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Yang K, Liu X, Peng W, Hua F, Li L, Chen K, Zhang J, Luo S, Li W, Ding Y, Chen J, Xiao J. Effects of Thalidomide on Erythropoiesis and Iron Homeostasis in Transfusion-Dependent β-Thalassemia. Mediterr J Hematol Infect Dis 2024; 16:e2024001. [PMID: 38223482 PMCID: PMC10786143 DOI: 10.4084/mjhid.2024.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/02/2023] [Indexed: 01/16/2024] Open
Abstract
Thalidomide is a therapeutic option for patients with β-thalassemia by increasing fetal hemoglobin and thereby reducing the requirement for blood transfusions. However, information on changes in erythropoiesis and iron homeostasis during thalidomide treatment is lacking. This study investigated the effects of thalidomide treatment on hematologic, erythropoietic, and ironstatus parameters in 22 patients with transfusion-dependent β-thalassemia (TDT). Thalidomide significantly improved anemia endpoints, including increases in hemoglobin (p<0.001), red blood cells (p<0.001), and hematocrit (p<0.001), as well as reducing erythropoietin levels (p=0.033) and ameliorating erythropoiesis. Thalidomide treatment significantly reduced serum iron levels (p=0.018) and transferrin saturation (p=0.039) and increased serum transferrin levels (p=0.030). Thalidomide had no observed effect on serum ferritin or hepcidin, but changes in hepcidin (r=0.439, p=0.041) and serum iron (r=-0.536, p=0.010) were significantly correlated with hemoglobin increment. This comprehensive study indicates that thalidomide treatment can ameliorate erythropoiesis and iron homeostasis in patients with TDT, thus supporting the effectiveness of this drug.
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Affiliation(s)
| | - Xiaodong Liu
- Department of Hematology, Zigong First People’s Hospital, Zigong, China
| | - Wei Peng
- Department of Hematology, Zigong First People’s Hospital, Zigong, China
| | - Fang Hua
- Department of Hematology, Zigong First People’s Hospital, Zigong, China
| | - Lan Li
- Department of Hematology, Zigong First People’s Hospital, Zigong, China
| | - Kun Chen
- Department of Hematology, Zigong First People’s Hospital, Zigong, China
| | - Jin Zhang
- Department of Hematology, Zigong First People’s Hospital, Zigong, China
| | - Shan Luo
- Department of Hematology, Zigong First People’s Hospital, Zigong, China
| | - Wanting Li
- Department of Hematology, Zigong First People’s Hospital, Zigong, China
| | - Yuxi Ding
- Department of Hematology, Zigong First People’s Hospital, Zigong, China
| | - Jie Chen
- Department of Hematology, Zigong First People’s Hospital, Zigong, China
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Chen JM, Zhu WJ, Liu J, Wang GZ, Chen XQ, Tan Y, Xu WW, Qu LW, Li JY, Yang HJ, Huang L, Cai N, Wang WD, Huang K, Xu JQ, Li GH, He S, Luo TY, Huang Y, Liu SH, Wu WQ, Lu QY, Zhou MG, Chen SY, Li RL, Hu ML, Huang Y, Wei JH, Li JM, Chen SJ, Zhou GB. Safety and efficacy of thalidomide in patients with transfusion-dependent β-thalassemia: a randomized clinical trial. Signal Transduct Target Ther 2021; 6:405. [PMID: 34795208 PMCID: PMC8602273 DOI: 10.1038/s41392-021-00811-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 01/19/2023] Open
Abstract
Thalidomide induces γ-globin expression in erythroid progenitor cells, but its efficacy on patients with transfusion-dependent β-thalassemia (TDT) remains unclear. In this phase 2, multi-center, randomized, double-blind clinical trial, we aimed to determine the safety and efficacy of thalidomide in TDT patients. A hundred patients of 14 years or older were randomly assigned to receive placebo or thalidomide for 12 weeks, followed by an extension phase of at least 36 weeks. The primary endpoint was the change of hemoglobin (Hb) level in the patients. The secondary endpoints included the red blood cell (RBC) units transfused and adverse effects. In the placebo-controlled period, Hb concentrations in patients treated with thalidomide achieved a median elevation of 14.0 (range, 2.5 to 37.5) g/L, whereas Hb in patients treated with placebo did not significantly change. Within the 12 weeks, the mean RBC transfusion volume for patients treated with thalidomide and placebo was 5.4 ± 5.0 U and 10.3 ± 6.4 U, respectively (P < 0.001). Adverse events of drowsiness, dizziness, fatigue, pyrexia, sore throat, and rash were more common with thalidomide than placebo. In the extension phase, treatment with thalidomide for 24 weeks resulted in a sustainable increase in Hb concentrations which reached 104.9 ± 19.0 g/L, without blood transfusion. Significant increase in Hb concentration and reduction in RBC transfusions were associated with non β0/β0 and HBS1L-MYB (rs9399137 C/T, C/C; rs4895441 A/G, G/G) genotypes. These results demonstrated that thalidomide is effective in patients with TDT.
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Affiliation(s)
- Jiang-Ming Chen
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China.
| | - Wei-Jian Zhu
- Department of Hematology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 541000, Guangdong, China
| | - Jie Liu
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.,Department of Reproductive Medicine, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, Hebei, China
| | - Gui-Zhen Wang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiao-Qin Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Medical Oncology Department, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Yun Tan
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wei-Wei Xu
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Li-Wei Qu
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.,State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences & University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Jin-Yan Li
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Huan-Ju Yang
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Lan Huang
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Ning Cai
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Wei-Da Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Medical Oncology Department, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Ken Huang
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise City, 533000, Guangxi, China
| | - Jian-Quan Xu
- Department of Hematology, Yulin Guinan Hospital, Yulin, 537005, Guangxi, China
| | - Guo-Hui Li
- Department of neurology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Sheng He
- Guangxi Key Laboratory of Basic Research on Birth Defects Prevention and Treatment, Guangxi Zhuang Autonomous Region Women and Children Health Care Hospital, Nanning, 530000, Guangxi, China
| | - Tian-Ying Luo
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Yi Huang
- Department of Hematology, Guigang People's Hospital, Guigang, 537100, Guangxi, China
| | - Song-Hua Liu
- Department of Hematology, Hospital of Traditional Chinese Medicine of Wuzhou City, Wuzhou, 543002, Guangxi, China
| | - Wen-Qiang Wu
- Department of Hematology, Wuzhou Red Cross Hospital, Wuzhou, 543002, Guangxi, China
| | - Qi-Yang Lu
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Mei-Guang Zhou
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Shu-Ying Chen
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Rong-Lan Li
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Mei-Ling Hu
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Ying Huang
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, 543001, Guangxi, China
| | - Jin-Hua Wei
- Department of Hematology, Hechi People's Hospital, Hechi City, 547000, Guangxi, China
| | - Jun-Min Li
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Sai-Juan Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Guang-Biao Zhou
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Bian X, Gao Y. DNA methylation and gene expression alterations in zebrafish embryos exposed to cadmium. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:30101-30110. [PMID: 33586102 DOI: 10.1007/s11356-021-12691-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
An unexplored attributing molecular mechanism of Cd toxicity is interference with the epigenetic machinery, such as DNA methylation, processes that are crucial for early fetal development. In order to investigate the effects of Cd on the expression of metallothionein (MT) and Dnmts transcripts, markers of DNA methylation, and signaling pathway gene expression, zebrafish embryos were exposed during 24 hours post-fertilization (starting at maximum 8-cell stage) to 0.0089, 0.089, and 0.89 μM Cd. The results showed that the Cd accumulation in zebrafish embryo reached a stable level after 12 hpf, and the Cd accumulation at individual time points was significantly different among different concentration groups. MT mRNA fold was significantly positive with the Cd content in embryos. We observed that the expression level of DNA methyltransferase (Dnmts) in the 0.089 μM Cd exposure group was significantly up-regulated. Dnmt1 expression was significantly up-regulated in the 0.89 μM Cd exposure group, and Dnmt3s expression and global methylation levels were significantly down-regulated. Cd up-regulated ErbB-3 gene expression, down-regulated ErbB-4 gene expression, and neutralized ErbB-1 gene expression. Cd activated Ca2+, MAPK-JUK, p38 MAP kinase, PI3K-AKT, and VEGF signaling pathway genes, indicating these pathway genes related to Cd exposure level. The results are helpful to clarify the molecular mechanism of DNA methylation in zebrafish embryo under metal pressure and further interference with the epigenetic machinery.
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Affiliation(s)
- Xiaoxue Bian
- Key Laboratory of Pollution Process and Environmental Criteria of Ministry of Education and Tianjin Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin, 300071, China
| | - Yongfei Gao
- Key Laboratory of Pollution Process and Environmental Criteria of Ministry of Education and Tianjin Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin, 300071, China.
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