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Duarte TL, Viveiros N, Godinho C, Duarte D. Heme (dys)homeostasis and liver disease. Front Physiol 2024; 15:1436897. [PMID: 39135705 PMCID: PMC11317413 DOI: 10.3389/fphys.2024.1436897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
Heme is essential for a variety of proteins involved in vital physiological functions in the body, such as oxygen transport, drug metabolism, biosynthesis of steroids, signal transduction, antioxidant defense and mitochondrial respiration. However, free heme is potentially cytotoxic due to the capacity of heme iron to promote the oxidation of cellular molecules. The liver plays a central role in heme metabolism by significantly contributing to heme synthesis, heme detoxification, and recycling of heme iron. Conversely, enzymatic defects in the heme biosynthetic pathway originate multisystemic diseases (porphyrias) that are highly associated with liver damage. In addition, there is growing evidence that heme contributes to the outcomes of inflammatory, metabolic and malignant liver diseases. In this review, we summarize the contribution of the liver to heme metabolism and the association of heme dyshomeostasis with liver disease.
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Affiliation(s)
- Tiago L. Duarte
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC–Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Nicole Viveiros
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Catarina Godinho
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - Delfim Duarte
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Serviço de Hematologia e Transplantação da Medula Óssea, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E. (IPO Porto), Porto, Portugal
- Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
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2
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Grujcic M, Milovanovic M, Nedeljkovic J, Jovanovic D, Arsenijevic D, Solovjova N, Stankovic V, Tanaskovic I, Arsenijevic A, Milovanovic J. The Possible Effects of Galectin-3 on Mechanisms of Renal and Hepatocellular Injury Induced by Intravascular Hemolysis. Int J Mol Sci 2024; 25:8129. [PMID: 39125698 PMCID: PMC11311984 DOI: 10.3390/ijms25158129] [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: 06/05/2024] [Revised: 07/20/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Intravascular hemolysis is a central feature of congenital and acquired hemolytic anemias, complement disorders, infectious diseases, and toxemias. Massive and/or chronic hemolysis is followed by the induction of inflammation, very often with severe damage of organs, which enhances the morbidity and mortality of hemolytic diseases. Galectin-3 (Gal-3) is a β-galactoside-binding lectin that modulates the functions of many immune cells, thus affecting inflammatory processes. Gal-3 is also one of the main regulators of fibrosis. The role of Gal-3 in the development of different kidney and liver diseases and the potential of therapeutic Gal-3 inhibition have been demonstrated. Therefore, the objective of this review is to discuss the possible effects of Gal-3 on the process of kidney and liver damage induced by intravascular hemolysis, as well as to shed light on the potential therapeutic targeting of Gal-3 in intravascular hemolysis.
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Affiliation(s)
- Mirjana Grujcic
- Institute for Transfusiology and Hemobiology of Military Medical Academy, 11000 Belgrade, Serbia;
| | - Marija Milovanovic
- Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia; (M.M.); (D.A.); (V.S.); (A.A.)
- Department of Microbiology and Immunology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia
| | - Jelena Nedeljkovic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Danijela Jovanovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Dragana Arsenijevic
- Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia; (M.M.); (D.A.); (V.S.); (A.A.)
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Natalija Solovjova
- Academy of Applied Studies Belgrade, The College of Health Science, Cara Dušana 254, 11080 Belgrade, Serbia;
| | - Vesna Stankovic
- Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia; (M.M.); (D.A.); (V.S.); (A.A.)
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Irena Tanaskovic
- Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia; (M.M.); (D.A.); (V.S.); (A.A.)
- Department of Histology and Embriology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Aleksandar Arsenijevic
- Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia; (M.M.); (D.A.); (V.S.); (A.A.)
- Department of Microbiology and Immunology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia
| | - Jelena Milovanovic
- Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia; (M.M.); (D.A.); (V.S.); (A.A.)
- Department of Histology and Embriology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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3
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Rizvi I, Solipuram D, Kaur N, Komel A, Batool S, Wang J. The enigma of sickle cell hepatopathy: Pathophysiology, clinical manifestations and therapy. Br J Haematol 2024. [PMID: 38978231 DOI: 10.1111/bjh.19620] [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: 03/27/2024] [Accepted: 06/19/2024] [Indexed: 07/10/2024]
Abstract
Sickle cell disease (SCD) is one of the most common genetic disorders in the world predominantly affecting economically disadvantaged populations. There is a notable discrepancy between the growing adult SCD population and available diagnostic and therapeutic interventions for SCD. Sickle cell hepatopathy (SCH) is an all-inclusive term to describe the acute and chronic liver manifestations of SCD. The pathophysiology of SCH follows no defined pattern or sequence that poses challenges to clinicians and researchers alike. Evidence is lacking for this underreported disease at various levels from diagnostic to therapeutic options. This paper reviews the basic pathophysiology, clinical features, biochemical and radiological findings of various SCH manifestations and outlines the management of each condition. Old and new therapy options in SCD including hydroxyurea, red blood cell exchange transfusion, ursodeoxycholic acid, voxelotor, l-glutamine and crizanlizumab have been reviewed to investigate the role of these options in treating SCH. The role of liver transplant, haematopoietic stem cell transplant and gene therapy in SCH patients have been reviewed.
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Affiliation(s)
- Insia Rizvi
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Divya Solipuram
- Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA
| | - Navneet Kaur
- Internal Medicine, North Alabama Medical Center, Florence, Alabama, USA
| | - Aqsa Komel
- Internal Medicine, Nishtar Medical College and Hospital, Multan, Punjab, Pakistan
| | - Saba Batool
- Internal Medicine, Carle Health Methodist Hospital, Peoria, Illinois, USA
| | - Jennifer Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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4
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Dasiah YSP, Saeid M, Ahmed F. Intrahepatic Cholestasis in a Pregnant Patient With Sickle Cell Disease: A Case Report. Cureus 2024; 16:e60611. [PMID: 38894784 PMCID: PMC11185666 DOI: 10.7759/cureus.60611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
Sickle cell intrahepatic cholestasis (SCIC) is a potentially fatal complication of sickle cell disease (SCD) with a high mortality rate, observed mainly in patients with homozygous SCD. Intrahepatic cholestasis of pregnancy is a known complication in pregnancy and usually presents in the late second or third trimester with itching, elevated bile acids, and elevated liver enzymes. Intrahepatic cholestasis in a pregnant patient with homozygous SCD is a rare occurrence. We present the case of a patient who was diagnosed with homozygous SCD during her second pregnancy and developed cholestasis with abnormal levels of liver enzymes at 25 weeks gestation, requiring delivery at 30 weeks gestation due to very high bile acid and liver enzyme levels. The patient was successfully managed.
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Affiliation(s)
| | - Martina Saeid
- Internal Medicine, New Medical Center (NMC) Royal Women's Hospital, Abu Dhabi, ARE
| | - Fatmaelzahraa Ahmed
- Obstetrics and Gynaecology, New Medical Center (NMC) Royal Women's Hospital, Abu Dhabi, ARE
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Hassanzadeh M, Sanat ZM, Khayatian S, Sotoudeheian M, Shahbazian A, Hoseini S. Acute sickle cell hepatopathy: A case report and literature review. J Natl Med Assoc 2024; 116:119-125. [PMID: 38383222 DOI: 10.1016/j.jnma.2023.09.013] [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: 02/20/2023] [Revised: 09/01/2023] [Accepted: 09/30/2023] [Indexed: 02/23/2024]
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy with protean clinical manifestations. The liver could be affected by various SCD-associated complications of an overlapping nature. The clinical presentations of "sickle cell hepatopathy" range from clinically asymptomatic patients to those with life-threatening complications. Herein we report an SCD patient who presented with right upper quadrant abdominal pain and jaundice, eventually diagnosed as a self-limited form of acute sickle cell hepatopathy with overlapping features of acute hepatic crisis and benign intrahepatic cholestasis. Using this patient as an illustration, we will review the spectrum of hepatobiliary presentations in the SCD population.
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Affiliation(s)
- Morteza Hassanzadeh
- Department of Internal Medicine, School of Medicine, Colorectal Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Zahra Momayez Sanat
- Department of Internal Medicine, School of Medicine, Digestive Diseases Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Somayeh Khayatian
- Department of Internal Medicine, School of Medicine, Digestive Diseases Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Amirmasoud Shahbazian
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Vadlapudi SS, Srivastava A, Rai P, Singh RK, Sarma MS, Poddar U, Yadav RR. Jaundice in a Child with Sickle Cell Anemia: A Case Based Approach. Indian J Pediatr 2024; 91:73-80. [PMID: 37556033 DOI: 10.1007/s12098-023-04747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/21/2023] [Indexed: 08/10/2023]
Abstract
Sickle cell anemia (SCA) is an autosomal recessive disorder caused by a mutation in beta globin gene. Hepatobiliary system is affected in 10-40% of patients with SCA and has a multifactorial etiology. The authors present a child with SCA and conjugated hyperbilirubinemia due to biliary obstruction. He underwent endoscopic retrograde cholangiopancreatography (ERCP) and biliary stenting, had complications of post sphincterotomy bleed, retroperitoneal hematoma and post laparoscopic cholecystectomy sepsis with acute sickle hepatic crisis. He was managed successfully and is doing well on follow-up. Here authors discuss a stepwise approach in management of jaundice in a patient with SCA. Patients with SCA are prone to develop vaso-occlusive crisis (VOC) during periods of stress. VOC affects the liver as acute sickle hepatic crisis, acute hepatic sequestration or sickle cell intrahepatic cholestasis and is collectively termed as sickle cell hepatopathy. Hemolysis due to sickling results in cholelithiasis with its associated complications. These patients are vulnerable to viral hepatitis and hemochromatosis due to multiple blood transfusions. There may be a concomitant acute viral hepatitis, drug induced liver injury, Budd-Chiari syndrome or other chronic liver diseases. These conditions have considerable clinical overlap and may coexist, making the evaluation more challenging. Detailed history, examination and investigations are required for differentiation of etiology. Periods of stress must be tackled with proper hydration, oxygen supplementation, maintaining hemoglobin >10 g/dL, and a low hemoglobin S fraction. Patients with SCA and conjugated hyperbilirubinemia are "high-risk" and best managed by a multidisciplinary team. Preventive strategies like timely vaccinations, chelation, etc. must be practised.
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Affiliation(s)
- Srinivas Srinidhi Vadlapudi
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajneesh K Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajanikant R Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
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7
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Mishkin AD, Prince EJ, Leimbach EJ, Mapara MY, Carroll CP. Psychiatric comorbidities in adults with sickle cell disease: A narrative review. Br J Haematol 2023; 203:747-759. [PMID: 37455514 DOI: 10.1111/bjh.18981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Although descriptions of quality of life and patient reports of mood in sickle cell disease (SCD) have become more common in the literature, less is known about psychiatric illness prevalence, presentation, and treatment, particularly for adults. We provide a narrative review of what is known about common and debilitating psychiatric conditions such as depression, anxiety, and cognitive impairment, specifically for adults with SCD. We discuss the limitations of the current evidence, make provisional recommendations, and identify opportunities for research and improved care.
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Affiliation(s)
- Adrienne D Mishkin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Blood and Marrow Transplantation Program, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elizabeth J Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth J Leimbach
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Markus Y Mapara
- Blood and Marrow Transplantation Program, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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8
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Al Shamousi K, Al Maimani M. Prevalence and Risk Factors of Choledocholithiasis in Omani Patients With Sickle Cell Disease Undergoing Endoscopic Retrograde Cholangiopancreatography: A Retrospective Analysis. Cureus 2023; 15:e51133. [PMID: 38274900 PMCID: PMC10810723 DOI: 10.7759/cureus.51133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Background Sickle cell disease (SCD) is a prevalent genetic disorder in the Middle East, particularly in Oman, leading to significant morbidity. It is caused by a mutation in the gene encoding hemoglobin (Hb) molecules, resulting in the formation and polymerization of hemoglobin S (HbS), which subsequently leads to hemolysis. Chronic hemolysis in SCD patients often results in various complications, including increased bilirubin levels in the gallbladder and the formation of pigmented biliary stones, which may obstruct the biliary tract system. In such cases, endoscopic retrograde cholangiopancreatography (ERCP) is often employed as a diagnostic and therapeutic tool to manage biliary complications. Objectives and rationale Considering the lack of studies on the Omani population with SCD, our study aims to determine the incidence of biliary stone formation in SCD patients undergoing ERCP and identify associated risk factors. Subjects and methods This retrospective study included 79 SCD patients aged over 12 years who underwent ERCP at Sultan Qaboos University Hospital, Muscat, Oman, between January 2010 and January 2023. Patient data were extracted from medical records. Continuous variables were analyzed using mean and standard deviation calculations, with independent sample t-tests for mean comparisons. The chi-square test assessed associations between categorized variables, with a p-value of ≤0.05 denoting statistical significance. Results The prevalence of choledocholithiasis in SCD patients undergoing ERCP was 67.1%. The incidence was higher in females (68.9%) than males (65.9%), in patients aged 12-29 (71.2%) compared to those aged ≥29 (59.3%), in patients with SCD (70.6%) versus sickle cell thalassemia (66.1%), and in those who had undergone gallbladder removal (80.0%) compared to those who did not (61.3%). Prevalence was also higher in patients not using hydroxyurea and folic acid (70.6% and 84.6%, respectively); however, chi-square analysis showed no significant association (p-value > 0.05). Additionally, t-test comparisons of HbS and HbF levels showed no significant differences. Conclusion This study documents a high prevalence of choledocholithiasis (67.1%) in SCD patients undergoing ERCP. Although the prevalence is notable, the examined risk factors did not show a significant association with stone formation.
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Affiliation(s)
| | - Maimoona Al Maimani
- Internal Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
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Lynch K, Mega A, Daves M, Sadiq A, Fogarty H, Piccin A. Liver Disease and Sickle Cell Disease: Auto-Immune Hepatitis more than a Coincidence; A Systematic Review of the Literature. Mediterr J Hematol Infect Dis 2023; 15:e2023060. [PMID: 38028400 PMCID: PMC10631714 DOI: 10.4084/mjhid.2023.060] [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: 06/27/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
In patients with SCD, chronic liver damage is a common manifestation. More than 50% of SCD patients have elevated liver enzymes. Common underlying aetiologies include sickle cell hepatic crisis, viral hepatitis, sickle cell intrahepatic cholestasis and hepatic sequestration in the acute setting, and cholelithiasis and iron overload in the chronic setting. Autoimmune hepatitis (AIH) is a rare disease that appears to occur more commonly in the sickle cell disease (SCD) population than in the general population. There are many schools of thought as to why this is the case, including the phosphatidylserine hypothesis, the heme inflammatory hypothesis, the complement generation hypothesis, and the transfusion alloimmunization hypothesis. Due to the natural history of the two illnesses, SCD is almost always diagnosed first in cases of dual pathology. Symptoms such as jaundice, fatigue, and abdominal pain are common in SCD, as are abnormal liver function tests (LFTs). These abnormalities, attributed to the other more frequent liver involvements in SCD, can lead to delays in AIH diagnosis in this population. Corticosteroids, sometimes with other immunosuppressive agents, such as azathioprine, are the cornerstone of acute AIH treatment. However, corticosteroid use in the SCD population has been shown to carry an increased risk of vaso-occlusive crises, providing a treatment dilemma. The following is a review of AIH in the SCD population, where we explore the pathophysiology behind the association between the two disorders, discuss an approach to investigating abnormal LFTs in SCD, and examine treatment options in this population with co-existing diseases.
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Affiliation(s)
- Kelvin Lynch
- Dept of Gastroenterology, Cork University Hospital, Cork, Ireland
| | - Andrea Mega
- Dept of Gastroenterology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Massimo Daves
- Dept of Laboratory Medicine, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Asma Sadiq
- Northern Ireland Blood Transfusion Service, Belfast, UK
| | - Helen Fogarty
- Department of Haematology, Children's Health Ireland at Crumlin, Dublin
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin
| | - Andrea Piccin
- Northern Ireland Blood Transfusion Service, Belfast, UK
- Dept of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
- Dept of Industrial Engineering, University of Trento, Trento, Italy
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10
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Lisk C, Cendali F, Setua S, Thangaraju K, Pak DI, Swindle D, Dzieciatkowska M, Gamboni F, Hassell K, Nuss R, George G, Davizon-Castillo P, Buehler PW, D'Alessandro A, Irwin DC. Metabolic and Proteomic Divergence Is Present in Circulating Monocytes and Tissue-Resident Macrophages from Berkeley Sickle Cell Anemia and β-Thalassemia Mice. J Proteome Res 2023; 22:2925-2935. [PMID: 37606205 DOI: 10.1021/acs.jproteome.3c00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Sickle cell disease and β-thalassemia represent hemoglobinopathies arising from dysfunctional or underproduced β-globin chains, respectively. In both diseases, red blood cell injury and anemia are the impetus for end organ injury. Because persistent erythrophagocytosis is a hallmark of these genetic maladies, it is critical to understand how macrophage phenotype polarizations in tissue compartments can inform on disease progression. Murine models of sickle cell disease and β-thalassemia allow for a basic understanding of the mechanisms and provide for translation to human disease. A multi-omics approach to understanding the macrophage metabolism and protein changes in two murine models of β-globinopathy was performed on peripheral blood mononuclear cells as well as spleen and liver macrophages isolated from Berkley sickle cell disease (Berk-ss) and heterozygous B1/B2 globin gene deletion (Hbbth3/+) mice. The results from these experiments revealed that the metabolome and proteome of macrophages are polarized to a distinct phenotype in Berk-ss and Hbbth3/+ compared with each other and their common-background mice (C57BL6/J). Further, spleen and liver macrophages revealed distinct disease-specific phenotypes, suggesting that macrophages become differentially polarized and reprogrammed within tissue compartments. We conclude that tissue recruitment, polarization, and metabolic and proteomic reprogramming of macrophages in Berk-ss and Hbbth3/+ mice may be relevant to disease progression in other tissue.
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Affiliation(s)
- Christina Lisk
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado 80045, United States
| | - Francesca Cendali
- Department of Biochemistry & Molecular Genetics, Graduate School, University of Colorado, Anschutz, Medical Campus, Aurora, Colorado 80045, United States
| | - Saini Setua
- The Center for Blood Oxygen Transport, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland 21201, United States
| | - Kiruphararan Thangaraju
- The Center for Blood Oxygen Transport, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland 21201, United States
| | - David I Pak
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado 80045, United States
| | - Delaney Swindle
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado 80045, United States
| | - Monika Dzieciatkowska
- Department of Biochemistry & Molecular Genetics, Graduate School, University of Colorado, Anschutz, Medical Campus, Aurora, Colorado 80045, United States
| | - Fabia Gamboni
- Department of Biochemistry & Molecular Genetics, Graduate School, University of Colorado, Anschutz, Medical Campus, Aurora, Colorado 80045, United States
| | - Kathryn Hassell
- Division of Hematology Colorado Sickle Cell Treatment and Research Center, School of Medicine, Anschutz Medical Campus, University of Colorado-Denver School of Medicine, Aurora, Colorado 80045, United States
| | - Rachelle Nuss
- Division of Hematology Colorado Sickle Cell Treatment and Research Center, School of Medicine, Anschutz Medical Campus, University of Colorado-Denver School of Medicine, Aurora, Colorado 80045, United States
| | - Gemlyn George
- Division of Hematology Colorado Sickle Cell Treatment and Research Center, School of Medicine, Anschutz Medical Campus, University of Colorado-Denver School of Medicine, Aurora, Colorado 80045, United States
| | - Pavel Davizon-Castillo
- Department of Pediatrics, Hemophilia and Thrombosis Center, University of Colorado, Anschutz, Medical Campus, Aurora, Colorado 80045, United States
| | - Paul W Buehler
- The Center for Blood Oxygen Transport, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland 21201, United States
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland 21201, United States
| | - Angelo D'Alessandro
- Department of Biochemistry & Molecular Genetics, Graduate School, University of Colorado, Anschutz, Medical Campus, Aurora, Colorado 80045, United States
| | - David C Irwin
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado 80045, United States
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11
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Manganas K, Delicou S, Xydaki A, Kourakli A, Evliati L, Vlachaki E, Klironomos E, Diamantidis M, Lafiatis I, Kattamis A, Koskinas J. Predisposing factors for advanced liver fibrosis in patients with sickle cell disease. Br J Haematol 2023; 202:1192-1198. [PMID: 37438880 DOI: 10.1111/bjh.18970] [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: 12/27/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
Sickle cell disease (SCD) is one of the most common monogenic disorders worldwide and liver complications are common in this group of patients. Our study aims to highlight the prevalence of chronic liver complications and the main predisposing factors for advanced liver fibrosis in SCD patients. For this purpose, 219 patients from eight Thalassemia and Sickle Cell Units across Greece enrolled in our study and history of liver related disease complications was recorded, as well as a full laboratory and imaging analysis concerning their liver function. 13.6% of the patients had advanced liver fibrosis. The presence of liver fibrosis was significantly correlated with advanced age, male gender, cholelithiasis and higher LDH, γ-GT, INR, direct and indirect bilirubin levels. These patients had exhibited significantly more episodes of liver crises and acute intrahepatic cholestasis. No correlation was observed with right heart failure or previous viral hepatitis. Patients with advanced liver fibrosis were receiving a more intensive transfusion therapy for a longer period of time and had higher Liver Iron Concentration levels. Our study shows that liver complications and cirrhosis is a significant cause of morbidity in patients with SCD and it is primarily associated with intravascular hemolysis and vaso-occlusive phenomena and secondarily with iron overload.
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Affiliation(s)
| | - Sophia Delicou
- Thalassemia and Sickle Cell Unit, Hippokration General Hospital, Athens, Greece
| | - Aikaterini Xydaki
- Thalassemia and Sickle Cell Unit, Hippokration General Hospital, Athens, Greece
| | - Alexandra Kourakli
- Thalassemia & Hemoglobinopathies Unit, Hematology Division, Department of Internal Medicine, University of Patras Medical School, University Hospital, Patras, Greece
| | - Loukia Evliati
- Thalassemia and Sickle Cell Unit, General Hospital of Athens "Evaggelismos", Athens, Greece
| | - Efthymia Vlachaki
- Thalassemia and Sickle Cell Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Klironomos
- Thalassemia and Sickle Cell Unit, "Venizelion" General Hospital, Heraklion, Greece
| | - Michail Diamantidis
- Thalassemia and Sickle Cell Unit, General Hospital of Larissa, Larissa, Greece
| | - Ioannis Lafiatis
- Thalassemia and Sickle Cell Unit, "Vostanio" General Hospital of Mytilene, Mytilene, Greece
| | - Antonios Kattamis
- "Agia Sophia" Children Hospital, First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - John Koskinas
- Department of Internal Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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12
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Gotardo ÉMF, Brito PL, Gushiken LFS, Chweih H, Leonardo FC, Costa FF, Conran N. Molecular and cellular effects of in vivo chronic intravascular hemolysis and anti-inflammatory therapeutic approaches. Vascul Pharmacol 2023; 150:107176. [PMID: 37116732 DOI: 10.1016/j.vph.2023.107176] [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: 01/24/2023] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 04/30/2023]
Abstract
Intravascular hemolysis (IVH) occurs in numerous inherited and acquired disorders, including sickle cell disease (SCD), malaria and sepsis. These diseases display unique symptoms, but often share complications, such as vasomotor dysfunction and pulmonary hypertension. Consequently, in vivo models are needed to study the effects of continuous intravascular hemolytic processes, independently of the molecular or extrinsic alteration that leads to erythrocyte destruction. We gave twice-weekly low-dose phenylhydrazine (LDPHZ) to C57BL/6 J mice for 4 weeks, and measured parameters indicative of anemia, hemoglobin-clearance pathways, inflammation and iron turnover, comparing these to those of a murine model of SCD, which displays associated IVH. LDPHZ administration provoked discreet anemia in mice and significant reticulocytosis, in association with hemoglobin/heme-clearance pathway protein depletion. Mice subjected to chronic hemolysis displayed elevated leukocyte counts and plasma levels of interleukin (IL)-1β, TNF-α, IL-6, soluble ICAM-1, endothelin-1 and anti-inflammatory IL-10, closely emulating alterations indicative of systemic inflammatory and endothelial activation in SCD, and confirming chronic IVH in itself as a serious complication. Discreet accelerations in hepatic and splenic iron turnover also occurred in LDPHZ mice, without alterations in liver damage markers. Examining the effects of two therapies on hemolysis-induced inflammation, the administration of hydroxyurea (and to a lesser extent, l-glutamine) significantly abrogated hemolytic inflammation in mice, without apparent inhibition of hemolysis. In conclusion, the isolation of chronic IVH, a common disease mechanism, using this model, may allow the study of hemolysis-specific sequelae at the cellular and systemic level, and the investigation of candidate agents that could potentially counter hemolytic inflammation.
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Affiliation(s)
- Érica M F Gotardo
- Hematology and Transfusion Center, University of Campinas - UNICAMP, Campinas, SP, Brazil.
| | - Pâmela L Brito
- Hematology and Transfusion Center, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Lucas F S Gushiken
- Hematology and Transfusion Center, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Hanan Chweih
- Hematology and Transfusion Center, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Flavia C Leonardo
- Hematology and Transfusion Center, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Fernando F Costa
- Hematology and Transfusion Center, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Nicola Conran
- Hematology and Transfusion Center, University of Campinas - UNICAMP, Campinas, SP, Brazil.
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13
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Pathophysiological characterization of the Townes mouse model for sickle cell disease. Transl Res 2023; 254:77-91. [PMID: 36323381 DOI: 10.1016/j.trsl.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022]
Abstract
A deeper pathophysiologic understanding of available mouse models of sickle cell disease (SCD), such as the Townes model, will help improve preclinical studies. We evaluated groups of Townes mice expressing either normal adult human hemoglobin (HbA), sickle cell trait (HbAS), or SCD (HbS), comparing younger versus older adults, and females versus males. We obtained hematologic parameters in steady-state and hypoxic conditions and evaluated metabolic markers and cytokines from serum. Kidney function was evaluated by measuring the urine protein/creatinine ratio and urine osmolality. In vivo studies included von Frey assay, non-invasive plethysmography, and echocardiography. Histopathological evaluations were performed in lung, liver, spleen, and kidney tissues. HbS mice displayed elevated hemolysis markers and white blood cell counts, with some increases more pronounced in older adults. After extended in vivo hypoxia, hemoglobin, platelet counts, and white blood cell counts decreased significantly in HbS mice, whereas they remained stable in HbA mice. Cytokine analyses showed increased TNF-alpha in HbS mice. Kidney function assays revealed worsened kidney function in HbS mice. The von Frey assay showed a lower threshold to response in the HbS mice than controls, with more noticeable differences in males. Echocardiography in HbS mice suggested left ventricular hypertrophy and dilatation. Plethysmography suggested obstructive lung disease and inflammatory changes in HbS mice. Histopathological studies showed vascular congestion, increased iron deposition, and disruption of normal tissue architecture in HbS mice. These data correlate with clinical manifestations in SCD patients and highlight analyses and groups to be included in preclinical therapeutic studies.
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14
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Santos EDC, Santana PVB, de Jesus LLS, Melo GIV, Yahouédéhou SCMA, da Guarda CC, Santiago RP, Fiuza LM, Carvalho SP, dos Santos LO, Adorno EV, Aleluia ACM, Luiz LCGC, Fonseca TCC, Gonçalves MDS, Aleluia MM. Leg Ulcers in Sickle Cell Disease: A Multifactorial Analysis Highlights the Hemolytic Profile. Hematol Rep 2023; 15:119-129. [PMID: 36810556 PMCID: PMC9945128 DOI: 10.3390/hematolrep15010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/12/2023] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
Sickle cell disease (SCD) is characterized by the presence of the variant S hemoglobin (HbS). The homozygous genotype (HbSS) is sickle cell anemia (SCA), while the double heterozygous of HbS and HbC (HbSC) is defined as SC hemoglobinopathy. The pathophysiology is based on chronic hemolysis, inflammation, endothelial dysfunction, and vaso-occlusion, which results in vasculopathy and serious clinical manifestations. Sickle leg ulcers (SLUs) are cutaneous lesions around the malleoli frequent in 20% of Brazilian patients with SCD. SLUs present a variable clinical and laboratory pattern modulated by several characteristics that are not fully understood. Hence, this study aimed to investigate laboratory biomarkers and genetic and clinical parameters associated with the development of SLUs. This descriptive cross-sectional study included 69 SCD patients, 52 without SLU (SLU-) and 17 with active or previous SLU history (SLU+). The results showed a higher incidence of SLU in SCA patients and there was no observed association of α-3.7 Kb thalassemia in SLU occurrence. Alterations in NO metabolism and hemolysis were associated with clinical evolution and severity of SLU, in addition to hemolysis modulating the etiology and recurrence of SLU. Our multifactorial analyses demonstrate and extend the role of hemolysis driving the pathophysiological mechanism of SLU.
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Affiliation(s)
- Edvan do Carmo Santos
- Laboratório de Patologia Aplicada e Genética, Departamento de Ciências Biológicas, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, Brazil
| | - Paulo Vinícius Bispo Santana
- Laboratório de Patologia Aplicada e Genética, Departamento de Ciências Biológicas, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, Brazil
| | - Laíne Lopes Silva de Jesus
- Laboratório de Patologia Aplicada e Genética, Departamento de Ciências Biológicas, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, Brazil
| | - Gabriela Imbassahy Valentim Melo
- Laboratório de Patologia Aplicada e Genética, Departamento de Ciências Biológicas, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, Brazil
| | | | - Caroline Conceição da Guarda
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
| | - Rayra Pereira Santiago
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
| | - Luciana Magalhães Fiuza
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
| | - Suéllen Pinheiro Carvalho
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
| | - Liz Oliveira dos Santos
- Centro de Ciência e Tecnologia em Energia e Sustentabilidade, Universidade Federal do Recôncavo da Bahia, Feira de Santana 44042-280, Brazil
| | - Elisângela Vitória Adorno
- Laboratório de Pesquisa em Anemias, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador 40170-115, Brazil
| | | | | | | | - Marilda de Souza Gonçalves
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil
- Centro de Ciência e Tecnologia em Energia e Sustentabilidade, Universidade Federal do Recôncavo da Bahia, Feira de Santana 44042-280, Brazil
| | - Milena Magalhães Aleluia
- Laboratório de Patologia Aplicada e Genética, Departamento de Ciências Biológicas, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, Brazil
- Correspondence: ; Tel.: +55-73-3680-5574
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15
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Kouroumalis E, Tsomidis I, Voumvouraki A. Iron as a therapeutic target in chronic liver disease. World J Gastroenterol 2023; 29:616-655. [PMID: 36742167 PMCID: PMC9896614 DOI: 10.3748/wjg.v29.i4.616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/03/2022] [Accepted: 12/31/2022] [Indexed: 01/20/2023] Open
Abstract
It was clearly realized more than 50 years ago that iron deposition in the liver may be a critical factor in the development and progression of liver disease. The recent clarification of ferroptosis as a specific form of regulated hepatocyte death different from apoptosis and the description of ferritinophagy as a specific variation of autophagy prompted detailed investigations on the association of iron and the liver. In this review, we will present a brief discussion of iron absorption and handling by the liver with emphasis on the role of liver macrophages and the significance of the iron regulators hepcidin, transferrin, and ferritin in iron homeostasis. The regulation of ferroptosis by endogenous and exogenous mod-ulators will be examined. Furthermore, the involvement of iron and ferroptosis in various liver diseases including alcoholic and non-alcoholic liver disease, chronic hepatitis B and C, liver fibrosis, and hepatocellular carcinoma (HCC) will be analyzed. Finally, experimental and clinical results following interventions to reduce iron deposition and the promising manipulation of ferroptosis will be presented. Most liver diseases will be benefited by ferroptosis inhibition using exogenous inhibitors with the notable exception of HCC, where induction of ferroptosis is the desired effect. Current evidence mostly stems from in vitro and in vivo experimental studies and the need for well-designed future clinical trials is warranted.
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Affiliation(s)
- Elias Kouroumalis
- Liver Research Laboratory, University of Crete Medical School, Heraklion 71003, Greece
| | - Ioannis Tsomidis
- First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki 54621, Greece
| | - Argyro Voumvouraki
- First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki 54621, Greece
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16
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Dutra VDF, Biassi TP, Figueiredo MS. Sickle cell anemia: hierarchical cluster analysis and clinical profile in a cohort in Brazil. Hematol Transfus Cell Ther 2023; 45:45-51. [PMID: 34930711 PMCID: PMC9938484 DOI: 10.1016/j.htct.2021.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Sickle cell anemia is a monogenic disorder caused by a mutation in the β-hemoglobin gene, resulting in sickle hemoglobin that can polymerize. Presentation and clinical course have significant inter-individual variability and classifying these patients for severity is a challenge. METHODS We applied hierarchical clusters with 10 routine laboratory tests to understand if this grouping could be associated with clinical manifestations. We included 145 adult homozygous patients (SS) at an outpatient clinic in a retrospective study. RESULTS We found five clusters by counting those that had been differentiated by unconjugated bilirubin, reticulocytes, LDH, leukocytes, lymphocytes and monocytes. When comparing groups to clinical findings, the clusters were different only for liver abnormality. Cluster 3 had the lower median of reticulocytes, LDH, leukocytes, lymphocytes and monocytes and a higher percentage of patients under treatment. Clusters 4 and 5 had higher frequencies of liver impairment and higher medians of reticulocytes, LDH, leukocytes, lymphocytes and monocytes. Hemolysis and inflammation seemed to influence the grouping. CONCLUSION In our study, cluster analysis showed five groups that exhibited different degrees of inflammation and hemolysis. When comparing clinical data, the result was different only for the criteria of liver abnormality.
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Affiliation(s)
- Valéria de Freitas Dutra
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil.
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17
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Solomon N, Segaran N, Badawy M, Elsayes KM, Pellerito JS, Katz DS, Moshiri M, Revzin MV. Manifestations of Sickle Cell Disorder at Abdominal and Pelvic Imaging. Radiographics 2022; 42:1103-1122. [PMID: 35559660 DOI: 10.1148/rg.210154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sickle cell disorder (SCD) refers to a spectrum of hematologic disorders that cause a characteristic clinical syndrome affecting the entire body. It is the most prevalent monogenetic hemoglobinopathy worldwide, with a wide range of focal and systemic expressions. Hemoglobin gene mutation leads to the formation of abnormal sickle-shaped red blood cells, which cause vascular occlusion and result in tissue and organ ischemia and infarction. Recurrent episodes of acute illness lead to progressive multisystem organ damage and dysfunction. Vaso-occlusion, hemolysis, and infection as a result of functional asplenia are at the core of the disease manifestations. Imaging plays an essential role in the diagnosis and management of SCD-related complications in the abdomen and pelvis. A thorough understanding of the key imaging findings of SCD complications involving hepatobiliary, gastrointestinal, genitourinary, and musculoskeletal systems is crucial to timely recognition and accurate diagnosis. The authors aim to familiarize the radiologist with the SCD spectrum, focusing on the detection and evaluation of manifestations that may appear at imaging of the abdomen and pelvis. The topics the authors address include (a) the pathophysiology of the disease, (b) the placement of SCD among hemoglobinopathies, (c) the clinical presentation of SCD, (d) the role of imaging in the evaluation and diagnosis of patients with SCD who present with abdominal and pelvic manifestations in addition to extraperitoneal manifestations detectable at abdominal or pelvic imaging, (e) imaging features associated with common and uncommon sequelae of SCD in abdominal and pelvic imaging studies, and (f) a brief overview of management and treatment of patients with SCD. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Nadia Solomon
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Nicole Segaran
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Mohamed Badawy
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Khaled M Elsayes
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - John S Pellerito
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Douglas S Katz
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Mariam Moshiri
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
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18
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Alvarez O, Cumming V, Fifi AC. Assessment of Liver Fibrosis by Transient Elastography in Children and Young Adults With Sickle Cell Disease With and Without Iron Overload. J Pediatr Hematol Oncol 2022; 44:155-158. [PMID: 35180764 DOI: 10.1097/mph.0000000000002433] [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: 06/02/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Abstract
Transfusion-associated iron overload may cause liver fibrosis. We compared transient elastography (TE) and aspartate aminotransferase-platelet ratio index (APRI), noninvasive markers for hepatic fibrosis, to liver histology in children and young adults with sickle cell disease (SCD) who were iron overloaded (cohort 1). Age-matched subjects with SCD but without iron overload (cohort 2) were enrolled for APRI and TE assessments. Nineteen subjects ages 10 to 21 years were transfused for a mean of 9.67 years, had a mean serum ferritin of 4899±2849 ng/mL, and a liver iron concentration of 15.56±10.12 mg/g dry liver weight by R2-magnetic resonance imaging. Mean APRI was 0.33±0.13 in cohort 1 and 0.27±0.10 in cohort 2. The mean liver stiffness measures (LSM) in cohort 1, assessed by TE, was 8.46±3.95 kPa, ranging from 3.5 to 14.6 kPa (expected normal <7 kPa). Cohort 2 had a mean LSM of 5.72±1.74 kPa (4.6 to 8.7 kPa). There was a good correlation between LSM and histologic fibrosis (t value 6.94, P<0.0001). There was no significant correlation between APRI and histologic fibrosis and between APRI and LSM. A high LSM suggests liver fibrosis in children and adults with SCD with iron overload and may merit histologic confirmation especially if persistent.
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Affiliation(s)
| | | | - Amanda C Fifi
- Pediatric Gastroenterology, University of Miami Miller School of Medicine, Miami, FL
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19
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Santos EDC, Melo GIV, Santana PVB, Quadros IGS, Yahouédéhou SCMA, da Guarda CC, Santiago RP, Fiuza LM, Carvalho SP, Adorno EV, Kaneto CM, Fonseca TCC, Goncalves MS, Aleluia MM. A Description of the Hemolytic Component in Sickle Leg Ulcer: The Role of Circulating miR-199a-5p, miR-144, and miR-126. Biomolecules 2022; 12:biom12020317. [PMID: 35204817 PMCID: PMC8869177 DOI: 10.3390/biom12020317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 12/04/2022] Open
Abstract
Sickle leg ulcers (SLU) are malleoli lesions with exuberant hemolytic pathophysiology. The microRNAs are potential genetic biomarkers for several pathologies. Thereby, we aimed to assess the expression of circulating miR-199a-5p, miR-144, and miR-126 in association with hemolytic biomarkers in SLU. This cross-sectional study included 69 patients with sickle cell disease, 52 patients without SLU (SLU-) and 17 patients with active SLU or previous history (SLU+). The results demonstrated elevated expression of circulating miR-199a-5p and miR-144 in SLU+ patients while miR-126 expression was reduced. Circulating miR-199a-5p and miR-144 were associated with hemolytic biomarkers such as LDH, indirect bilirubin, AST, GGT, iron, ferritin, RBC, hemoglobin, and NOm, in addition to association with impaired clinical profile of SLU. Furthermore, in silico analyses indicated interactions of miR-199a-5p with HIF1A, Ets-1, and TGFB2 genes, which are associated with vasculopathy and reduced NO. In contrast, miR-126 was associated with an attenuating clinical profile of SLU, in addition to not characterizing hemolysis. In summary, this study demonstrates, for the first time, that hemolytic mechanism in SLU can be characterized by circulating miR-199a-5p and miR-144. The circulating miR-126 may play a protective role in SLU. Thus, these microRNAs can support to establish prognosis and therapeutic strategy in SLU.
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Affiliation(s)
- Edvan do Carmo Santos
- Laboratório de Patologia Aplicada e Genética, Departamento de Ciências Biológicas, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, BA, Brazil; (E.d.C.S.); (G.I.V.M.); (P.V.B.S.); (C.M.K.)
| | - Gabriela Imbassahy Valentim Melo
- Laboratório de Patologia Aplicada e Genética, Departamento de Ciências Biológicas, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, BA, Brazil; (E.d.C.S.); (G.I.V.M.); (P.V.B.S.); (C.M.K.)
| | - Paulo Vinícius Bispo Santana
- Laboratório de Patologia Aplicada e Genética, Departamento de Ciências Biológicas, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, BA, Brazil; (E.d.C.S.); (G.I.V.M.); (P.V.B.S.); (C.M.K.)
| | | | - Sètondji Cocou Modeste Alexandre Yahouédéhou
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, BA, Brazil; (S.C.M.A.Y.); (C.C.d.G.); (R.P.S.); (L.M.F.); (S.P.C.); (M.S.G.)
| | - Caroline Conceição da Guarda
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, BA, Brazil; (S.C.M.A.Y.); (C.C.d.G.); (R.P.S.); (L.M.F.); (S.P.C.); (M.S.G.)
| | - Rayra Pereira Santiago
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, BA, Brazil; (S.C.M.A.Y.); (C.C.d.G.); (R.P.S.); (L.M.F.); (S.P.C.); (M.S.G.)
| | - Luciana Magalhães Fiuza
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, BA, Brazil; (S.C.M.A.Y.); (C.C.d.G.); (R.P.S.); (L.M.F.); (S.P.C.); (M.S.G.)
- Laboratório de Pesquisa em Anemias, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador 40170-115, BA, Brazil;
| | - Suéllen Pinheiro Carvalho
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, BA, Brazil; (S.C.M.A.Y.); (C.C.d.G.); (R.P.S.); (L.M.F.); (S.P.C.); (M.S.G.)
- Laboratório de Pesquisa em Anemias, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador 40170-115, BA, Brazil;
| | - Elisângela Vitória Adorno
- Laboratório de Pesquisa em Anemias, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador 40170-115, BA, Brazil;
| | - Carla Martins Kaneto
- Laboratório de Patologia Aplicada e Genética, Departamento de Ciências Biológicas, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, BA, Brazil; (E.d.C.S.); (G.I.V.M.); (P.V.B.S.); (C.M.K.)
| | | | - Marilda Souza Goncalves
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, BA, Brazil; (S.C.M.A.Y.); (C.C.d.G.); (R.P.S.); (L.M.F.); (S.P.C.); (M.S.G.)
- Laboratório de Pesquisa em Anemias, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador 40170-115, BA, Brazil;
| | - Milena Magalhães Aleluia
- Laboratório de Patologia Aplicada e Genética, Departamento de Ciências Biológicas, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, BA, Brazil; (E.d.C.S.); (G.I.V.M.); (P.V.B.S.); (C.M.K.)
- Correspondence: ; Tel.: +55-73-3680-5574
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Khan A, Nashed B, Issa M, Khan MZ. Sickle Cell Intrahepatic Cholestasis: Extremely Rare but Fatal Complication of Sickle Cell Disease. Cureus 2022; 14:e22050. [PMID: 35295370 PMCID: PMC8916923 DOI: 10.7759/cureus.22050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/09/2022] Open
Abstract
Sickle cell intrahepatic cholestasis (SCIC) is a rare but potentially fatal complication of sickle cell disease (SCD), with high mortality, observed mainly in patients with homozygous sickle cell anemia. Herein, we have reported a case of severe SCIC with a poor outcome despite aggressive measures including exchange transfusion and use of vasopressors. The patient was admitted with generalized weakness, confusion, rigors, chills, and signs of hepatic failure, such as hyperbilirubinemia, hypoalbuminemia, and coagulopathy. There was no evidence of viral hepatitis or biliary obstruction. The patient received two exchange transfusions, but he continued to deteriorate clinically despite exchange transfusion and developed hemorrhagic shock and multiorgan failure. The patient was made comfort care as per family wishes. This case emphasizes the importance of early diagnosis of sickle cell intrahepatic cholestasis and poor prognosis despite aggressive measures.
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21
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Pompeo CM, Ferreira Júnior MA, Cardoso AIDQ, Souza MDC, Frota OP, Mota FM, Ivo ML. Clinical-Epidemiological Characteristics and Mortality in Patients with Sickle Cell Anemia: A Retrospective Cohort Study of 1980 at 2018. Int J Gen Med 2022; 15:1057-1074. [PMID: 35140508 PMCID: PMC8818769 DOI: 10.2147/ijgm.s342971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/07/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To analyze the clinical-epidemiological characteristics and mortality in patients with sickle-cell anemia (SCA). PATIENTS AND METHODS A cohort study with retrospective data, conducted in two reference hospitals for SCA treatment from January 1980 to December 2018, recorded in two reference services. With a 5% significance level, the Chi-Square and Student's t-tests were employed in the inferential statistical analysis. RESULTS A total of 128 patients with SCA were studied. Diagnosis up to the fifth day of life was made in 10 patients. There were 19 deaths, of which 12 (63.2%) were female, and the average age at death was 27.05 (± 14.78) years. The leading causes of death were septic shock and cardiogenic shock. The use of invasive medical devices was considered a risk factor for death (RR=2.63; 95% CI=1.16-5.96; p=0.018), and monitoring time up to 20 years presented a 31% reduction in the risk of dying (RR=0.31; 95% CI=0.12-0.82; p=0.011) when compared to the monitoring of more than 20 years. CONCLUSION These findings are to be considered in the treatment of patients with SCA, mainly regarding early diagnosis and access to the treatment immediately afterward, since they are fundamental in improving survival and reducing severe complications.
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Affiliation(s)
- Carolina Mariano Pompeo
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | - Mercy da Costa Souza
- Graduate Program in Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Oleci Pereira Frota
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Felipe Machado Mota
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Maria Lúcia Ivo
- Graduate Program in Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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22
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Barbetta A, Goldbeck C, Lim A, Martin SP, Kahn JA, Sheikh MR, Emamaullee J. Treatment and outcomes of hepatocellular carcinoma in patients with Sickle cell disease: a population-based study in the U.S. HPB (Oxford) 2022; 24:234-243. [PMID: 34294525 PMCID: PMC8733051 DOI: 10.1016/j.hpb.2021.06.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/27/2021] [Accepted: 06/21/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a rare hemoglobinopathy which can result in chronic liver disease and cirrhosis. Patients with SCD have an increased risk of hematologic malignancy, but the prevalence of hepatocellular carcinoma (HCC) in this population is unknown. Herein, the association of SCD with HCC was examined using registry data. METHODS The SEER-Medicare database was queried to identify patients diagnosed with HCC between 2000 and 2015, and further stratified by SCD status. Propensity matching was performed to examine cancer-related survival and treatment outcomes. RESULTS Overall 56,934 patients with HCC were identified, including 81 patients with SCD. Patients with SCD more frequently had cirrhosis [48.1% (39/81) vs 23.5% (13,377/56,853), p < 0.01] yet presented with smaller tumors [<5 cm: 51.9% (42/81) vs 38.5% (21,898/56,853), p = 0.01]. After propensity matching, SCD was not associated with attenuated survival (aHR 0.73 95%CI 0.52-1.01). When stratified by treatment, patients with SCD had equivalent outcomes to chemotherapy (p = 0.65), TACE/TARE (p = 0.35), resection (p = 0.15) and transplantation (p = 0.67) when compared to non-SCD patients. CONCLUSION This study confirms that a subset of patients with SCD will develop HCC. Importantly, therapeutic options for HCC should not be limited by pre-existing SCD, and similar survival should be expected when compared to non-SCD patients.
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Affiliation(s)
- Arianna Barbetta
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA
| | - Cameron Goldbeck
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA
| | - Angelina Lim
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA
| | - Sean P Martin
- Deparment of Surgery, UPMC Pinnacle, 111 S Front St, Harrisburg, 17101, PA, USA
| | - Jeffrey A Kahn
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA
| | - M Raashid Sheikh
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA
| | - Juliet Emamaullee
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA.
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23
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Saeed O, Panarelli N, Umrau K, Lee H, Westerhoff M, Cheng J, Lin J. The Histopathologic Features of Sickle Cell Hepatopathy: A Multi-Institutional Study. Am J Clin Pathol 2022; 157:73-81. [PMID: 34463318 DOI: 10.1093/ajcp/aqab096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/04/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Recent data on hepatic histopathology in patients with sickle cell disease (SCD) are lacking. METHODS A total of 39 liver biopsies from SCD patients from 4 medical institutes were systematically evaluated. RESULTS The average age of patients was 27 years; 23 were female. The majority of the patients had hemoglobin SS (33), 3 had hemoglobin SC, and 3 sickle cell trait. Elevated liver functional tests and evaluation for cirrhosis were the main indications for biopsy. At the time of biopsy, most had elevated liver transaminases or hepatomegaly. The most common histopathologic abnormalities were Kupffer cell erythrophagocytosis (76.9%), hemosiderosis (74.4%), sinusoidal dilatation (71.8%), and intrasinusoidal sickled red cells (69.3%). Portal inflammation, lobular inflammation, and bile duct injury were mild to minimal and present in a minority of cases. Advanced fibrosis was present in 28.2% of the cases. CONCLUSIONS The typical histopathologic features seen in patients with SCD include Kupffer cell erythrophagocytosis, hemosiderosis, sinusoidal dilatation, and intrasinusoidal sickled red cells in a pauci-inflammatory or uninflamed background. Necrosis is less common than reported in older literature. Pathologists should be aware that significant portal and lobular inflammation, interface activity, and bile duct injury are unusual and may be suggestive of other etiologies.
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Affiliation(s)
- Omer Saeed
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Nicole Panarelli
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kavita Umrau
- Anatomic Pathology, Albany Medical College, Albany, NY, USA
| | - Hwajeong Lee
- Anatomic Pathology, Albany Medical College, Albany, NY, USA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Jerome Cheng
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Jingmei Lin
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, USA
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24
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Towerman AS, Wilson DB, Hulbert ML. Epstein-Barr virus-induced sickle hepatopathy. Pediatr Blood Cancer 2021; 68:e29196. [PMID: 34180131 DOI: 10.1002/pbc.29196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/26/2021] [Accepted: 06/12/2021] [Indexed: 11/05/2022]
Abstract
Sickle hepatopathy comprises a spectrum of disorders that vary in severity. Intravascular sickling and sinusoidal occlusion are the principal drivers of sickle hepatopathy, but infection or autoimmunity can act as triggers. We describe two cases of acute sickle hepatopathy initiated by primary Epstein-Barr virus (EBV) infection, a previously unreported association. The first case entailed a 14-year-old girl with hemoglobin SC (HbSC) disease who developed hepatic sequestration crisis that responded to a simple transfusion of erythrocytes. The second case was that of a 16-year-old boy with HbSC disease who experienced life-threatening intrahepatic cholestasis with multiorgan failure.
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Affiliation(s)
- Alison S Towerman
- Departments of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.,School of Nursing, St. Louis University, St. Louis, Missouri, USA
| | - David B Wilson
- Departments of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.,Department of Developmental Biology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Monica L Hulbert
- Departments of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
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25
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Burley NB, Miller KD. Acute Liver Failure in Sickle Cell Disease: A Perfect Storm. Cureus 2021; 13:e15680. [PMID: 34159039 PMCID: PMC8212850 DOI: 10.7759/cureus.15680] [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] [Indexed: 12/01/2022] Open
Abstract
Sickle cell hepatopathy is a well-described but uncommonly seen complication of sickle cell disease and is usually caused by multiple overlapping processes. A more acute liver complication is hepatic sequestration which is important to recognize in order to initiate life-saving treatment. A 33-year-old woman with sickle cell disease complicated by painful crises, splenic infarction and significant alcohol abuse presented with gastrointestinal distress, pain crisis, acute-on-chronic anemia, and hyperbilirubinemia in the setting of greater than baseline alcohol consumption. She was found to have hepatomegaly, encephalopathy, severe jaundice, and severe hyperbilirubinemia. She was treated with red cell exchange and supportive care which resulted in an improvement in her symptoms as well as hyperbilirubinemia. She was discharged with plans for monthly red cell exchange, iron chelation therapy, and close monitoring of liver disease was planned upon discharge. This case illustrates that chronic liver disease can occur in sickle cell disease (Hgb SS) especially in the setting of acquired iron overload. More acutely, sequestration is a serious and life-threatening complication of sickle cell disease that can culminate in acute liver failure. Primary treatment for hepatic sequestration is red cell exchange along with management of contributing comorbidities, and symptomatic management of encephalopathy. In end-stage liver disease, transplantation may be considered in the context of the patient’s clinical status.
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26
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Rodrigues L, Almeida S, Salgado C, Gonçalves C. Pediatric Acute Liver Failure in Sickle Cell Disease. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 29:192-196. [DOI: 10.1159/000515469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/20/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Sickle cell intrahepatic cholestasis (SCIC) is one of the rarest and the most severe acute hepatic manifestations of sickle cell disease (SCD) and it can rapidly progress to acute liver failure. It is associated with a high mortality rate, demanding prompt recognition and management. <b><i>Case Presentation:</i></b> We report a case of a 7-year-old boy with a history of homozygous HbS SCD who presented to the emergency department with fever, increasing abdominal pain, and jaundice. His course was complicated by acute liver injury (AST 9,472 IU/L, ALT 2,683 IU/L, total bilirubin 15.4 mg/dL; conjugated bilirubin 8.69 mg/dL, hypoalbuminemia 2.6 g/dL, and persistent hypoglycemia), with acute liver failure (coagulopathy not corrected by vitamin K administration with INR 3.26, decreased factors V 10% and VII 28%, and West Haven grade I hepatic encephalopathy associated with mild hyperammonemia of 71 µmol/L). After excluding other causes of acute liver failure, the patient was diagnosed as having SCIC and was successfully treated with manual exchange transfusion. <b><i>Conclusion:</i></b> This case reinforces that exchange transfusion is an effective treatment for SCIC and that it should be introduced promptly to prevent fulminant and potentially fatal liver failure.
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27
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Yalamanoglu A, Dubach IL, Schulthess N, Ingoglia G, Swindle DC, Humar R, Schaer DJ, Buehler PW, Irwin DC, Vallelian F. Agonistic Anti-CD40 Antibody Triggers an Acute Liver Crisis With Systemic Inflammation in Humanized Sickle Cell Disease Mice. Front Immunol 2021; 12:627944. [PMID: 33763072 PMCID: PMC7982888 DOI: 10.3389/fimmu.2021.627944] [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: 11/10/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited hemolytic disorder, defined by a point mutation in the β-globin gene. Stress conditions such as infection, inflammation, dehydration, and hypoxia trigger erythrocyte sickling. Sickled red blood cells (RBCs) hemolyze more rapidly, show impaired deformability, and increased adhesive properties to the endothelium. In a proinflammatory, pro-coagulative environment with preexisting endothelial dysfunction, sickled RBCs promote vascular occlusion. Hepatobiliary involvement related to the sickling process, such as an acute sickle hepatic crisis, is observed in about 10% of acute sickle cell crisis incidents. In mice, ligation of CD40 with an agonistic antibody leads to a macrophage activation in the liver, triggering a sequence of systemic inflammation, endothelial cell activation, thrombosis, and focal ischemia. We found that anti-CD40 antibody injection in sickle cell mice induces a systemic inflammatory and hemodynamic response with accelerated hemolysis, extensive vaso-occlusion, and large ischemic infarctions in the liver mimicking an acute hepatic crisis. Administration of the tumor necrosis factor-α (TNF-α) blocker, etanercept, and the heme scavenger protein, hemopexin attenuated end-organ damage. These data collectively suggest that anti-CD40 administration offers a novel acute liver crisis model in humanized sickle mice, allowing for evaluation of therapeutic proof-of-concept.
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Affiliation(s)
- Ayla Yalamanoglu
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Irina L Dubach
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Nadja Schulthess
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Giada Ingoglia
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Delaney C Swindle
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Aurora, CO, United States
| | - Rok Humar
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Dominik J Schaer
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Paul W Buehler
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States.,Center for Blood Oxygen Transport and Hemostasis, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - David C Irwin
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Aurora, CO, United States
| | - Florence Vallelian
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland
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Sachdev V, Tian X, Gu Y, Nichols J, Sidenko S, Li W, Beri A, Layne WA, Allen D, Wu CO, Thein SL. A phenotypic risk score for predicting mortality in sickle cell disease. Br J Haematol 2021; 192:932-941. [PMID: 33506990 PMCID: PMC9123430 DOI: 10.1111/bjh.17342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/30/2020] [Indexed: 02/02/2023]
Abstract
Risk assessment for patients with sickle cell disease (SCD) remains challenging as it depends on an individual physician's experience and ability to integrate a variety of test results. We aimed to provide a new risk score that combines clinical, laboratory, and imaging data. In a prospective cohort of 600 adult patients with SCD, we assessed the relationship of 70 baseline covariates to all-cause mortality. Random survival forest and regularised Cox regression machine learning (ML) methods were used to select top predictors. Multivariable models and a risk score were developed and internally validated. Over a median follow-up of 4·3 years, 131 deaths were recorded. Multivariable models were developed using nine independent predictors of mortality: tricuspid regurgitant velocity, estimated right atrial pressure, mitral E velocity, left ventricular septal thickness, body mass index, blood urea nitrogen, alkaline phosphatase, heart rate and age. Our prognostic risk score had superior performance with a bias-corrected C-statistic of 0·763. Our model stratified patients into four groups with significantly different 4-year mortality rates (3%, 11%, 35% and 75% respectively). Using readily available variables from patients with SCD, we applied ML techniques to develop and validate a mortality risk scoring method that reflects the summation of cardiopulmonary, renal and liver end-organ damage. Trial Registration: ClinicalTrials.gov Identifier: NCT#00011648.
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Affiliation(s)
- Vandana Sachdev
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Xin Tian
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Yuan Gu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - James Nichols
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Stanislav Sidenko
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Wen Li
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Andrea Beri
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - W. Austin Layne
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Darlene Allen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Colin O. Wu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Swee Lay Thein
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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30
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Abstract
Sickle hepatopathy is an umbrella term describing various pattern of liver injury seen in patients with sickle cell disease. The disease is not uncommon in India; in terms of prevalence, India is second only to Sub-Saharan Africa where sickle cell disease is most prevalent. Hepatic involvement in sickle cell disease is not uncommon. Liver disease may result from viral hepatitis and iron overload due to multiple transfusions of blood products or due to disease activity causing varying changes in vasculature. The clinical spectrum of disease ranges from ischemic injury due to sickling of red blood cells in hepatic sinusoids, pigment gall stones, and acute/chronic sequestration syndromes. The sequestration syndromes are usually episodic and self-limiting requiring conservative management such as antibiotics and intravenous fluids or packed red cell transfusions. However, rarely these episodes may present with coagulopathy and encephalopathy like acute liver failure, which are life-threatening, requiring exchange transfusions or even liver transplantation. However, evidence for their benefits, optimal indications, and threshold to start exchange transfusion is limited. Similarly, there is paucity of the literature regarding the end point of exchange transfusion in this scenario. Liver transplantation may also be beneficial in end-stage liver disease. Hydroxyurea, the antitumor agent, which is popularly used to prevent life-threatening complications such as acute chest syndrome or stroke in these patients, has been used only sparingly in hepatic sequestrations. The purpose of this review is to provide insights into epidemiology of sickle cell disease in India and pathogenesis and classification of hepatobiliary involvement in sickle cell disease. Finally, various management options including exchange transfusion, liver transplantation, and hydroxyurea in hepatic sequestration syndromes will be discussed in brief.
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Key Words
- AASLD, American Association for the Study of Liver Diseases
- ACLF, Acute on chronic liver failure
- ALF, Acute liver failure
- ALT, Alanine transaminase
- AST, Aspartate transaminase
- FFP, Fresh frozen plasma
- GIT, Gastrointestinal tract
- HAV, Hepatitis A virus
- HBV, Hepatitis B virus
- HCV, Hepatitis C virus
- HEV, Hepatitis E virus
- HIC, Hepatic iron content
- HbS, Sickle hemoglobin
- HbSS, Sickle cell disease homozygous
- INR, International normalized ratio
- PT, Prothrombin time
- RUQ, Right upper quadrant
- SC, Scheduled caste
- SCD, Sickle cell disease
- SCIC, Sickle cell intrahepatic cholestasis
- ST, Scheduled tribe
- TJLB, Transjugular liver biopsy
- UDCA, Ursodeoxycholic acid
- cholelithiasis
- intrahepatic cholestasis
- sickle cell hepatopathy
- sickle cholangiopathy
- sickle hepatic crisis
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Affiliation(s)
| | - Anil C. Anand
- Address for correspondence. Anil C Anand, Professor and Head, Department of Gastroenterology & Hepatology, Kalinga Institute of Medical Sciences, Bhubneshwar, India.
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Levesque E, Lim C, Feray C, Salloum C, Quere A, Robin B, Merle J, Esposito F, Duvoux C, Cherqui D, Habibi A, Galacteros F, Bartolucci P, Azoulay D. Liver transplantation in patients with sickle cell disease: possible but challenging—a cohort study. Transpl Int 2020; 33:1220-1229. [DOI: 10.1111/tri.13669] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Eric Levesque
- Department of Anesthesia and Surgical Intensive Care‐Liver ICU AP‐HP Henri Mondor Hospital Créteil France
- Ecole Nationale Vétérinaire d’Alfort (ENVA) Faculté de Médecine de Créteil EA Dynamyc Université Paris‐Est Créteil (UPEC) Créteil France
| | - Chetana Lim
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation Assistance Publique‐Hôpitaux de Paris Pitié‐Salpêtrière Hospital Paris France
| | - Cyrille Feray
- Centre Hepato‐Biliaire AP‐HP Paul Brousse Hospital Villejuif France
| | - Chady Salloum
- Centre Hepato‐Biliaire AP‐HP Paul Brousse Hospital Villejuif France
| | - Anne‐Laure Quere
- Department of Anesthesia and Surgical Intensive Care‐Liver ICU AP‐HP Henri Mondor Hospital Créteil France
| | - Benoit Robin
- Department of Anesthesia and Surgical Intensive Care‐Liver ICU AP‐HP Henri Mondor Hospital Créteil France
| | - Jean‐Claude Merle
- Department of Anesthesia and Surgical Intensive Care‐Liver ICU AP‐HP Henri Mondor Hospital Créteil France
| | | | | | - Daniel Cherqui
- Centre Hepato‐Biliaire AP‐HP Paul Brousse Hospital Villejuif France
| | - Anoosha Habibi
- Department of Internal Medicine Sickle Cell National Referral Center AP‐HP Henri Mondor Hospital‐UPEC Créteil France
| | - Frédéric Galacteros
- Department of Internal Medicine Sickle Cell National Referral Center AP‐HP Henri Mondor Hospital‐UPEC Créteil France
| | - Pablo Bartolucci
- Department of Internal Medicine Sickle Cell National Referral Center AP‐HP Henri Mondor Hospital‐UPEC Créteil France
| | - Daniel Azoulay
- Centre Hepato‐Biliaire AP‐HP Paul Brousse Hospital Villejuif France
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation Sheba Medical Center Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Martí-Carvajal AJ, Martí-Amarista CE. Interventions for treating intrahepatic cholestasis in people with sickle cell disease. Cochrane Database Syst Rev 2020; 6:CD010985. [PMID: 32567054 PMCID: PMC7388850 DOI: 10.1002/14651858.cd010985.pub4] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sickle cell disease is the most common hemoglobinopathy occurring worldwide and sickle cell intrahepatic cholestasis is a complication long recognized in this population. Cholestatic liver diseases are characterized by impaired formation or excretion (or both) of bile from the liver. There is a need to assess the clinical benefits and harms of the interventions used to treat intrahepatic cholestasis in people with sickle cell disease. This is an update of a previously published Cochrane Review. OBJECTIVES To assess the benefits and harms of the interventions for treating intrahepatic cholestasis in people with sickle cell disease. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 21 January 2020), the WHO International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov (21 January 2020). Date of last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 25 November 2019. SELECTION CRITERIA We searched for published or unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS Each author intended to independently extract data, assess the risk of bias of the trials by standard Cochrane methodologies and assess the quality of the evidence using the GRADE criteria; however, no trials were included in the review. MAIN RESULTS We did not identify any randomised controlled trials. AUTHORS' CONCLUSIONS This updated Cochrane Review did not identify any randomised controlled trials assessing interventions for treating intrahepatic cholestasis in people with sickle cell disease. Randomised controlled trials are needed to establish the optimum treatment for this condition.
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Affiliation(s)
- Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE (Cochrane Ecuador), Quito, Ecuador
- School of Medicine, Universidad Francisco de Vitoria (Cochrane Madrid), Madrid, Spain
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Hogen R, Kim M, Lee Y, Lo M, Kaur N, Kahn J, Chopra S, Qazi Y, Sedra A, Kim J, O'Brien L, Genyk Y, Sher L, Emamaullee J. Liver Transplantation in Patients with Sickle Cell Disease in the United States. J Surg Res 2020; 255:23-32. [PMID: 32540577 DOI: 10.1016/j.jss.2020.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/26/2020] [Accepted: 05/06/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Up to 30% of patients with sickle cell disease (SCD) develop chronic liver disease via etiologies including sickle cell hepatopathy, acquired viral hepatitis, or secondary hemochromatosis. It is unclear how many patients with SCD ultimately undergo liver transplantation (LT) and what factors are associated with survival after LT. In this study, we examined LT outcomes in these patients by reviewing the Scientific Registry of Transplant Recipients (SRTR) and our institutional experience. METHODS Analysis of the SRTR identified 23 LT recipients and five simultaneous liver and kidney transplantation (SLKT) recipients with SCD. Patient demographics and graft and patient survival were analyzed. Two patients with SCD at our institution underwent SLKT. RESULTS Review of the SRTR revealed that recipients with SCD had significantly higher model for end-stage liver disease scores (33 versus 21, P = 0.004), preoperative intensive care unit admission (43.5% versus 19.1%, P = 0.007), preoperative dialysis (17.4% versus 4.9%, P = 0.009), and were more likely to be status 1 (26.1% versus 12.1%, P = 0.041) when compared with the reference population of African American LT recipients. Despite being higher risk at the time of LT, patients with SCD had equivalent posttransplant graft and patient survival when compared with the reference population (P = 0.5 and P = 0.2, respectively) and a 2:1 propensity score-matched group (P = 0.5 and P = 0.2, respectively). Two recent SLKT recipients with SCD from our institution have performed well with stable allograft function. CONCLUSIONS Data from the SRTR demonstrate that patients with SCD can expect equivalent graft and patient survival after LT despite exhibiting more comorbidities at the time of LT. The low number of patients with SCD who underwent LT in the SRTR in comparison with the rate of chronic liver disease in this population raises the question as to whether a disparity in access to LT exists for this complex population.
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Affiliation(s)
- Rachel Hogen
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Michelle Kim
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Yelim Lee
- California Institute of Technology, Pasadena, California
| | - Mary Lo
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Navpreet Kaur
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Jeff Kahn
- Department of Laboratory Medicine and Pathology, University of Southern California, Los Angeles, California
| | - Shefali Chopra
- Department of Laboratory Medicine and Pathology, University of Southern California, Los Angeles, California
| | - Yasir Qazi
- Department of Medicine, University of Southern California, Los Angeles, California
| | - Ashraf Sedra
- Department of Anesthesiology, University of Southern California, Los Angeles, California
| | - Jim Kim
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Lauren O'Brien
- Department of Laboratory Medicine and Pathology, University of Southern California, Los Angeles, California
| | - Yuri Genyk
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Linda Sher
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California
| | - Juliet Emamaullee
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
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Maffei L, Sorrentino F, Caprari P, Taliani G, Massimi S, Risoluti R, Materazzi S. HCV Infection in Thalassemia Syndromes and Hemoglobinopathies: New Perspectives. Front Mol Biosci 2020; 7:7. [PMID: 32118034 PMCID: PMC7025587 DOI: 10.3389/fmolb.2020.00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/10/2020] [Indexed: 01/19/2023] Open
Abstract
Hepatitis C virus (HCV) infection is one of the most serious complications of transfusion therapy in the thalassemia and sickle cell disease (SCD) population before 1990; in fact, since 1990 serological tests were made available to detect infection in blood donors. The iron chelation therapy has improved the life expectancy of these patients and, consequently, a decrease in death due to heart disease may be observed, as well as an increase in liver disease due to the iron overload and HCV infection that lead to liver fibrosis, cirrhosis, and hepatocellular carcinoma. Until few years ago, the recommended therapy for HCV treatment consisted of pegylated-interferon alpha plus ribavirin, a therapy with important side effects. This treatment has been severely limited to thalassemic and SCD patients due to the hemolytic anemia induced by ribavirin causing an increase in the number of blood transfusions. The development of highly effective Direct-acting Antiviral Agents toward different viral genotypes has led to a real HCV eradication with negative viremia and sustained viral response between 90 and 98%. At the beginning some indications of Direct-acting Antiviral Agents administration were available for those patients exhibiting advanced cirrhosis or needing liver transplantation over time for the high costs of the new drugs. Recently, all treatment regimens can be used for patients with various HCV genotypes, different stages of liver disease, and comorbidities. The HCV eradication has also led to a marked improvement in the parameters of martial accumulation, demonstrating a synergic action also between the effect of antiviral therapy and iron chelation.
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Affiliation(s)
- Laura Maffei
- Thalassemia Unit, S. Eugenio Hospital, Rome, Italy
| | | | - Patrizia Caprari
- National Centre for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Gloria Taliani
- Chronic Infectious Diseases Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Sara Massimi
- National Centre for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Risoluti
- Department of Chemistry, Sapienza University of Rome, Rome, Italy
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Suddle AR. Management of liver complications in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:345-350. [PMID: 31808845 PMCID: PMC6913458 DOI: 10.1182/hematology.2019000037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Liver disease is an important cause of morbidity and mortality in patients with sickle cell disease (SCD). Despite this, the natural history of liver disease is not well characterized and the evidence basis for specific therapeutic intervention is not robust. The spectrum of clinical liver disease encountered includes asymptomatic abnormalities of liver function; acute deteriorations in liver function, sometimes with a dramatic clinical phenotype; and decompensated chronic liver disease. In this paper, the pathophysiology and clinical presentation of patients with acute and chronic liver disease will be outlined. Advice will be given regarding initial assessment and investigation. The evidence for specific medical and surgical interventions will be reviewed, and management recommendations made for each specific clinical presentation. The potential role for liver transplantation will be considered in detail.
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Affiliation(s)
- Abid R Suddle
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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