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Kirkham JK, Estepp JH, Weiss MJ, Rashkin SR. Genetic Variation and Sickle Cell Disease Severity: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2337484. [PMID: 37851445 PMCID: PMC10585422 DOI: 10.1001/jamanetworkopen.2023.37484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/30/2023] [Indexed: 10/19/2023] Open
Abstract
Importance Sickle cell disease (SCD) is a monogenic disorder, yet clinical outcomes are influenced by additional genetic factors. Despite decades of research, the genetics of SCD remain poorly understood. Objective To assess all reported genetic modifiers of SCD, evaluate the design of associated studies, and provide guidelines for future analyses according to modern genetic study recommendations. Data Sources PubMed, Web of Science, and Scopus were searched through May 16, 2023, identifying 5290 publications. Study Selection At least 2 reviewers identified 571 original, peer-reviewed English-language publications reporting genetic modifiers of human SCD phenotypes, wherein the outcome was not treatment response, and the comparison was not between SCD subtypes or including healthy controls. Data Extraction and Synthesis Data relevant to all genetic modifiers of SCD were extracted, evaluated, and presented following STREGA and PRISMA guidelines. Weighted z score meta-analyses and pathway analyses were conducted. Main Outcomes and Measures Outcomes were aggregated into 25 categories, grouped as acute complications, chronic conditions, hematologic parameters or biomarkers, and general or mixed measures of SCD severity. Results The 571 included studies reported on 29 670 unique individuals (50% ≤ 18 years of age) from 43 countries. Of the 17 757 extracted results (4890 significant) in 1552 genes, 3675 results met the study criteria for meta-analysis: reported phenotype and genotype, association size and direction, variability measure, sample size, and statistical test. Only 173 results for 62 associations could be cross-study combined. The remaining associations could not be aggregated because they were only reported once or methods (eg, study design, reporting practice) and genotype or phenotype definitions were insufficiently harmonized. Gene variants regulating fetal hemoglobin and α-thalassemia (important markers for SCD severity) were frequently identified: 19 single-nucleotide variants in BCL11A, HBS1L-MYB, and HBG2 were significantly associated with fetal hemoglobin (absolute value of Z = 4.00 to 20.66; P = 8.63 × 10-95 to 6.19 × 10-5), and α-thalassemia deletions were significantly associated with increased hemoglobin level and reduced risk of albuminuria, abnormal transcranial Doppler velocity, and stroke (absolute value of Z = 3.43 to 5.16; P = 2.42 × 10-7 to 6.00 × 10-4). However, other associations remain unconfirmed. Pathway analyses of significant genes highlighted the importance of cellular adhesion, inflammation, oxidative and toxic stress, and blood vessel regulation in SCD (23 of the top 25 Gene Ontology pathways involve these processes) and suggested future research areas. Conclusions and Relevance The findings of this comprehensive systematic review and meta-analysis of all published genetic modifiers of SCD indicated that implementation of standardized phenotypes, statistical methods, and reporting practices should accelerate discovery and validation of genetic modifiers and development of clinically actionable genetic profiles.
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Affiliation(s)
- Justin K. Kirkham
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jeremie H. Estepp
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
- Now with Agios Pharmaceuticals, Cambridge, Massachusetts
| | - Mitch J. Weiss
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sara R. Rashkin
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
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Ceglie G, Di Mauro M, Tarissi De Jacobis I, de Gennaro F, Quaranta M, Baronci C, Villani A, Palumbo G. Gender-Related Differences in Sickle Cell Disease in a Pediatric Cohort: A Single-Center Retrospective Study. Front Mol Biosci 2019; 6:140. [PMID: 31867340 PMCID: PMC6906547 DOI: 10.3389/fmolb.2019.00140] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/19/2019] [Indexed: 01/02/2023] Open
Abstract
Sickle cell disease (SCD) is one of the most common monogenic disease worldwide. The incidence of SCD is not strictly gender-related as it is transmitted as an autosomal recessive disorder. In particular, the gender-related differences in pediatric SCD are not well-characterized. To address this matter, we retrospectively analyzed the clinical records of 39 pediatric patients with a diagnosis of SCD (hemoglobin SS genotype) focusing on gender differences analyzing various aspects of the disease and comprising both acute symptoms and late complications. We found various gender-related differences in our pediatric population. In particular, pain crisis frequency per year was significantly increased in the male population with a mean number of crisis per year of 1.6 vs. 0.6 in the female population (p = 0.04). Also, severe complications (both infectious and cardiovascular) were mostly found in the male population. SCD-related late cardiac complications were observed mainly in the male population (p = 0.04). Our data support the hypothesis that gender could play a role in determining the clinical course of SCD, even though further studies are needed to assess the exact weight of its influence over the course of the disease. The higher morbidity in males is a well-known feature of SCD in adults and these findings have been only partially studied in the pediatric population. These differences have, in adults, been attributed to hormonal variations found in the two sexes after puberty. In a pediatric population, other factors must be responsible for these discrepancies. These findings suggest that gender could be a valuable factor in the risk stratification of these patients at diagnosis, and possibly guide therapeutic decisions, with the final aim of personalizing the therapy.
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Affiliation(s)
- Giulia Ceglie
- Department of Onco-Hematology and Cell and Gene Therapy, Scientific Institute for Research and Healthcare (IRCCS), Childrens' Hospital Bambino Gesù, Rome, Italy.,University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Margherita Di Mauro
- Department of Onco-Hematology and Cell and Gene Therapy, Scientific Institute for Research and Healthcare (IRCCS), Childrens' Hospital Bambino Gesù, Rome, Italy.,University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Isabella Tarissi De Jacobis
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, Scientific Institute for Research and Healthcare (IRCCS), Childrens' Hospital Bambino Gesù, Rome, Italy
| | - Francesca de Gennaro
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Martina Quaranta
- Department of Onco-Hematology and Cell and Gene Therapy, Scientific Institute for Research and Healthcare (IRCCS), Childrens' Hospital Bambino Gesù, Rome, Italy.,University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Baronci
- Department of Onco-Hematology and Cell and Gene Therapy, Scientific Institute for Research and Healthcare (IRCCS), Childrens' Hospital Bambino Gesù, Rome, Italy
| | - Alberto Villani
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, Scientific Institute for Research and Healthcare (IRCCS), Childrens' Hospital Bambino Gesù, Rome, Italy
| | - Giuseppe Palumbo
- Department of Onco-Hematology and Cell and Gene Therapy, Scientific Institute for Research and Healthcare (IRCCS), Childrens' Hospital Bambino Gesù, Rome, Italy
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Association of plasma homocysteine level with vaso-occlusive crisis in sickle cell anemia patients of Odisha, India. Ann Hematol 2019; 98:2257-2265. [PMID: 31440871 DOI: 10.1007/s00277-019-03776-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
Vascular complications of sickle cell anemia (SCA) are influenced by many factors. Elevated plasma homocysteine (Hcy) is supposed to be an independent risk factor and is either genetic or nutritional origin. The present study evaluated the plasma Hcy level, MTHFR C677T gene polymorphism, effect of folic acid (FA) supplementation' and hemato-biochemical parameters in SCA and their effect on the vaso-occlusive crisis (VOC) in SCA patients of an Asian-Indian haplotype population. One hundred twenty cases of SCA (HbSS) and 50 controls with normal hemoglobin(HbAA) were studied. It was found that the plasma Hcy level is significantly higher (p < 0.0001) in patients with SCA (22.41 ± 7.8 μmol/L) compared to controls (13.2 ± 4.4 μmol/L). Moreover, patients without FA supplementation had a significantly (p < 0.001) higher Hcy level (27 ± 7 μmol/L) compared to those with supplementation (17.75 ± 5.7 μmol/L). Turkey-Kramer multiple comparison tests show that there is a significant difference (p < 0.05) in HbF percent, hemoglobin (Hb), platelet count, serum bilirubin (direct:Bil-D and total:Bil-T), aspartate transaminase (AST), lactate dehydrogenase (LDH), and plasma Hcy levels between mild and severe VOC. Between moderate VOC and severe VOC, there was a significant difference (p < 0.05) in HbF%, Bil-D, AST, Hcy. Pearson correlation revealed that plasma Hcy had a significantly (p < 0.05) positive correlation with AST, serum bilirubin (indirect and total), LDH, jaundice, stroke, VOC per year, and hospitalization per year whereas it was inversely correlated with HbF percentage, Hb level, and FA treatment. In the study population, increased plasma Hcy level, hemolysis, and platelet activation were found to influence VOC in SCA.
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Jit BP, Mohanty PK, Pradhan A, Purohit P, Das K, Patel S, Meher S, Sinha S, Mohanty JR, Behera RK, Das P. Erythrocyte cAMP in Determining Frequency of Acute Pain Episodes in Sickle Cell Disease Patients from Odisha State, India. Hemoglobin 2019; 43:88-94. [PMID: 31290363 DOI: 10.1080/03630269.2019.1623248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Vaso-occlusive crisis (VOC) occurs more frequently during stress in sickle cell disease patients. Epinephrine released during stress increases adhesion of sickled red blood cells (RBCs) to endothelium and to leukocytes, a process mediated through erythrocyte cyclic adenosine monophosphate (cAMP). Increased adhesion of sickled RBCs retards blood flow through the capillaries and promotes vaso-occlusion. Therefore, we examined the association of RBC-cAMP levels with frequency of acute pain episodes in sickle cell disease subjects. Using a case control study design, we measured RBC-cAMP levels, fetal hemoglobin (Hb F), α-thalassemia (α-thal) and other hematological parameters at baseline (sham treated) and after stimulation with epinephrine. The cases consisted of sickle cell disease subjects with three or more acute pain episodes in the last 12 months, and those without a single acute pain episode in the last 12 months were considered as controls. Significantly higher cAMP values were found in cases than the controls, in both sham treated (p < 0.001) and epinephrine treated RBCs (p < 0.001) by Wilcoxon Rank Sum test. However, significant association of cAMP values was observed both on univariate [odds ratio (OR): 4.8, 95% confidence interval (95% CI): 1.51-15.19, p < 0.008) and multivariate logistic regression analyses only in epinephrine treated (OR: 5.07, 95% CI: 1.53-16.82, p < 0.008) but not in sham-treated RBCs. In the covariates, Hb F consistently showed protective effects in univariate as well as in multivariate analyses. Frequent acute pain episodes are associated with higher cAMP levels than those with less frequent pain episodes, only after stimulation with epinephrine but not with baseline level.
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Affiliation(s)
- Bimal P Jit
- a School of Life Sciences , AIPH University , Bhubaneswar , Odisha State , India.,b Sickle Cell Clinic and Molecular Biology Laboratory , Veer Surendra Sai Institute of Medical Sciences and Research , Burla, Sambalpur , Odisha State , India.,c School of Life Sciences , Sambalpur University , Jyoti Vihar, Burla , Sambalpur , Odisha State , India
| | - Pradeep K Mohanty
- b Sickle Cell Clinic and Molecular Biology Laboratory , Veer Surendra Sai Institute of Medical Sciences and Research , Burla, Sambalpur , Odisha State , India.,d Department of Medicine , Veer Surendra Sai Institute of Medical Sciences and Research , Burla, Sambalpur , Odisha State , India
| | - Avinash Pradhan
- e Central Institute of Freshwater Aquaculture , Bhubaneswar , Odisha State , India
| | - Prasanta Purohit
- b Sickle Cell Clinic and Molecular Biology Laboratory , Veer Surendra Sai Institute of Medical Sciences and Research , Burla, Sambalpur , Odisha State , India.,f Multidisciplinary Research Unit , Maharaja Krishna Chandra Gajapati Medical College , Berhampur , Odisha State , India
| | - Kishalaya Das
- b Sickle Cell Clinic and Molecular Biology Laboratory , Veer Surendra Sai Institute of Medical Sciences and Research , Burla, Sambalpur , Odisha State , India
| | - Siris Patel
- b Sickle Cell Clinic and Molecular Biology Laboratory , Veer Surendra Sai Institute of Medical Sciences and Research , Burla, Sambalpur , Odisha State , India
| | - Satyabrata Meher
- b Sickle Cell Clinic and Molecular Biology Laboratory , Veer Surendra Sai Institute of Medical Sciences and Research , Burla, Sambalpur , Odisha State , India
| | - Shalini Sinha
- a School of Life Sciences , AIPH University , Bhubaneswar , Odisha State , India
| | - Jyoti R Mohanty
- a School of Life Sciences , AIPH University , Bhubaneswar , Odisha State , India
| | - Rajendra Kumar Behera
- c School of Life Sciences , Sambalpur University , Jyoti Vihar, Burla , Sambalpur , Odisha State , India
| | - Padmalaya Das
- a School of Life Sciences , AIPH University , Bhubaneswar , Odisha State , India
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Mikobi TM, Lukusa PT, Muamba JMM, Rhama T. Homozygous Deletion Alpha-Thalassemia and Hereditary Persistence of Fetal Hemoglobin, Two Genetic Factors Predictive the Reduction of Morbidity and Mortality During Pregnancy in Sickle Cell Patients. A Report from the Democratic Republic of Congo. Mediterr J Hematol Infect Dis 2019; 11:e2019039. [PMID: 31308915 PMCID: PMC6613621 DOI: 10.4084/mjhid.2019.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/22/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE to determine the beneficial role of Fetal Hemoglobin (FHb) and alpha-thal on fetal and maternal morbidity during pregnancy in sickle cell patients. STUDY SITE the study was conducted at the sickle cell center of Kinshasa between 2008 and 2018. SETTING AND STUDY POPULATION this is a documentary and analytical study that included 980 deliveries of homozygous sickle cell patients. METHODS the diagnosis of SCD and the quantification of FHb were performed with the capillary electrophoresis technique. The molecular test confirmed the diagnosis of SCD. The diagnosis of alpha-thal was made with the multiplex ligation-dependent probe amplification (MLPA) technique. Sickle cell pregnancies were followed according to the protocol of care in force in the University of Kinshasa Hospital service. The variables of interest were: hematological variables, sickle cell crises during pregnancy, maternal and fetal complications. STATISTICS statistical analyses were performed with SPSS 20.0 software. Means and standard deviations were compared with the Student's t and ANOVA tests. The value of p <0.05 was considered the significance level. RESULTS the Hb-SS / alpha-thal and HbSS / HPFH genotypes were observed in 101 and 121 women, respectively. Otherwise, 758 women had HbSS genotype. The morbidity related to sickle cell complications in the mother and fetus were less frequent in the Hb-SS / alpha-thal and HbSS / HPFH groups than in HB-SS group. The differences were statistically significant. CONCLUSION this study showed a significant protective effect of alpha-thal and HPFH during pregnancy in sickle-cell pregnant women.
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Affiliation(s)
- Tite Minga Mikobi
- Center for Human Genetics, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, DRC
- Division of Gynecology Obstetrics, Center for Sickle Cell Anemia, Kinshasa, DRC
| | - Prosper Tshilobo Lukusa
- Center for Human Genetics, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, DRC
- Division of Pediatrics, Hospital University, Faculty of Medicine, University of Kinshasa, DRC
| | - Jean-Marie Mbuyi Muamba
- Division of Internal Medicine, Service of Immuno hemato Rheumatology, Hospital University, Faculty of Medicine, University of Kinshasa, DRC
| | - Tozin Rhama
- Division of Gynecology Obstetrics, Hospital University, Faculty of Medicine, University of Kinshasa, DRC
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