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Gursoy V, Sadri S, Kucukelyas HD, Hunutlu FC, Pinar IE, Yegen ZS, Alkış N, Ersal T, Ali R, Ozkocaman V, Ozkalemkas F. HALP score as a novel prognostic factor for patients with myelodysplastic syndromes. Sci Rep 2024; 14:13843. [PMID: 38879594 PMCID: PMC11180126 DOI: 10.1038/s41598-024-64166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/05/2024] [Indexed: 06/19/2024] Open
Abstract
Myelodysplastic syndrome (MDS) is a heterogeneous spectrum of clonal hematopoietic disorders with varying degrees of cytopenia and morphologic dysplasia. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a prognostic marker in several types of malignant tumors. Prognostic value of HALP score remains unclear for MDS. To determine the prognostic value of baseline HALP score in MDS. We retrospectively analyzed data from 130 newly diagnosed MDS patients evaluated and classified under HALP score. By the receiver operating characteristic (ROC) analysis, the optimal cut-off value of HALP was > 67.5 in predicting mortality. Patients were divided into two groups: with low and high HALP scores, and the characteristics were compared between both groups. Patients' median age was 68 (19-84) years, and 79 (60.8%) were male. Higher HALP score was detected in MDS patients with intermediate-risk under IPSS score, and at high and very high risks under IPSS-R score, and those receiving azacitidine (AZA) treatment. The survival rates of those with a HALP score > 67.5 were significantly lower than those with low HALP score at 17.77 ± 3.98 (median ± SE) (p < 0.001). The 3-, 5- and 10-years survival rates of individuals with HALP scores > 67.5 were found as 25, 18, and 11%, respectively. Median overall survival (OS) was also determined as 33.10 (95% CI 16.34-49.88) months by the Kaplan-Meier method. HALP score has shown an ability to be a useful prognostic biomarker in various cancers, including MDS. The meaningful cut-off value of HALP is disease-specific and largely study-specific. High HALP score is associated with unfavorable clinicopathological characteristics. Also, it may be useful in predicting OS and mortality of MDS.
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Affiliation(s)
- Vildan Gursoy
- Department of Hematology, Bursa City Hospital, Bursa, Turkey.
| | - Sevil Sadri
- Department of Hematology, Bursa City Hospital, Bursa, Turkey
| | | | | | | | | | - Nihan Alkış
- Department of Hematology, Bursa City Hospital, Bursa, Turkey
| | - Tuba Ersal
- Department of Hematology, Uludag University Medical Faculty, Bursa, Turkey
| | - Ridvan Ali
- Department of Hematology, Uludag University Medical Faculty, Bursa, Turkey
| | - Vildan Ozkocaman
- Department of Hematology, Uludag University Medical Faculty, Bursa, Turkey
| | - Fahir Ozkalemkas
- Department of Hematology, Uludag University Medical Faculty, Bursa, Turkey
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Madonna R, Biondi F, Alberti M, Ghelardoni S, Mattii L, D'Alleva A. Cardiovascular outcomes and molecular targets for the cardiac effects of Sodium-Glucose Cotransporter 2 Inhibitors: A systematic review. Biomed Pharmacother 2024; 175:116650. [PMID: 38678962 DOI: 10.1016/j.biopha.2024.116650] [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: 02/19/2024] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 05/01/2024] Open
Abstract
Sodium-glucose cotransporter 2 inhibitors (SGLT2i), a new class of glucose-lowering drugs traditionally used to control blood glucose levels in patients with type 2 diabetes mellitus, have been proven to reduce major adverse cardiovascular events, including cardiovascular death, in patients with heart failure irrespective of ejection fraction and independently of the hypoglycemic effect. Because of their favorable effects on the kidney and cardiovascular outcomes, their use has been expanded in all patients with any combination of diabetes mellitus type 2, chronic kidney disease and heart failure. Although mechanisms explaining the effects of these drugs on the cardiovascular system are not well understood, their effectiveness in all these conditions suggests that they act at the intersection of the metabolic, renal and cardiac axes, thus disrupting maladaptive vicious cycles while contrasting direct organ damage. In this systematic review we provide a state of the art of the randomized controlled trials investigating the effect of SGLT2i on cardiovascular outcomes in patients with chronic kidney disease and/or heart failure irrespective of ejection fraction and diabetes. We also discuss the molecular targets and signaling pathways potentially explaining the cardiac effects of these pharmacological agents, from a clinical and experimental perspective.
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Affiliation(s)
- Rosalinda Madonna
- Department of Pathology, Cardiology Division, University of Pisa, Via Paradisa, Pisa 56124, Italy.
| | - Filippo Biondi
- Department of Pathology, Cardiology Division, University of Pisa, Via Paradisa, Pisa 56124, Italy
| | - Mattia Alberti
- Department of Pathology, Cardiology Division, University of Pisa, Via Paradisa, Pisa 56124, Italy
| | - Sandra Ghelardoni
- Department of Pathology, Laboratory of Biochemistry, University of Pisa, Italy
| | - Letizia Mattii
- Department of Clinical and Experimental Medicine, Histology Division, University of Pisa, Pisa, Italy
| | - Alberto D'Alleva
- Cardiac Intensive Care and Interventional Cardiology Unit, Santo Spirito Hospital, Pescara, Italy
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3
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Coimbra S, Rocha S, Catarino C, Valente MJ, Rocha-Pereira P, Sameiro-Faria M, Oliveira JG, Madureira J, Fernandes JC, Miranda V, Belo L, Bronze-da-Rocha E, Santos-Silva A. Impact of TNFRSF1B (rs3397, rs1061624 and rs1061622) and IL6 (rs1800796, rs1800797 and rs1554606) Gene Polymorphisms on Inflammatory Response in Patients with End-Stage Kidney Disease Undergoing Dialysis. Biomedicines 2024; 12:1228. [PMID: 38927435 PMCID: PMC11200861 DOI: 10.3390/biomedicines12061228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
We aimed to study the impact of polymorphisms in the genes encoding interleukin-6 (IL6) and tumor necrosis factor receptor-2 (TNFR2), reported to be mortality risk predictors, in patients with end-stage kidney disease (ESKD) undergoing dialysis. TNFRSF1B (rs3397, rs1061624, and rs1061622) and IL6 (rs1800796, rs1800797, and rs1554606) polymorphisms were studied in patients with ESKD and controls; the genotype and allele frequencies and the associations with inflammatory and erythropoiesis markers were determined; deaths were recorded throughout the following two years. The genotype and allele frequencies for the TNFRSF1B rs3397 polymorphism were different in these patients compared to those in the controls and the global and European populations, and patients with the C allele were less common. Patients with the CC genotype for TNFRSF1B rs3397 presented higher hemoglobin and erythrocyte counts and lower TNF-α levels, suggesting a more favorable inflammatory response that seems to be associated with erythropoiesis improvement. Patients with the GG genotype for TNFRSF1B rs1061622 showed lower serum ferritin levels. None of the TNFRSF1B (rs3397, rs1061624, and rs1061622) or IL6 (rs1800796, rs1800797, and rs1554606) polymorphisms had a significant impact on the all-cause mortality rate of Portuguese patients with ESKD.
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Affiliation(s)
- Susana Coimbra
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- 1H-TOXRUN—One Health Toxicology Research Unit, University Institute of Health Sciences, CESPU (Advanced Polytechnic and University Cooperative, CRL), 4585-116 Gandra, Portugal
| | - Susana Rocha
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Cristina Catarino
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Maria João Valente
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark;
| | - Petronila Rocha-Pereira
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- Health Science Research Centre, University of Beira Interior, 6201-001 Covilhã, Portugal
| | - Maria Sameiro-Faria
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- Hemodialysis Clinic Hospital Agostinho Ribeiro, 4610-106 Felgueiras, Portugal
| | - José Gerardo Oliveira
- Hemodialysis Clinic of Porto (CHP), 4200-227 Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - José Madureira
- Hemodialysis Unit of Barcelos | Nefroserve, 4750-110 Barcelos, Portugal
| | - João Carlos Fernandes
- Hemodialysis Unit of Viana do Castelo | Nefroserve, 4900-281 Viana do Castelo, Portugal
| | - Vasco Miranda
- Hemodialysis Clinic of Gondomar, 4420-086 Gondomar, Portugal
| | - Luís Belo
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Elsa Bronze-da-Rocha
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Alice Santos-Silva
- UCIBIO—Applied Molecular Biosciences Unit, Associate Laboratory, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal; (S.R.); (C.C.); (L.B.); (E.B.-d.-R.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
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Gregers E, Frederiksen PH, Udesen NLJ, Linde L, Banke A, Povlsen AL, Larsen JP, Hassager C, Jensen LO, Lassen JF, Schmidt H, Ravn HB, Heegaard PMH, Møller JE. Immediate inflammatory response to mechanical circulatory support in a porcine model of severe cardiogenic shock. Intensive Care Med Exp 2024; 12:39. [PMID: 38647741 PMCID: PMC11035503 DOI: 10.1186/s40635-024-00625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In selected cases of cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is combined with trans valvular micro axial flow pumps (ECMELLA). Observational studies indicate that ECMELLA may reduce mortality but exposing the patient to two advanced mechanical support devices may affect the early inflammatory response. We aimed to explore inflammatory biomarkers in a porcine cardiogenic shock model managed with V-A ECMO or ECMELLA. METHODS Fourteen landrace pigs had acute myocardial infarction-induced cardiogenic shock with minimal arterial pulsatility by microsphere embolization and were afterwards managed 1:1 with either V-A ECMO or ECMELLA for 4 h. Serial blood samples were drawn hourly and analyzed for serum concentrations of interleukin 6 (IL-6), IL-8, tumor necrosis factor alpha, and serum amyloid A (SAA). RESULTS An increase in IL-6, IL-8, and SAA levels was observed during the experiment for both groups. At 2-4 h of support, IL-6 levels were higher in ECMELLA compared to V-A ECMO animals (difference: 1416 pg/ml, 1278 pg/ml, and 1030 pg/ml). SAA levels were higher in ECMELLA animals after 3 and 4 h of support (difference: 401 ng/ml and 524 ng/ml) and a significant treatment-by-time effect of ECMELLA on SAA was identified (p = 0.04). No statistical significant between-group differences were observed in carotid artery blood flow, urine output, and lactate levels. CONCLUSIONS Left ventricular unloading with Impella during V-A ECMO resulted in a more extensive inflammatory reaction despite similar end-organ perfusion.
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Affiliation(s)
- Emilie Gregers
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark.
| | | | - Nanna L J Udesen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ann Banke
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Amalie L Povlsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jeppe P Larsen
- Department of Cardiothoracic Anesthesiology, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens F Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anesthesiology, Odense University Hospital, Odense, Denmark
| | - Hanne B Ravn
- Department of Cardiothoracic Anesthesiology, Odense University Hospital, Odense, Denmark
| | - Peter M H Heegaard
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Jacob E Møller
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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5
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Han Y, Gao C, Liu Y, Zhang H, Wang S, Zhao H, Bao W, Guo X, Vinchi F, Lobo C, Shi P, Mendelson A, Luchsinger L, Zhong H, Yazdanbakhsh K, An X. Hemolysis-driven IFNα production impairs erythropoiesis by negatively regulating EPO signaling in sickle cell disease. Blood 2024; 143:1018-1031. [PMID: 38127913 PMCID: PMC10950476 DOI: 10.1182/blood.2023021658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
ABSTRACT Disordered erythropoiesis is a feature of many hematologic diseases, including sickle cell disease (SCD). However, very little is known about erythropoiesis in SCD. Here, we show that although bone marrow (BM) erythroid progenitors and erythroblasts in Hbbth3/+ thalassemia mice were increased more than twofold, they were expanded by only ∼40% in Townes sickle mice (SS). We further show that the colony-forming ability of SS erythroid progenitors was decreased and erythropoietin (EPO)/EPO receptor (EPOR) signaling was impaired in SS erythroid cells. Furthermore, SS mice exhibited reduced responses to EPO. Injection of mice with red cell lysates or hemin, mimicking hemolysis in SCD, led to suppression of erythropoiesis and reduced EPO/EPOR signaling, indicating hemolysis, a hallmark of SCD, and could contribute to the impaired erythropoiesis in SCD. In vitro hemin treatment did not affect Stat5 phosphorylation, suggesting that hemin-induced erythropoiesis suppression in vivo is via an indirect mechanism. Treatment with interferon α (IFNα), which is upregulated by hemolysis and elevated in SCD, led to suppression of mouse BM erythropoiesis in vivo and human erythropoiesis in vitro, along with inhibition of Stat5 phosphorylation. Notably, in sickle erythroid cells, IFN-1 signaling was activated and the expression of cytokine inducible SH2-containing protein (CISH), a negative regulator of EPO/EPOR signaling, was increased. CISH deletion in human erythroblasts partially rescued IFNα-mediated impairment of cell growth and EPOR signaling. Knocking out Ifnar1 in SS mice rescued the defective BM erythropoiesis and improved EPO/EPOR signaling. Our findings identify an unexpected role of hemolysis on the impaired erythropoiesis in SCD through inhibition of EPO/EPOR signaling via a heme-IFNα-CISH axis.
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Affiliation(s)
- Yongshuai Han
- Laboratory of Membrane Biology, New York Blood Center, New York, NY
| | - Chengjie Gao
- Laboratory of Membrane Biology, New York Blood Center, New York, NY
| | - Yunfeng Liu
- Laboratory of Complement Biology, New York Blood Center, New York, NY
| | - Huan Zhang
- Laboratory of Membrane Biology, New York Blood Center, New York, NY
| | - Shihui Wang
- Laboratory of Membrane Biology, New York Blood Center, New York, NY
| | - Huizhi Zhao
- Laboratory of Membrane Biology, New York Blood Center, New York, NY
| | - Weili Bao
- Laboratory of Complement Biology, New York Blood Center, New York, NY
| | - Xinhua Guo
- Laboratory of Membrane Biology, New York Blood Center, New York, NY
| | - Francesca Vinchi
- Laboratory of Iron Research, New York Blood Center, New York, NY
| | - Cheryl Lobo
- Laboratory of Blood Borne Parasites, New York Blood Center, New York, NY
| | - Patricia Shi
- Sickle Cell Clinical Research Program, New York Blood Center, New York, NY
| | - Avital Mendelson
- Laboratory of Stem Cell Biology and Engineering Research, New York Blood Center, New York, NY
| | - Larry Luchsinger
- Laboratory of Stem Cell Regenerative Research, New York Blood Center, New York, NY
| | - Hui Zhong
- Laboratory of Immune Regulation, New York Blood Center, New York, NY
| | | | - Xiuli An
- Laboratory of Membrane Biology, New York Blood Center, New York, NY
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6
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Chaudhary R, Prasad A, Agarwal V, Rehman M, Kumar A, Kaushik AS, Srivastava S, Srivastava S, Mishra V. Chronic stress predisposes to the aggravation of inflammation in autoimmune diseases with focus on rheumatoid arthritis and psoriasis. Int Immunopharmacol 2023; 125:111046. [PMID: 37879231 DOI: 10.1016/j.intimp.2023.111046] [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: 08/24/2023] [Revised: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023]
Abstract
The global incidence of autoimmune diseases is on the rise, and many healthcare professionals believe that chronic stress plays a prominent role in both the aggravation and remission of these conditions. It is believed that prolonged exposure to stress is associated with neuroimmune axis malfunction, which eventually dysregulates multiple immunological factors as well as deregulates autoimmune responses that play a central role in various autoimmune diseases, including rheumatoid arthritis and psoriasis. Herein, we performed validation of an 8-week long rat model of chronic unpredictable stress (CUS) which consisted of exposing groups of rats to random stressors daily for 8 weeks. Additionally, we developed a novel rat model combining 8-week long random stressor-induced CUS with CIA-triggered arthritis and IMQ-triggered psoriasis and have successfully used both these models to assess the role of chronic stress in the aggravation of arthritis and psoriasis, respectively. Notably, the 8-week CUS protocol extensively aggravated and prolonged both arthritis and psoriasis condition in the rat model by upregulating the release of different pro-inflammatory cytokines, dysregulation of immune cell responses and oxidative stress system, which were all related to severe inflammation. Further, CUS aggravated macroscopic features and the increase in destruction of joint tissue and epidermal thickness induced by CIA and IMQ, respectively, in rats. In conclusion, this study suggests that exposure to an 8-week long CUS paradigm aggravates the distinctive characteristics of rheumatoid arthritis and psoriasis in rats via amplifying the inflammatory circuits and immune cell responses linked to these autoimmune diseases.
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Affiliation(s)
- Rishabh Chaudhary
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Ajay Prasad
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Vipul Agarwal
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Mujeeba Rehman
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Anand Kumar
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Arjun Singh Kaushik
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Siddhi Srivastava
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Sukriti Srivastava
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Vikas Mishra
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India.
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7
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Leimbacher AC, Villiger P, Desboeufs N, Aboouf MA, Nanni M, Armbruster J, Ademi H, Flüchter P, Ruetten M, Gantenbein F, Haider TJ, Gassmann M, Thiersch M. Voluntary exercise does not always suppress lung cancer progression. iScience 2023; 26:107298. [PMID: 37520731 PMCID: PMC10374464 DOI: 10.1016/j.isci.2023.107298] [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: 01/26/2023] [Revised: 05/11/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Physical exercise can lower lung cancer incidence. However, its effect on lung cancer progression is less understood. Studies on exercising mice have shown decreased ectopic lung cancer growth through the secretion of interleukin-6 from muscles and the recruitment of natural killer (NK) cells to tumors. We asked if exercise suppresses lung cancer in an orthotopic model also. Single-housed C57Bl/6 male mice in cages with running wheels were tail vein-injected with LLC1.1 lung cancer cells, and lung tumor nodules were analyzed. Exercise did not affect lung cancer. Therefore, we also tested the effect of exercise on a subcutaneous LLC1 tumor and a tail vein-injected B16F10 melanoma model. Except for one case of excessive exercise, tumor progression was not influenced. Moderately exercising mice did not increase IL-6 or recruit NK cells to the tumor. Our data suggest that the exercise dose may dictate how efficiently the immune system is stimulated and controls tumor progression.
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Affiliation(s)
- Aurelia C. Leimbacher
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Philipp Villiger
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Nina Desboeufs
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Mostafa A. Aboouf
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
- Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, 8057 Zurich, Switzerland
- Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
- Department of Biochemistry, Faculty of Pharmacy, Ain Shams University, Cairo 11566, Egypt
| | - Monica Nanni
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Julia Armbruster
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Hyrije Ademi
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Pascal Flüchter
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Maja Ruetten
- PathoVet AG, Pathology Diagnostic Laboratory, 8317 Tagelswangen ZH, Switzerland
| | - Felix Gantenbein
- Zurich Integrative Rodent Physiology (ZIRP), University of Zurich, 8057 Zurich, Switzerland
| | - Thomas J. Haider
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Max Gassmann
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
- Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, 8057 Zurich, Switzerland
| | - Markus Thiersch
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
- Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, 8057 Zurich, Switzerland
- Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
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8
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Ginzburg YZ. Hepcidin and its multiple partners: Complex regulation of iron metabolism in health and disease. VITAMINS AND HORMONES 2023; 123:249-284. [PMID: 37717987 DOI: 10.1016/bs.vh.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
The peptide hormone hepcidin is central to the regulation of iron metabolism, influencing the movement of iron into the circulation and determining total body iron stores. Its effect on a cellular level involves binding ferroportin, the main iron export protein, preventing iron egress and leading to iron sequestration within ferroportin-expressing cells. Hepcidin expression is enhanced by iron loading and inflammation and suppressed by erythropoietic stimulation. Aberrantly increased hepcidin leads to systemic iron deficiency and/or iron restricted erythropoiesis as occurs in anemia of chronic inflammation. Furthermore, insufficiently elevated hepcidin occurs in multiple diseases associated with iron overload such as hereditary hemochromatosis and iron loading anemias. Abnormal iron metabolism as a consequence of hepcidin dysregulation is an underlying factor resulting in pathophysiology of multiple diseases and several agents aimed at manipulating this pathway have been designed, with some already in clinical trials. In this chapter, we assess the complex regulation of hepcidin, delineate the many binding partners involved in its regulation, and present an update on the development of hepcidin agonists and antagonists in various clinical scenarios.
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Affiliation(s)
- Yelena Z Ginzburg
- Tisch Cancer Institute, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United Sates.
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9
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Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP's prognostic ability in different cancer types. Oncotarget 2023; 14:153-172. [PMID: 36848404 PMCID: PMC9970084 DOI: 10.18632/oncotarget.28367] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Since its inception, the Hemoglobin, Albumin, Lymphocyte, Platelet Score (HALP) has gained attention as a new prognostic biomarker to predict several clinical outcomes in a multitude of cancers. In our review, we searched PubMed for articles between the first paper on HALP in 2015 through September 2022, yielding 32 studies in total that evaluated HALP's association with various cancers, including Gastric, Colorectal, Bladder, Prostate, Kidney, Esophageal, Pharyngeal, Lung, Breast, and Cervical cancers, among others. This review highlights the collective association HALP has with demographic factors such as age and sex in addition to TNM staging, grade, and tumor size. Furthermore, this review summarizes HALP's prognostic ability to predict overall survival, progression-free survival, recurrence-free survival, among other outcomes. In some studies, HALP has also been able to predict response to immunotherapy and chemotherapy. This review article also aims to serve as a comprehensive and encyclopedic report on the literature that has evaluated HALP as a biomarker in various cancers, highlighting the heterogeneity surrounding HALP's utilization. Because HALP requires only a complete blood count and albumin - already routinely collected for cancer patients - HALP shows potential as a cost-effective biomarker to aid clinicians in improving outcomes for immuno-nutritionally deficient patients.
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Affiliation(s)
- Christian Mark Farag
- Department of Urology, George Washington University School of Medicine, Washington, DC 20052, USA
| | - Ryan Antar
- Department of Urology, George Washington University School of Medicine, Washington, DC 20052, USA
| | - Sinan Akosman
- Department of Urology, George Washington University School of Medicine, Washington, DC 20052, USA
| | - Matthew Ng
- Department of Surgery, George Washington University School of Medicine, Washington, DC 20052, USA
| | - Michael J Whalen
- Department of Urology, George Washington University School of Medicine, Washington, DC 20052, USA
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10
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Kowsar R, Rahimi AM, Sroka M, Mansouri A, Sadeghi K, Bonakdar E, Kateb SF, Mahdavi AH. Risk of mortality in COVID-19 patients: a meta- and network analysis. Sci Rep 2023; 13:2138. [PMID: 36747045 PMCID: PMC9901837 DOI: 10.1038/s41598-023-29364-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Understanding the most relevant hematological/biochemical characteristics, pre-existing health conditions and complications in survivors and non-survivor will aid in predicting COVID-19 patient mortality, as well as intensive care unit (ICU) referral and death. A literature review was conducted for COVID-19 mortality in PubMed, Scopus, and various preprint servers (bioRxiv, medRxiv and SSRN), with 97 observational studies and preprints, consisting of survivor and non-survivor sub-populations. This meta/network analysis comprised 19,014 COVID-19 patients, consisting of 14,359 survivors and 4655 non-survivors. Meta and network analyses were performed using META-MAR V2.7.0 and PAST software. The study revealed that non-survivors of COVID-19 had elevated levels of gamma-glutamyl transferase and creatinine, as well as a higher number of neutrophils. Non-survivors had fewer lymphocytes and platelets, as well as lower hemoglobin and albumin concentrations. Age, hypertension, and cerebrovascular disease were shown to be the most influential risk factors among non-survivors. The most common complication among non-survivors was heart failure, followed by septic shock and respiratory failure. Platelet counts, creatinine, aspartate aminotransferase, albumin, and blood urea nitrogen levels were all linked to ICU admission. Hemoglobin levels preferred non-ICU patients. Lower levels of hemoglobin, lymphocytes, and albumin were associated with increased mortality in ICU patients. This meta-analysis showed that inexpensive and fast biochemical and hematological tests, as well as pre-existing conditions and complications, can be used to estimate the risk of mortality in COVID-19 patients.
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Affiliation(s)
- Rasoul Kowsar
- Department of Animal Sciences, College of Agriculture, Isfahan University of Technology, Isfahan, 84156-83111, Iran.
| | - Amir Mohammad Rahimi
- Department of Developmental Biology, Göttingen Center for Molecular Biosciences (GZMB), Georg-August-University, 37073, Göttingen, Germany
| | - Magdalena Sroka
- University Medical Center Göttingen, Georg-August-University, 37075, Göttingen, Germany
| | - Alireza Mansouri
- Global Agromedicine Research Center (GAMRC), Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
| | - Khaled Sadeghi
- Department of Animal Sciences, College of Agriculture, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Elham Bonakdar
- Department of Animal Sciences, College of Agriculture, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | | | - Amir Hossein Mahdavi
- Department of Animal Sciences, College of Agriculture, Isfahan University of Technology, Isfahan, 84156-83111, Iran
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11
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Kralova B, Sochorcova L, Song J, Jahoda O, Hlusickova Kapralova K, Prchal JT, Divoky V, Horvathova M. Developmental changes in iron metabolism and erythropoiesis in mice with human gain-of-function erythropoietin receptor. Am J Hematol 2022; 97:1286-1299. [PMID: 35815815 DOI: 10.1002/ajh.26658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 01/24/2023]
Abstract
Iron availability for erythropoiesis is controlled by the iron-regulatory hormone hepcidin. Increased erythropoiesis negatively regulates hepcidin synthesis by erythroferrone (ERFE), a hormone produced by erythroid precursors in response to erythropoietin (EPO). The mechanisms coordinating erythropoietic activity with iron homeostasis in erythrocytosis with low EPO are not well defined as exemplified by dominantly inherited (heterozygous) gain-of-function mutation of human EPO receptor (mtHEPOR) with low EPO characterized by postnatal erythrocytosis. We previously created a mouse model of this mtHEPOR that develops fetal erythrocytosis with a transient perinatal amelioration of erythrocytosis and its reappearance at 3-6 weeks of age. Prenatally and perinatally, mtHEPOR heterozygous and homozygous mice (differing in erythrocytosis severity) had increased Erfe transcripts, reduced hepcidin, and iron deficiency. Epo was transiently normal in the prenatal life; then decreased at postnatal day 7, and remained reduced in adulthood. Postnatally, hepcidin increased in mtHEPOR heterozygotes and homozygotes, accompanied by low Erfe induction and iron accumulation. With aging, the old, especially mtHEPOR homozygotes had a decline of erythropoiesis, myeloid expansion, and local bone marrow inflammatory stress. In addition, mtHEPOR erythrocytes had a reduced lifespan. This, together with reduced iron demand for erythropoiesis, due to its age-related attenuation, likely contributes to increased iron deposition in the aged mtHEPOR mice. In conclusion, the erythroid drive-mediated inhibition of hepcidin production in mtHEPOR mice in the prenatal/perinatal period is postnatally abrogated by increasing iron stores promoting hepcidin synthesis. The differences observed in studied characteristics between mtHEPOR heterozygotes and homozygotes suggest dose-dependent alterations of downstream EPOR stimulation.
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Affiliation(s)
- Barbora Kralova
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Lucie Sochorcova
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Jihyun Song
- Division of Hematology & Hematologic Malignancies, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ondrej Jahoda
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | | | - Josef T Prchal
- Division of Hematology & Hematologic Malignancies, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Vladimir Divoky
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Monika Horvathova
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
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12
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The Key Role of Hepcidin-25 in Anemia in Multiple Myeloma Patients with Renal Impairment. Medicina (B Aires) 2022; 58:medicina58030417. [PMID: 35334593 PMCID: PMC8955231 DOI: 10.3390/medicina58030417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/06/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objectives: Anemia is common in multiple myeloma (MM) and is caused by a complex pathomechanism, including impaired iron homeostasis. Our aim is to evaluate the biomarkers of iron turnover: serum soluble transferrin receptor (sTfR) and hepcidin-25 in patients at various stages of MM in relation with markers of anemia, iron status, inflammation, renal impairment and burden of the disease and as predictors of mortality. Materials and methods: Seventy-three MM patients (six with smoldering and 67 with symptomatic disease) were recruited and observed for up to 27 months. Control group included 21 healthy individuals. Serum sTfR and hepcidin were measured with immunoenzymatic assays. Results: MM patients with and without anemia had higher sTFR compared to controls, while only anemic patients had higher hepcidin-25. Both hepcidin-25 and sTfR were higher in anemic than non-anemic patients. Higher hepcidin-25 (but not sTfR) was associated with increasing MM advancement (from smoldering to International Staging System stage III disease) and with poor response to MM treatment, which was accompanied by lower blood hemoglobin and increased anisocytosis. Neither serum hepcidin-25 nor sTfR were correlated with markers of renal impairment. Hepcidin-25 predicted blood hemoglobin in MM patients independently of other predictors, including markers of renal impairment, inflammation and MM burden. Moreover, both blood hemoglobin and serum hepcidin-25 were independently associated with patients’ 2-year survival. Conclusions: Our results suggest that hepcidin-25 is involved in anemia in MM and its concentrations are not affected by kidney impairment. Moreover, serum hepcidin-25 may be an early predictor of survival in this disease, independent of hemoglobin concentration. It should be further evaluated whether including hepcidin improves the early diagnosis of anemia in MM.
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Segura-Saldaña PA, Chambergo-Michilot D, Alarcón-Santos JE, Aguilar C, Alvarez-Vargas ML, Padilla-Reyes M, Leon-Vivar R, Pariona-Javier M. Evaluating three biomarkers as prognostic factors of in-hospital mortality and severity in heart failure: A prospective cohort. Rev Port Cardiol 2022; 41:31-40. [DOI: 10.1016/j.repc.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/21/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022] Open
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14
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Eissa M, Shaarawy S, Abdellateif MS. The Role of Different Inflammatory Indices in the Diagnosis of COVID-19. Int J Gen Med 2021; 14:7843-7853. [PMID: 34795505 PMCID: PMC8593597 DOI: 10.2147/ijgm.s337488] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022] Open
Abstract
AIM To assess the role of different inflammatory indices in the diagnosis of COVID-19 infection. METHODS The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), derived NLR (dNLR), neutrophil to lymphocyte, platelet ratio (NLPR), systemic inflammation index (SII), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI) and C-reactive protein-to-lymphocyte ratio (CRP/L) were assessed in 88 COVID-19 patients compared to 41 healthy control subjects. RESULTS The NLR, PLR, NLPR, SIRI, and CRP/L were significantly increased, while LMR was significantly decreased in COVID-19 patients compared to the control group (P = 0.008, 0.011, <0.001, 0.032, 0.002 and P < 0.001; respectively). The AUC for the assessed indices was LMR (0.738, P = 0.008), NLPR (0.721, P < 0.001), CRP/L (0.692, P = 0.002), NLR (0.649, P < 0.001), PLR (0.643, P = 0.011), SIRI (0.623, P = 0.032), dNLR (0.590, P = 0.111), SII (0.571, P = 0.207), and AISI (0.567, P-0.244). Multivariate analysis showed that NLPR >0.011 (OR: 38.751, P = 0.014), and CRP/L >7.6 (OR: 7.604, P = 0.022) are possible independent diagnostic factors for COVID-19 infection. CONCLUSION NLPR and CRP/L could be potential independent diagnostic factors for COVID-19 infection.
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Affiliation(s)
- Marwa Eissa
- Internal Medicine and Endocrinology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
- Endocrinology Department, Faculty of Armed Forces of Medical College (AFMC), Cairo, Egypt
| | - Sabry Shaarawy
- Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mona S Abdellateif
- Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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15
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Kay J, Harigai M, Rancourt J, Dickson C, Melby T, Issa M, de la Torre I, Isaka Y, Cardoso A, Saifan C, Keystone EC, van Vollenhoven RF, Giles JT, Huizinga TW, Kremer JM. Changes in selected haematological parameters associated with JAK1/JAK2 inhibition observed in patients with rheumatoid arthritis treated with baricitinib. RMD Open 2021; 6:rmdopen-2020-001370. [PMID: 33028675 PMCID: PMC7722368 DOI: 10.1136/rmdopen-2020-001370] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/28/2020] [Accepted: 09/22/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To characterise changes in selected haematological parameters following once-daily oral baricitinib dosing. METHODS Data were pooled from eight randomised clinical trials (four phase 3, three phase 2, one phase 1b) and one long-term extension. Changes in haematological parameters were evaluated up to 128 weeks (N=2387); overall safety of baricitinib was assessed up to 6 years (N=3492). RESULTS Mean absolute neutrophil counts decreased (-1.36×109/L) within 1 month, followed by stabilisation within the normal reference range through week 128. The incidence of serious infections was not elevated in patients with neutropenia during the 24-week placebo-controlled period. Mean lymphocyte counts increased (+0.30×109/L) within 1 month, then decreased to baseline (weeks 12-24). Mean platelet counts increased at week 2 (+51×109/L), then decreased towards baseline. Overall, mean haemoglobin concentrations decreased (-0.12 mmol/L), then returned to baseline; however, reduced baseline haemoglobin concentrations observed in the highest baseline high-sensitivity C reactive protein quartile increased over time. Permanent drug discontinuation occurred due to laboratory abnormalities related to neutrophil count in 8 (0.2%), lymphocyte counts in 6 (0.2%), platelet counts in 8 (0.2%), and haemoglobin levels in 16 (0.5%) of all baricitinib-treated patients (N=3492 with 7993 total person-years of exposure). CONCLUSIONS Moderate decreases in neutrophils were seen during baricitinib treatment; however, serious infection was uncommon in patients with neutropenia. Transient increases were observed in lymphocytes and platelets, which returned to baseline over time. Changes in haemoglobin concentration were generally small. Haematological abnormalities seldom led to drug discontinuation.
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Affiliation(s)
- Jonathan Kay
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts, USA .,Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Masayoshi Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | | | - Maher Issa
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | - Chadi Saifan
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Edward C Keystone
- Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Jon T Giles
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, New York, USA
| | - Tom Wj Huizinga
- Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Joel M Kremer
- Division of Rheumatology, Department of Medicine, Albany Medical College, Albany, New York, USA
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16
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Ma H, Liu J, Li Z, Xiong H, Zhang Y, Song Y, Lai J. Expression profile analysis reveals hub genes that are associated with immune system dysregulation in primary myelofibrosis. ACTA ACUST UNITED AC 2021; 26:478-490. [PMID: 34238135 DOI: 10.1080/16078454.2021.1945237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTION Primary myelofibrosis (PMF) is a familiar chronic myeloproliferative disease with an unfavorable prognosis. The effect of infection on the prognosis of patients with PMF is crucial. Immune system dysregulation plays a central role in the pathophysiology of PMF. To date, very little research has been conducted on the molecular mechanism of immune compromise in patients with PMF. METHODS To explore potential candidate genes, microarray datasets GSE61629 and 26049 were obtained from the Gene Expression Omnibus (GEO) database. The differentially expressed genes (DEGs) between PMF patients and normal individuals were evaluated, gene function was measured and a series of hub genes were identified. Several significant immune cells were selected via cell type enrichment analysis. The correlation between hub genes and significant immune cells was determined. RESULTS A total of 282 DEGs were found, involving 217 upregulated genes and 65 downregulated genes. Several immune cells were found to be reduced in PMF, such as CD4+ T cells, CD4+ Tems, CD4+ memory T cells. Gene Ontology (GO) enrichment analysis of DEGs reflected that most biological processes were associated with immune processes. Six hub genes, namely, HP, MPO, MMP9, EPB42, SLC4A1, and ALAS2, were identified, and correlation analysis revealed that these hub genes have a negative correlation with immune cell abundance. CONCLUSIONS Taken together, the gene expression profile of whole blood cells in PMF patients indicated a battery of immune events, and the DEGs and hub genes might contribute to immune system dysregulation.
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Affiliation(s)
- Haotian Ma
- College of Forensic Science, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Jincen Liu
- College of Forensic Science, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Zilong Li
- College of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Huaye Xiong
- College of Resources and Environment, Southwest University, Chongqing, People's Republic of China
| | - Yulei Zhang
- College of Forensic Science, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yanping Song
- Institute of Hematology, Central Hospital of Xi'an, Xi'an, People's Republic of China
| | - Jianghua Lai
- College of Forensic Science, Xi'an Jiaotong University, Xi'an, People's Republic of China
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17
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Grzywa TM, Nowis D, Golab J. The role of CD71 + erythroid cells in the regulation of the immune response. Pharmacol Ther 2021; 228:107927. [PMID: 34171326 DOI: 10.1016/j.pharmthera.2021.107927] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 02/07/2023]
Abstract
Complex regulation of the immune response is necessary to support effective defense of an organism against hostile invaders and to maintain tolerance to harmless microorganisms and autoantigens. Recent studies revealed previously unappreciated roles of CD71+ erythroid cells (CECs) in regulation of the immune response. CECs physiologically reside in the bone marrow where erythropoiesis takes place. Under stress conditions, CECs are enriched in some organs outside of the bone marrow as a result of extramedullary erythropoiesis. However, the role of CECs goes well beyond the production of erythrocytes. In neonates, increased numbers of CECs contribute to their vulnerability to infectious diseases. On the other side, neonatal CECs suppress activation of immune cells in response to abrupt colonization with commensal microorganisms after delivery. CECs are also enriched in the peripheral blood of pregnant women as well as in the placenta and are responsible for the regulation of feto-maternal tolerance. In patients with cancer, anemia leads to increased frequency of CECs in the peripheral blood contributing to diminished antiviral and antibacterial immunity, as well as to accelerated cancer progression. Moreover, recent studies revealed the role of CECs in HIV and SARS-CoV-2 infections. CECs use a full arsenal of mechanisms to regulate immune response. These cells suppress proinflammatory responses of myeloid cells and T-cell proliferation by the depletion of ʟ-arginine by arginase. Moreover, CECs produce reactive oxygen species to decrease T-cell proliferation. CECs also secrete cytokines, including transforming growth factor β (TGF-β), which promotes T-cell differentiation into regulatory T-cells. Here, we comprehensively describe the role of CECs in orchestrating immune response and indicate some therapeutic approaches that might be used to regulate their effector functions in the treatment of human conditions.
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Affiliation(s)
- Tomasz M Grzywa
- Department of Immunology, Medical University of Warsaw, Nielubowicza 5 Street, 02-097 Warsaw, Poland; Doctoral School, Medical University of Warsaw, Zwirki and Wigury 61 Street, 02-091 Warsaw, Poland; Laboratory of Experimental Medicine, Medical University of Warsaw, Nielubowicza 5 Street, 02-097 Warsaw, Poland.
| | - Dominika Nowis
- Department of Immunology, Medical University of Warsaw, Nielubowicza 5 Street, 02-097 Warsaw, Poland; Laboratory of Experimental Medicine, Medical University of Warsaw, Nielubowicza 5 Street, 02-097 Warsaw, Poland.
| | - Jakub Golab
- Department of Immunology, Medical University of Warsaw, Nielubowicza 5 Street, 02-097 Warsaw, Poland; Centre of Preclinical Research, Medical University of Warsaw, Banacha 1b Street, 02-097 Warsaw, Poland.
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18
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Solorzano S, Kim J, Chen J, Feng X, Young NS. Minimal role of interleukin 6 and toll-like receptor 2 and 4 in murine models of immune-mediated bone marrow failure. PLoS One 2021; 16:e0248343. [PMID: 33711076 PMCID: PMC7954294 DOI: 10.1371/journal.pone.0248343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 02/24/2021] [Indexed: 02/05/2023] Open
Abstract
Immune aplastic anemia (AA) results from T cell attack on hematopoietic cells, resulting in bone marrow hypocellularity and pancytopenia. Animal models have been successfully developed to study pathophysiological mechanisms in AA. While we have systemically defined the critical components of the adaptive immune response in the pathogenesis of immune marrow failure using this model, the role of innate immunity has not been fully investigated. Here, we demonstrate that lymph node (LN) cells from B6-based donor mice carrying IL-6, TLR2, or TLR4 gene deletions were fully functional in inducing severe pancytopenia and bone marrow failure (BMF) when infused into MHC-mismatched CByB6F1 recipients. Conversely, B6-based recipient mice with IL-6, TLR2, and TLR4 deletion backgrounds were all susceptible to immune-mediated BMF relative to wild-type B6 recipients following infusion of MHC-mismatched LN cells from FVB donors, but the disease appeared more severe in IL-6 deficient mice. We conclude that IL-6, TLR2, and TLR4, molecular elements important in maintenance of normal innate immunity, have limited roles in a murine model of immune-mediated BMF. Rather, adaptive immunity appears to be the major contributor to the animal disease.
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Affiliation(s)
- Sabrina Solorzano
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- Center for Cancer and Blood Disorders, Children’s National Medical Center, Washington DC, United States of America
| | - Jisoo Kim
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jichun Chen
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Xingmin Feng
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Neal S. Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
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19
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Swann JW, Koneva LA, Regan-Komito D, Sansom SN, Powrie F, Griseri T. IL-33 promotes anemia during chronic inflammation by inhibiting differentiation of erythroid progenitors. J Exp Med 2021; 217:151849. [PMID: 32520308 PMCID: PMC7478740 DOI: 10.1084/jem.20200164] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/10/2020] [Accepted: 05/08/2020] [Indexed: 12/14/2022] Open
Abstract
An important comorbidity of chronic inflammation is anemia, which may be related to dysregulated activity of hematopoietic stem and progenitor cells (HSPCs) in the bone marrow (BM). Among HSPCs, we found that the receptor for IL-33, ST2, is expressed preferentially and highly on erythroid progenitors. Induction of inflammatory spondyloarthritis in mice increased IL-33 in BM plasma, and IL-33 was required for inflammation-dependent suppression of erythropoiesis in BM. Conversely, administration of IL-33 in healthy mice suppressed erythropoiesis, decreased hemoglobin expression, and caused anemia. Using purified erythroid progenitors in vitro, we show that IL-33 directly inhibited terminal maturation. This effect was dependent on NF-κB activation and associated with altered signaling events downstream of the erythropoietin receptor. Accordingly, IL-33 also suppressed erythropoietin-accelerated erythropoiesis in vivo. These results reveal a role for IL-33 in pathogenesis of anemia during inflammatory disease and define a new target for its treatment.
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Affiliation(s)
- James W Swann
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Lada A Koneva
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | | | - Stephen N Sansom
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Fiona Powrie
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Thibault Griseri
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
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20
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Sheng Y, Ma R, Yu C, Wu Q, Zhang S, Paulsen K, Zhang J, Ni H, Huang Y, Zheng Y, Qian Z. Role of c-Myc haploinsufficiency in the maintenance of HSCs in mice. Blood 2021; 137:610-623. [PMID: 33538795 PMCID: PMC8215193 DOI: 10.1182/blood.2019004688] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
This study was conducted to determine the dosage effect of c-Myc on hematopoiesis and its distinct role in mediating the Wnt/β-catenin pathway in hematopoietic stem cell (HSC) and bone marrow niche cells. c-Myc haploinsufficiency led to ineffective hematopoiesis by inhibiting HSC self-renewal and quiescence and by promoting apoptosis. We have identified Nr4a1, Nr4a2, and Jmjd3, which are critical for the maintenance of HSC functions, as previously unrecognized downstream targets of c-Myc in HSCs. c-Myc directly binds to the promoter regions of Nr4a1, Nr4a2, and Jmjd3 and regulates their expression. Our results revealed that Nr4a1 and Nr4a2 mediates the function of c-Myc in regulating HSC quiescence, whereas all 3 genes contribute to the function of c-Myc in the maintenance of HSC survival. Adenomatous polyposis coli (Apc) is a negative regulator of the Wnt/β-catenin pathway. We have provided the first evidence that Apc haploinsufficiency induces a blockage of erythroid lineage differentiation through promoting secretion of IL6 in bone marrow endothelial cells. We found that c-Myc haploinsufficiency failed to rescue defective function of Apc-deficient HSCs in vivo but it was sufficient to prevent the development of severe anemia in Apc-heterozygous mice and to significantly prolong the survival of those mice. Furthermore, we showed that c-Myc-mediated Apc loss induced IL6 secretion in endothelial cells, and c-Myc haploinsufficiency reversed the negative effect of Apc-deficient endothelial cells on erythroid cell differentiation. Our studies indicate that c-Myc has a context-dependent role in mediating the function of Apc in hematopoiesis.
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Affiliation(s)
- Yue Sheng
- Department of Medicine and
- Department of Biochemistry and Molecular Biology, UF Health Cancer Center, University of Florida, Gainesville, FL
- Department of Medicine and
| | - Rui Ma
- Institute for Tuberculosis Research, University of Illinois at Chicago, Chicago, IL
| | - Chunjie Yu
- Department of Medicine and
- Department of Biochemistry and Molecular Biology, UF Health Cancer Center, University of Florida, Gainesville, FL
- Department of Medicine and
- Institute for Tuberculosis Research, University of Illinois at Chicago, Chicago, IL
| | - Qiong Wu
- Department of Medicine and
- Department of Biochemistry and Molecular Biology, UF Health Cancer Center, University of Florida, Gainesville, FL
- Department of Medicine and
- Institute for Tuberculosis Research, University of Illinois at Chicago, Chicago, IL
| | - Steven Zhang
- Department of Radiation Oncology, UF Health Cancer Center, University of Florida, Gainesville, FL
| | - Kimberly Paulsen
- Department of Medicine and
- Department of Biochemistry and Molecular Biology, UF Health Cancer Center, University of Florida, Gainesville, FL
| | - Jiwang Zhang
- Oncology Institute, Cardinal Bernardin Cancer Center, Department of Cancer Biology, Loyola University Medical Center, Maywood, IL
| | - Hongyu Ni
- Department of Pathology, University of Illinois at Chicago, Chicago, IL
| | - Yong Huang
- Department of Medicine, University of Virginia, Charlottesville, VA; and
| | - Yi Zheng
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Zhijian Qian
- Department of Medicine and
- Department of Biochemistry and Molecular Biology, UF Health Cancer Center, University of Florida, Gainesville, FL
- Department of Medicine and
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21
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Cancer Related Anemia: An Integrated Multitarget Approach and Lifestyle Interventions. Nutrients 2021; 13:nu13020482. [PMID: 33535496 PMCID: PMC7912724 DOI: 10.3390/nu13020482] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/16/2022] Open
Abstract
Cancer is often accompanied by worsening of the patient's iron profile, and the resulting anemia could be a factor that negatively impacts antineoplastic treatment efficacy and patient survival. The first line of therapy is usually based on oral or intravenous iron supplementation; however, many patients remain anemic and do not respond. The key might lie in the pathogenesis of the anemia itself. Cancer-related anemia (CRA) is characterized by a decreased circulating serum iron concentration and transferrin saturation despite ample iron stores, pointing to a more complex problem related to iron homeostatic regulation and additional factors such as chronic inflammatory status. This review explores our current understanding of iron homeostasis in cancer, shedding light on the modulatory role of hepcidin in intestinal iron absorption, iron recycling, mobilization from liver deposits, and inducible regulators by infections and inflammation. The underlying relationship between CRA and systemic low-grade inflammation will be discussed, and an integrated multitarget approach based on nutrition and exercise to improve iron utilization by reducing low-grade inflammation, modulating the immune response, and supporting antioxidant mechanisms will also be proposed. Indeed, a Mediterranean-based diet, nutritional supplements and exercise are suggested as potential individualized strategies and as a complementary approach to conventional CRA therapy.
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22
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Joharapurkar AA, Patel VJ, Kshirsagar SG, Patel MS, Savsani HH, Jain MR. Prolyl hydroxylase inhibitor desidustat protects against acute and chronic kidney injury by reducing inflammatory cytokines and oxidative stress. Drug Dev Res 2021; 82:852-860. [PMID: 33480036 DOI: 10.1002/ddr.21792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/21/2020] [Accepted: 01/08/2021] [Indexed: 12/19/2022]
Abstract
Chronic kidney disease (CKD) is associated with activated inflammatory responses. Desidustat, a prolyl hydroxylase (PHD) inhibitor is useful for treatment of anemia associated with CKD, but its effect on the inflammatory and fibrotic changes in CKD is not evaluated. In this study, we investigated the effect of desidustat on the inflammatory and fibrotic changes in preclinical models of acute and chronic kidney injury. Acute kidney injury was induced in male Sprague Dawley rats by ischemia-reperfusion, in which effect of desidustat (15 mg/kg, PO) was estimated. In a separate experiment, male C57 mice were treated with adenine for 14 days to induce CKD. These mice were treated with desidustat (15 mg/kg, PO, alternate day) treatment for 14 days, with adenine continued. Desidustat prevented elevation of serum creatinine, urea, IL-1β, IL-6, and kidney injury molecule-1 (KIM-1), and elevated the erythropoietin levels in rats that were subjected to acute kidney injury. Mice treated with adenine developed CKD and anemia, and desidustat treatment caused improvement in serum creatinine, urea, and also improved hemoglobin and reduced hepatic and serum hepcidin. A significant reduction in IL-1β, IL-6, myeloperoxidase (MPO) and oxidative stress was observed by desidustat treatment. Desidustat treatment also reduced renal fibrosis as observed by histological analysis and hydroxyproline content. Desidustat treatment reduced the renal fibrosis and inflammation along with a reduction in anemia in preclinical models of kidney injury, which may translate to protective effects in CKD patients.
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Affiliation(s)
- Amit A Joharapurkar
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, India
| | - Vishal J Patel
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, India
| | - Samadhan G Kshirsagar
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, India
| | - Maulik S Patel
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, India
| | - Hardikkumar H Savsani
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, India
| | - Mukul R Jain
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, India
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23
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Brandes N, Linial N, Linial M. PWAS: proteome-wide association study-linking genes and phenotypes by functional variation in proteins. Genome Biol 2020; 21:173. [PMID: 32665031 PMCID: PMC7386203 DOI: 10.1186/s13059-020-02089-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/01/2020] [Indexed: 12/16/2022] Open
Abstract
We introduce Proteome-Wide Association Study (PWAS), a new method for detecting gene-phenotype associations mediated by protein function alterations. PWAS aggregates the signal of all variants jointly affecting a protein-coding gene and assesses their overall impact on the protein's function using machine learning and probabilistic models. Subsequently, it tests whether the gene exhibits functional variability between individuals that correlates with the phenotype of interest. PWAS can capture complex modes of heritability, including recessive inheritance. A comparison with GWAS and other existing methods proves its capacity to recover causal protein-coding genes and highlight new associations. PWAS is available as a command-line tool.
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Affiliation(s)
- Nadav Brandes
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Nathan Linial
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Linial
- Department of Biological Chemistry, The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.
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24
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Khartabil TA, Russcher H, van der Ven A, de Rijke YB. A summary of the diagnostic and prognostic value of hemocytometry markers in COVID-19 patients. Crit Rev Clin Lab Sci 2020; 57:415-431. [PMID: 32568604 DOI: 10.1080/10408363.2020.1774736] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many studies have reported hemocytometric changes in COVID-19 infection at admission and during the course of disease, but an overview is lacking. We provide a summary of the literature of hemocytometric changes and evaluate whether these changes may assist clinicians in diagnosing and predicting disease progression of COVID-19. Eighty-three out of 250 articles from December 2019 to 20 May 2020 were included from the databases, PubMed, Web of Science Core Collection, Embase, Cochrane and MedRxiv. Our review of the literature indicates that lymphopenia and an elevated neutrophil/lymphocyte ratio are the most consistent abnormal hemocytometric findings and that these alterations may augment in the course of time, especially in those with severe disease.
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Affiliation(s)
- T A Khartabil
- Department of Clinical Chemistry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - H Russcher
- Department of Clinical Chemistry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Ajam van der Ven
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - Y B de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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25
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Terminal Maturation of Orthochromatic Erythroblasts Is Impaired in Burn Patients. J Burn Care Res 2019; 39:286-294. [PMID: 28570310 DOI: 10.1097/bcr.0000000000000592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/01/2017] [Indexed: 12/19/2022]
Abstract
Mechanisms of erythropoietin (Epo)-resistant anemia in burn patients are poorly understood. We have recently found that administering a nonselective beta 1,2-adrenergic blocker propranolol (PR) was effective in reversing myelo-erythroid commitment through MafB regulation and increase megakaryocyte erythrocyte progenitors in burn patients' peripheral blood mononuclear cell (PBMC)-derived ex vivo culture system. Having known that Epo-dependent proliferation of early erythroblasts is intact after burn injury, here we inquired whether or not Epo-independent maturation stage of erythropoiesis is affected by burn injury and the relative role of PR on late-stage erythropoiesis. While majority of erythropoiesis occurs in the bone marrow, maturation into reticulocytes is crucial for their release into sinusoids to occupy the peripheral circulation for which enucleation is vital. peripheral blood mononuclear cells (PBMCs) from burn patients were extended beyond commitment and proliferation stages to late maturation stage in ex vivo culture to understand the role of PR in burn patients. Burn impedes late maturation of orthochromatic erythroblasts into reticulocytes by restricting the enucleation step. Late-stage erythropoiesis is impaired in burn patients irrespective of PR treatment. Further, substituting the microenvironment with control plasma (homologous) in place of autologous plasma rescues the conversion of orthochromatic erythroblasts to reticulocytes. Results show promise in formulating interventions to regulate late-stage erythropoiesis, which can be used in combination with PR to reduce the number of transfusions.
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26
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Ugajin M, Matsuura Y, Matsuura K, Matsuura H. Impact of initial plasma presepsin level for clinical outcome in hospitalized patients with pneumonia. J Thorac Dis 2019; 11:1387-1396. [PMID: 31179081 DOI: 10.21037/jtd.2019.03.74] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Presepsin, the soluble CD14 subtype, is known as a sepsis biomarker. However, its clinical significance in pneumonia is unclear. We investigated the effects of plasma presepsin level on clinical outcomes in patients with pneumonia. Methods Patients over 18 years old admitted to our hospital due to pneumonia from May 2016 through November 2017 were reviewed using electronic medical records. One hundred and seventy-two patients who underwent measurement of plasma presepsin levels on admission were enrolled. Median age of enrolled patients was 81 years [interquartile range (IQR), 68-86 years]. Pneumonia severity index (PSI) class and A-DROP score on admission were calculated. The receiver operating characteristic (ROC) curve analysis was performed to assess the prognostic value of 30-day mortality and to identify the optimal cut-off value of plasma presepsin level. Correlations between plasma presepsin level and other factors were assessed using the Spearman's test. The Kaplan-Meier survival analysis and the log-rank test were performed to assess the two curves differentiated with the optimal cut-off value of plasma presepsin level. Results Seventeen patients (9.9%) died within 30 days of admission. The deceased patients had higher value of plasma presepsin on admission (539 pg/mL; IQR, 414-832 pg/mL) compared with the survivors (334 pg/mL; IQR, 223-484 pg/mL) (P=0.001). The areas under ROC curve for predicting 30-day mortality were 0.742 for plasma presepsin, 0.755 for A-DROP score, and 0.774 for PSI class. Plasma presepsin level was not associated with etiology of pneumonia. However, it was moderately correlated with serum creatinine level (rs =0.524, P<0.001). The ROC curve analysis derived 470 pg/mL of plasma presepsin level as the optimal cut-off value for predicting 30-day mortality. The Kaplan-Meier survival analysis showed that patients with plasma presepsin level ≥470 pg/mL on admission had significantly higher 30-day mortality than those with plasma presepsin level <470 pg/mL (P<0.001). Among patients with A-DROP score ≥3, those with plasma presepsin level ≥470 mg on admission had significantly higher 30-day mortality (P=0.013). Similarly, among patients with PSI class ≥4, those with plasma presepsin level ≥470 mg on admission had significantly higher 30-day mortality (P=0.005). Conclusions In hospitalized pneumonia patients, plasma presepsin level on admission could be a useful predictor of 30-day mortality and an additional prognostic biomarker on existing severity assessment scales.
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Affiliation(s)
- Motoi Ugajin
- Department of Respiratory Medicine, Nagoya Tokushukai General Hospital, Kasugai City, Aichi Prefecture, Japan
| | - Yu Matsuura
- Department of Internal Medicine, Nagoya Tokushukai General Hospital, Kasugai City, Aichi Prefecture, Japan
| | - Kei Matsuura
- Department of Internal Medicine, Nagoya Tokushukai General Hospital, Kasugai City, Aichi Prefecture, Japan
| | - Hiroshi Matsuura
- Department of Internal Medicine, Nagoya Tokushukai General Hospital, Kasugai City, Aichi Prefecture, Japan
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27
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Abstract
Hepcidin is central to regulation of iron metabolism. Its effect on a cellular level involves binding ferroportin, the main iron export protein, resulting in its internalization and degradation and leading to iron sequestration within ferroportin-expressing cells. Aberrantly increased hepcidin leads to systemic iron deficiency and/or iron restricted erythropoiesis. Furthermore, insufficiently elevated hepcidin occurs in multiple diseases associated with iron overload. Abnormal iron metabolism as a consequence of hepcidin dysregulation is an underlying factor resulting in pathophysiology of multiple diseases and several agents aimed at manipulating this pathway have been designed, with some already in clinical trials. In this chapter, we present an overview of and rationale for exploring the development of hepcidin agonists and antagonists in various clinical scenarios.
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Affiliation(s)
- Yelena Z Ginzburg
- Tisch Cancer Institute, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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28
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Santos-Silva A, Ribeiro S, Reis F, Belo L. Hepcidin in chronic kidney disease anemia. VITAMINS AND HORMONES 2019; 110:243-264. [PMID: 30798815 DOI: 10.1016/bs.vh.2019.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic kidney disease (CKD) is associated with several complications that worsen with progression of disease; anemia, disturbances in iron metabolism and inflammation are common features. Inflammatory response starts early, releasing pro-inflammatory cytokines, acute phase reactants and hepcidin. Hepcidin production is modulated by several factors, as hypoxia/anemia, erythropoietin and erythropoiesis products, transferrin saturation (TSAT) and liver iron levels, which are altered in CKD. Treatment of CKD anemia is based on pharmaceutical intervention, with erythropoietic stimulating agents and/or iron supplementation; however, in spite of the erythropoietic benefits, this therapy, on a regular basis, involves risks, namely iron overload. To overcome these risks, some therapeutic approaches are under study to target CKD anemia. Considering the actual alerts about risk of iron overload in dialysis patients, inhibition of hepcidin, the central key player in iron homeostasis, could be a pivotal strategy in the management of CKD anemia.
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Affiliation(s)
- Alice Santos-Silva
- UCIBIO\REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
| | - Sandra Ribeiro
- UCIBIO\REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Flávio Reis
- Institute of Pharmacology & Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, CNC.IBILI Consortium & CIBB Consortium, University of Coimbra, Coimbra, Portugal
| | - Luís Belo
- UCIBIO\REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
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29
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Akchurin O, Patino E, Dalal V, Meza K, Bhatia D, Brovender S, Zhu YS, Cunningham-Rundles S, Perelstein E, Kumar J, Rivella S, Choi ME. Interleukin-6 Contributes to the Development of Anemia in Juvenile CKD. Kidney Int Rep 2018; 4:470-483. [PMID: 30899874 PMCID: PMC6409399 DOI: 10.1016/j.ekir.2018.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction Anemia is a common complication of chronic kidney disease (CKD) in children; however, the role of inflammation in its pathogenesis remains incompletely understood. Methods To elucidate the role of interleukin (IL)-6 in renal anemia, we induced CKD by adenine diet in juvenile wild-type (WT) and IL-6 deficient (Il6KO) mice, and examined serum IL-6 and relevant parameters in children with CKD. Results WT-CKD mice developed anemia despite increases in serum erythropoietin and displayed low serum iron and elevated serum IL-6. IL-6 deficiency resulted in a significant improvement of red blood cell count and hemoglobin in CKD mice. This effect was associated with improvement of hypoferremia by Il6 deletion, likely mediated by hepcidin. However, correction of hypoferremia by oral iron supplementation in WT-CKD mice did not fully replicate the protective effects of Il6 deletion, suggesting an additional iron-independent role for IL-6 in CKD-anemia. Indeed, Il6 deletion mitigated the severity of renal fibrosis and alleviated relative erythropoietin insufficiency in CKD mice. Cytokine profiling in a pediatric CKD cohort demonstrated that of 10 cytokines (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, tumor necrosis factor (TNF)-α, and interferon-γ), only IL-6 was significantly (inversely) associated with hemoglobin when adjusted for glomerular filtration rate (GFR). The association between IL-6 and hemoglobin in children with CKD remained significant after adjustment for CKD stage, iron therapy, and hepcidin. Discussion IL-6 contributes to development of anemia in juvenile CKD, through mechanisms that include induction of hypoferremia, aggravation of renal fibrosis, and alteration of the erythropoietin axis. IL-6 appears to be a promising therapeutic target in the management of CKD-anemia.
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Affiliation(s)
- Oleh Akchurin
- Department of Pediatrics, Division of Pediatric Nephrology, Weill Cornell Medicine, New York, New York, USA
| | - Edwin Patino
- Joan and Sanford I. Weill Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York, USA
| | - Vidhi Dalal
- Department of Pediatrics, Division of Pediatric Nephrology, Weill Cornell Medicine, New York, New York, USA
| | - Kelly Meza
- Department of Pediatrics, Division of Pediatric Nephrology, Weill Cornell Medicine, New York, New York, USA
| | - Divya Bhatia
- Joan and Sanford I. Weill Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York, USA
| | - Simon Brovender
- Department of Pediatrics, Division of Pediatric Nephrology, Weill Cornell Medicine, New York, New York, USA
| | - Yuan-Shan Zhu
- Clinical and Translational Science Center and Department of Medicine, Division of Endocrinology, Weill Cornell Medicine, New York, New York, USA
| | - Susanna Cunningham-Rundles
- Department of Pediatrics, Division of Pediatric Nephrology, Weill Cornell Medicine, New York, New York, USA
| | - Eduardo Perelstein
- Department of Pediatrics, Division of Pediatric Nephrology, Weill Cornell Medicine, New York, New York, USA
| | - Juhi Kumar
- Department of Pediatrics, Division of Pediatric Nephrology, Weill Cornell Medicine, New York, New York, USA
| | - Stefano Rivella
- Cell and Molecular Biology Graduate Group, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mary E Choi
- Joan and Sanford I. Weill Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York, USA
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Madeddu C, Gramignano G, Astara G, Demontis R, Sanna E, Atzeni V, Macciò A. Pathogenesis and Treatment Options of Cancer Related Anemia: Perspective for a Targeted Mechanism-Based Approach. Front Physiol 2018; 9:1294. [PMID: 30294279 PMCID: PMC6159745 DOI: 10.3389/fphys.2018.01294] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 08/28/2018] [Indexed: 01/28/2023] Open
Abstract
Cancer-related anemia (CRA) is a common sign occurring in more than 30% of cancer patients at diagnosis before the initiation of antineoplastic therapy. CRA has a relevant influence on survival, disease progression, treatment efficacy, and the patients' quality of life. It is more often detected in patients with advanced stage disease, where it represents a specific symptom of the neoplastic disease, as a consequence of chronic inflammation. In fact, CRA is characterized by biological and hematologic features that resemble those described in anemia associated to chronic inflammatory disease. Proinflammatory cytokine, mainly IL-6, which are released by both tumor and immune cells, play a pivotal action in CRA etiopathogenesis: they promote alterations in erythroid progenitor proliferation, erythropoietin (EPO) production, survival of circulating erythrocytes, iron balance, redox status, and energy metabolism, all of which can lead to anemia. The discovery of hepcidin allowed a greater knowledge of the relationships between immune cells, iron metabolism, and anemia in chronic inflammatory diseases. Additionally, chronic inflammation influences a compromised nutritional status, which in turn might induce or contribute to CRA. In the present review we examine the multifactorial pathogenesis of CRA discussing the main and novel mechanisms by which immune, nutritional, and metabolic components affect its onset and severity. Moreover, we analyze the status of the art and the perspective for the treatment of CRA. Notably, despite the high incidence and clinical relevance of CRA, controlled clinical studies testing the most appropriate treatment for CRA are scarce, and its management in clinical practice remains challenging. The present review may be useful to indicate the development of an effective approach based on a detailed assessment of all factors potentially involved in the pathogenesis of CRA. This mechanism-based approach is essential for clinicians to plan a safe, targeted, and successful therapy, thereby promoting a relevant amelioration of patients' quality of life.
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Affiliation(s)
- Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Giorgio Astara
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Cagliari, Cagliari, Italy
| | - Roberto Demontis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Elisabetta Sanna
- Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Vinicio Atzeni
- Hospital Medical Management, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Antonio Macciò
- Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari, Italy
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31
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Möller B, Everts-Graber J, Florentinus S, Li Y, Kupper H, Finckh A. Low Hemoglobin and Radiographic Damage Progression in Early Rheumatoid Arthritis: Secondary Analysis From a Phase III Trial. Arthritis Care Res (Hoboken) 2018; 70:861-868. [PMID: 28950430 DOI: 10.1002/acr.23427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/19/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study low blood hemoglobin concentrations as a predictor of radiographic damage progression in patients with rheumatoid arthritis (RA). METHODS Post hoc analyses were performed in patients from the PREMIER trial with early RA undergoing 2 years of adalimumab (ADA), methotrexate (MTX), or ADA + MTX combination therapy. Low disease activity was defined as a score <3.2 on the 28-joint Disease Activity Score using the C-reactive protein level (DAS28-CRP), and clinical response by the American College of Rheumatology criteria for 20% improvement at week 24. Baseline or mean hemoglobin concentrations over time, or anemia as defined using sex-specific World Health Organization criteria, were analyzed in mixed-effects models for longitudinal data in men and women as predictors of progressive joint damage, as measured by the modified total Sharp/van der Heijde score (ΔSHS). Data were adjusted for treatment and other patient characteristics, including the DAS28-CRP. RESULTS Baseline hemoglobin was inversely associated with ΔSHS in adjusted analyses (P < 0.05 for both sexes). Baseline anemia predicted greater ΔSHS in MTX-treated patients over 104 weeks, and in ADA- and combination-treated patients over 26 weeks. Lower hemoglobin concentrations over time, as well as time with anemia, were associated with greater damage progression (P < 0.001). The effect of low hemoglobin concentrations on joint damage progression remained significant, even in patients achieving low disease activity. CONCLUSION Low hemoglobin is a DAS28-CRP-independent predictor of radiographic joint damage progression in MTX-treated patients with early RA. This effect decreases over time in ADA- and combination-treated patients, and in clinical responders irrespective of treatment modality.
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Affiliation(s)
| | | | | | | | | | - Axel Finckh
- University Hospital of Geneva, Geneva, Switzerland
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Hemmati S, Haque T, Gritsman K. Inflammatory Signaling Pathways in Preleukemic and Leukemic Stem Cells. Front Oncol 2017; 7:265. [PMID: 29181334 PMCID: PMC5693908 DOI: 10.3389/fonc.2017.00265] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/20/2017] [Indexed: 12/15/2022] Open
Abstract
Hematopoietic stem cells (HSCs) are a rare subset of bone marrow cells that usually exist in a quiescent state, only entering the cell cycle to replenish the blood compartment, thereby limiting the potential for errors in replication. Inflammatory signals that are released in response to environmental stressors, such as infection, trigger active cycling of HSCs. These inflammatory signals can also directly induce HSCs to release cytokines into the bone marrow environment, promoting myeloid differentiation. After stress myelopoiesis is triggered, HSCs require intracellular signaling programs to deactivate this response and return to steady state. Prolonged or excessive exposure to inflammatory cytokines, such as in prolonged infection or in chronic rheumatologic conditions, can lead to continued HSC cycling and eventual HSC loss. This promotes bone marrow failure, and can precipitate preleukemic states or leukemia through the acquisition of genetic and epigenetic changes in HSCs. This can occur through the initiation of clonal hematopoiesis, followed by the emergence preleukemic stem cells (pre-LSCs). In this review, we describe the roles of multiple inflammatory signaling pathways in the generation of pre-LSCs and in progression to myelodysplastic syndrome (MDS), myeloproliferative neoplasms, and acute myeloid leukemia (AML). In AML, activation of some inflammatory signaling pathways can promote the cycling and differentiation of LSCs, and this can be exploited therapeutically. We also discuss the therapeutic potential of modulating inflammatory signaling for the treatment of myeloid malignancies.
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Affiliation(s)
- Shayda Hemmati
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Tamanna Haque
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Oncology, Montefiore Medical Center, Bronx, NY, United States
| | - Kira Gritsman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Oncology, Montefiore Medical Center, Bronx, NY, United States
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Liu WS, Chu DC, Chan HL, Li SY, Liu CK, Yang CY, Chen YW, Lee PC, Lai YT, Lin CC. Fixed dose of long-acting erythropoietic stimulating agents at higher frequency improves appetite, reduces inflammation and corrects anaemia in patients on haemodialysis. Clin Exp Pharmacol Physiol 2017; 43:875-82. [PMID: 27385380 DOI: 10.1111/1440-1681.12618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/14/2016] [Accepted: 07/03/2016] [Indexed: 12/21/2022]
Abstract
Anaemia is an important issue in patients undergoing haemodialysis. We aimed to identify a better dosing schedule of a fixed monthly dose of continuous erythropoietin receptor activator (CERA) in patients with chronic kidney disease (CKD) on haemodialysis. The CERA dosing schedule included 100 μg once monthly for 2 months, 50 μg twice monthly for 2 months and then 100 μg once monthly for two months. The effectiveness was determined by comparing haematocrit, nutritional status (serum protein and albumin) and inflammatory markers (tumour necrosis factor (TNF)-α, interleukin (IL)-1, IL-6 and Hepcidin) at the beginning of the study with those at the end of the study. Forty-seven out of 67 patients completed the trial. At the end, haematocrit was significantly higher (34.51 vs 33.22%, P=.004), levels of inflammatory markers were significantly lower (TNF-α (30.71 vs 35.67 ng/mL, P=.007), IL-6 (5.12 vs 7.95 ng/mL, P=.033), hepcidin (60.39 vs 74.39 ng/mL, P=.002)), blood glucose levels were significantly lower (112.40 vs 139.02 mg/dL, P=.003) and albumin was significantly higher (4.11 vs 3.98, P=.001). Patients with a better than average response had a lower initial number of red blood cells (3.3 vs 3.6 × 10(6) /mm(3) , P=.025) and a lower IL-1 (3.8 vs 12.9 ng/mL, P=.01). They also had significantly lower blood glucose levels at the end. (91.3 vs 124.0 mg/dL, P=.03). We demonstrate that a fixed monthly dose of CERA at a twice monthly dosing schedule improves nutrition, reduces the inflammation and corrects anaemia in patients on haemodialysis. This finding may provide a new strategy for treating CKD-related anaemia.
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Affiliation(s)
- Wen-Sheng Liu
- Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhong-Xing Branch, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,College of Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Da-Chen Chu
- Institute of Public Health and Community Medicine Research Centre, National Yang-Ming University, Taipei, Taiwan.,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan
| | - Hsiang-Lin Chan
- Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Szu-Yuan Li
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Kuang Liu
- College of Medicine & Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chih-Yu Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Wei Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pui-Ching Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Ting Lai
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.,Department of Nursing, Yuanpei University, Hsinchu, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Langer AL, Ginzburg YZ. Role of hepcidin-ferroportin axis in the pathophysiology, diagnosis, and treatment of anemia of chronic inflammation. Hemodial Int 2017; 21 Suppl 1:S37-S46. [PMID: 28328181 DOI: 10.1111/hdi.12543] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Anemia of chronic inflammation (ACI) is a frequently diagnosed anemia and portends an independently increased morbidity and poor outcome associated with multiple underlying diseases. The pathophysiology of ACI is multifactorial, resulting from the effects of inflammatory cytokines which both directly and indirectly suppress erythropoiesis. Recent advances in molecular understanding of iron metabolism provide strong evidence that immune mediators, such as IL-6, lead to hepcidin-induced hypoferremia, iron sequestration, and decreased iron availability for erythropoiesis. The role of hepcidin-ferroportin axis in the pathophysiology of ACI is stimulating the development of new diagnostics and targeted therapies. In this review, we present an overview of and rationale for inflammation-, iron-, and erythropoiesis-related strategies currently in development.
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Affiliation(s)
- Arielle L Langer
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yelena Z Ginzburg
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Abstract
Anaemia is the most common haematological disorder affecting humanity and is usually observed in chronic disease states such as non-specific anaemia, which may cause diagnostic difficulties. In chronically ill patients with anaemia, this has a negative impact on quality of life as well as survival. This paper aims at reviewing the pathogenesis of this form of anaemia with a view to suggesting future targets for therapeutic intervention. The ability to diagnose this disorder depends on the ability of the physician to correlate the possible clinical pathways of the underlying disease with the patients' ferrokinetic state. It is important to rule out iron deficiency and other causes of anaemia as misdiagnosis will in most cases lead to refractoriness to standard therapy. The cytokines and acute-phase proteins play important roles in the pathogenesis of anaemia of chronic disease. Alterations in the metabolism of iron via the molecule hepcidin and ferritin are largely responsible for the consequent anaemia. Concomitant iron deficiency might be present and could affect the diagnosis and therapeutic protocol. Treatment options involve the use of erythropoiesis-stimulating agents, blood transfusion, and iron supplementation, in addition to treating the underlying disease.
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Affiliation(s)
- Anazoeze Jude Madu
- Department of Haematology and Immunology, University of Nigeria, Enugu, Nigeria
- *Dr. Anazoeze J. Madu, Department of Haematology and Immunology, University of Nigeria, Enugu Campus (UNEC), PMB 01129, Enugu 400001 (Nigeria), E-Mail
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Abstract
PURPOSE OF REVIEW Anemia is prevalent in patients with infections and other inflammatory conditions. Induction of the iron regulatory hormone hepcidin has been implicated in the pathogenesis of anemia of inflammation. This review outlines recent discoveries in understanding how hepcidin and its receptor ferroportin are regulated, how they contribute to anemia of inflammation, and how this knowledge may help guide new diagnostic and therapeutic strategies for this disease. RECENT FINDINGS IL-6 is a primary driver for hepcidin induction in many models of anemia of inflammation, but the SMAD1/5/8 pathway also contributes, likely via Activin B and SMAD-STAT3 interactions at the hepcidin promoter. Hepcidin has an important functional role in many, but not all forms of anemia of inflammation, although hepcidin-independent mechanisms also contribute. In certain populations, hepcidin assays may help target therapy with iron or erythropoiesis-stimulating agents to patients who may benefit most. New therapies targeting the hepcidin-ferroportin axis have shown efficacy in preclinical and early clinical studies. SUMMARY Recent studies confirm an important role for the hepcidin-ferroportin axis in the development of anemia of inflammation, but also highlight the diverse and complex pathogenesis of this disorder depending on the underlying disease. Hepcidin-based diagnostic and therapeutic strategies offer promise to improve anemia treatment, but more work is needed in this area.
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MIF-Mediated Hemodilution Promotes Pathogenic Anemia in Experimental African Trypanosomosis. PLoS Pathog 2016; 12:e1005862. [PMID: 27632207 PMCID: PMC5025191 DOI: 10.1371/journal.ppat.1005862] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/11/2016] [Indexed: 12/31/2022] Open
Abstract
Animal African trypanosomosis is a major threat to the economic development and human health in sub-Saharan Africa. Trypanosoma congolense infections represent the major constraint in livestock production, with anemia as the major pathogenic lethal feature. The mechanisms underlying anemia development are ill defined, which hampers the development of an effective therapy. Here, the contribution of the erythropoietic and erythrophagocytic potential as well as of hemodilution to the development of T. congolense-induced anemia were addressed in a mouse model of low virulence relevant for bovine trypanosomosis. We show that in infected mice, splenic extramedullary erythropoiesis could compensate for the chronic low-grade type I inflammation-induced phagocytosis of senescent red blood cells (RBCs) in spleen and liver myeloid cells, as well as for the impaired maturation of RBCs occurring in the bone marrow and spleen. Rather, anemia resulted from hemodilution. Our data also suggest that the heme catabolism subsequent to sustained erythrophagocytosis resulted in iron accumulation in tissue and hyperbilirubinemia. Moreover, hypoalbuminemia, potentially resulting from hemodilution and liver injury in infected mice, impaired the elimination of toxic circulating molecules like bilirubin. Hemodilutional thrombocytopenia also coincided with impaired coagulation. Combined, these effects could elicit multiple organ failure and uncontrolled bleeding thus reduce the survival of infected mice. MIF (macrophage migrating inhibitory factor), a potential pathogenic molecule in African trypanosomosis, was found herein to promote erythrophagocytosis, to block extramedullary erythropoiesis and RBC maturation, and to trigger hemodilution. Hence, these data prompt considering MIF as a potential target for treatment of natural bovine trypanosomosis. Bovine African trypanosomosis is a parasitic disease of veterinary importance that adversely affects the public health and economic development of sub-Saharan Africa. Anemia is a major cause of death associated with this disease. Yet, the mechanisms underlying anemia development are not elucidated, which hampers the design of effective therapeutic strategies. We show here that in a Trypanosoma congolense infection mouse model relevant for bovine trypanosomosis, red blood cells (RBCs) are generated in the spleen. This compensates for the impaired maturation of RBCs occurring in the bone marrow, the normal site of RBC generation, and for the destruction of RBCs taking place in the liver and the spleen. Instead, anemia results from an increase in blood volume (hemodilution). The immune molecule Macrophage Migration Inhibitory Factor (MIF) was found to drive RBC destruction, to block RBC maturation, as well as to trigger hemodilution. Iron accumulation in tissue due to sustained RBC destruction and hemodilution causes tissue damage, which culminates in the release of toxic molecules like bilirubin, in impaired production of blood detoxifying molecules like albumin, and in defective coagulation. Combined, these effects initiate multiple organ failure that can reduce the survival of infected mice. Given the unmet medical need for this parasite infection, our findings offer promise for improved treatment protocols in the field.
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Lofruthe N, Gallitz I, Traeger L, Bäumer N, Schulze I, Kuhlmann T, Müller-Tidow C, Steinbicker AU. Intravenous Iron Carboxymaltose as a Potential Therapeutic in Anemia of Inflammation. PLoS One 2016; 11:e0158599. [PMID: 27404499 PMCID: PMC4942094 DOI: 10.1371/journal.pone.0158599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/18/2016] [Indexed: 01/28/2023] Open
Abstract
Intravenous iron supplementation is an effective therapy in iron deficiency anemia (IDA), but controversial in anemia of inflammation (AI). Unbound iron can be used by bacteria and viruses for their replication and enhance the inflammatory response. Nowadays available high molecular weight iron complexes for intravenous iron substitution, such as ferric carboxymaltose, might be useful in AI, as these pharmaceuticals deliver low doses of free iron over a prolonged period of time. We tested the effects of intravenous iron carboxymaltose in murine AI: Wild-type mice were exposed to the heat-killed Brucella abortus (BA) model and treated with or without high molecular weight intravenous iron. 4h after BA injection followed by 2h after intravenous iron treatment, inflammatory cytokines were upregulated by BA, but not enhanced by iron treatment. In long term experiments, mice were fed a regular or an iron deficient diet and then treated with intravenous iron or saline 14 days after BA injection. Iron treatment in mice with BA-induced AI was effective 24h after iron administration. In contrast, mice with IDA (on iron deficiency diet) prior to BA-IA required 7d to recover from AI. In these experiments, inflammatory markers were not further induced in iron-treated compared to vehicle-treated BA-injected mice. These results demonstrate that intravenous iron supplementation effectively treated the murine BA-induced AI without further enhancement of the inflammatory response. Studies in humans have to reveal treatment options for AI in patients.
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Affiliation(s)
- Niklas Lofruthe
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Inka Gallitz
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Lisa Traeger
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Nicole Bäumer
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Isabell Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Tanja Kuhlmann
- Institute for Neuropathology, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Carsten Müller-Tidow
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Andrea U. Steinbicker
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
- * E-mail:
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Noguchi-Sasaki M, Sasaki Y, Shimonaka Y, Mori K, Fujimoto-Ouchi K. Treatment with anti-IL-6 receptor antibody prevented increase in serum hepcidin levels and improved anemia in mice inoculated with IL-6-producing lung carcinoma cells. BMC Cancer 2016; 16:270. [PMID: 27068103 PMCID: PMC4828826 DOI: 10.1186/s12885-016-2305-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 04/07/2016] [Indexed: 12/21/2022] Open
Abstract
Background Hepcidin, a key regulator of iron metabolism, is produced mainly by interleukin-6 (IL-6) during inflammation. A mechanism linking cancer-related anemia and IL-6 through hepcidin production is suggested. To clarify the hypothesis that overproduction of IL-6 elevates hepcidin levels and contributes to the development of cancer-related anemia, we evaluated anti-IL-6 receptor antibody treatment of cancer-related anemia in an IL-6–producing human lung cancer xenograft model. Methods Nude mice were subcutaneously inoculated with cells of the IL-6–producing human lung cancer cell line LC-06-JCK and assessed as a model of cancer-related anemia. Mice bearing LC-06-JCK were administered rat anti-mouse IL-6 receptor antibody MR16-1 and their serum hepcidin levels and hematological parameters were determined. Results LC-06-JCK–bearing mice developed anemia according to the production of human IL-6 from xenografts, with decreased values of hemoglobin, hematocrit, and mean corpuscular volume (MCV) compared to non–tumor-bearing (NTB) mice. LC-06-JCK–bearing mice showed decreased body weight and serum albumin with increased serum amyloid A. MR16-1 treatment showed significant inhibition of decreased body weight and serum albumin levels, and suppressed serum amyloid A level. There was no difference in tumor volume between MR16-1-treated mice and immunoglobulin G (IgG)-treated control mice. Decreased hemoglobin, hematocrit, and MCV in LC-06-JCK–bearing mice was significantly relieved by MR16-1 treatment. LC-06-JCK–bearing mice showed high red blood cell counts and erythropoietin levels as compared to NTB mice, whereas MR16-1 treatment did not affect their levels. Serum hepcidin and ferritin levels were statistically elevated in mice bearing LC-06-JCK. LC-06-JCK–bearing mice showed lower values of MCV, mean corpuscular hemoglobin (MCH), and serum iron as compared to NTB mice. Administration of MR16-1 to mice bearing LC-06-JCK significantly suppressed levels of both serum hepcidin and ferritin, with increased values of MCV and MCH. Conclusions Our results suggest that overproduction of hepcidin by IL-6 signaling might be a major factor that leads to functionally iron-deficient cancer-related anemia in the LC-06-JCK model. We demonstrated that inhibition of the IL-6 signaling pathway by MR16-1 treatment resulted in significant recovery of iron-deficiency anemia and alleviation of cancer-related symptoms. These results indicate that IL-6 signaling might be one possible target pathway to treat cancer-related anemia disorders.
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Affiliation(s)
- Mariko Noguchi-Sasaki
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan.
| | - Yusuke Sasaki
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Yasushi Shimonaka
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Kazushige Mori
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Kaori Fujimoto-Ouchi
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
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Lippi G, Mattiuzzi C, Cervellin G. Learning more and spending less with neglected laboratory parameters: the paradigmatic case of red blood cell distribution width. ACTA BIO-MEDICA : ATENEI PARMENSIS 2016; 87:323-328. [PMID: 28112703 PMCID: PMC10521889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/19/2016] [Indexed: 06/06/2023]
Abstract
Due to increasing shortage of public healthcare resources in many countries around the globe, the use of simple, rapid and inexpensive laboratory parameters may be seen as a valuable aid for preliminary and cost-effective risk stratification of patients. Anisocytosis, conventionally measured by hematologic analyzers as the red blood cell distribution width (RDW), is an index of the heterogeneity of erythrocytes volumes. Several lines of evidence now attest that increased RDW values are commonplace in patients with many disorders, especially in those with the most prevalent conditions such as cardiovascular disease, diabetes, cancer and infections. Although the nature of this association remains to be definitely disclosed, what is strongly emerging from the recent scientific research is that the RDW should now be regarded as a "non" innocent bystander, wherein anisocytosis may be an active player in the pathogenesis of many pathologies. Therefore, major attention should be placed on this inexpensive but clinically meaningful parameter. The recent finding that dynamic changes of RDW are strongly predictors of mortality also suggests that continuous monitoring of anisocytosis may be an ancillary useful tool for establishing the effectiveness of managed care, as well as for deciding whether or not the overall clinical status is improving.
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Tandara L, Grubisic TZ, Ivan G, Jurisic Z, Tandara M, Gugo K, Mladinov S, Salamunic I. Systemic inflammation up-regulates serum hepcidin in exacerbations and stabile chronic obstructive pulmonary disease. Clin Biochem 2015; 48:1252-7. [DOI: 10.1016/j.clinbiochem.2015.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/25/2015] [Accepted: 07/06/2015] [Indexed: 10/24/2022]
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Ciniselli CM, De Bortoli M, Taverna E, Varinelli L, Pizzamiglio S, Veneroni S, Bonini C, Orlandi R, Verderio P, Bongarzone I. Plasma hepcidin in early-stage breast cancer patients: no relationship with interleukin-6, erythropoietin and erythroferrone. Expert Rev Proteomics 2015; 12:695-701. [PMID: 26496240 DOI: 10.1586/14789450.2015.1099436] [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: 01/22/2023]
Abstract
OBJECTIVE Hepcidin-25 production is stimulated by systemic inflammation, and it interferes with iron utilization, leading to anemia. This study aimed to investigate the relationships between the plasma levels of hepcidin, interleukin-6 (IL-6), erythropoietin (EPO) and erythroferrone (ERFE) in patients with benign breast disease or cancer. METHODS Plasma samples from a cohort of 131 patients (47 with benign breast disease and 84 with breast cancer) were subjected to the evaluation of hepcidin, IL-6, EPO and ERFE using SELDI-TOF-MS or immunoassays. RESULTS An elevated hepcidin was observed in malignant breast tumors compared to benign ones. No correlation was observed between hepcidin and IL-6, EPO or ERFE. CONCLUSION Since the study included a cohort of patients (87%) with breast cancers smaller than 2 cm, these results may support our previous evidence about the potential role of hepcidin in breast cancer disease.
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Affiliation(s)
- Chiara Maura Ciniselli
- a Unit of Medical Statistics, Biometry and Bioinformatics , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Maida De Bortoli
- b Laboratory of Proteomics , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Elena Taverna
- b Laboratory of Proteomics , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Luca Varinelli
- b Laboratory of Proteomics , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Sara Pizzamiglio
- a Unit of Medical Statistics, Biometry and Bioinformatics , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Silvia Veneroni
- c Biomarkers Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Chiara Bonini
- d Laboratory Medicine , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Rosaria Orlandi
- e Molecular Targeting Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Paolo Verderio
- a Unit of Medical Statistics, Biometry and Bioinformatics , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Italia Bongarzone
- b Laboratory of Proteomics , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
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Means RT. Hepcidin in differential diagnosis: ready for the clinic? Eur J Haematol 2015; 94:2-3. [PMID: 25683959 DOI: 10.1111/ejh.12414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Robert T Means
- Office of the Dean and the Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, C200 Stanton Gerber Hall, P.O. Box 70694, Johnson City, TN 37614, USA
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Anemia in Inflammatory Bowel Disease: The Opening of Pandora's Box? Clin Gastroenterol Hepatol 2015; 13:1767-9. [PMID: 26091737 DOI: 10.1016/j.cgh.2015.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 02/07/2023]
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Kim M, Tan YS, Cheng WC, Kingsbury TJ, Heimfeld S, Civin CI. MIR144 and MIR451 regulate human erythropoiesis via RAB14. Br J Haematol 2014; 168:583-97. [PMID: 25312678 DOI: 10.1111/bjh.13164] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/15/2014] [Indexed: 12/11/2022]
Abstract
Expression levels of MIR144 and MIR451 increase during erythropoiesis, a pattern that is conserved from zebrafish to humans. As these two miRs are expressed from the same polycistronic transcript, we manipulated MIR144 and MIR451 in human erythroid cells individually and together to investigate their effects on human erythropoiesis. Inhibition of endogenous human MIR451 resulted in decreased numbers of erythroid (CD71(hi) CD235a(hi) CD34(-) ) cells, consistent with prior studies in zebrafish and mice. In addition, inhibition of MIR144 impaired human erythroid differentiation, unlike in zebrafish and mouse studies where the functional effect of MIR144 on erythropoiesis was minimal. In this study, we found RAB14 is a direct target of both MIR144 and MIR451. As MIR144 and MIR451 expression increased during human erythropoiesis, RAB14 protein expression decreased. Enforced RAB14 expression phenocopied the effect of MIR144 and/or MIR451 depletion, whereas shRNA-mediated RAB14 knockdown protected cells from MIR144 and/or MIR451 depletion-mediated erythropoietic inhibition. RAB14 knockdown increased the frequency and number of erythroid cells, increased β-haemoglobin expression, and decreased CBFA2T3 expression during human erythropoiesis. In summary, we utilized MIR144 and MIR451 to identify RAB14 as a novel physiological inhibitor of human erythropoiesis.
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Affiliation(s)
- MinJung Kim
- Departments of Physiology and Pediatrics, Center for Stem Cell Biology & Regenerative Medicine, Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Hoo ZH, Wildman MJ. Regarding the article entitled "Iron supplementation does not worsen respiratory health or alter the sputum microbiome in cystic fibrosis". J Cyst Fibros 2014; 14:158-9. [PMID: 24972893 DOI: 10.1016/j.jcf.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Z H Hoo
- Adult Cystic Fibrosis Unit, Northern General Hospital, Sheffield, United Kingdom; School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
| | - M J Wildman
- Adult Cystic Fibrosis Unit, Northern General Hospital, Sheffield, United Kingdom; School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
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Langdon JM, Yates SC, Femnou LK, McCranor BJ, Cheadle C, Xue QL, Vaulont S, Civin CI, Walston JD, Roy CN. Hepcidin-dependent and hepcidin-independent regulation of erythropoiesis in a mouse model of anemia of chronic inflammation. Am J Hematol 2014; 89:470-9. [PMID: 24415655 PMCID: PMC4200395 DOI: 10.1002/ajh.23670] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 01/02/2014] [Accepted: 01/08/2014] [Indexed: 12/21/2022]
Abstract
Increased hepcidin antimicrobial peptide correlates with hypoferremia and anemia in various disease states, but its requirement for anemia of inflammation has not been adequately demonstrated. Anemia of inflammation is usually described as normocytic and normochromic, while diseases associated with over expression of hepcidin, alone, are often microcytic and hypochromic. These differences in erythrocyte parameters suggest anemia in many inflammatory states may not be fully explained by hepcidin-mediated iron sequestration. We used turpentine-induced sterile abscesses to model chronic inflammation in mice with targeted disruption of Hepcidin 1 [Hepc1 (-/-)] or its positive regulator, Interleukin-6 [IL-6 (-/-)], to determine whether these genes are required for features characteristic of anemia of inflammation. Although hemoglobin levels did not decline in Hepc1 (-/-) mice with sterile abscesses, erythrocyte numbers were significantly reduced compared to untreated Hepc1 (-/-) mice. In contrast, both hemoglobin concentration and erythrocyte number declined significantly in wild type and IL-6 (-/-) mice with sterile abscesses. Both Hepc1 (-/-) and IL-6 (-/-) mice had increased erythrocyte mean cell volume and mean cell hemoglobin following sterile abscesses, while wild types had no change. Thus, IL-6 (-/-) mice with sterile abscesses exhibit an intermediate phenotype between wild type and Hepc1 (-/-). Our results demonstrate the requirement of Hepc1 for the development of anemia in this rodent model. Simultaneously, our results demonstrate hepcidin-independent effects of inflammation on the suppression of erythropoiesis. Our results suggest chronic anemia associated with inflammation may benefit from interventions protecting erythrocyte number in addition to anti-hepcidin interventions aimed at enhancing iron availability.
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Affiliation(s)
- Jacqueline M. Langdon
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saiah C. Yates
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laurette K. Femnou
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan J. McCranor
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chris Cheadle
- Lowe Family Genomics Core, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sophie Vaulont
- Institut Cochin, Institut National de la Santé et de la Recherche Medicale U1016, Paris, France
| | - Curt I. Civin
- Center for Stem Cell Biology and Regenerative Medicine, Department of Pediatrics, University of Maryland, Baltimore, Maryland
- Center for Stem Cell Biology and Regenerative Medicine, Department of Physiology, University of Maryland, Baltimore, Maryland
| | - Jeremy D. Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cindy N. Roy
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Fiorino G, Allocca M, Danese S. Commentary: anaemia in inflammatory bowel disease--the most common and ignored extra intestinal manifestation. Aliment Pharmacol Ther 2014; 39:227-8. [PMID: 24330239 DOI: 10.1111/apt.12578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/17/2013] [Indexed: 02/06/2023]
Affiliation(s)
- G Fiorino
- IBD Center, Gastroenterology, IRCCS Humanitas, Rozzano, Milan, Italy
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Distinct roles for hepcidin and interleukin-6 in the recovery from anemia in mice injected with heat-killed Brucella abortus. Blood 2013; 123:1137-45. [PMID: 24357729 DOI: 10.1182/blood-2013-08-521625] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Anemia of inflammation (AI) is commonly observed in chronic inflammatory states and may hinder patient recovery and survival. Induction of hepcidin, mediated by interleukin 6, leads to iron-restricted erythropoiesis and anemia. Several translational studies have been directed at neutralizing hepcidin overexpression as a therapeutic strategy against AI. However, additional hepcidin-independent mechanisms contribute to AI, which are likely mediated by a direct effect of inflammatory cytokines on erythropoiesis. In this study, we used wild-type, hepcidin knockout (Hamp-KO) and interleukin 6 knockout (IL-6-KO) mice as models of AI. AI was induced with heat-killed Brucella abortus (BA). The distinct roles of iron metabolism and inflammation triggered by interleukin 6 and hepcidin were investigated. BA-treated wild-type mice showed increased expression of hepcidin and inflammatory cytokines, as well as transitory suppression of erythropoiesis and shortened red blood cell lifespan, all of which contributed to the severe anemia of these mice. In contrast, BA-treated Hamp-KO or IL-6-KO mice showed milder anemia and faster recovery compared with normal mice. Moreover, they exhibited different patterns in the development and resolution of anemia, supporting the notion that interleukin 6 and hepcidin play distinct roles in modulating erythropoiesis in AI.
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