos
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Richard van Wijk
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eduard J van Beers
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology and Oncology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Minke A E Rab
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
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3
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Ansong-Ansongton YON, Adamson TD. Computing Sickle Erythrocyte Health Index on quantitative phase imaging and machine learning. Exp Hematol 2024; 131:104166. [PMID: 38246310 DOI: 10.1016/j.exphem.2024.104166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
Sickle cell disease (SCD) is a genetic disorder characterized by abnormal hemoglobin and deformation of red blood cells (RBCs), leading to complications and reduced life expectancy. This study developed an in vitro assessment, the Sickle Erythrocyte Health Index, using quantitative phase imaging (QPI) and machine learning to model the health of RBCs in people with SCD. The health index combines assessment of cell deformation, sickle-shaped classification, and membrane flexibility to evaluate erythrocyte health. Using QPI and image processing, the percentage of sickle-shaped cells and membrane flexibility were quantified. Statistically significant differences were observed between individuals with and without SCD, indicating the impact of underlying pathophysiology on erythrocyte health. Additionally, sodium metabisulfite led to an increase in sickle-shaped cells and a decrease in flexibility in the sickle cell blood samples. Based on these findings, two approaches were used to calculate the Sickle Erythrocyte Health Index: one using hand-crafted features and one using learned features from deep learning models. Both indices showed significant differences between non-SCD and SCD groups and sensitivity to changes induced by sodium metabisulfite. The Sickle Erythrocyte Health Index has important clinical implications for SCD management and could be used by providers when making treatment decisions. Further research is warranted to evaluate the clinical utility and applicability of the Sickle Erythrocyte Health Index in diverse patient populations.
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Affiliation(s)
- Yaw Ofosu Nyansa Ansong-Ansongton
- Department of Bioengineering, KovaDx, New Haven, CT; Department of Bioengineering, University of California Berkeley, Bioengineering, Berkeley, CA.
| | - Timothy D Adamson
- Department of Bioengineering, KovaDx, New Haven, CT; Department of Bioengineering, University of California Berkeley, Bioengineering, Berkeley, CA
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van Dijk MJ, Traets MJM, van Oirschot BA, Ruiter TJJ, de Wilde JRA, Bos J, van Solinge WW, Koziel MJ, Jans JJM, Wani R, van Beers EJ, van Wijk R, Rab MAE. A novel composition of endogenous metabolic modulators improves red blood cell properties in sickle cell disease. EJHAEM 2024; 5:21-32. [PMID: 38406513 PMCID: PMC10887255 DOI: 10.1002/jha2.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/18/2023] [Accepted: 01/08/2024] [Indexed: 02/27/2024]
Abstract
The most common forms of sickle cell disease (SCD) are sickle cell anemia (SCA; HbSS) and HbSC disease. In both, especially the more dense, dehydrated and adherent red blood cells (RBCs) with reduced deformability are prone to hemolysis and sickling, and thereby vaso-occlusion. Based on plasma amino acid profiling in SCD, a composition of 10 amino acids and derivatives (RCitNacQCarLKHVS; Axcella Therapeutics, USA), referred to as endogenous metabolic modulators (EMMs), was designed to target RBC metabolism. The effects of ex vivo treatment with the EMM composition on different RBC properties were studied in SCD (n = 9 SCA, n = 5 HbSC disease). Dose-dependent improvements were observed in RBC hydration assessed by hemocytometry (MCV, MCHC, dense RBCs) and osmotic gradient ektacytometry (Ohyper). Median (interquartile range [IQR]) increase in Ohyper compared to vehicle was 4.9% (4.0%-5.5%), 7.5% (6.9%-9.4%), and 12.8% (11.5%-14.0%) with increasing 20×, 40×, and 80X concentrations, respectively (all p < 0.0001). RBC deformability (EImax using oxygen gradient ektacytometry) increased by 8.1% (2.2%-12.1%; p = 0.0012), 9.6% (2.9%-15.1%; p = 0.0013), and 13.3% (5.7%-25.5%; p = 0.0007), respectively. Besides, RBC adhesion to subendothelial laminin decreased by 43% (6%-68%; p = 0.4324), 58% (48%-72%; p = 0.0185), and 71% (49%-82%; p = 0.0016), respectively. Together, these results provide a rationale for further studies with the EMM composition targeting multiple RBC properties in SCD.
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Affiliation(s)
- Myrthe J. van Dijk
- Department of Central Diagnostic Laboratory—Research, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Center for Benign Hematology, Thrombosis and Hemostasis—Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Marissa J. M. Traets
- Department of Central Diagnostic Laboratory—Research, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Brigitte A. van Oirschot
- Department of Central Diagnostic Laboratory—Research, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Titine J. J. Ruiter
- Department of Central Diagnostic Laboratory—Research, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Section Metabolic Diagnostics, Department of GeneticsUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Jonathan R. A. de Wilde
- Department of Central Diagnostic Laboratory—Research, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Jennifer Bos
- Department of Central Diagnostic Laboratory—Research, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Wouter W. van Solinge
- Department of Central Diagnostic Laboratory—Research, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | | | - Judith J. M. Jans
- Section Metabolic Diagnostics, Department of GeneticsUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Revati Wani
- Axcella TherapeuticsCambridgeMassachusettsUSA
- Boehringer Ingelheim Pharmaceuticals, Inc.CambridgeMassachusettsUSA
| | - Eduard J. van Beers
- Center for Benign Hematology, Thrombosis and Hemostasis—Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Richard van Wijk
- Department of Central Diagnostic Laboratory—Research, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Minke A. E. Rab
- Department of Central Diagnostic Laboratory—Research, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Department of HematologyUniversity Medical Center UtrechtUtrechtThe Netherlands
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Chonat S, Fields E, Baratz H, Watt A, Pochron M, Dixon S, Tonda M, Brown C, Archer D. Voxelotor improves red blood cell functionality in children with sickle cell anaemia: An ancillary study of the HOPE-KIDS 1 trial. EJHAEM 2024; 5:125-130. [PMID: 38406531 PMCID: PMC10887232 DOI: 10.1002/jha2.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Sickle haemoglobin (HbS) polymerisation perturbs red blood cell (RBC) rheology and drives sickle cell disease (SCD) pathophysiology. Voxelotor is an HbS polymerisation inhibitor that increases haemoglobin (Hb)-oxygen affinity. METHODS/RESULTS In this 48-week, prospective, single-centre translational study, 10 children aged 4-11 years with SCD were treated with voxelotor. Improvements in RBC deformability were observed using osmotic/oxygen gradient ektacytometry, with increases in minimal and maximal elongation index and reductions in point of sickling. Increased Hb and reduced markers of haemolysis were also observed. CONCLUSION These findings suggest that voxelotor treatment is associated with reduced RBC sickling and haemolysis in children with SCD.
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Affiliation(s)
- Satheesh Chonat
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
| | - Earl Fields
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
| | - Hannah Baratz
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
| | - Amanda Watt
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
| | | | | | | | - Clark Brown
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
- Present address:
Pfizer IncNew YorkNew YorkUSA
| | - David Archer
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
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Rab MAE, Kanne CK, Boisson C, Bos J, van Oirschot BA, Houwing ME, Renoux C, Bartels M, Rijneveld AW, Nur E, Cnossen MH, Joly P, Nader E, Fort R, Connes P, van Wijk R, Sheehan VA, van Beers EJ. Oxygen gradient ektacytometry-derived biomarkers are associated with acute complications in sickle cell disease. Blood Adv 2024; 8:276-286. [PMID: 37976458 PMCID: PMC10824684 DOI: 10.1182/bloodadvances.2023011013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/26/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
ABSTRACT We investigated the potential of the point of sickling (PoS; the pO2 tension at which red cells start to sickle), determined by oxygen gradient ektacytometry to serve as a biomarker associated with the incidence of acute sickle cell disease-related complications in 177 children and 50 adults. In the pediatric cohort, for every 10 mmHg increase in PoS reflecting a greater likelihood of sickling, the likelihood of an individual experiencing >1 type of acute complication increased; the adjusted odds ratio (aOR) was 1.65. For every 0.1 increase in minimum elongation index (EImin; reflecting improved red blood cell deformability at hypoxia), the aOR was 0.50. In the adult cohort, for every 10 mmHg increase in PoS, we found an aOR of 3.00, although this was not significant after correcting for multiple testing. There was a trend for an association between higher PoS and greater likelihood of vaso-occlusive episodes (VOEs; children aOR, 1.35; adults aOR, 2.22). In children, only EImin was associated with VOEs (aOR, 0.68). When data of both cohorts were pooled, significant associations with PoS and/or EImin were found for all acute complications, independently and when >1 type of acute complication was assessed. These findings indicate that oxygen gradient ektacytometry generates novel biomarkers and provides a rationale for further development of these biomarkers in the assessment of clinical severity, evaluation of novel therapies, and as surrogate clinical trial end points. These biomarkers may be useful in assessing efficacy of novel therapies like pyruvate kinase activators, voxelotor, and L-glutamine.
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Affiliation(s)
- Minke A. E. Rab
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Celeste K. Kanne
- Department of Pediatrics Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Camille Boisson
- Laboratory LIBM EA7424, University of Lyon 1, “Vascular Biology and Red Blood Cell” team, Lyon, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Jennifer Bos
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Brigitte A. van Oirschot
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maite E. Houwing
- Department of Pediatric Hematology and Oncology, Erasmus Medical Center Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Céline Renoux
- Laboratory LIBM EA7424, University of Lyon 1, “Vascular Biology and Red Blood Cell” team, Lyon, France
- Laboratory of Excellence GR-Ex, Paris, France
- Laboratory of Biochemistry and Molecular Biology, UF Biochemistry of Red Blood Cell Diseases, Est Center of Biology and Pathology, Hospices Civils de Lyon, Lyon, France
| | - Marije Bartels
- Van Creveldkliniek, Divison of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anita W. Rijneveld
- Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam University Medical Center, The Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric Hematology and Oncology, Erasmus Medical Center Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Philippe Joly
- Laboratory LIBM EA7424, University of Lyon 1, “Vascular Biology and Red Blood Cell” team, Lyon, France
- Laboratory of Excellence GR-Ex, Paris, France
- Laboratory of Biochemistry and Molecular Biology, UF Biochemistry of Red Blood Cell Diseases, Est Center of Biology and Pathology, Hospices Civils de Lyon, Lyon, France
| | - Elie Nader
- Laboratory LIBM EA7424, University of Lyon 1, “Vascular Biology and Red Blood Cell” team, Lyon, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Romain Fort
- Laboratory LIBM EA7424, University of Lyon 1, “Vascular Biology and Red Blood Cell” team, Lyon, France
- Laboratory of Excellence GR-Ex, Paris, France
- Department of Internal Medicine, Hospices Civils de Lyon, Lyon, France
| | - Philippe Connes
- Laboratory LIBM EA7424, University of Lyon 1, “Vascular Biology and Red Blood Cell” team, Lyon, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Richard van Wijk
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Vivien A. Sheehan
- Department of Pediatrics Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Eduard J. van Beers
- Van Creveldkliniek, Divison of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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7
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van Dijk MJ, Rab MAE, van Oirschot BA, Bos J, Derichs C, Rijneveld AW, Cnossen MH, Nur E, Biemond BJ, Bartels M, Jans JJM, van Solinge WW, Schutgens REG, van Wijk R, van Beers EJ. One-year safety and efficacy of mitapivat in sickle cell disease: follow-up results of a phase 2, open-label study. Blood Adv 2023; 7:7539-7550. [PMID: 37934880 PMCID: PMC10761354 DOI: 10.1182/bloodadvances.2023011477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/20/2023] [Accepted: 10/12/2023] [Indexed: 11/09/2023] Open
Abstract
Targeting the primary pathogenic event of sickle cell disease (SCD), the polymerization of sickle hemoglobin (HbS), may prevent downstream clinical events. Mitapivat, an oral pyruvate kinase (PK) activator, has therapeutic potential by increasing adenosine triphosphate (ATP) and decreasing 2,3-diphosphoglycerate (2,3-DPG), a glycolytic red blood cell (RBC) intermediate. In the previously reported 8-week dose-finding period of this phase 2, investigator-initiated, open-label study, mitapivat was well tolerated and showed efficacy in SCD. Here, the 1-year fixed-dose extension period is reported in which 9 of 10 included patients (90%) aged ≥16 years with SCD (HbSS, HbS/β0, or HbS/β+) continued with mitapivat. Mostly mild treatment-emergent adverse events (AEs) (most commonly, transaminase increase and headache) were still reported. Apart from the reported nontreatment-related serious AE (SAE) of a urinary tract infection in the dose-finding period, 1 nontreatment-related SAE occurred in the fixed-dose extension period in a patient who died of massive pulmonary embolism due to COVID-19. Importantly, sustained improvement in Hb level (mean increase, 1.1 ± 0.7 g/dL; P = .0014) was seen, which was accompanied by decreases in markers of hemolysis. In addition, the annualized rate of vaso-occlusive events reduced significantly from a historic baseline of 1.33 ± 1.32 to 0.64 ± 0.87 (P = .0489) when combining the dose-finding period and fixed-dose extension period. Cellularly, the ATP:2,3-DPG ratio and Hb-oxygen affinity significantly increased and RBC sickling (point of sickling) nonsignificantly reduced. Overall, this study demonstrated 1-year safety and efficacy of treatment with mitapivat in SCD, supporting further evaluation in ongoing phase 2/3 study (RISE UP, NCT05031780). This trial was registered at https://www.clinicaltrialsregister.eu/ as NL8517 and EudraCT 2019-003438-18.
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Affiliation(s)
- Myrthe J. van Dijk
- Center for Benign Hematology, Thrombosis and Hemostasis - Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Minke A. E. Rab
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Brigitte A. van Oirschot
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jennifer Bos
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cleo Derichs
- Center for Benign Hematology, Thrombosis and Hemostasis - Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anita W. Rijneveld
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric Hematology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research, Amsterdam, The Netherlands
| | - Bart J. Biemond
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marije Bartels
- Center for Benign Hematology, Thrombosis and Hemostasis - Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Judith J. M. Jans
- Section Metabolic Diagnostics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wouter W. van Solinge
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roger E. G. Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis - Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Richard van Wijk
- Department of Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eduard J. van Beers
- Center for Benign Hematology, Thrombosis and Hemostasis - Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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D'Alessandro A, Nouraie SM, Zhang Y, Cendali F, Gamboni F, Reisz JA, Zhang X, Bartsch KW, Galbraith MD, Espinosa JM, Gordeuk VR, Gladwin MT. Metabolic signatures of cardiorenal dysfunction in plasma from sickle cell patients as a function of therapeutic transfusion and hydroxyurea treatment. Haematologica 2023; 108:3418-3432. [PMID: 37439373 PMCID: PMC10690926 DOI: 10.3324/haematol.2023.283288] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023] Open
Abstract
Metabolomics studies in sickle cell disease (SCD) have been so far limited to tens of samples, owing to technical and experimental limitations. To overcome these limitations, we performed plasma metabolomics analyses on 596 samples from patients with SCD enrolled in the WALK-PHaSST study (clinicaltrials gov. Identifier: NCT00492531). Clinical covariates informed the biological interpretation of metabolomics data, including genotypes (hemoglobin [Hb] SS, hemoglobin SC), history of recent transfusion (HbA%), response to hydroxyurea treatment (fetal Hb%). We investigated metabolic correlates to the degree of intravascular hemolysis, cardiorenal function, as determined by tricuspid regurgitation velocity (TRV), estimated glomerular filtration rate (eGFR), and overall hazard ratio (unadjusted or adjusted by age). Recent transfusion events or hydroxyurea treatment were associated with elevation in plasma-free fatty acids and decreases in acyl-carnitines, urate, kynurenine, indoles, carboxylic acids, and glycine- or taurine-conjugated bile acids. High levels of these metabolites, along with low levels of plasma S1P and L-arginine were identified as top markers of hemolysis, cardiorenal function (TRV, eGFR), and overall hazard ratio. We thus uploaded all omics and clinical data on a novel online portal that we used to identify a potential mechanism of dysregulated red cell S1P synthesis and export as a contributor to the more severe clinical manifestations in patients with the SS genotype compared to SC. In conclusion, plasma metabolic signatures - including low S1P, arginine and elevated kynurenine, acyl-carnitines and bile acids - are associated with clinical manifestation and therapeutic efficacy in SCD patients, suggesting new avenues for metabolic interventions in this patient population.
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Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA; Department of Medicine - Division of Hematology, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO.
| | - S Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Yingze Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Francesca Cendali
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO
| | - Fabia Gamboni
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO
| | - Julie A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO
| | - Xu Zhang
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Kyle W Bartsch
- Linda Crnic Institute for Down Syndrome, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA; Department of Pharmacology, University of Colorado Anschutz Medical Campus
| | - Matthew D Galbraith
- Linda Crnic Institute for Down Syndrome, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA; Department of Pharmacology, University of Colorado Anschutz Medical Campus
| | - Joaquin M Espinosa
- Linda Crnic Institute for Down Syndrome, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA; Department of Pharmacology, University of Colorado Anschutz Medical Campus; School of Medicine Information Services, University of Colorado Anschutz Medical Campus
| | - Victor R Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Mark T Gladwin
- University of Maryland School of Medicine, University of Maryland, Baltimore, MD.
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9
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Joly P, Nader E, Ketels F, Boisson C, Carin R, Renoux C, Gauthier A, Poutrel S, Bertrand Y, Connes P. Effects of pyruvate kinase activators on red blood cell properties in sickle cell disease. Br J Haematol 2023; 202:e27-e30. [PMID: 37278058 DOI: 10.1111/bjh.18916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Philippe Joly
- Laboratoire de Biochimie et de Biologie Moléculaire, UF de Biochimie des Pathologies Erythrocytaires, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
- Laboratoire interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Universié Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Elie Nader
- Laboratoire interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Universié Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Flora Ketels
- Laboratoire interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Universié Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Camille Boisson
- Laboratoire de Biochimie et de Biologie Moléculaire, UF de Biochimie des Pathologies Erythrocytaires, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
- Laboratoire interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Universié Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Romain Carin
- Laboratoire interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Universié Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Céline Renoux
- Laboratoire de Biochimie et de Biologie Moléculaire, UF de Biochimie des Pathologies Erythrocytaires, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
- Laboratoire interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Universié Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Alexandra Gauthier
- Laboratoire interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Universié Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
- Institut d'Hématologique et d'Oncologique Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Solene Poutrel
- Laboratoire interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Universié Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
- Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Yves Bertrand
- Institut d'Hématologique et d'Oncologique Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Philippe Connes
- Laboratoire interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Universié Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
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10
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D'Alessandro A, Nouraie SM, Zhang Y, Cendali F, Gamboni F, Reisz JA, Zhang X, Bartsch KW, Galbraith MD, Espinosa JM, Gordeuk VR, Gladwin MT. Metabolic signatures of cardiorenal dysfunction in plasma from sickle cell patients, as a function of therapeutic transfusion and hydroxyurea treatment. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.05.535693. [PMID: 37066337 PMCID: PMC10104066 DOI: 10.1101/2023.04.05.535693] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Metabolomics studies in sickle cell disease (SCD) have been so far limited to tens of samples, owing to technical and experimental limitations. To overcome these limitations, we performed plasma metabolomics analyses on 596 samples from patients with sickle cell sickle cell disease (SCD) enrolled in the WALK-PHaSST study. Clinical covariates informed the biological interpretation of metabolomics data, including genotypes (hemoglobin SS, hemoglobin SC), history of recent transfusion (HbA%), response to hydroxyurea treatment (HbF%). We investigated metabolic correlates to the degree of hemolysis, cardiorenal function, as determined by tricuspid regurgitation velocity (TRV), estimated glomerular filtration rate (eGFR), and overall hazard ratio (unadjusted or adjusted by age). Recent transfusion events or hydroxyurea treatment were associated with elevation in plasma free fatty acids and decreases in acyl-carnitines, urate, kynurenine, indoles, carboxylic acids, and glycine- or taurine-conjugated bile acids. High levels of these metabolites, along with low levels of plasma S1P and L-arginine were identified as top markers of hemolysis, cardiorenal function (TRV, eGFR), and overall hazard ratio. We thus uploaded all omics and clinical data on a novel online portal that we used to identify a potential mechanism of dysregulated red cell S1P synthesis and export as a contributor to the more severe clinical manifestations in patients with the SS genotype compared to SC. In conclusion, plasma metabolic signatures - including low S1P, arginine and elevated kynurenine, acyl-carnitines and bile acids - are associated with clinical manifestation and therapeutic efficacy in SCD patients, suggesting new avenues for metabolic interventions in this patient population.
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11
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Cremonesi F, Planat V, Kalokyri V, Kondylakis H, Sanavia T, Miguel Mateos Resinas V, Singh B, Uribe S. The need for multimodal health data modeling: a practical approach for a federated-learning healthcare platform. J Biomed Inform 2023; 141:104338. [PMID: 37023843 DOI: 10.1016/j.jbi.2023.104338] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 04/08/2023]
Abstract
Federated learning initiatives in healthcare are being developed to collaboratively train predictive models without the need to centralize sensitive personal data. GenoMed4All is one such project, with the goal of connecting European clinical and -omics data repositories on rare diseases through a federated learning platform. Currently, the consortium faces the challenge of a lack of well-established international datasets and interoperability standards for federated learning applications on rare diseases. This paper presents our practical approach to select and implement a Common Data Model (CDM) suitable for the federated training of predictive models applied to the medical domain, during the initial design phase of our federated learning platform. We describe our selection process, composed of identifying the consortium's needs, reviewing our functional and technical architecture specifications, and extracting a list of business requirements. We review the state of the art and evaluate three widely-used approaches (FHIR, OMOP and Phenopackets) based on a checklist of requirements and specifications. We discuss the pros and cons of each approach considering the use cases specific to our consortium as well as the generic issues of implementing a European federated learning healthcare platform. A list of lessons learned from the experience in our consortium is discussed, from the importance of establishing the proper communication channels for all stakeholders to technical aspects related to -omics data. For federated learning projects focused on secondary use of health data for predictive modeling, encompassing multiple data modalities, a phase of data model convergence is sorely needed to gather different data representations developed in the context of medical research, interoperability of clinical care software, imaging, and -omics analysis into a coherent, unified data model. Our work identifies this need and presents our experience and a list of actionable lessons learned for future work in this direction.
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Affiliation(s)
- Francesco Cremonesi
- Université Côte d'Azur, Inria Sophia Antipolis-Méditeranée, Epione Research Project, France AND Datawizard S.r.l, Rome, Italy.
| | | | - Varvara Kalokyri
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Crete, Greece
| | - Haridimos Kondylakis
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Crete, Greece
| | - Tiziana Sanavia
- Department of Medical Sciences, University of Torino, Torino, Italy
| | | | - Babita Singh
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Silvia Uribe
- Escuela Técnica Superior de Ingeniería de Sistemas Informáticos, Universidad Politécnica de Madrid, Madrid, Spain
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12
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Darrin M, Samudre A, Sahun M, Atwell S, Badens C, Charrier A, Helfer E, Viallat A, Cohen-Addad V, Giffard-Roisin S. Classification of red cell dynamics with convolutional and recurrent neural networks: a sickle cell disease case study. Sci Rep 2023; 13:745. [PMID: 36639503 PMCID: PMC9839696 DOI: 10.1038/s41598-023-27718-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
The fraction of red blood cells adopting a specific motion under low shear flow is a promising inexpensive marker for monitoring the clinical status of patients with sickle cell disease. Its high-throughput measurement relies on the video analysis of thousands of cell motions for each blood sample to eliminate a large majority of unreliable samples (out of focus or overlapping cells) and discriminate between tank-treading and flipping motion, characterizing highly and poorly deformable cells respectively. Moreover, these videos are of different durations (from 6 to more than 100 frames). We present a two-stage end-to-end machine learning pipeline able to automatically classify cell motions in videos with a high class imbalance. By extending, comparing, and combining two state-of-the-art methods, a convolutional neural network (CNN) model and a recurrent CNN, we are able to automatically discard 97% of the unreliable cell sequences (first stage) and classify highly and poorly deformable red cell sequences with 97% accuracy and an F1-score of 0.94 (second stage). Dataset and codes are publicly released for the community.
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Affiliation(s)
| | | | - Maxime Sahun
- Aix Marseille Univ, CNRS, CINAM, Marseille, France
| | - Scott Atwell
- Aix Marseille Univ, CNRS, CINAM, Marseille, France
| | - Catherine Badens
- Aix Marseille University, INSERM, Marseille Medical Genetics (MMG), 13005, Marseille, France
| | | | | | | | | | - Sophie Giffard-Roisin
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, IRD, IFSTTAR, ISTerre, Grenoble, France.
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13
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Using Transfer Learning to Train a Binary Classifier for Lorrca Ektacytometery Microscopic Images of Sickle Cells and Healthy Red Blood Cells. DATA 2022. [DOI: 10.3390/data7090126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Multiple blood images of stressed and sheared cells, taken by a Lorrca Ektacytometery microscope, needed a classification for biomedical researchers to assess several treatment options for blood-related diseases. The study proposes the design of a model capable of classifying these images, with high accuracy, into healthy Red Blood Cells (RBCs) or Sickle Cells (SCs) images. The performances of five Deep Learning (DL) models with two different optimizers, namely Adam and Stochastic Gradient Descent (SGD), were compared. The first three models consisted of 1, 2 and 3 blocks of CNN, respectively, and the last two models used a transfer learning approach to extract features. The dataset was first augmented, scaled, and then trained to develop models. The performance of the models was evaluated by testing on new images and was illustrated by confusion matrices, performance metrics (accuracy, recall, precision and f1 score), a receiver operating characteristic (ROC) curve and the area under the curve (AUC) value. The first, second and third models with the Adam optimizer could not achieve training, validation or testing accuracy above 50%. However, the second and third models with SGD optimizers showed good loss and accuracy scores during training and validation, but the testing accuracy did not exceed 51%. The fourth and fifth models used VGG16 and Resnet50 pre-trained models for feature extraction, respectively. VGG16 performed better than Resnet50, scoring 98% accuracy and an AUC of 0.98 with both optimizers. The study suggests that transfer learning with the VGG16 model helped to extract features from images for the classification of healthy RBCs and SCs, thus making a significant difference in performance comparing the first, second, third and fifth models.
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14
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Man Y, An R, Monchamp K, Sekyonda Z, Kucukal E, Federici C, Wulftange WJ, Goreke U, Bode A, Sheehan VA, Gurkan UA. OcclusionChip: A functional microcapillary occlusion assay complementary to ektacytometry for detection of small-fraction red blood cells with abnormal deformability. Front Physiol 2022; 13:954106. [PMID: 36091387 PMCID: PMC9452903 DOI: 10.3389/fphys.2022.954106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
Red blood cell (RBC) deformability is a valuable hemorheological biomarker that can be used to assess the clinical status and response to therapy of individuals with sickle cell disease (SCD). RBC deformability has been measured by ektacytometry for decades, which uses shear or osmolar stress. However, ektacytometry is a population based measurement that does not detect small-fractions of abnormal RBCs. A single cell-based, functional RBC deformability assay would complement ektacytometry and provide additional information. Here, we tested the relative merits of the OcclusionChip, which measures RBC deformability by microcapillary occlusion, and ektacytometry. We tested samples containing glutaraldehyde-stiffened RBCs for up to 1% volume fraction; ektacytometry detected no significant change in Elongation Index (EI), while the OcclusionChip showed significant differences in Occlusion Index (OI). OcclusionChip detected a significant increase in OI in RBCs from an individual with sickle cell trait (SCT) and from a subject with SCD who received allogeneic hematopoietic stem cell transplant (HSCT), as the sample was taken from normoxic (pO2:159 mmHg) to physiologic hypoxic (pO2:45 mmHg) conditions. Oxygen gradient ektacytometry detected no difference in EI for SCT or HSCT. These results suggest that the single cell-based OcclusionChip enables detection of sickle hemoglobin (HbS)-related RBC abnormalities in SCT and SCD, particularly when the HbS level is low. We conclude that the OcclusionChip is complementary to the population based ektacytometry assays, and providing additional sensitivity and capacity to detect modest abnormalities in red cell function or small populations of abnormal red cells.
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Affiliation(s)
- Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Karamoja Monchamp
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
- Division of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Zoe Sekyonda
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Chiara Federici
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
- Division of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - William J. Wulftange
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
- Division of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Vivien A. Sheehan
- Aflac Cancer & Blood Disorders Center Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States
- *Correspondence: Umut A. Gurkan,
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15
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The oral ferroportin inhibitor vamifeport improves hemodynamics in a mouse model of sickle cell disease. Blood 2022; 140:769-781. [PMID: 35714304 PMCID: PMC9389634 DOI: 10.1182/blood.2021014716] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited hemolytic anemia caused by a single point mutation in the β-globin gene of hemoglobin that leads to synthesis of sickle hemoglobin (HbS) in red blood cells (RBCs). HbS polymerizes in hypoxic conditions, leading to intravascular hemolysis, release of free hemoglobin and heme, and increased adhesion of blood cells to the endothelial vasculature, which causes painful vaso-occlusion and organ damage. HbS polymerization kinetics are strongly dependent on the intracellular HbS concentration; a relatively small reduction in cellular HbS concentration may prevent HbS polymerization and its sequelae. We hypothesized that iron restriction via blocking ferroportin, the unique iron transporter in mammals, might reduce HbS concentration in RBCs, thereby decreasing hemolysis, improving blood flow, and preventing vaso-occlusive events. Indeed, vamifeport (also known as VIT-2763), a clinical-stage oral ferroportin inhibitor, reduced hemolysis markers in the Townes model of SCD. The RBC indices of vamifeport-treated male and female Townes mice exhibited changes attributable to iron-restricted erythropoiesis: decreased corpuscular hemoglobin concentration mean and mean corpuscular volume, as well as increased hypochromic and microcytic RBC fractions. Furthermore, vamifeport reduced plasma soluble VCAM-1 concentrations, which suggests lowered vascular inflammation. Accordingly, intravital video microscopy of fluorescently labeled blood cells in the microvasculature of Townes mice treated with vamifeport revealed diminished adhesion to the endothelium and improved hemodynamics. These preclinical data provide a strong proof-of-concept for vamifeport in the Townes model of SCD and support further development of this compound as a potential novel therapy in SCD.
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16
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Azul M, Vital EF, Lam WA, Wood DK, Beckman JD. Microfluidic methods to advance mechanistic understanding and translational research in sickle cell disease. Transl Res 2022; 246:1-14. [PMID: 35354090 PMCID: PMC9218997 DOI: 10.1016/j.trsl.2022.03.010] [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: 05/04/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/15/2022]
Abstract
Sickle cell disease (SCD) is caused by a single point mutation in the β-globin gene of hemoglobin, which produces an altered sickle hemoglobin (HbS). The ability of HbS to polymerize under deoxygenated conditions gives rise to chronic hemolysis, oxidative stress, inflammation, and vaso-occlusion. Herein, we review recent findings using microfluidic technologies that have elucidated mechanisms of oxygen-dependent and -independent induction of HbS polymerization and how these mechanisms elicit the biophysical and inflammatory consequences in SCD pathophysiology. We also discuss how validation and use of microfluidics in SCD provides the opportunity to advance development of numerous therapeutic strategies, including curative gene therapies.
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Affiliation(s)
- Melissa Azul
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Eudorah F Vital
- Wallace H. Coulter Department of Biomedical Engineering and Institute for Electronics and Nanotechnology, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Wilbur A Lam
- Wallace H. Coulter Department of Biomedical Engineering and Institute for Electronics and Nanotechnology, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - David K Wood
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Joan D Beckman
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota.
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17
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van Dijk MJ, Rab MAE, van Oirschot BA, Bos J, Derichs C, Rijneveld AW, Cnossen MH, Nur E, Biemond BJ, Bartels M, Jans JJM, van Solinge WW, Schutgens REG, van Wijk R, van Beers EJ. Safety and efficacy of mitapivat, an oral pyruvate kinase activator, in sickle cell disease: A phase 2, open-label study. Am J Hematol 2022; 97:E226-E229. [PMID: 35384026 DOI: 10.1002/ajh.26554] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Myrthe J. van Dijk
- Center for Benign Hematology, Thrombosis and Hemostasis ‐ Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
- Department of Central Diagnostic Laboratory – Research University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Minke A. E. Rab
- Department of Central Diagnostic Laboratory – Research University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
- Department of Hematology University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Brigitte A. van Oirschot
- Department of Central Diagnostic Laboratory – Research University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Jennifer Bos
- Department of Central Diagnostic Laboratory – Research University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Cleo Derichs
- Center for Benign Hematology, Thrombosis and Hemostasis ‐ Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Anita W. Rijneveld
- Department of Hematology Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric Hematology Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Erfan Nur
- Department of Hematology Amsterdam University Medical Center Amsterdam The Netherlands
- Department of Blood Cell Research Sanquin Research Amsterdam The Netherlands
| | - Bart J. Biemond
- Department of Hematology Amsterdam University Medical Center Amsterdam The Netherlands
| | - Marije Bartels
- Center for Benign Hematology, Thrombosis and Hemostasis ‐ Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Judith J. M. Jans
- Section Metabolic Diagnostics Department of Genetics, University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Wouter W. van Solinge
- Department of Central Diagnostic Laboratory – Research University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Roger E. G. Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis ‐ Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Richard van Wijk
- Department of Central Diagnostic Laboratory – Research University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Eduard J. van Beers
- Center for Benign Hematology, Thrombosis and Hemostasis ‐ Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
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18
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Hypoxia and hemorheological properties in older individuals. Ageing Res Rev 2022; 79:101650. [PMID: 35597435 DOI: 10.1016/j.arr.2022.101650] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 12/17/2022]
Abstract
Hypoxia is caused by insufficient oxygen availability for the organism leading to reduced oxygen delivery to tissues and cells. It has been regarded as a severe threat to human health and it is indeed implicated in pathophysiological mechanisms involved in the development and progression of many diseases. Nevertheless, the potential of controlled hypoxia interventions (i.e. hypoxia conditioning) for improving cardio-vascular health is gaining increased attention. However, blood rheology is often a forgotten factor for vascular health while aging and hypoxia exposure are both suspected to alter hemorheological properties. These changes in blood rheology may influence the benefits-risks balance of hypoxia exposure in older individuals. The benefits of hypoxia exposure for vascular health are mainly reported for healthy populations and the combined impact of aging and hypoxia on blood rheology could therefore be deleterious in older individuals. This review discusses evidence of hypoxia-related and aging-related changes in blood viscosity and its determinants. It draws upon an extensive literature search on the effects of hypoxia/altitude and aging on blood rheology. Aging increases blood viscosity mainly through a rise in plasma viscosity, red blood cell (RBC) aggregation and a decrease in RBC deformability. Hypoxia also causes an increase in RBC aggregation and plasma viscosity. In addition, hypoxia exposure may increase hematocrit and modulate RBC deformability, depending on the hypoxic dose, i.e, beneficial effect of intermittent hypoxia with moderate dose vs deleterious effect of chronic continuous or intermittent hypoxia or if the hypoxic dose is too high. Special attention is directed toward the risks vs. benefits of hemorheological changes during hypoxia exposure in older individuals, and its clinical relevance for vascular disorders.
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19
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Franck P, Buijs P, Meenhuis A, Dane M, Postma C, Spaans A, Gijsbertha N, Kuypers FA, Hudig C, Kerkhoffs JL. The ektacytometric elongation Index (EI) of erythrocytes, validation of a prognostic, rheological biomarker for patients with sickle cell disease. Eur J Haematol Suppl 2022; 108:413-422. [PMID: 35088912 DOI: 10.1111/ejh.13748] [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: 10/01/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Validation of the measurement of erythrocyte deformability as a useful prognostic, rheological biomarker for patients with sickle cell disease (SCD). METHODS The degree of reduced deformability was based on the value of the maximum elongation index (EImax ) of the deformability curve of an osmotic gradient ektacytometer. The performance of this technique was analytically and clinically validated by analysing 200 normal subjects and 100 patients with well-documented thalassemia's and Hb variants in relation to their clinical condition. RESULTS In this study, we show that EImax is a reproducible parameter with a small inter-individual coefficient of (Biological) variation (CV)=1.6% and a small intra-individual CV=3.5%. We demonstrate that loss of deformability correlates with the clinical condition and the various mutations underlying sickle cell disease and thalassemia. For SCD patients, a strongly reduced EImax with a cut-off =0.360 is a signal for future vaso-occlusive (VOC) events requiring hospitalisation with a specificity=85%, sensitivity=80%, PPV=81% and NPV=84% based on a ROC curve (AUC=0.89). CONCLUSION This study validated the clinical utility of EImax as a prognostic marker for future clinical problems in individual high-risk SCD patients. In addition, EImax may help to achieve an adequate personal transfusion policy for an optimal blood flow in anaemic patients with SCD.
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Affiliation(s)
- Paul Franck
- Laboratory of Clinical Chemistry and Hematology, LabWest / Haga Teaching Hospital, The Hague, The Netherlands
| | - Petra Buijs
- Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Annemarie Meenhuis
- Laboratory of Clinical Chemistry and Hematology, Tergooi Medical Centre, Hilversum, The Netherlands
| | - Martijn Dane
- Laboratory of Clinical Chemistry and Hematology, LabWest / Haga Teaching Hospital, The Hague, The Netherlands
| | - Cobie Postma
- Laboratory of Clinical Chemistry and Hematology, LabWest / Haga Teaching Hospital, The Hague, The Netherlands
| | - Anja Spaans
- Laboratory of Clinical Chemistry and Hematology, LabWest / Haga Teaching Hospital, The Hague, The Netherlands
| | | | - Frans A Kuypers
- Division of Hematology, Department of Pediatrics, University of California, San Francisco, USA
| | - Cisca Hudig
- Laboratory of Clinical Chemistry and Hematology, LabWest / Haga Teaching Hospital, The Hague, The Netherlands
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20
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Matthews K, Lamoureux ES, Myrand-Lapierre ME, Duffy SP, Ma H. Technologies for measuring red blood cell deformability. LAB ON A CHIP 2022; 22:1254-1274. [PMID: 35266475 DOI: 10.1039/d1lc01058a] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Human red blood cells (RBCs) are approximately 8 μm in diameter, but must repeatedly deform through capillaries as small as 2 μm in order to deliver oxygen to all parts of the body. The loss of this capability is associated with the pathology of many diseases, and is therefore a potential biomarker for disease status and treatment efficacy. Measuring RBC deformability is a difficult problem because of the minute forces (∼pN) that must be exerted on these cells, as well as the requirements for throughput and multiplexing. The development of technologies for measuring RBC deformability date back to the 1960s with the development of micropipette aspiration, ektacytometry, and the cell transit analyzer. In the past 10 years, significant progress has been made using microfluidics by leveraging the ability to precisely control fluid flow through microstructures at the size scale of individual RBCs. These technologies have now surpassed traditional methods in terms of sensitivity, throughput, consistency, and ease of use. As a result, these efforts are beginning to move beyond feasibility studies and into applications to enable biomedical discoveries. In this review, we provide an overview of both traditional and microfluidic techniques for measuring RBC deformability. We discuss the capabilities of each technique and compare their sensitivity, throughput, and robustness in measuring bulk and single-cell RBC deformability. Finally, we discuss how these tools could be used to measure changes in RBC deformability in the context of various applications including pathologies caused by malaria and hemoglobinopathies, as well as degradation during storage in blood bags prior to blood transfusions.
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Affiliation(s)
- Kerryn Matthews
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada.
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Erik S Lamoureux
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada.
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Marie-Eve Myrand-Lapierre
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada.
| | - Simon P Duffy
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
- British Columbia Institute of Technology, Vancouver, BC, Canada
| | - Hongshen Ma
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada.
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
- Department of Urologic Science, University of British Columbia, Vancouver, BC, Canada
- Vancouver Prostate Centre, Vancouver General Hospital, Vancouver, BC, Canada
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21
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Kang YJ. Assessment of Blood Biophysical Properties Using Pressure Sensing with Micropump and Microfluidic Comparator. MICROMACHINES 2022; 13:438. [PMID: 35334730 PMCID: PMC8949505 DOI: 10.3390/mi13030438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 12/04/2022]
Abstract
To identify the biophysical properties of blood samples consistently, macroscopic pumps have been used to maintain constant flow rates in a microfluidic comparator. In this study, the bulk-sized and expensive pump is replaced with a cheap and portable micropump. A specific reference fluid (i.e., glycerin solution [40%]) with a small volume of red blood cell (RBC) (i.e., 1% volume fraction) as fluid tracers is supplied into the microfluidic comparator. An averaged velocity () obtained with micro-particle image velocimetry is converted into the flow rate of reference fluid (Qr) (i.e., Qr = CQ × Ac × , Ac: cross-sectional area, CQ = 1.156). Two control variables of the micropump (i.e., frequency: 400 Hz and volt: 150 au) are selected to guarantee a consistent flow rate (i.e., COV < 1%). Simultaneously, the blood sample is supplied into the microfluidic channel under specific flow patterns (i.e., constant, sinusoidal, and periodic on-off fashion). By monitoring the interface in the comparator as well as Qr, three biophysical properties (i.e., viscosity, junction pressure, and pressure-induced work) are obtained using analytical expressions derived with a discrete fluidic circuit model. According to the quantitative comparison results between the present method (i.e., micropump) and the previous method (i.e., syringe pump), the micropump provides consistent results when compared with the syringe pump. Thereafter, representative biophysical properties, including the RBC aggregation, are consistently obtained for specific blood samples prepared with dextran solutions ranging from 0 to 40 mg/mL. In conclusion, the present method could be considered as an effective method for quantifying the physical properties of blood samples, where the reference fluid is supplied with a cheap and portable micropump.
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Affiliation(s)
- Yang Jun Kang
- Department of Mechanical Engineering, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea
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22
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Sheehan VA, van Beers EJ, Connes P, van Wijk R, Rab MAE. Comment on: Oxygen gradient ektacytometry does not predict pain in children with sickle cell anaemia. Br J Haematol 2022; 197:e61-e62. [PMID: 35141896 PMCID: PMC9304313 DOI: 10.1111/bjh.18069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Vivien A Sheehan
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Eduard J van Beers
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philippe Connes
- Laboratory LIBM EA7424, "Vascular Biology and Red Blood Cell" Team, University of Lyon 1, Lyon, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Richard van Wijk
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Minke A E Rab
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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23
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Shear-Stress-Gradient and Oxygen-Gradient Ektacytometry in Sickle Cell Patients at Steady State and during Vaso-Occlusive Crises. Cells 2022; 11:cells11030585. [PMID: 35159394 PMCID: PMC8834105 DOI: 10.3390/cells11030585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 12/02/2022] Open
Abstract
Oxygen gradient ektacytometry (oxygenscan) measures the changes in red blood cell (RBC) deformability in normoxia and during deoxygenation. We investigated the changes in RBC deformability, measured by both oxygenscan and classical shear-stress-gradient ektacytometry, in 10 patients with sickle cell disease (SCD) during vaso-occlusive crisis (VOC) versus steady state. Oxygenscan and shear-stress-gradient ektacytometry parameters were also measured in 38 SCD patients at steady state on two different occasions. Shear-stress-gradient ektacytometry parameters, maximal RBC deformability at normoxia and the minimum RBC deformability during deoxygenation were lower during VOC compared to steady state. The oxygen partial pressure at which RBCs started to sickle (PoS) was not significantly affected by VOC, but the results were very heterogeneous: the PoS increased in 5 in 10 patients and decreased in 4 in 10 patients. Both oxygenscan and shear-stress-gradient ektacytometry parameters remained unchanged in patients at steady state between two sets of measurements, performed at 17 ± 8 months intervals. In conclusion, the present study showed that both oxygen gradient ektacytometry and shear-stress-gradient ektacytometry are sensitive to disease activity in SCD, and that both techniques give comparable results; however, the oxygen-dependent propensity of RBCs to sickle was highly variable during VOC.
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24
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Joly P, Boisson C, Renoux C, Caillat N, Robert M, Gauthier-Vasserot A, Poutrel S, Cibiel A, Nader E, Connes P. Determinants of the point of sickling measured by oxygen gradient ektacytometry in sickle cell anaemia. Br J Haematol 2022; 197:e56-e58. [PMID: 35106753 DOI: 10.1111/bjh.18043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/09/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Philippe Joly
- UF « Biochimie des pathologies érythrocytaires », Laboratoire de Biochimie et Biologie moléculaire Grand-Est, Groupement hospitalier Est, Hospices Civils de Lyon, Bron, France.,Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Camille Boisson
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Céline Renoux
- UF « Biochimie des pathologies érythrocytaires », Laboratoire de Biochimie et Biologie moléculaire Grand-Est, Groupement hospitalier Est, Hospices Civils de Lyon, Bron, France.,Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Noémie Caillat
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France
| | - Mélanie Robert
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Erytech Pharma, Lyon, France
| | - Alexandra Gauthier-Vasserot
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Solène Poutrel
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Elie Nader
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
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25
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Schroeder P, Fulzele K, Forsyth S, Ribadeneira MD, Guichard S, Wilker E, Marshall CG, Drake A, Fessler R, Konstantinidis DG, Seu KG, Kalfa TA. Etavopivat, a Pyruvate Kinase Activator in Red Blood Cells, for the Treatment of Sickle Cell Disease. J Pharmacol Exp Ther 2022; 380:210-219. [PMID: 35031585 DOI: 10.1124/jpet.121.000743] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022] Open
Abstract
Etavopivat is an investigational, oral, small molecule activator of erythrocyte pyruvate kinase (PKR) in development for the treatment of sickle cell disease (SCD) and other hemoglobinopathies. PKR activation is proposed to ameliorate the sickling of SCD red blood cells (RBC) through multiple mechanisms, including reduction of 2,3-diphosphoglycerate (2,3-DPG), which consequently increases hemoglobin (Hb)-oxygen affinity; increased binding of oxygen reduces HbS polymerization and sickling. In addition, PKR activation increases adenosine triphosphate (ATP) produced via glycolytic flux, which helps preserve membrane integrity and RBC deformability. We evaluated the pharmacodynamic response to etavopivat in non-human primates (NHP) and in healthy human subjects, and the effects in RBC from patients with SCD after ex vivo treatment with etavopivat. A single dose of etavopivat decreased 2,3-DPG in NHP and healthy subjects. Hb-oxygen affinity was significantly increased in healthy subjects after 24 hours. Following daily dosing of etavopivat over 5 consecutive days in NHP, ATP was increased by 38% from baseline. Etavopivat increased Hb-oxygen affinity and reduced sickling in RBC collected from SCD patients with either HbSS or HbSC disease. Collectively, these results demonstrate the ability of etavopivat to decrease 2,3-DPG and increase ATP, resulting in increased Hb-oxygen affinity and improved sickle RBC function. Etavopivat is currently being evaluated in clinical trials for the treatment of SCD. ClinicalTrials.gov identifier: NCT03815695 Significance Statement Etavopivat-a small molecule activator of the glycolytic enzyme erythrocyte pyruvate kinase -decreased 2,3-diphosphoglycerate in red blood cells (RBC) from non-human primates and healthy subjects and significantly increased hemoglobin (Hb)-oxygen affinity in healthy subjects. Using ex vivo RBC from donors with sickle cell disease (SCD) (HbSS or HbSC genotype), etavopivat increased Hb-oxygen affinity and reduced sickling under deoxygenation. Etavopivat shows promise as a treatment for SCD, that potentially might reduce vaso-occlusion and improve anemia.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rose Fessler
- Cincinnati Children's Hospital Medical Center, United States
| | | | - Katie G Seu
- Cincinnati Children's Hospital Medical Center, United States
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26
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Hequet O, Boisson C, Joly P, Revesz D, Kebaili K, Gauthier A, Renoux C, Creppy S, Nader E, Nicolas JF, Berard F, Cognasse F, Vocanson M, Bertrand Y, Connes P. Priming With Red Blood Cells Allows Red Blood Cell Exchange for Sickle Cell Disease in Low-Weight Children. Front Med (Lausanne) 2022; 8:743483. [PMID: 35004720 PMCID: PMC8729904 DOI: 10.3389/fmed.2021.743483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Red blood cell exchanges are frequently used to treat and prevent cerebrovascular complications in patients with sickle cell anemia (SCA). However, the low weight of young children represents serious concerns for this procedure. The Spectra Optia device can perform automatic priming using red blood cells (RBCs) (RCE/RBC-primed) which could allow RBC exchanges (RCE) to be performed in young children without hypovolemic complications, but this method requires evaluation. We prospectively analyzed the clinical safety of the RCE/RBC-primed procedure in 12 SCA low-weight children under either a chronic RCE program or emergency treatment over 65 sessions. We monitored grade 2 adverse events (AEs) such as a decrease in blood pressure, increase in heart rate, fainting sensation, or transfusion reactions and identified the critical times during the sessions in which AEs could occur. Post-apheresis hematocrit (Hct) and a fraction of cell remaining (FCR) values were compared to the expected values. We also compared the impact of automatic RCE (n = 7) vs. RCE/RBC-primed (n = 8) on blood viscosity and RBC rheology. A low incidence of complications was observed in the 65 RCE sessions with only seven episodes of transient grade 2 AEs. Post-apheresis Hct and FCR reached expected values with the RCE/RBC-primed method. Both the automatic and priming procedures improved RBC deformability and decreased the sickling tendency during deoxygenation. Blood rheological features improved in both RCE/RBC-primed and automatic RCE without priming conditions. The RCE/RBC-primed procedure provides blood rheological benefits, and is safe and efficient to treat, notably in young children with SCA in prophylactic programs or curatively when a SCA complication occurs.
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Affiliation(s)
- Olivier Hequet
- Etablissement Français du Sang Rhône Alpes, Apheresis Unit, Centre Hospitalier Lyon Sud, Lyon, France.,CIRI, International Center for Infectiology Research, INSERM U1111, Université de Lyon, Lyon, France
| | - Camille Boisson
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Lyon, France.,Laboratoire d'Excellence Sur le Globule Rouge (Labex GR-Ex), Paris, France.,Service de Biochimie et Biologie Moléculaire, Laboratoire de Biologie Médicale Multi-site, Hospices Civils de Lyon, Lyon, France
| | - Philippe Joly
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Lyon, France.,Laboratoire d'Excellence Sur le Globule Rouge (Labex GR-Ex), Paris, France.,Service de Biochimie et Biologie Moléculaire, Laboratoire de Biologie Médicale Multi-site, Hospices Civils de Lyon, Lyon, France
| | - Daniela Revesz
- Etablissement Français du Sang Rhône Alpes, Apheresis Unit, Centre Hospitalier Lyon Sud, Lyon, France
| | - Kamila Kebaili
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Lyon, France.,Laboratoire d'Excellence Sur le Globule Rouge (Labex GR-Ex), Paris, France.,Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Alexandra Gauthier
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Lyon, France.,Laboratoire d'Excellence Sur le Globule Rouge (Labex GR-Ex), Paris, France.,Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Celine Renoux
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Lyon, France.,Laboratoire d'Excellence Sur le Globule Rouge (Labex GR-Ex), Paris, France.,Service de Biochimie et Biologie Moléculaire, Laboratoire de Biologie Médicale Multi-site, Hospices Civils de Lyon, Lyon, France
| | - Severine Creppy
- Distribution Unit, Centre Hospitalier Edouard Herriot, Etablissement Français du Sang Auvergne Rhône Alpes, Lyon, France
| | - Elie Nader
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Lyon, France.,Laboratoire d'Excellence Sur le Globule Rouge (Labex GR-Ex), Paris, France
| | - Jean François Nicolas
- CIRI, International Center for Infectiology Research, INSERM U1111, Université de Lyon, Lyon, France.,Clinical Immunology and Allergology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Berard
- CIRI, International Center for Infectiology Research, INSERM U1111, Université de Lyon, Lyon, France.,Clinical Immunology and Allergology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Fabrice Cognasse
- Scientific Department, Etablissement Français du Sang Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Marc Vocanson
- CIRI, International Center for Infectiology Research, INSERM U1111, Université de Lyon, Lyon, France
| | - Yves Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Lyon, France.,Laboratoire d'Excellence Sur le Globule Rouge (Labex GR-Ex), Paris, France
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27
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Nardo-Marino A, Petersen J, Brewin JN, Birgens H, Williams TN, Kurtzhals JAL, Rees DC, Glenthøj A. Oxygen gradient ektacytometry does not predict pain in children with sickle cell anaemia. Br J Haematol 2021; 197:609-617. [PMID: 34859420 PMCID: PMC7613550 DOI: 10.1111/bjh.17975] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/15/2021] [Indexed: 01/29/2023]
Abstract
The loss of red blood cell (RBC) deformability in sickle cell anaemia (SCA) is considered the primary factor responsible for episodes of acute pain and downstream progressive organ dysfunction. Oxygen gradient ektacytometry (Oxygenscan) is a recently commercialised functional assay that aims to describe the deformability of RBCs in SCA at differing oxygen tensions. So far, the Oxygenscan has been evaluated only by a small number of research groups and the validity and clinical value of Oxygenscan-derived biomarkers have not yet been fully established. In this study we examined RBC deformability measured with the Oxygenscan in 91 children with SCA at King's College Hospital in London. We found a significant correlation between Oxygenscan-derived biomarkers and well-recognised modifiers of disease severity in SCA: haemoglobin F and co-inherited α-thalassaemia. We failed, however, to find any independent predictive value of the Oxygenscan in the clinical outcome measure of pain, as well as other important parameters such as hydroxycarbamide treatment. Although the Oxygenscan remains an intriguing tool for basic research, our results question whether it provides any additional information in predicting the clinical course in children with SCA, beyond measuring known markers of disease severity.
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Affiliation(s)
- Amina Nardo-Marino
- Department of Haematology, Centre for Haemoglobinopathies, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.,Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark.,Department of Haematological Medicine, King's College Hospital, London, United Kingdom.,School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Jesper Petersen
- Department of Haematology, Centre for Haemoglobinopathies, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - John N Brewin
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom.,School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Henrik Birgens
- Department of Haematology, Centre for Haemoglobinopathies, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Thomas N Williams
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Medicine, Imperial College London, London, United Kingdom
| | - Jørgen A L Kurtzhals
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - David C Rees
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom.,School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Andreas Glenthøj
- Department of Haematology, Centre for Haemoglobinopathies, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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28
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Venugopal J, Wang J, Guo C, Eitzman DT. Interleukin-1 receptor antagonism leads to improved anaemia in a murine model of sickle cell disease and is associated with reduced ex vivo platelet-mediated erythrocyte sickling. Br J Haematol 2021; 196:1040-1051. [PMID: 34786709 DOI: 10.1111/bjh.17941] [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: 06/02/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
Sickle cell disease (SCD) is associated with haemolytic anaemia and secondary activation of leucocytes and platelets, which in turn may further exacerbate haemolysis. As cytokine signalling pathways may participate in this cycle, the present study investigated whether pharmacological blockade of the interleukin-1 receptor (IL-1R) would mitigate anaemia in a murine model of SCD. Within 2 weeks of treatment, reduced markers of haemolysis were observed in anakinra-treated mice compared to vehicle-treated mice. After 4 weeks of anakinra treatment, mice showed increased numbers of erythrocytes, haemoglobin, and haematocrit, along with reduced reticulocytes. Blood from anakinra-treated mice was less susceptible to ex vivo erythrocyte sickling and was resistant to exogenous IL-1β-mediated sickling. Supernatant generated from IL-1β-treated platelets was sufficient to promote erythrocyte sickling, an effect not observed with platelet supernatant generated from IL-1R-/- mice. The sickling effect of IL-1β-treated platelet supernatant was inhibited by a transforming growth factor-β (TGF-β) neutralising antibody, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibition, and superoxide scavengers, but replicated by recombinant TGF-β. In conclusion, pharmacological IL-1R antagonism leads to improved anaemia in a murine SCD model. IL-1β stimulation of platelets promotes erythrocyte sickling. This effect may be mediated by platelet-derived TGF-β-induced reactive oxygen species generation though erythrocyte NADPH oxidase.
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Affiliation(s)
- Jessica Venugopal
- University of Michigan Internal Medicine - Cardiology Division, Ann Arbor, MI, USA
| | - Jintao Wang
- University of Michigan Internal Medicine - Cardiology Division, Ann Arbor, MI, USA
| | - Chiao Guo
- University of Michigan Internal Medicine - Cardiology Division, Ann Arbor, MI, USA
| | - Daniel T Eitzman
- University of Michigan Internal Medicine - Cardiology Division, Ann Arbor, MI, USA
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29
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Kanne CK, Nebor D, Pochron M, Oksenberg D, Sheehan VA. Rheological Impact of GBT1118 Cessation in a Sickle Mouse Model. Front Physiol 2021; 12:742784. [PMID: 34630162 PMCID: PMC8497897 DOI: 10.3389/fphys.2021.742784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
In sickle cell disease (SCD), higher whole blood viscosity is a risk factor for vaso-occlusive crisis, avascular necrosis, and proliferative retinopathy. Blood viscosity is strongly impacted by hemoglobin (Hb) levels and red blood cell (RBC) deformability. Voxelotor is a hemoglobin S (HbS) polymerization inhibitor with anti-sickling properties that increases the Hb affinity for oxygen, thereby reducing HbS polymerization. In clinical trials, voxelotor increased Hb by an average of 1g/dl, creating concern that this rise in Hb could increase viscosity, particularly when the drug was cleared. To investigate this potential rebound hyperviscosity effect, we treated SCD mice with GBT1118, a voxelotor analog, and stopped the treatment to determine the effect on blood viscosity and RBC deformability under a range of oxygen concentrations. GBT1118 treatment increased Hb, improved RBC deformability by increasing the elongation index under normoxic (EImax) and hypoxic conditions (EImin), and decreased the point of sickling (PoS) without increasing blood viscosity. The anti-sickling effects and improvement of RBC deformability balanced the effect of increased Hb such that there was no increase in blood viscosity. Forty-eight hours after ceasing GBT1118, Hb declined from the rise induced by treatment, viscosity did not increase, and EImin remained elevated compared to control animals. Hb and PoS were not different from control animals, suggesting a return to native oxygen affinity and clearance of the drug. RBC deformability did not return to baseline, suggesting some residual rheological improvement. These data suggest that concerns regarding viscosity rise above pre-treatment levels upon sudden cessation of voxelotor are not warranted.
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Affiliation(s)
- Celeste K. Kanne
- Aflac Cancer & Blood Disorders Center Children’s Healthcare of Atlanta, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, United States
| | - Danitza Nebor
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, United States
| | - Mira Pochron
- Global Blood Therapeutics, South, San Francisco, CA, United States
| | - Donna Oksenberg
- Global Blood Therapeutics, South, San Francisco, CA, United States
| | - Vivien A. Sheehan
- Aflac Cancer & Blood Disorders Center Children’s Healthcare of Atlanta, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, United States
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30
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Boisson C, Renoux C, Nader E, Gauthier A, Poutrel S, Rab M, Fort R, Bertrand Y, Stauffer E, Cannas G, Kebaili K, Virot E, Hot A, Sheehan V, van Beers E, van Wijk R, Joly P, Connes P. Comparisons of oxygen gradient ektacytometry parameters between sickle cell patients with or without α-thalassaemia. Br J Haematol 2021; 195:629-633. [PMID: 34396507 DOI: 10.1111/bjh.17777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 12/01/2022]
Abstract
The present study tested the impact of α-thalassaemia on oxygen gradient ektacytometry in sickle cell anaemia (SCA). Three SCA groups were compared: (i) no α-thalassaemia (four α-genes, n = 62), (ii) silent α-thalassaemia (three α-genes, n = 35) and (iii) homozygous α-thalassaemia (two α-genes, n = 12). Red blood cell (RBC) deformability measured in normoxia was not different between the three groups. The lowest RBC deformability reached at low oxygen partial pressure (pO2 ) was greater and the pO2 at which RBC started to sickle was lower in the two α-genes group compared to the other groups. Our present study showed an effect of α-thalassaemia on oxygen gradient ektacytometry in SCA.
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Affiliation(s)
- Camille Boisson
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Céline Renoux
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Laboratoire de Biochimie et de Biologie Moléculaire, UF de Biochimie des Pathologies Érythrocytaires, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Elie Nader
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Alexandra Gauthier
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Solène Poutrel
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Minke Rab
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Romain Fort
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Yves Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Emeric Stauffer
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Service d'Exploration Fonctionnelle Respiratoire et de Médecine du Sport, Hôpital Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Giovanna Cannas
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Kamila Kebaili
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Emilie Virot
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Vivien Sheehan
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Eduard van Beers
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard van Wijk
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Philippe Joly
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Laboratoire de Biochimie et de Biologie Moléculaire, UF de Biochimie des Pathologies Érythrocytaires, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Philippe Connes
- Team 'Vascular Biology and Red Blood Cell', Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
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31
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Decreased activity and stability of pyruvate kinase in sickle cell disease: a novel target for mitapivat therapy. Blood 2021; 137:2997-3001. [PMID: 33690814 DOI: 10.1182/blood.2020008635] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/18/2021] [Indexed: 01/19/2023] Open
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32
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Boisson C, Rab MAE, Nader E, Renoux C, van Oirschot BA, Joly P, Fort R, Stauffer E, van Beers EJ, Sheehan VA, van Wijk R, Connes P. Methodological aspects of oxygen gradient ektacytometry in sickle cell disease: Effects of sample storage on outcome parameters in distinct patient subgroups. Clin Hemorheol Microcirc 2021; 77:391-394. [PMID: 33361587 DOI: 10.3233/ch-201037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Sickle cell disease (SCD) is a genetic disorder characterized by the production of an abnormal hemoglobin (Hb), which, under deoxygenation, may polymerize and cause a mechanical distortion of red blood cell (RBC) into a crescent-like shape. Recently a method, using ektacytometry principle, has been developed to assess RBC deformability as a function of oxygen tension (pO2) and is called oxygen gradient ektacytometry (oxygenscan). However, standardization of this test is needed to properly assess the tendency of sickling of RBCs under deoxygenation and to allow comparisons between different laboratories. The study compared the oxygenscan responses during blood storage between distinct populations of SCD patients. Blood from 40 non-transfused homozygous SCD patients (HbSS), 16 chronically transfused HbSS patients, and 14 individuals with compound heterozygous hemoglobin SC disease (HbSC) at steady-state was collected in EDTA tubes. Measurements were performed within 4 hours after collection and after 24 hours of storage at 4°C. We showed that storage affected the minimum RBC deformability reached during deoxygenation (EImin) in both non-transfused HbSS and HbSC patients and the maximum RBC deformability (EImax) measured before deoxygenation (i.e., in normoxia) in the three groups. In contrast, the tendency of RBCs to sickle under deoxygenation (i.e., the point of sickling; PoS) remained rather stable between the two time of measurements. Collectively, since the time between blood sampling and analysis affects some key oxygen gradient ektacytometry-derived parameters we recommend that each laboratory performs oxygenscan measurements at a standardized time point.
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Affiliation(s)
- Camille Boisson
- "Vascular Biology and Red Blood Cell" Team, Laboratory LIBM EA7424, University of Lyon 1, Lyon, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Minke A E Rab
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Van Creveldkliniek,University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elie Nader
- "Vascular Biology and Red Blood Cell" Team, Laboratory LIBM EA7424, University of Lyon 1, Lyon, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Céline Renoux
- "Vascular Biology and Red Blood Cell" Team, Laboratory LIBM EA7424, University of Lyon 1, Lyon, France.,Laboratory of Excellence GR-Ex, Paris, France.,Laboratory of Biochemistry and Molecular Biology, UF Biochemistry of Red Blood Cell Diseases, Est Center of Biology and Pathology, Hospices Civils de Lyon, Lyon, France
| | - Brigitte A van Oirschot
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philippe Joly
- "Vascular Biology and Red Blood Cell" Team, Laboratory LIBM EA7424, University of Lyon 1, Lyon, France.,Laboratory of Excellence GR-Ex, Paris, France.,Laboratory of Biochemistry and Molecular Biology, UF Biochemistry of Red Blood Cell Diseases, Est Center of Biology and Pathology, Hospices Civils de Lyon, Lyon, France
| | - Romain Fort
- Department of Internal Medicine, Hospices Civils de Lyon, Lyon, France
| | - Emeric Stauffer
- Department of Functional Respiratory Investigations, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Eduard J van Beers
- Van Creveldkliniek,University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Richard van Wijk
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philippe Connes
- "Vascular Biology and Red Blood Cell" Team, Laboratory LIBM EA7424, University of Lyon 1, Lyon, France.,Laboratory of Excellence GR-Ex, Paris, France
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33
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Jordan LC, DeBaun MR, Donahue MJ. Advances in neuroimaging to improve care in sickle cell disease. Lancet Neurol 2021; 20:398-408. [PMID: 33894194 DOI: 10.1016/s1474-4422(20)30490-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/26/2022]
Abstract
Sickle cell disease is associated with progressive and increased neurological morbidity throughout the lifespan. In people with sickle cell anaemia (the most common and severe type of sickle cell disease), silent cerebral infarcts are found in more than a third of adolescents by age 18 years and roughly half of young adults by age 30 years, many of whom have cognitive impairment despite having few or no conventional stroke risk factors. Common anatomical neuroimaging in individuals with sickle disease can assess structural brain injury, such as stroke and silent cerebral infarcts; however, emerging advanced neuroimaging methods can provide novel insights into the pathophysiology of sickle cell disease, including insights into the cerebral haemodynamic and metabolic contributors of neurological injury. Advanced neuroimaging methods, particularly methods that report on aberrant cerebral blood flow and oxygen delivery, have potential for triaging patients for appropriate disease-modifying or curative therapies before they have irreversible neurological injury, and for confirming the benefit of new therapies on brain health in clinical trials.
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Affiliation(s)
- Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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34
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Gutierrez M, Shamoun M, Seu KG, Tanski T, Kalfa TA, Eniola-Adefeso O. Characterizing bulk rigidity of rigid red blood cell populations in sickle-cell disease patients. Sci Rep 2021; 11:7909. [PMID: 33846383 PMCID: PMC8041827 DOI: 10.1038/s41598-021-86582-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 03/11/2021] [Indexed: 01/25/2023] Open
Abstract
In this work, we utilized a parameterization model of ektacytometry to quantify the bulk rigidity of the rigid red blood cell (RBC) population in sickle cell disease (SCD) patients. Current ektacytometry techniques implement laser diffraction viscometry to estimate the RBC deformability in a whole blood sample. However, the diffraction measurement is an average of all cells present in the measured sample. By coupling an existing parameterization model of ektacytometry to an artificially rigid RBC model, we formulated an innovative system for estimating the average rigidity of the rigid RBC population in SCD blood. We demonstrated that this method could more accurately determine the bulk stiffness of the rigid RBC populations. This information could potentially help develop the ektacytometry technique as a tool for assessing disease severity in SCD patients, offering novel insights into the disease pathology and treatment.
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Affiliation(s)
- Mario Gutierrez
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Mark Shamoun
- Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Katie Giger Seu
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tyler Tanski
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Theodosia A Kalfa
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Omolola Eniola-Adefeso
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.
- Macromolecular Science and Engineering Program, University of Michigan, Ann Arbor, MI, 48109, USA.
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35
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Boisson C, Rab MAE, Nader E, Renoux C, Kanne C, Bos J, van Oirschot BA, Joly P, Fort R, Gauthier A, Stauffer E, Poutrel S, Kebaili K, Cannas G, Garnier N, Renard C, Hequet O, Hot A, Bertrand Y, van Wijk R, Sheehan VA, van Beers EJ, Connes P. Effects of Genotypes and Treatment on Oxygenscan Parameters in Sickle Cell Disease. Cells 2021; 10:cells10040811. [PMID: 33916502 PMCID: PMC8067408 DOI: 10.3390/cells10040811] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023] Open
Abstract
(1) Background: The aim of the present study was to compare oxygen gradient ektacytometry parameters between sickle cell patients of different genotypes (SS, SC, and S/β+) or under different treatments (hydroxyurea or chronic red blood cell exchange). (2) Methods: Oxygen gradient ektacytometry was performed in 167 adults and children at steady state. In addition, five SS patients had oxygenscan measurements at steady state and during an acute complication requiring hospitalization. (3) Results: Red blood cell (RBC) deformability upon deoxygenation (EImin) and in normoxia (EImax) was increased, and the susceptibility of RBC to sickle upon deoxygenation was decreased in SC patients when compared to untreated SS patients older than 5 years old. SS patients under chronic red blood cell exchange had higher EImin and EImax and lower susceptibility of RBC to sickle upon deoxygenation compared to untreated SS patients, SS patients younger than 5 years old, and hydroxyurea-treated SS and SC patients. The susceptibility of RBC to sickle upon deoxygenation was increased in the five SS patients during acute complication compared to steady state, although the difference between steady state and acute complication was variable from one patient to another. (4) Conclusions: The present study demonstrates that oxygen gradient ektacytometry parameters are affected by sickle cell disease (SCD) genotype and treatment.
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Affiliation(s)
- Camille Boisson
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (C.B.); (E.N.); (C.R.); (P.J.); (R.F.); (A.G.); (E.S.); (S.P.); (K.K.)
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, 75006 Paris, France
- Laboratoire de Biochimie et de Biologie Moléculaire, UF de Biochimie des Pathologies Érythrocytaires, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, 69500 Bron, France
| | - Minke A. E. Rab
- Central Diagnostic Laboratory—Research, University Medical Center Utrecht, Utrecht University, 85500, 3508 GA Utrecht, The Netherlands; (M.A.E.R.); (J.B.); (B.A.v.O.); (R.v.W.)
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, 85500, 3508 GA Utrecht, The Netherlands;
| | - Elie Nader
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (C.B.); (E.N.); (C.R.); (P.J.); (R.F.); (A.G.); (E.S.); (S.P.); (K.K.)
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, 75006 Paris, France
| | - Céline Renoux
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (C.B.); (E.N.); (C.R.); (P.J.); (R.F.); (A.G.); (E.S.); (S.P.); (K.K.)
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, 75006 Paris, France
- Laboratoire de Biochimie et de Biologie Moléculaire, UF de Biochimie des Pathologies Érythrocytaires, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, 69500 Bron, France
| | - Celeste Kanne
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX 77030, USA; (C.K.); (V.A.S.)
| | - Jennifer Bos
- Central Diagnostic Laboratory—Research, University Medical Center Utrecht, Utrecht University, 85500, 3508 GA Utrecht, The Netherlands; (M.A.E.R.); (J.B.); (B.A.v.O.); (R.v.W.)
| | - Brigitte A. van Oirschot
- Central Diagnostic Laboratory—Research, University Medical Center Utrecht, Utrecht University, 85500, 3508 GA Utrecht, The Netherlands; (M.A.E.R.); (J.B.); (B.A.v.O.); (R.v.W.)
| | - Philippe Joly
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (C.B.); (E.N.); (C.R.); (P.J.); (R.F.); (A.G.); (E.S.); (S.P.); (K.K.)
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, 75006 Paris, France
- Laboratoire de Biochimie et de Biologie Moléculaire, UF de Biochimie des Pathologies Érythrocytaires, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, 69500 Bron, France
| | - Romain Fort
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (C.B.); (E.N.); (C.R.); (P.J.); (R.F.); (A.G.); (E.S.); (S.P.); (K.K.)
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, 75006 Paris, France
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69008 Lyon, France; (G.C.); (A.H.)
| | - Alexandra Gauthier
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (C.B.); (E.N.); (C.R.); (P.J.); (R.F.); (A.G.); (E.S.); (S.P.); (K.K.)
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, 75006 Paris, France
- Institut d’Hématologie et d’Oncologie Pédiatrique, Hospices Civils de Lyon, 69008 Lyon, France; (N.G.); (C.R.); (Y.B.)
| | - Emeric Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (C.B.); (E.N.); (C.R.); (P.J.); (R.F.); (A.G.); (E.S.); (S.P.); (K.K.)
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, 75006 Paris, France
- Centre de Médecine du Sommeil et des Maladies Respiratoires, Hôpital Croix Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Solene Poutrel
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (C.B.); (E.N.); (C.R.); (P.J.); (R.F.); (A.G.); (E.S.); (S.P.); (K.K.)
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, 75006 Paris, France
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69008 Lyon, France; (G.C.); (A.H.)
| | - Kamila Kebaili
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (C.B.); (E.N.); (C.R.); (P.J.); (R.F.); (A.G.); (E.S.); (S.P.); (K.K.)
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, 75006 Paris, France
- Institut d’Hématologie et d’Oncologie Pédiatrique, Hospices Civils de Lyon, 69008 Lyon, France; (N.G.); (C.R.); (Y.B.)
| | - Giovanna Cannas
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69008 Lyon, France; (G.C.); (A.H.)
| | - Nathalie Garnier
- Institut d’Hématologie et d’Oncologie Pédiatrique, Hospices Civils de Lyon, 69008 Lyon, France; (N.G.); (C.R.); (Y.B.)
| | - Cécile Renard
- Institut d’Hématologie et d’Oncologie Pédiatrique, Hospices Civils de Lyon, 69008 Lyon, France; (N.G.); (C.R.); (Y.B.)
| | - Olivier Hequet
- Apheresis Unit, Etablissement Français du Sang Rhône Alpes, Centre Hospitalier Lyon Sud Pierre Bénite, 69310 Pierre Bénite, France;
| | - Arnaud Hot
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69008 Lyon, France; (G.C.); (A.H.)
| | - Yves Bertrand
- Institut d’Hématologie et d’Oncologie Pédiatrique, Hospices Civils de Lyon, 69008 Lyon, France; (N.G.); (C.R.); (Y.B.)
| | - Richard van Wijk
- Central Diagnostic Laboratory—Research, University Medical Center Utrecht, Utrecht University, 85500, 3508 GA Utrecht, The Netherlands; (M.A.E.R.); (J.B.); (B.A.v.O.); (R.v.W.)
| | - Vivien A. Sheehan
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX 77030, USA; (C.K.); (V.A.S.)
| | - Eduard J. van Beers
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, 85500, 3508 GA Utrecht, The Netherlands;
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team « Vascular Biology and Red Blood Cell », Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (C.B.); (E.N.); (C.R.); (P.J.); (R.F.); (A.G.); (E.S.); (S.P.); (K.K.)
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, 75006 Paris, France
- Correspondence:
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Sadaf A, Seu KG, Thaman E, Fessler R, Konstantinidis DG, Bonar HA, Korpik J, Ware RE, McGann PT, Quinn CT, Kalfa TA. Automated Oxygen Gradient Ektacytometry: A Novel Biomarker in Sickle Cell Anemia. Front Physiol 2021; 12:636609. [PMID: 33841173 PMCID: PMC8027356 DOI: 10.3389/fphys.2021.636609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/05/2021] [Indexed: 12/01/2022] Open
Abstract
Sickle cell anemia (SCA) is a hereditary hemoglobinopathy with a variable phenotype. There is no single biomarker that adequately predicts disease severity and can be used to monitor treatment response in patients in clinical trials and clinical care. The use of clinical outcomes, such as vaso-occlusive crises (VOC), requires long and expensive studies, sometimes with inconclusive results. To address these limitations, there are several biomarkers under study to improve the ability to predict complications and assess treatment response in both clinical and research settings. Oxygen gradient ektacytometry, also called as oxygenscan, is an assay that measures the effects of deoxygenation and reoxygenation on red blood cell (RBC) deformability and is gaining popularity in SCA research, because it captures the dynamic sickling capacity of a patient’s RBCs as they are subjected to an oxygen gradient under steady shear stress. We describe here the oxygenscan methodology and evaluate the correlation between oxygenscan parameters and more well-known biomarkers of SCA such as fetal hemoglobin (HbF), F-cells, and dense red blood cells (DRBCs). Our data indicate that the oxygenscan curve is affected by all these parameters and the result incorporates the effects of %HbF, %F-cells, RBC hydration, and RBC membrane deformability.
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Affiliation(s)
- Alina Sadaf
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Katie G Seu
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Elizabeth Thaman
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Rose Fessler
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Diamantis G Konstantinidis
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Holly A Bonar
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Immunopathology Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jennifer Korpik
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Erythrocyte Diagnostic Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Russell E Ware
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Patrick T McGann
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Charles T Quinn
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Erythrocyte Diagnostic Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Erythrocyte Diagnostic Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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37
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Parrow NL, Violet PC, George NA, Ali F, Bhanvadia S, Wong R, Tisdale JF, Fitzhugh C, Levine M, Thein SL, Fleming RE. Dietary iron restriction improves markers of disease severity in murine sickle cell anemia. Blood 2021; 137:1553-1555. [PMID: 33512468 PMCID: PMC7976514 DOI: 10.1182/blood.2020006919] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/19/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Nermi L Parrow
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO
| | - Pierre-Christian Violet
- Molecular and Clinical Nutrition Section, Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases
| | - Nisha Ajit George
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO
| | - Faris Ali
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO
| | - Shivam Bhanvadia
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO
| | - Ryan Wong
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO
| | | | | | - Mark Levine
- Molecular and Clinical Nutrition Section, Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD; and
| | - Robert E Fleming
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St Louis, MO
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38
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Rab MAE, Kanne CK, Bos J, Oirschot BA, Boisson C, Houwing ME, Gerritsma J, Teske E, Renoux C, Riedl J, Schutgens REG, Bartels M, Nur E, Joly P, Fort R, Cnossen MH, Wijk R, Connes P, Beers EJ, Sheehan VA. Oxygen gradient ektacytometry-derived biomarkers are associated with vaso-occlusive crises and correlate with treatment response in sickle cell disease. Am J Hematol 2021; 96:E29-E32. [PMID: 33095451 PMCID: PMC7756395 DOI: 10.1002/ajh.26031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Minke A. E. Rab
- Central Diagnostic Laboratory‐Research University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
- Van Creveldkliniek, University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Celeste K. Kanne
- Department of Pediatrics Emory University School of Medicine Childrenʼs Healthcare of Atlanta Atlanta Georgia USA
| | - Jennifer Bos
- Central Diagnostic Laboratory‐Research University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Brigitte A. Oirschot
- Central Diagnostic Laboratory‐Research University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Camille Boisson
- Laboratory LIBM EA7424, University of Lyon 1, “Vascular Biology and Red Blood Cell” team Lyon France
- Laboratory of Excellence GR‐Ex Paris France
| | - Maite E. Houwing
- Department of Pediatric Hematology Erasmus Medical Center Rotterdam The Netherlands
| | - Jorn Gerritsma
- Emma Childrenʼs Hospital, Pediatric Hematology Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Erik Teske
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine Utrecht University Utrecht The Netherlands
| | - Celine Renoux
- Laboratory LIBM EA7424, University of Lyon 1, “Vascular Biology and Red Blood Cell” team Lyon France
- Laboratory of Excellence GR‐Ex Paris France
- Laboratory of Biochemistry and Molecular Biology, UF Biochemistry of Red Blood Cell diseases, Est Center of Biology and Pathology Hospices Civils de Lyon Lyon France
| | - Jurgen Riedl
- Result Laboratory Albert Schweitzer Hospital Dordrecht The Netherlands
| | - Roger E. G. Schutgens
- Van Creveldkliniek, University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Marije Bartels
- Van Creveldkliniek, University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Erfan Nur
- Department of Hematology Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Philippe Joly
- Laboratory LIBM EA7424, University of Lyon 1, “Vascular Biology and Red Blood Cell” team Lyon France
- Laboratory of Excellence GR‐Ex Paris France
- Laboratory of Biochemistry and Molecular Biology, UF Biochemistry of Red Blood Cell diseases, Est Center of Biology and Pathology Hospices Civils de Lyon Lyon France
| | - Romain Fort
- Department of Internal Medicine Hospices Civils de Lyon Lyon France
| | - Marjon H. Cnossen
- Department of Pediatric Hematology Erasmus Medical Center Rotterdam The Netherlands
| | - Richard Wijk
- Central Diagnostic Laboratory‐Research University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Philippe Connes
- Laboratory LIBM EA7424, University of Lyon 1, “Vascular Biology and Red Blood Cell” team Lyon France
- Laboratory of Excellence GR‐Ex Paris France
| | - Eduard J. Beers
- Van Creveldkliniek, University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Vivien A. Sheehan
- Department of Pediatrics Emory University School of Medicine Childrenʼs Healthcare of Atlanta Atlanta Georgia USA
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Yarnoff K, Dodd-O JM. Mixing commonly used crystalloid solutions with red blood cells in five common additives does not negatively impact hemolysis, aggregometry, or deformability. Transfusion 2020; 60:2991-3000. [PMID: 33032376 DOI: 10.1111/trf.16089] [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: 12/04/2019] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Literature is beginning to challenge the belief that it is unsafe to coinfuse red blood cells (RBCs) with solutions other than isotonic saline. We recently showed that additive-free RBCs tolerated coincubation with Plasma-Lyte or catecholamines dissolved in normal saline (NS), though 5% dextrose in water (D5W) promoted hemolysis. Herein, we evaluate the effect of coincubating crystalloids on additive-preserved RBC hemolysis, aggregation, and membrane deformability. STUDY DESIGN AND METHODS RBCs were coincubated 5 minutes with plasma, NS, Plasma-Lyte, lactated Ringer's (LR) or D5W (1 mL PRBC +131.3 μL solution). Samples were then assessed for hemolysis (free hemoglobin), aggregation (critical shear stress [mPa]), and membrane deformability (elongation index [EI]). Significance (P ≤ .05) by t test or ANOVA with post-hoc Tukey-Kramer test. RESULTS Additive-prepared RBCs coincubated with crystalloid instead of plasma demonstrated: (a) no increase in hemolysis as indicated by plasma free hemoglobin levels that is likely to be clinically relevant; (b) no increase, but in some cases a decrease, in aggregation as indicated by critical shear stress; and (c) in some combinations, a deterioration in deformability. When present, the deformability decrease was likely clinically insignificant in degree, and always returned to normal when the crystalloid was subsequently diluted out with plasma. CONCLUSION Our data suggest that additive-prepared RBCs coincubated for 5 minutes with any of four common crystalloids demonstrate no clinically relevant increased lysis, increased aggregation, or decreased deformability.
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Affiliation(s)
- Kristine Yarnoff
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey M Dodd-O
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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40
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Noomuna P, Risinger M, Zhou S, Seu K, Man Y, An R, Sheik DA, Wan J, Little JA, Gurkan UA, Turrini FM, Kalfa T, Low PS. Inhibition of Band 3 tyrosine phosphorylation: a new mechanism for treatment of sickle cell disease. Br J Haematol 2020; 190:599-609. [PMID: 32346864 PMCID: PMC7606656 DOI: 10.1111/bjh.16671] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022]
Abstract
Many hypotheses have been proposed to explain how a glutamate to valine substitution in sickle haemoglobin (HbS) can cause sickle cell disease (SCD). We propose and document a new mechanism in which elevated tyrosine phosphorylation of Band 3 initiates sequelae that cause vaso-occlusion and the symptoms of SCD. In this mechanism, denaturation of HbS and release of heme generate intracellular oxidants which cause inhibition of erythrocyte tyrosine phosphatases, thus permitting constitutive tyrosine phosphorylation of Band 3. This phosphorylation in turn induces dissociation of the spectrin-actin cytoskeleton from the membrane, leading to membrane weakening, discharge of membrane-derived microparticles (which initiate the coagulation cascade) and release of cell-free HbS (which consumes nitric oxide) and activates the endothelium to express adhesion receptors). These processes promote vaso-occlusive events which cause SCD. We further show that inhibitors of Syk tyrosine kinase block Band 3 tyrosine phosphorylation, prevent release of cell-free Hb, inhibit discharge of membrane-derived microparticles, increase sickle cell deformability, reduce sickle cell adhesion to human endothelial cells, and enhance sickle cell flow through microcapillaries. In view of reports that imatinib (a Syk inhibitor) successfully treats symptoms of sickle cell disease, we suggest that Syk tyrosine kinase inhibitors warrant repurposing as potential treatments for SCD.
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Affiliation(s)
- Panae Noomuna
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
- Institute for Drug Discovery, Purdue University, West Lafayette, IN, USA
| | - Mary Risinger
- College of Nursing, University of Cincinnati, Cincinnati, OH
| | - Sitong Zhou
- Department of Chemical Engineering, University of California, Davis, CA
| | - Katie Seu
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | - Daniel A. Sheik
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
- Institute for Drug Discovery, Purdue University, West Lafayette, IN, USA
| | - Jiandi Wan
- Department of Chemical Engineering, University of California, Davis, CA
| | - Jane A. Little
- Department of Medicine, Division of Hematology/Oncology and UNC Blood Research Center, University of North Carolina, Chapel Hill, NC
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland
- Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA
| | | | - Theodosia Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Philip S. Low
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
- Institute for Drug Discovery, Purdue University, West Lafayette, IN, USA
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41
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Chikezie PC, Ekeanyanwu RC, Chile-Agada AB. Phytocomponents from Anacardium occidentale, Psidium guajava, and Terminalia catappa altered membrane osmotic stability of sickle erythrocytes. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2020. [DOI: 10.1186/s43088-019-0030-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
The present study identified, quantified, and characterized the combinations of phytocomponents from fractionated leaf extracts of Anacardium occidentale, Psidium guajava, and Terminalia catappa that stabilized sickle erythrocyte membrane against osmotic stress, or otherwise, using standard chromatographic-spectrophotometric techniques, namely GC-MS, FT-IR, and UV-visible systems.
Results
The percentage hemolysis of the control sample, in 0.9 g/100 mL NaCl, was 35.08 ± 11.64%, whereas those of the samples containing 40 mg/100 mL, 60 mg/100 mL, and 80 mg/100 mL of ethylacetate extracts of T. catappa ranged between 31.82 ± 8.32 and 39.18 ± 6.94%. Ethylacetate extract of T. catappa contained comparative high quantities of hexadecanoic acid methyl ester, 9,11-octadecadienoic acid, methyl ester, (E, E)-, trans-13-octadecenoic acid methyl ester, and methyl stearate. FT-IR and UV-visible spectra showed that ethylacetate extract of T. catappa contained aromatic compounds as well as nitro-compounds, phenolics, and esters.
Conclusion
To mention but a few, the combinations of major phytocomponents that stabilized sickle erythrocyte membrane against osmotic stress were hexadecanoic acid, methyl ester, 11-octadecenoic acid, methyl ester, dibutyl phthalate, pentacosane, trans-13-octadecenoic acid, methyl ester, whereas the minor phytocomponents include methyl tetradecanoate, methoxyacetic acid, 3-pentadecyl ester, methyl stearate, hexadecanoic acid, isoxazole, 4,5-dimethyl-.
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42
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Lu M, Rab MA, Shevkoplyas SS, Sheehan VA. Blood rheology biomarkers in sickle cell disease. Exp Biol Med (Maywood) 2020; 245:155-165. [PMID: 31948290 DOI: 10.1177/1535370219900494] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sickle cell disease (SCD) is the most common inherited blood disorder, affecting approximately 100,000 patients in the U.S. and millions more worldwide. Patients with SCD experience a wide range of clinical complications, including frequent pain crises, stroke, and early mortality, all originating from a single-point mutation in the β-globin subunit. The RBC changes resulting from the sickle mutation lead to a host of rheological abnormalities that diminish microvascular blood flow, and produce severe anemia due to RBC hemolysis, and ischemia from vaso-occlusion initiated by sticky, rigid sickle RBCs. While the pathophysiology and mechanisms of SCD have been investigated for many years, therapies to treat the disease are limited. In addition to RBC transfusion, there are only two US Food and Drug Administration (FDA)-approved drugs to ameliorate SCD complications: hydroxyurea (HU) and L-glutamine (Endari™). The only curative therapy currently available is allogeneic hematopoietic stem cell transplantation (HSCT), which is generally reserved for individuals with a matched related donor, comprising only 10–15% of the total SCD population. Potentially curative advanced gene therapy approaches for SCD are under investigation in ongoing clinical trials. The ultimate goal of any curative treatment should be to repair the hemorheological abnormalities caused by SCD, and thus normalize blood flow and prevent clinical complications. Our mini-review highlights a set of key hemorheological biomarkers (and the current and emerging technologies used to measure them) that may be used to guide the development of novel curative and palliative therapies for SCD, and functionally assess outcomes. Impact statement Severe impairment of blood rheology is the hallmark of SCD pathophysiology, and one of the key factors predisposing SCD patients to pain crises, organ damage, and early mortality. As novel therapies emerge to treat or cure SCD, it is crucial that these treatments are functionally evaluated for their effect on blood rheology. This review describes a comprehensive panel of rheological biomarkers, their clinical uses, and the technologies used to obtain them. The described technologies can produce highly sensitive measurements of the ability of current treatments to improve blood rheology of SCD patients. The goal of curative therapies should be to achieve blood rheology biomarkers measurements in the range of sickle cell trait individuals (HbAS). The use of the panel of rheological biomarkers proposed in this review could significantly accelerate the development, optimization, and clinical translation of novel therapies for SCD.
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Affiliation(s)
- Madeleine Lu
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA
| | - Minke Ae Rab
- Laboratory of Clinical Chemistry & Hematology, University Medical Center Utrecht, Utrecht University, Utrecht 3584, The Netherlands
| | - Sergey S Shevkoplyas
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA
| | - Vivien A Sheehan
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX 77030, USA
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43
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Rab MA, Kanne CK, Bos J, Boisson C, Oirschot BA, Nader E, Renoux C, Joly P, Fort R, Beers EJ, Sheehan VA, Wijk R, Connes P. Methodological aspects of the oxygenscan in sickle cell disease: A need for standardization. Am J Hematol 2020; 95:E5-E8. [PMID: 31591742 PMCID: PMC6916384 DOI: 10.1002/ajh.25655] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Minke A.E. Rab
- Department of Clinical Chemistry & HaematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
- Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Celeste K. Kanne
- Department of Pediatrics, Division of Hematology/OncologyBaylor College of Medicine Houston Texas
| | - Jennifer Bos
- Department of Clinical Chemistry & HaematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Camille Boisson
- Laboratory LIBM EA7424University of Lyon 1, “Vascular Biology and Red Blood Cell” Team Lyon France
- Laboratory of Excellence GR‐Ex Paris France
| | - Brigitte A. Oirschot
- Department of Clinical Chemistry & HaematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Elie Nader
- Laboratory LIBM EA7424University of Lyon 1, “Vascular Biology and Red Blood Cell” Team Lyon France
- Laboratory of Excellence GR‐Ex Paris France
| | - Céline Renoux
- Laboratory LIBM EA7424University of Lyon 1, “Vascular Biology and Red Blood Cell” Team Lyon France
- Laboratory of Excellence GR‐Ex Paris France
- Laboratory of Biochemistry and Molecular Biology, UF Biochemistry of Red Blood Cell diseases, Est Center of Biology and PathologyHospices Civils de Lyon Lyon France
| | - Philippe Joly
- Laboratory LIBM EA7424University of Lyon 1, “Vascular Biology and Red Blood Cell” Team Lyon France
- Laboratory of Excellence GR‐Ex Paris France
- Laboratory of Biochemistry and Molecular Biology, UF Biochemistry of Red Blood Cell diseases, Est Center of Biology and PathologyHospices Civils de Lyon Lyon France
| | - Romain Fort
- Department of Internal MedicineHospices Civils de Lyon Lyon France
| | - Eduard J. Beers
- Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Vivien A. Sheehan
- Department of Pediatrics, Division of Hematology/OncologyBaylor College of Medicine Houston Texas
| | - Richard Wijk
- Department of Clinical Chemistry & HaematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Philippe Connes
- Laboratory LIBM EA7424University of Lyon 1, “Vascular Biology and Red Blood Cell” Team Lyon France
- Laboratory of Excellence GR‐Ex Paris France
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44
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Rab MA, Oirschot BA, Bos J, Merkx TH, Wesel AC, Abdulmalik O, Safo MK, Versluijs BA, Houwing ME, Cnossen MH, Riedl J, Schutgens RE, Pasterkamp G, Bartels M, Beers EJ, Wijk R. Rapid and reproducible characterization of sickling during automated deoxygenation in sickle cell disease patients. Am J Hematol 2019; 94:575-584. [PMID: 30784099 PMCID: PMC6518936 DOI: 10.1002/ajh.25443] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 01/02/2023]
Abstract
In sickle cell disease (SCD), sickle hemoglobin (HbS) polymerizes upon deoxygenation, resulting in sickling of red blood cells (RBCs). These sickled RBCs have strongly reduced deformability, leading to vaso‐occlusive crises and chronic hemolytic anemia. To date, there are no reliable laboratory parameters or assays capable of predicting disease severity or monitoring treatment effects. We here report on the oxygenscan, a newly developed method to measure RBC deformability (expressed as Elongation Index ‐ EI) as a function of pO2. Upon a standardized, 22 minute, automated cycle of deoxygenation (pO2 median 16 mmHg ± 0.17) and reoxygenation, a number of clinically relevant parameters are produced in a highly reproducible manner (coefficients of variation <5%). In particular, physiological modulators of oxygen affinity, such as, pH and 2,3‐diphosphoglycerate showed a significant correlation (respectively R = ‑0.993 and R = 0.980) with Point of Sickling (PoS5%), which is defined as the pO2 where a 5% decrease in EI is observed during deoxygenation. Furthermore, in vitro treatment with antisickling agents, including GBT440, which alter the oxygen affinity of hemoglobin, caused a reproducible left‐shift of the PoS, indicating improved deformability at lower oxygen tensions. When RBCs from 21 SCD patients were analyzed, we observed a significantly higher PoS in untreated homozygous SCD patients compared to treated patients and other genotypes. We conclude that the oxygenscan is a state‐of‐the‐art technique that allows for rapid analysis of sickling behavior in SCD patients. The method is promising for personalized treatment, development of new treatment strategies and could have potential in prediction of complications.
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Affiliation(s)
- Minke A.E. Rab
- Laboratory of Clinical Chemistry & HematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
- Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Brigitte A. Oirschot
- Laboratory of Clinical Chemistry & HematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Jennifer Bos
- Laboratory of Clinical Chemistry & HematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Tesy H. Merkx
- Laboratory of Clinical Chemistry & HematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Annet C.W. Wesel
- Laboratory of Clinical Chemistry & HematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Osheiza Abdulmalik
- Division of HematologyThe Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Martin K. Safo
- Department of Medicinal Chemistry, Institute for Structural Biology, Drug Discovery and Development, School of PharmacyVirginia Commonwealth University Virginia
| | - Birgitta A. Versluijs
- Department of Pediatric HematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Maite E. Houwing
- Department of Pediatric HematologyErasmus University Medical Center– Sophia Children's Hospital Rotterdam The Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric HematologyErasmus University Medical Center– Sophia Children's Hospital Rotterdam The Netherlands
| | - Jurgen Riedl
- Result LaboratoryAlbert Schweitzer Hospital Dordrecht The Netherlands
| | - Roger E.G. Schutgens
- Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry & HematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Marije Bartels
- Department of Pediatric HematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Eduard J. Beers
- Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Richard Wijk
- Laboratory of Clinical Chemistry & HematologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
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