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Santos B, Ginete C, Gonçalves E, Delgadinho M, Miranda A, Faustino P, Arez AP, Brito M. Characterization of a cohort of Angolan children with sickle cell anemia treated with hydroxyurea. Blood Cells Mol Dis 2024; 105:102822. [PMID: 38215581 DOI: 10.1016/j.bcmd.2023.102822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Sickle Cell Anemia (SCA) is a monogenic disease, although its severity and response to treatment are very heterogeneous. OBJECTIVES This study aims to characterize a cohort of Angolan children with SCA and evaluate their response to hydroxyurea (HU) treatment and the potential side effects and toxicity. METHODS The study enrolled 215 patients between 3 and 12 years old before and after the administration of HU, at a fix dose of 20 mg/kg/day for 12 months. RESULTS A total of 157 patients started HU medication and 141 of them completed the 12-month treatment. After initiating HU treatment, the frequency of clinical events decreased (transfusions 53.4 %, hospitalizations 47.1 %). The response to HU medication varied among patients, with some experiencing an increase in fetal hemoglobin (HbF) of <5 %. The mean increase in HbF was 11.9 %, ranging from 1.8 % to 31 %. Responders to HU treatment were 57 %, inadequate responders 38.7 % and non-adherent 4.2 %. No clinical side effects related to HU were reported. Hematological toxicities were transient and reversible. Children naïve to HU and with lower HbF reported higher number of hospitalizations caused by malaria infection. During HU treatment, the frequency of malaria episodes did not appear to be affected by HbF levels. CONCLUSIONS the present study provided a valuable contribution to the understanding of the clinical and laboratory profiles of Angolan children with SCA. These findings support the evidence that the implementation of prophylactic measures and treatment with HU is associated with increased survival in children with SCA.
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Affiliation(s)
- Brígida Santos
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Angola; Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola; Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Catarina Ginete
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Elisângela Gonçalves
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Mariana Delgadinho
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Armandina Miranda
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Paula Faustino
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ana Paula Arez
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Miguel Brito
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Angola; H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal.
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Lad H, Naskar S, Punyasri Pasupuleti SKDB, Nahrel R, Sihare P, Chandak GR, Patra PK. Evaluation of pharmacological efficacy and safety of hydroxyurea in sickle cell disease: Study of a pediatric cohort from Chhattisgarh, India. Pediatr Hematol Oncol 2022; 40:395-406. [PMID: 36226857 DOI: 10.1080/08880018.2022.2126042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sickle cell disease (SCD) is a disease of abnormal hemoglobin associated with severe clinical phenotype and recurrent complications. Hydroxyurea (HU) is one of the US-FDA approved and commonly used drug for the treatment of adult SCD patients with clinical -severity. However, its use in the pediatric groups remains atypical. Despite a high prevalence of the disease in the state Chhattisgarh, there is a lack of evidence supporting its use in pediatric patients. This study aimed to evaluate the pharmacological and clinical efficacy and safety of HU in a large pediatric cohort with SCD from Central India. The study cohort consisted of 164 SCD (138 Hb SS and 26 Hb S beta-thalassemia) children (≤14 years of age) on HU therapy, who were monitored for toxicity, hematological and clinical efficacy at baseline (Pre-HU) and after 24 months (Post-HU). The results highlight the beneficial effects of HU at a mean dose of 18.7 ± 7.0 mg/kg/day. A significant improvement was observed, not only in physical and clinical parameters but also in hematological parameters which include fetal hemoglobin (Hb F), total hemoglobin, hematocrit, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) levels, when evaluated against the baseline. We did not observe any significant adverse effects during the treatment period. Similar results were obtained on independent analysis of Hb SS and Hb Sβ patients. These findings strengthen the beneficial effect of hydroxyurea in pediatric population also without any serious adverse effects and builds up ground for expanding its use under regular monitoring.
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Affiliation(s)
- Harsha Lad
- Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, India
| | - Shoma Naskar
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, Telangana, India
| | - S K D B Punyasri Pasupuleti
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, Telangana, India
| | - Rakesh Nahrel
- Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, India
| | - Pradeep Sihare
- Sihare Children's Hospital, Bilaspur, Chhattisgarh, India
| | - Giriraj R Chandak
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, Telangana, India
| | - Pradeep K Patra
- Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, India
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Single Nucleotide Polymorphisms in XMN1-HBG2, HBS1L-MYB, and BCL11A and Their Relation to High Fetal Hemoglobin Levels That Alleviate Anemia. Diagnostics (Basel) 2022; 12:diagnostics12061374. [PMID: 35741184 PMCID: PMC9221560 DOI: 10.3390/diagnostics12061374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
Anemia is a condition in which red blood cells and/or hemoglobin (Hb) concentrations are decreased below the normal range, resulting in a lack of oxygen being transported to tissues and organs. Those afflicted with this condition may feel lethargic and weak, which reduces their quality of life. The condition may be manifested in inherited blood disorders, such as thalassemia and sickle cell disease, whereas acquired disorders include aplastic anemia, chronic disease, drug toxicity, pregnancy, and nutritional deficiency. The augmentation of fetal hemoglobin (HbF) results in the reduction in clinical symptoms in beta-hemoglobinopathies. Several transcription factors as well as medications such as hydroxyurea may help red blood cells produce more HbF. HbF expression increases with the downregulation of three main quantitative trait loci, namely, the XMN1-HBG2, HBS1L-MYB, and BCL11A genes. These genes contain single nucleotide polymorphisms (SNPs) that modulate the expression of HbF differently in various populations. Allele discrimination is important in SNP genotyping and is widely applied in many assays. In conclusion, the expression of HbF with a genetic modifier is crucial in determining the severity of anemic diseases, and genetic modification of HbF expression may offer clinical benefits in diagnosis and disease management.
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Manu GP, Segbefia C, N’guessan BB, Coffie SA, Adjei GO. Association Between Selected Single Nucleotide Polymorphisms in Globin and Related Genes and Response to Hydroxyurea Therapy in Ghanaian Children with Sickle Cell Disease. Pharmgenomics Pers Med 2022; 15:205-214. [PMID: 35300055 PMCID: PMC8922234 DOI: 10.2147/pgpm.s351599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Gloria Pokuaa Manu
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Catherine Segbefia
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Benoit Banga N’guessan
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - George Obeng Adjei
- Centre for Tropical, Clinical Pharmacology and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Correspondence: George Obeng Adjei, Email
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Ansari SH, Hussain Z, Zohaib M, Parveen S, Kaleem B, Qamar H, Adil O, Khan MT, Shamsi TS. A Pragmatic Scoring Tool to Predict Hydroxyurea Response Among β-Thalassemia Major Patients in Pakistan. J Pediatr Hematol Oncol 2022; 44:e77-e83. [PMID: 33710118 DOI: 10.1097/mph.0000000000002136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/02/2021] [Indexed: 11/26/2022]
Abstract
Despite high prevalence and incidence of β-thalassemia in Pakistan, there is very limited work on the use of hydroxyurea (HU) in thalassemia patients in the country. This is the first insight regarding genetic profiling of BCL11A and HU responses in Pakistani β-thalassemia. It correlates single-nucleotide polymorphisms on BCL11A (rs4671393, rs766432) and HBG2 (XmnI), age at first transfusion, and β-globin mutations with HU response in β-thalassemia major (BTM). Of 272 patients treated with HU, 98 were complete responders, 55 partial responders, and 119 nonresponders. Our analysis shows that HU response was significantly associated with patients having IVSI-1 or CD 30 mutation (P<0.001), age at first transfusion >1 year (P<0.001), and with the presence of XmnI polymorphism (P<0.001). The single-nucleotide polymorphisms of BCL11A were more prevalent among responders, but could not show significant association with HU response (P>0.05). Cumulative effect of all 5 predicting factors through simple binary scoring indicates that the likelihood of HU response increases with the number of primary and secondary genetic modifiers (P<0.001). Predictors scoring is a pragmatic tool to foresee HU response in patients with BTM. The authors recommend a score of ≥2 for starting HU therapy in Pakistani patients with BTM.
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Affiliation(s)
- Saqib H Ansari
- National Institute of Blood Diseases and Bone Marrow Transplantation
| | - Zeeshan Hussain
- National Institute of Blood Diseases and Bone Marrow Transplantation
- Omair Sana Foundation
| | - Muhammad Zohaib
- Omair Sana Foundation
- National Center for Proteomics, University of Karachi, Karachi, Pakistan
| | - Sadia Parveen
- National Institute of Blood Diseases and Bone Marrow Transplantation
| | - Bushra Kaleem
- National Institute of Blood Diseases and Bone Marrow Transplantation
| | - Hina Qamar
- National Institute of Blood Diseases and Bone Marrow Transplantation
| | | | | | - Tahir S Shamsi
- National Institute of Blood Diseases and Bone Marrow Transplantation
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Sales RR, Belisário AR, Faria G, Mendes F, Luizon MR, Viana MB. Functional polymorphisms of BCL11A and HBS1L-MYB genes affect both fetal hemoglobin level and clinical outcomes in a cohort of children with sickle cell anemia. Ann Hematol 2020; 99:1453-1463. [PMID: 32447424 DOI: 10.1007/s00277-020-04079-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/04/2020] [Indexed: 01/28/2023]
Abstract
Fetal hemoglobin (HbF) ameliorates clinical severity of sickle cell anemia (SCA). The major loci regulating HbF levels are HBB cluster, BCL11A, and HMIP-2 (HBS1L-MYB). However, the impact of noncoding single-nucleotide polymorphisms (SNPs) in these loci on clinical outcomes and their functional role on regulating HbF levels should be better elucidated. Therefore, we performed comprehensive association analyses of 14 noncoding SNPs in five loci with HbF levels and with clinical outcomes in a cohort of 250 children with SCA from Southeastern Brazil, and further performed functional annotation of these SNPs. We found SNPs independently associated with HbF levels: rs4671393 in BCL11A (β-coefficient = 0.28), rs9399137 in HMIP-2A (β-coefficient = 0.16), and rs4895441 in HMIP-2B (β-coefficient = 0.15). Patients carrying minor (HbF-boosting) alleles for rs1427407, rs93979137, rs4895441, rs9402686, and rs9494145 showed reduced count of reticulocytes (p < 0.01), while those carrying the T allele of rs9494145 showed lower white blood cell count (p = 0.002). Carriers of the minor allele for rs9402686 showed higher peripheral saturation of oxygen (p = 0.002). Patients carrying minor alleles in BCL11A showed lower risk of transfusion incidence rate ratio (IRR ≥ 1.3; p < 0.0001). This effect was independent of HbF effect (p = 0.005). Carriers of minor alleles for rs9399137 and rs9402686 showed lower risk of acute chest syndrome (IRR > 1.3; p ≤ 0.01). Carriers of the reference allele for rs4671393 showed lower risk of infections (IRR = 1.16; p = 0.01). In conclusion, patients carrying HbF-boosting alleles of BCL11A and HMIP-2 were associated with milder clinical phenotypes. Higher HbF concentration may underlie this effect.
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Affiliation(s)
- Rahyssa Rodrigues Sales
- Programa de Pós-Graduação em Genética, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil. .,Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil. .,Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | - André Rolim Belisário
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Lagoa Santa, Minas Gerais, 33400-000, Brazil
| | - Gabriela Faria
- Serviço de Pesquisa, Fundação Hemominas, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiola Mendes
- Serviço de Pesquisa, Fundação Hemominas, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Rizzatti Luizon
- Programa de Pós-Graduação em Genética, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.,Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Marcos Borato Viana
- Faculdade de Medicina/NUPAD, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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7
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Abstract
Fetal haemoglobin (HbF) levels have a clinically beneficial effect on sickle cell disease (SCD). Patients with SCD demonstrate extreme variability in HbF levels (1-30%), a large part of which is likely genetically determined. The main genetic modifier loci for HbF persistence, HBS1L-MYB, BCL11A and the β-globin gene cluster in adults also act in SCD patients. Their effects are, however, modified significantly by a disease pathology that includes a drastically shortened erythrocyte lifespan with an enhanced survival of those red blood cells that carry HbF (F cells). We propose a model of how HbF modifier genes and disease pathology interact to shape HbF levels measured in patients. We review current knowledge on the action of these loci in SCD, their genetic architecture, and their putative functional components. At each locus, one strong candidate for a causative, functional DNA change has been proposed: Xmn1-HBG2 at the β-globin cluster, rs1427407 at BCL11A and the 3 bp deletion rs66650371 at HBS1L-MYB. These, however, explain only part of the impact of these loci and additional variants are yet to be identified. Further progress in understanding the genetic control of HbF levels requires that confounding factors inherent in SCD, such as ethnic complexity, the role of F cells and the influence of drugs, are suitably addressed. This will depend on international collaboration and on large, well-characterised patient cohorts with genome-wide single-nucleotide polymorphism or sequence data.
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Affiliation(s)
- Stephan Menzel
- School of Cancer and Pharmaceutical Sciences, King's College London, The Rayne Institute, 123 Coldharbour Lane, London, SE5 9NU, UK.
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung and Blood Institute, The National Institutes of Health, Building 10, Room 5-5142, 10 Center Drive, Bethesda, MD, 20814, USA.
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8
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Adekile A, Hassan M, Asbeutah A, Al-Hinai M, Trad O, Farhan N. Transcranial Doppler Ultrasound in Peninsular Arab Patients With Sickle Cell Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:165-172. [PMID: 29732592 DOI: 10.1002/jum.14680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/07/2018] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Transcranial Doppler ultrasound is used to identify patients with sickle cell disease (SCD) at risk for stroke. We performed transcranial Doppler studies in patients from 4 countries in the Arabian Peninsula (Kuwait, Oman, Iraq, and United Arab Emirates) to document the prevalence of abnormal transcranial Doppler findings. METHODS The patients were recruited from outpatient clinics and studied in a steady state. Transcranial Doppler examinations were performed with standard equipment by experienced operators. The time-averaged maximum mean velocity (TAMMV) was documented in the arteries of the circle of Willis. The hemoglobin (Hb) genotype was confirmed, and the fetal Hb level and complete blood counts were determined. RESULTS There were 415 patients in the study, aged 2 to 18 years (mean ± SD, 8.6 ± 3.5 years). None of the patients had an abnormal TAMMV (ie, > 200 cm/s), whereas only 13 (3.1%), all from Iraq, had conditional values (170-200 cm/s) in the right middle cerebral artery and 7 (1.7%) in the left middle cerebral artery. There were no consistent TAMMV differences among male and female patients or in patients with different Hb genotypes (sickle cell anemia, sickle cell β0- thalassemia, and sickle D). The use of hydroxyurea was associated with a lower TAMMV, whereas a blood transfusion history had no influence. Total hemoglobin, reticulocyte count, serum bilirubin, and fetal Hb values showed varying degrees of association with the TAMMV in the different vessels. CONCLUSIONS This study has demonstrated the rarity of abnormal transcranial Doppler findings among Peninsular Arab patients with SCD. The guidelines for transcranial Doppler screening in this population need further studies and recommendations.
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Affiliation(s)
- Adekunle Adekile
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Meaad Hassan
- Department of Pediatrics, College of Medicine, University of Basra, Basra, Iraq
| | - Akram Asbeutah
- Department of Radiologic Sciences, Faculty of Allied Health Sciences, Kuwait University, Safat, Kuwait
| | - Mohamed Al-Hinai
- Department of Pediatric Hematology-Oncology, Royal Hospital, Muscat, Oman
| | - Omar Trad
- Department of Pediatric Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Nayef Farhan
- Department of Pediatrics, Basra Specialty Hospital, Basra, Iraq
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George PE, Bazo-Alvarez JC, Sheehan VA. A Retrospective Analysis of Sociodemographic and Hematologic Characteristics Associated With Achieving Optimal Hydroxyurea Therapy in Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2018; 40:341-347. [PMID: 29683954 PMCID: PMC6019152 DOI: 10.1097/mph.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hydroxyurea (HU) has proven hematologic and clinical benefits, especially when escalated to the maximum tolerated dose (MTD). We reviewed clinical data from patients with sickle cell disease (January 2011 to 2016) to determine baseline sociodemographic and laboratory parameters associated with reaching HU MTD without significant delays. In total, 210 patients (mean HU start age, 6.6 y) were included. Initial Kaplan-Meier event analysis showed 1 year to be an inflection point for reaching MTD. In total, 116 patients (55%) reached MTD in <1 year, with 56 (27%) taking >1 year to reach MTD and 38 (18%) patients not successfully reaching MTD during follow-up. In both crude and adjusted analyses, age at HU start was found to be significantly and inversely associated with reaching MTD within 1 year. The data presented, specifically the inflection point of reaching MTD at 1 year and the association of young HU start age with reaching MTD within a year, suggest that successful achievement of MTD may be facilitated by starting patients on HU at a young age and that older patients should receive additional intervention to attain MTD within 1 year. Patients who do not achieve MTD within a year may need the most extensive intervention.
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Affiliation(s)
- Paul E. George
- Texas Children’s Hospital, Baylor College of Medicine. Houston, TX
| | - Juan Carlos Bazo-Alvarez
- Methodology Research Group, Department of Primary Care and Population Health, University College London (UCL), London, UK,Centro de Estudios de Población, Universidad Católica los Ángeles de Chimbote (ULADECH-Católica), Chimbote, Perú
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10
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Hu J, Gao J, Li J. Sex and age discrepancy of HbA1c and fetal hemoglobin determined by HPLC in a large Chinese Han population. J Diabetes 2018; 10:458-466. [PMID: 28256058 DOI: 10.1111/1753-0407.12544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It is accepted that HbA1c is an effective indicator to evaluate glycemic control. Fetal hemoglobin (HbF) is seldom measured because traditional detection is inconvenient. In this regard, there may be an advantage in using HPLC autoanalysis of HbA1c as a surrogate method for HbF detection. The aim of the present study was to explore the distribution of HbA1c and HbF in a large Chinese Han population. METHODS In all, 70 553 blood samples were collected between January 2012 and June 2016. Study subjects were inpatients undergoing routine medical care and were divided into four groups based on age: Group A, 20-39 years; Group B, 40-59 years; Group C, 60-79 years; and Group D, ≥80 years. Blood HbA1c and HbF concentrations were measured by HPLC using a Tosho Bioscience (Tokyo, Japan) G8 analyzer. RESULTS There was a positive association between HbA1c and age, and a negative association between HbF and age. The concentration range of HbF was narrow and HbF concentrations were significantly higher in females than males, regardless of age (median 0.7% vs 0.6%, respectively; P < 0.0001). There was a low degree of correlation between HbF and HbA1c (r = 0.181, P < 0.0001). Although median HbA1c levels were higher in male than female subjects aged 20-59 years (5.5% vs 5.4%, respectively, in Group A; 5.9% vs 5.8%, respectively in Group B), in the 60-79 years group, HbA1c levels were lower in males than females (6.1% vs 6.2%, respectively; P < 0.0001). CONCLUSIONS The data suggest that sex and age should be considered in clinical interpretation of HbA1c.
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Affiliation(s)
- Jihong Hu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Nanjing Medical University, Changzhou No. 2 People's Hospital, Changzhou, China
| | - Jun Gao
- Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital, Nanjing Traditional Chinese Medical University, Changzhou, China
| | - Jianbo Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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11
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Husain M, Hartman AD, Desai P. Pharmacogenomics of sickle cell disease: steps toward personalized medicine. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2017; 10:261-265. [PMID: 29089781 PMCID: PMC5656342 DOI: 10.2147/pgpm.s123427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sickle cell disease (SCD) is a monogenetic disease but has a wide range of phenotypic expressions. Some of these differences in phenotype can be explained by genetic polymorphisms in the human globin gene. These polymorphisms can result in different responses to typical treatment, sometimes leading to inadequate therapeutics. Research is revealing more polymorphisms, and therefore, new targets for intervention to improve outcomes in SCD. This area of pharmacogenomics is continuing to develop. We provide a brief review of the current literature on pharmacogenomics in SCD and possible targets for intervention.
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Affiliation(s)
| | | | - Payal Desai
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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12
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Disease burden and the role of pharmacogenomics in African populations. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2017; 2:e1. [PMID: 29868213 PMCID: PMC5870420 DOI: 10.1017/gheg.2016.21] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 12/15/2022]
Abstract
Background The burden of communicable and non-communicable diseases in Sub-Saharan Africa poses a challenge in achieving quality healthcare. Although therapeutic drugs have generally improved health, their efficacy differs from individual to individual. Variability in treatment response is mainly because of genetic variants that affect the pharmacokinetics and pharmacodynamics of drugs. Method The intersection of disease burden and therapeutic intervention is reviewed, and the status of pharmacogenomics knowledge in African populations is explored. Results The most commonly studied variants with pharmacogenomics relevance are discussed, especially in genes coding for enzymes that affect the response to drugs used for HIV, malaria, sickle cell disease and cardiovascular diseases. Conclusions The genetically diverse African population is likely to benefit from a pharmacogenomics-based healthcare approach, especially with respect to reduction of drug side effects, and separation of responders and non-responders leading to optimized drug choices and doses for each patient.
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13
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Sclafani S, Pecoraro A, Agrigento V, Troia A, Di Maggio R, Sacco M, Maggio A, D'Alcamo E, Di Marzo R. Study on Hydroxyurea Response in Hemoglobinopathies Patients Using Genetic Markers and Liquid Erythroid Cultures. Hematol Rep 2016; 8:6678. [PMID: 28053695 PMCID: PMC5178820 DOI: 10.4081/hr.2016.6678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/11/2016] [Indexed: 12/22/2022] Open
Abstract
Increased expression of fetal hemoglobin (HbF) may ameliorate the clinical course of hemoglobinopathies. Hydroxyurea (HU) is the only inducer approved for the treatment of these diseases able to stimulate HbF production but patients' response is highly variable indicating the utility of the identification of pharmacogenomic biomarkers in order to predict pharmacological treatment efficacy. To date few studies to evaluate the role of genetic determinants in HU response have been conducted showing contradictory results. In this study we analyzed BCL11A, GATA-1, KLF-1 genes and γ-globin promoter in 60 alleles from 30 hemoglobinopathies patients under HU treatment to assess the role of these markers in HU response. We did not find any association between these genetic determinants and HU response. Before treatment started, the same patients were analyzed in vitro using liquid erythroid cultures in a test able to predict their response to HU. The results of our analysis confirm the absence of pharmacogenomic biomarker associated to HU response indicating that, the quantification of γ-globin mRNA fold increase remains the only method able to predict in vivo patients response to the drug.
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Affiliation(s)
- Serena Sclafani
- Department of Oncology and Hematology, U.O.C. Hematology for Rare Blood and of Hematopoietic Organs Diseases, A.O. Reunited Hospitals Villa Sofia-Cervello , Palermo, Italy
| | - Alice Pecoraro
- Department of Oncology and Hematology, U.O.C. Hematology for Rare Blood and of Hematopoietic Organs Diseases, A.O. Reunited Hospitals Villa Sofia-Cervello , Palermo, Italy
| | - Veronica Agrigento
- Department of Oncology and Hematology, U.O.C. Hematology for Rare Blood and of Hematopoietic Organs Diseases, A.O. Reunited Hospitals Villa Sofia-Cervello , Palermo, Italy
| | - Antonio Troia
- Department of Oncology and Hematology, U.O.C. Hematology for Rare Blood and of Hematopoietic Organs Diseases, A.O. Reunited Hospitals Villa Sofia-Cervello , Palermo, Italy
| | - Rosario Di Maggio
- Department of Oncology and Hematology, U.O.C. Hematology for Rare Blood and of Hematopoietic Organs Diseases, A.O. Reunited Hospitals Villa Sofia-Cervello , Palermo, Italy
| | - Massimiliano Sacco
- Department of Oncology and Hematology, U.O.C. Hematology for Rare Blood and of Hematopoietic Organs Diseases, A.O. Reunited Hospitals Villa Sofia-Cervello , Palermo, Italy
| | - Aurelio Maggio
- Department of Oncology and Hematology, U.O.C. Hematology for Rare Blood and of Hematopoietic Organs Diseases, A.O. Reunited Hospitals Villa Sofia-Cervello , Palermo, Italy
| | - Elena D'Alcamo
- Department of Oncology and Hematology, U.O.C. Hematology for Rare Blood and of Hematopoietic Organs Diseases, A.O. Reunited Hospitals Villa Sofia-Cervello , Palermo, Italy
| | - Rosalba Di Marzo
- Department of Oncology and Hematology, U.O.C. Hematology for Rare Blood and of Hematopoietic Organs Diseases, A.O. Reunited Hospitals Villa Sofia-Cervello , Palermo, Italy
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14
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Wang WC. Minireview: Prognostic factors and the response to hydroxurea treatment in sickle cell disease. Exp Biol Med (Maywood) 2016; 241:730-6. [PMID: 27026724 DOI: 10.1177/1535370216642048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This review describes current considerations in the use of hydroxyurea for the management of sickle cell disease in the context of clinical severity. Randomized trials of hydroxyurea have generally enrolled subjects with increased severity based on frequent vaso-occlusive events. An exception was the BABY HUG study in infants which documented substantial benefit even for asymptomatic subjects. Increasing data indicate that hydroxyurea has a substantial effect on reducing mortality in both adults and children-perhaps the most compelling reason for advocating the drug's widespread use. Although the efficacy of hydroxyurea is mediated primarily through increased erythrocyte fetal hemoglobin and much has been learned about the genomic influences on fetal hemoglobin levels in sickle cell disease, our ability to predict the fetal hemoglobin response to hydroxyurea remains limited; much more work in this area is indicated. The review is concluded with the recommendations of the 2014 NIH Evidence-Based Management of Sickle Cell Disease Expert Panel Report.
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Affiliation(s)
- Winfred C Wang
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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15
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Keikhaei B, Yousefi H, Bahadoram M. Hydroxyurea: Clinical and Hematological Effects in Patients With Sickle Cell Anemia. Glob J Health Sci 2015; 8:252-6. [PMID: 26493428 PMCID: PMC4803938 DOI: 10.5539/gjhs.v8n3p252] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/29/2015] [Indexed: 01/13/2023] Open
Abstract
Background and Aim: It is well known that hydroxyurea impacts on clinical and hematologic indices in sickle cell disease (SCD), we aimed to evaluate the effect of hydroxyurea on clinical and hematological improvement of sickle cell anemia. Methods and Materials: In this cohort study 48 patients with sickle cell disease were enrolled and pain crisis, severity of pain, acute chest syndrome, the number of hospitalization, the rate of transfusion, spleen size, total Hb, HbF levels, MCV, MCH were compared before and after treatment with HU 10 mg/kg/day/for one year. Results: In patients with Sickle cell disease Hu significantly decreased the rate of transfusion, hospitalization, spleen size and significantly increased Hb, RBC indices and HbF. Furthermore, we did not find any remarkable adverse effect related to HU during the one year follow up in patients. Conclusion: We demonstrated that in the course of one year hydroxyurea 10 mg/kg/day can significantly increase HbF, total hemoglobin and RBC indices without any notable side effect in patients with SCD.
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Affiliation(s)
- Bijan Keikhaei
- Health Research Institute, Research Centre of Thalassemia and Hemoglobinopathies, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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16
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Gravia A, Chondrou V, Sgourou A, Papantoni I, Borg J, Katsila T, Papachatzopoulou A, Patrinos GP. Individualizing fetal hemoglobin augmenting therapy for β-type hemoglobinopathies patients. Pharmacogenomics 2015; 15:1355-64. [PMID: 25155936 DOI: 10.2217/pgs.14.101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Individual genetic composition is an important cause of variations in the response and tolerance to drug treatment. Pharmacogenomics is a modern discipline aiming to delineate individual genomic profiles and drug response. To date, there are several medical disciplines where pharmacogenomics is readily applicable, while in others its usefulness is yet to be demonstrated. Recent experimental evidence suggest that besides genomic variation within the human β-globin gene cluster, other variants in modifier genes residing outside the human β-globin gene cluster are significantly associated with response to hydroxyurea treatment in β-type hemoglobinopathies patients, deducted from the increase in fetal hemoglobin levels. This article aims to provide an update and to discuss future challenges on the application of pharmacogenomics for β-type hemoglobinopathies therapeutics in relation to the current pharmacological treatment modalities for those disorders.
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Affiliation(s)
- Aikaterini Gravia
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, GR-265 04, Patras, Greece
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17
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Papadopoulou E, Teli A, Theodoridou S, Gompakis N, Economou M. Safety and efficacy of hydroxyurea in children and adolescents with sickle/beta-thalassemia: two-year experience. Hippokratia 2015; 19:172-175. [PMID: 27418768 PMCID: PMC4938110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Hydroxyurea is a cytotoxic and myelosuppressive drug that has been used during recent years in the treatment of children with severe sickle cell disease. Nevertheless, questions remain regarding its role in young patients with no severe course, like sickle/beta-thalassemia (S/b-thal) patients often present. The aim of the present study was to evaluate the safety and efficacy of hydroxyurea in young patients with S/b-thal, which is the commonest form of the disease in Greece. PATIENTS-METHODS Hydroxyurea was given in thirteen children with S/b-thal for 24 months and for that period clinical and laboratory evaluation of the children was performed. RESULTS A reduction in pain crises and rate of hospitalization was noted. None of the patients presented with a severe clinical event, related to the disease during the study period. A significant increase in hemoglobin, hemoglobin F, mean corpuscular volume, and mean corpuscular hemoglobin and a decrease in reticulocyte count, white blood cell and platelet count, and total bilirubin level was noted. With regards to adverse events, these were transient, short-term and dose-dependable. CONCLUSIONS To the best of our knowledge, this is the first study to specifically assess the effect of hydroxyurea therapy in young patients with S/b-thal and the results indicate is safe and efficacious in this patient cohort. Hippokratia 2015; 19 (2):172-175.
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Affiliation(s)
- E Papadopoulou
- 1 Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - A Teli
- 1 Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - S Theodoridou
- Hemoglobinopathy Prevention Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - N Gompakis
- 2 Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - M Economou
- 1 Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
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18
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Abstract
Pain related to vasoocclusion is the most common reason for emergency department visits and hospital stays among pediatric patients with sickle cell disease. Using a prospective descriptive design, patients hospitalized with sickle cell pain were asked to complete the Adolescent Pediatric Pain Tool on each day of their hospital stay, providing data on the location, intensity, and quality of their pain. Data for 82 hospital stays were collected from 40 African American study participants. Mean age was 14.8 years, and mean length of stay (LOS) was 5.1 days. Mean LOS for 8 to 12 year olds (3.23 days; n = 22) was shorter than mean LOS for 13 to 19 year olds (5.85 days; n = 60). This LOS difference was significant (P = .004). Difference in LOS by gender was not significant. Higher initial number of body sites with pain was significantly associated with longer LOS (r = .39; P < .001). Higher initial pain intensity scores were significantly associated with longer LOS (r = .37; P = .001). Higher initial number of word descriptors was only weakly associated with longer LOS. Neither gender nor age differences were significant for Adolescent Pediatric Pain Tool data.
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Affiliation(s)
- Marian B Fosdal
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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19
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Gavini N, Hoots WK, Mensah GA, Hanspal M. An analysis of the NIH-supported sickle cell disease research portfolio. Blood Cells Mol Dis 2014; 54:198-205. [PMID: 25466208 DOI: 10.1016/j.bcmd.2014.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/09/2014] [Indexed: 02/02/2023]
Abstract
Sickle cell disease (SCD), an inherited blood disorder is due to a single amino acid substitution on the beta chain of hemoglobin, and is characterized by anemia, severe infections, acute and chronic pain, and multi-organ damage. The National Institutes of Health (NIH) is dedicated to support basic, translational and clinical science research to improve care and ultimately, to find a cure for SCD that causes such suffering. This report provides a detailed analysis of grants funded by the NIH for SCD research in Fiscal Years 2007 through 2013. During this period, the NIH supported 247 de novo grants totaling $272,210,367 that address various aspects of SCD. 83% of these funds supported research project grants investigating the following 5 scientific themes: Pathology of Sickle Red Blood Cells; Globin Gene Expression; Adhesion and Vascular Dysfunction; Neurological Complications and Organ-specific Dysfunction; and Pain Management and Intervention. The remaining 17% of total funds supported career development and training grants; Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grants; large Center grants; and Conference grants. Further analysis showed that the National Heart, Lung, and Blood Institute (NHLBI) is the largest funder of SCD research within NIH with 67% of total grants, contributing 77% of total funds; followed by the National Institute for Digestive Diseases and Kidney (NIDDK) that is funding 19% of grants, contributing 13% of total funds. The remaining 14% of grants totaling 10% of the funds were supported by all other NIH Institutes/Centers (ICs) combined. In summary, the NIH is using multiple funding mechanisms to support a sickle cell disease research agenda that is intended to advance the detection, treatment, and cure of this debilitating genetic disease.
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Affiliation(s)
- Nara Gavini
- Center for Translation Research and Implementation Science, The National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Bethesda, MD 20892, USA
| | - W Keith Hoots
- Division of Blood Diseases and Resources, The National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Bethesda, MD 20892, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science, The National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Bethesda, MD 20892, USA
| | - Manjit Hanspal
- Division of Blood Diseases and Resources, The National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Bethesda, MD 20892, USA.
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20
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Hydroxyurea-inducible SAR1 gene acts through the Giα/JNK/Jun pathway to regulate γ-globin expression. Blood 2014; 124:1146-56. [PMID: 24914133 DOI: 10.1182/blood-2013-10-534842] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Hydroxyurea (HU) is effectively used in the management of β-hemoglobinopathies by augmenting the production of fetal hemoglobin (HbF). However, the molecular mechanisms underlying HU-mediated HbF regulation remain unclear. We previously reported that overexpression of the HU-induced SAR1 gene closely mimics the known effects of HU on K562 and CD34(+) cells, including γ-globin induction and cell-cycle regulation. Here, we show that HU stimulated nuclear factor-κB interaction with its cognate-binding site on the SAR1 promoter to regulate transcriptional expression of SAR1 in K562 and CD34(+) cells. Silencing SAR1 expression not only significantly lowered both basal and HU-elicited HbF production in K562 and CD34(+) cells, but also significantly reduced HU-mediated S-phase cell-cycle arrest and apoptosis in K562 cells. Inhibition of c-Jun N-terminal kinase (JNK)/Jun phosphorylation and silencing of Giα expression in SAR1-transfected K562 and CD34(+) cells reduced both γ-globin expression and HbF level, indicating that activation of Giα/JNK/Jun proteins is required for SAR1-mediated HbF induction. Furthermore, reciprocal coimmunoprecipitation assays revealed an association between forcibly expressed SAR1 and Giα2 or Giα3 proteins in both K562 and nonerythroid cells. These results indicate that HU induces SAR1, which in turn activates γ-globin expression, predominantly through the Giα/JNK/Jun pathway. Our findings identify SAR1 as an alternative therapeutic target for β-globin disorders.
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21
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Thornburg CD. Sickle cell anemia: time for personalized prescription of hydroxyurea? Focus on "Organic anion transporting polypeptide 1B transporters modulate hydroxyurea pharmacokinetics". Am J Physiol Cell Physiol 2013; 305:C1209-10. [PMID: 24005044 DOI: 10.1152/ajpcell.00268.2013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Courtney D Thornburg
- Department of Pediatrics, University of California-San Diego, La Jolla, California; and Hemophilia and Thrombosis Center, Rady Children's Hospital-San Diego, San Diego, California
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22
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Fong C, Lizarralde-Iragorri MA, Rojas-Gallardo D, Barreto G. Frequency and origin of haplotypes associated with the beta-globin gene cluster in individuals with trait and sickle cell anemia in the Atlantic and Pacific coastal regions of Colombia. Genet Mol Biol 2013; 36:494-7. [PMID: 24385850 PMCID: PMC3873178 DOI: 10.1590/s1415-47572013000400005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/24/2013] [Indexed: 11/22/2022] Open
Abstract
Sickle cell anemia is a genetic disease with high prevalence in people of African descent. There are five typical haplotypes associated with this disease and the haplotypes associated with the beta-globin gene cluster have been used to establish the origin of African-descendant people in America. In this work, we determined the frequency and the origin of haplotypes associated with hemoglobin S in a sample of individuals with sickle cell anemia (HbSS) and sickle cell hemoglobin trait (HbAS) in coastal regions of Colombia. Blood samples from 71 HbAS and 79 HbSS individuals were obtained. Haplotypes were determined based on the presence of variable restriction sites within the β-globin gene cluster. On the Pacific coast of Colombia the most frequent haplotype was Benin, while on the Atlantic coast Bantu was marginally higher than Benin. Eight atypical haplotypes were observed on both coasts, being more diverse in the Atlantic than in the Pacific region. These results suggest a differential settlement of the coasts, dependent on where slaves were brought from, either from the Gulf of Guinea or from Angola, where the haplotype distributions are similar. Atypical haplotypes probably originated from point mutations that lost or gained a restriction site and/or by recombination events.
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Affiliation(s)
- Cristian Fong
- Laboratorio de Genética Molecular Humana, Departamento de Biología, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | | | - Diana Rojas-Gallardo
- Laboratorio de Genética Molecular Humana, Departamento de Biología, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Guillermo Barreto
- Laboratorio de Genética Molecular Humana, Departamento de Biología, Universidad del Valle, Cali, Valle del Cauca, Colombia
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23
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Efficacy of fixed low dose hydroxyurea in Indian children with sickle cell anemia: A single centre experience. Indian Pediatr 2013; 50:929-33. [DOI: 10.1007/s13312-013-0264-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 03/12/2013] [Indexed: 10/26/2022]
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Kumar R, Kaur A, Agarwal S. Influence of Xmn 1(G)γ (HBG2 c.-211 C → T) Globin Gene Polymorphism on Phenotype of Thalassemia Patients of North India. Indian J Hematol Blood Transfus 2013; 30:286-90. [PMID: 25435729 DOI: 10.1007/s12288-013-0293-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 08/08/2013] [Indexed: 10/26/2022] Open
Abstract
Beta (β) thalassemia is the most common single gene disorder in India. It has been reported that in patients with β-thalassemia in the presence of Xmn 1(G)γ polymorphic site the level of fetal hemoglobin (HbF) is increased thereby reducing the severity of disease. To determine the prevalence of Xmn 1(G)γ polymorphic site and its effect on the clinical phenotype and HbF level in 39 β-thalassemia major and 62 thalassemia intermedia patients, along with response to hydroxyurea therapy in thalassemia intermedia cases. Status of Xmn 1(G)γ polymorphism was determined by polymerase chain reaction-restricted fragment length polymorphism procedure. The HbF level was determined using high performance liquid chromatography. Genotypes and allele frequencies of the Xmn 1(G)γ polymorphism did not vary significantly between the various thalassemia groups. HbF levels were observed to be significantly increased and age at presentation was significantly greater in presence of Xmn 1(G)γ polymorphic site on both alleles as compared to its absence in thalassemia major but not in thalassemia intermedia cases. The response of hydroxyurea in thalassemia intermedia was found only in a few patients irrespective of their Xmn 1(G)γ status. Xmn 1(G)γ polymorphisms appear to significantly influence HbF levels and age at presentation in thalassemia major but not in thalassemia intermedia patients. Small numbers precluded a definitive correlation of the polymorphism with response to hydroxyurea therapy.
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Affiliation(s)
- Ravindra Kumar
- Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibarelly Road, Lucknow, 226014 India
| | - Anupriya Kaur
- Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibarelly Road, Lucknow, 226014 India
| | - Sarita Agarwal
- Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibarelly Road, Lucknow, 226014 India
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25
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Green NS, Ender KL, Pashankar F, Driscoll C, Giardina PJ, Mullen CA, Clark LN, Manwani D, Crotty J, Kisselev S, Neville KA, Hoppe C, Barral S. Candidate sequence variants and fetal hemoglobin in children with sickle cell disease treated with hydroxyurea. PLoS One 2013; 8:e55709. [PMID: 23409025 PMCID: PMC3567082 DOI: 10.1371/journal.pone.0055709] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 12/29/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Fetal hemoglobin level is a heritable complex trait that strongly correlates swith the clinical severity of sickle cell disease. Only few genetic loci have been identified as robustly associated with fetal hemoglobin in patients with sickle cell disease, primarily adults. The sole approved pharmacologic therapy for this disease is hydroxyurea, with effects largely attributable to induction of fetal hemoglobin. METHODOLOGY/PRINCIPAL FINDINGS In a multi-site observational analysis of children with sickle cell disease, candidate single nucleotide polymorphisms associated with baseline fetal hemoglobin levels in adult sickle cell disease were examined in children at baseline and induced by hydroxyurea therapy. For baseline levels, single marker analysis demonstrated significant association with BCL11A and the beta and epsilon globin loci (HBB and HBE, respectively), with an additive attributable variance from these loci of 23%. Among a subset of children on hydroxyurea, baseline fetal hemoglobin levels explained 33% of the variance in induced levels. The variant in HBE accounted for an additional 13% of the variance in induced levels, while variants in the HBB and BCL11A loci did not contribute beyond baseline levels. CONCLUSIONS/SIGNIFICANCE These findings clarify the overlap between baseline and hydroxyurea-induced fetal hemoglobin levels in pediatric disease. Studies assessing influences of specific sequence variants in these and other genetic loci in larger populations and in unusual hydroxyurea responders are needed to further understand the maintenance and therapeutic induction of fetal hemoglobin in pediatric sickle cell disease.
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Affiliation(s)
- Nancy S Green
- Department of Pediatrics, Columbia University, New York, New York, USA.
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26
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Banan M. Hydroxyurea treatment in β-thalassemia patients: to respond or not to respond? Ann Hematol 2013; 92:289-99. [PMID: 23318979 DOI: 10.1007/s00277-012-1671-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 12/29/2012] [Indexed: 01/03/2023]
Abstract
Hydroxyurea (HU) is a drug that induces fetal hemoglobin production. As a result, HU is widely used to treat β-thalassemia (β-thal) patients. However, the response of these patients to HU varies. Some β-thal patients respond favorably to treatment while others do not respond at all. HU has a number of side-effects and therefore its targeted prescription is beneficial. Hence, identifying the genetic determinants which lead to the differential HU response is important. This review summarizes recent findings which have shed light on this topic. Special emphasis is given to the mechanisms and genetic loci which may govern these differences. These findings have helped identify several single nucleotide polymorphisms which associate with the response to HU in both β-thal and sickle cell disease patients.
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Affiliation(s)
- Mehdi Banan
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Evin, Daneshjoo Blvd., Koodakyar St, Tehran, Iran.
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27
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Tamminga RYJ, Doornbos ME, Muskiet FAJ, Koetse HA. Rhabdomyolysis in a child with Hemoglobin SE. Pediatr Hematol Oncol 2012; 29:267-9. [PMID: 22475303 DOI: 10.3109/08880018.2012.655406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R Y J Tamminga
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, The Netherlands.
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28
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Torres LDS, da Silva DGH, Belini Junior E, de Almeida EA, Lobo CLDC, Cançado RD, Ruiz MA, Bonini-Domingos CR. The influence of hydroxyurea on oxidative stress in sickle cell anemia. Rev Bras Hematol Hemoter 2012; 34:421-5. [PMID: 23323065 PMCID: PMC3545428 DOI: 10.5581/1516-8484.20120106] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 08/08/2012] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The oxidative stress in 20 sickle cell anemia patients taking hydroxyurea and 13 sickle cell anemia patients who did not take hydroxyurea was compared with a control group of 96 individuals without any hemoglobinopathy. METHODS Oxidative stress was assessed by thiobarbituric acid reactive species production, the Trolox-equivalent antioxidant capacity and plasma glutathione levels. RESULTS Thiobarbituric acid reactive species values were higher in patients without specific medication, followed by patients taking hydroxyurea and the Control Group (p < 0.0001). The antioxidant capacity was higher in patients taking hydroxyurea and lower in the Control Group (p = 0.0002 for Trolox-equivalent antioxidant capacity and p < 0.0292 for plasma glutathione). Thiobarbituric acid reactive species levels were correlated with higher hemoglobin S levels (r = 0.55; p = 0.0040) and lower hemoglobin F concentrations(r = -0.52; p = 0.0067). On the other hand, plasma glutathione levels were negatively correlated with hemoglobin S levels (r = -0.49; p = 0.0111) and positively associated with hemoglobin F values (r = 0.56; p = 0.0031). CONCLUSION Sickle cell anemia patients have high oxidative stress and, conversely, increased antioxidant activity. The increase in hemoglobin F levels provided by hydroxyurea and its antioxidant action may explain the reduction in lipid peroxidation and increased antioxidant defenses in these individuals.
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Affiliation(s)
| | | | - Edis Belini Junior
- Universidade Estadual Paulista - UNESP, São José do Rio Preto, SP, Brazil
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29
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Neishabury M, Zamani S, Azarkeivan A, Abedini SS, Darvish H, Zamani F, Najmabadi H. The modifying effect of Xmn1-HBG2 on thalassemic phenotype is associated with its linked elements in the beta globin locus control region, including the palindromic site at 5'HS4. Blood Cells Mol Dis 2011; 48:1-5. [PMID: 22036762 DOI: 10.1016/j.bcmd.2011.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/28/2011] [Indexed: 11/24/2022]
Abstract
The core sequence of 5'HS4-beta globin locus control region and Xmn1-HBG2 site were analyzed and compared among 86 thalassemia patients with homozygous or compound heterozygous beta globin gene mutations and 101 normal individuals. Frequency of the G allele in the polymorphic palindromic sequence of 5'HS4 (TGGGG A/G CCCCA) and positive Xmn1-HBG2 profile was significantly higher in thalassemia patients compared to the normal population. Linkage disequilibrium was observed between the G allele and positive Xmn1-HBG2 profile in patient population. Furthermore, dominance of IVSII-1 in the mutation spectrum of the patients enabled us to identify linkage disequilibrium relationships between IVSII-1, positive Xmn1-HBG2 and the G allele at 5'HS4. The frequency of milder clinical phenotype was significantly higher in patients with GG/++ than cases with AA/-- genotypic pattern in 5'HS4/Xmn1-HBG2 loci. These data together with biochemical evidence suggesting a role for the A/G polymorphism at 5'HS4 palindromic site on modifying chromatin structure and in the absence of any evidence from functional studies relating the Xmn1-HBG2 site to the increased gamma chain expression, suggest that the phenotype modifying role long time assigned to Xmn1-HBG2 is possibly played by more functionally potent elements linked to it in LCR.
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Affiliation(s)
- Maryam Neishabury
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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Adekile AD. Limitations of Hb F as a phenotypic modifier in sickle cell disease: study of Kuwaiti Arab patients. Hemoglobin 2011; 35:607-17. [PMID: 21999156 DOI: 10.3109/03630269.2011.617230] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sickle cell disease is characterized by phenotypic heterogeneity and many genetic modifiers have been identified with elevated Hb F being the most recognized ameliorating factor. Kuwaiti sickle cell disease patients carry the India/Arab chromosomal haplotype, which is associated with elevated Hb F (on average ~22%) on account of the Xmn1 site in the (G)γ-globin gene promoter. Most patients had either Hb SS or Hb S-β(0)-thalassemia (β(0)-thal) and there are a few Hb SD compound heterozygotes. We have carried out longitudinal clinical studies of these patients to document the pattern of morbidity, spleen function, brain and hip magnetic resonance imaging (MRI) for prevalence of silent brain infarcts and avascular necrosis of the femoral head (AVNFH), respectively. In addition, pulmonary function, SPECT (single photon emission computerized tomography) brain cerebral blood flow and response of selected patients to hydroxyurea (HU) treatment were also studied. The Hb SS and Hb S-β-thal patients have a generally mild phenotype compared to sickle cell disease in other populations and most patients do not have their first pain crisis until about the age of 4 years. Spleen function is retained till late childhood; pneumococcemia and other severe bacterial infections are rare. Overt stroke and silent brain infarcts are uncommon in childhood (~3% prevalence) although SPECT reveals cerebral blood flow deficits in ~30%. Avascular necrosis of the femoral head is, however, common with a prevalence of ~26% in children and 50% in adults. There is brisk response to HU in patients with frequent pain crises, with marked increases in Hb F levels. Patients who are compound heterozygotes for Hbs S and D-Los Angeles, have the most severe phenotype despite Hb F levels of >20% and Hb S <30%. In conclusion, although the patients have a uniformly elevated Hb F level, there are still considerable phenotypic heterogeneity and other modulating genetic factors that require further studies.
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Fetal hemoglobin levels in African American and Hispanic children with sickle cell disease at baseline and in response to hydroxyurea. J Pediatr Hematol Oncol 2011; 33:496-9. [PMID: 21941141 PMCID: PMC3179608 DOI: 10.1097/mph.0b013e31822dcc21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The degree of fetal hemoglobin (HbF) expression is a major determinant of phenotypic severity of sickle cell disease (SCD). Genetic regulation of HbF production is complex and can vary among ethnic groups. The pediatric sickle cell population at our institution is approximately half Hispanic, nearly all from the Dominican Republic. Hydroxyurea (HU) is the only Food and Drug Administration (FDA)-approved drug to ameliorate symptoms of SCD. We retrospectively compared baseline and HU-induced percent HbF (%HbF) in African American (AA) and Hispanic (H) patients aged 4 to 21 years with homozygous Sickle hemoglobin or HbSβ(0)Thalassemia. No significant differences were detected in average baseline %HbF between AA (N=48) and H (N=58) patients (P=0.63). In the subset of children taking HU who reached maximum tolerated dose (MTD), no differences were found between the ethnic groups in laboratory response to drug, measured by %HbF at MTD (P=0.28), the increase in %HbF (P=0.31) or mean red cell volume (MCV) (P=0.93), or the MTD of HU (P=0.95). Regulation of HbF at baseline and in response to HU are comparable between Hispanics and African Americans at our center. If generalizable, our results support combining these 2 groups in future clinical and translational analyses focused on HbF and response to HU in this ethnically mixed patient population.
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Spicer JI, Rundle SD, Tills O. Studying the altered timing of physiological events during development: It's about time…or is it? Respir Physiol Neurobiol 2011; 178:3-12. [DOI: 10.1016/j.resp.2011.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 06/03/2011] [Accepted: 06/08/2011] [Indexed: 11/26/2022]
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dos Santos JL, Lanaro C, Lima LM, Gambero S, Franco-Penteado CF, Alexandre-Moreira MS, Wade M, Yerigenahally S, Kutlar A, Meiler SE, Costa FF, Chung M. Design, Synthesis, and Pharmacological Evaluation of Novel Hybrid Compounds To Treat Sickle Cell Disease Symptoms. J Med Chem 2011; 54:5811-9. [DOI: 10.1021/jm200531f] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jean Leandro dos Santos
- Laboratório de Pesquisa e Desenvolvimento de Fármacos (Lapdesf), Departamento de Fármacos e Medicamentos, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista (UNESP), Rodovia Araraquara Jaú Km. 01, 14801-902, Araraquara, SP, Brazil
| | - Carolina Lanaro
- The Haematology and Haemotherapy Centre, University of Campinas (UNICAMP), Hemocentro, Rua Carlos Chagas, 480, Cidade Universitária, Barão Geraldo, 13083-970, Campinas, SP, Brazil
| | - Lídia Moreira Lima
- Laboratório de Avaliação e Síntese de Substâncias Bioativas (LASSBio, ), Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, P.O. Box 68024, 21944-971, Rio de Janeiro, RJ, Brazil
| | - Sheley Gambero
- The Haematology and Haemotherapy Centre, University of Campinas (UNICAMP), Hemocentro, Rua Carlos Chagas, 480, Cidade Universitária, Barão Geraldo, 13083-970, Campinas, SP, Brazil
| | - Carla Fernanda Franco-Penteado
- The Haematology and Haemotherapy Centre, University of Campinas (UNICAMP), Hemocentro, Rua Carlos Chagas, 480, Cidade Universitária, Barão Geraldo, 13083-970, Campinas, SP, Brazil
| | - Magna Suzana Alexandre-Moreira
- Laboratório de Farmacologia e Imunidade (LaFI), Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Marlene Wade
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, Georgia, United States
| | - Shobha Yerigenahally
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, Georgia, United States
| | - Abdullah Kutlar
- Sickle Cell Center, Medical College of Georgia, Augusta, Georgia, United States
| | - Steffen E. Meiler
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, Georgia, United States
| | - Fernando Ferreira Costa
- The Haematology and Haemotherapy Centre, University of Campinas (UNICAMP), Hemocentro, Rua Carlos Chagas, 480, Cidade Universitária, Barão Geraldo, 13083-970, Campinas, SP, Brazil
| | - ManChin Chung
- Laboratório de Pesquisa e Desenvolvimento de Fármacos (Lapdesf), Departamento de Fármacos e Medicamentos, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista (UNESP), Rodovia Araraquara Jaú Km. 01, 14801-902, Araraquara, SP, Brazil
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