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Okolo AI, Jacob SA, Dixon BE, Valvi NR, Janson IA, Hardesty BM. Increasing Visibility of Sickle Cell Disease in Indiana: Establishing Baseline Prevalence Using Integrated Data From Multiple Sources. Public Health Rep 2024; 139:201-207. [PMID: 37232202 PMCID: PMC10851894 DOI: 10.1177/00333549231170229] [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: 05/27/2023] Open
Abstract
OBJECTIVE The Indiana Sickle Cell Data Collection (IN-SCDC) program aims to provide timely, reliable, and locally relevant information on the sickle cell disease (SCD) population in Indiana to inform public health interventions, research, and policy development. We describe the development of the IN-SCDC program and report the prevalence and geographic distribution of people with SCD in Indiana using an integrated data collection approach. METHODS Using multiple integrated data sources and case definitions established by the Centers for Disease Control and Prevention, we classified cases of SCD in Indiana during 2015-2019. We calculated the prevalence and incidence of SCD and described characteristics of people with SCD. RESULTS We identified 1695 people living with SCD in Indiana during the study period. The median age of people living with SCD was 21 years, and 1474 (87.0%) were Black or African American. Most (n = 1596, 91%) resided in metropolitan counties. The age-adjusted prevalence of SCD was 24.7 cases per 100 000 people. The prevalence of SCD among Black or African American people was 209.3 per 100 000 people. The incidence was 1 in 2608 live births overall and 1 in 446 live births among Black or African American people. Eighty-six deaths were confirmed in this population during 2015-2019. CONCLUSIONS Our results establish a baseline for the IN-SCDC program. Baseline and future surveillance program efforts will help accurately inform standards of care for treatments, identify gaps in coverage and access to care, and provide guidance for legislators and community-based organizations.
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Affiliation(s)
- Amanda I. Okolo
- Indiana Hemophilia and Thrombosis Center, Inc, Indianapolis, IN, USA
| | - Seethal A. Jacob
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN, USA
- Pediatric Hematology/Oncology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Brian E. Dixon
- Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Nimish R. Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Isaac A. Janson
- Indiana Hemophilia and Thrombosis Center, Inc, Indianapolis, IN, USA
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The Consortium on Newborn Screening in Africa for sickle cell disease: study rationale and methodology. Blood Adv 2022; 6:6187-6197. [PMID: 36264096 PMCID: PMC9791313 DOI: 10.1182/bloodadvances.2022007698] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/31/2022] [Accepted: 09/23/2022] [Indexed: 12/30/2022] Open
Abstract
Sickle cell disease (SCD) is a common condition within sub-Saharan Africa and associated with high under-5 mortality (U5M). The American Society of Hematology instituted the Consortium on Newborn Screening in Africa (CONSA) for SCD, a 7-country network of sites to implement standardized newborn hemoglobinopathy screening and early intervention for children with SCD in sub-Saharan Africa. CONSA's overall hypothesis is that early infant SCD screening and entry into standardized, continuous care will reduce U5M compared with historical estimates in the region. Primary trial objectives are to determine the population-based birth incidence of SCD and effectiveness of early standardized care for preventing early mortality consortium-wide at each country's site(s). Secondary objectives are to establish universal screening and early interventions for SCD within clinical networks of CONSA partners and assess trial implementation. Outcomes will be evaluated from data collected using a shared patient registry. Standardized trial procedures will be implemented among designated birth populations in 7 African countries whose programs met eligibility criteria. Treatment protocol includes administering antibacterial and antimalarial prophylaxis and standard childhood vaccinations against infections commonly affecting children with SCD. Infants with a positive screen and confirmation of SCD within the catchment areas defined by each consortium partner will be enrolled in the clinical intervention protocol and followed regularly until age of 5 years. Effectiveness of these early interventions, along with culturally appropriate family education and counseling, will be evaluated by comparing U5M in the enrolled cohort to estimated preprogram data. Here, we describe the methodology planned for this trial.
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Frequency of serious bacterial infection among febrile sickle cell disease children in the era of the conjugate vaccine: A retrospective study. INTERNATIONAL JOURNAL OF PEDIATRICS AND ADOLESCENT MEDICINE 2022; 9:165-170. [PMID: 36090129 PMCID: PMC9441249 DOI: 10.1016/j.ijpam.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/19/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
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Janson IA, Bloom EM, Hampton KC, Meier ER, Rampersad AG, Kronenberger WG. Development and Validation of the Patient/Caregiver Reported Hydroxyurea Evaluation of Adherence for Life (HEAL) Scale. Patient Prefer Adherence 2022; 16:3229-3239. [PMID: 36531301 PMCID: PMC9749495 DOI: 10.2147/ppa.s387227] [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: 08/23/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Hydroxyurea reduces the incidence of vaso-occlusive episodes, stroke, and respiratory, cardiac, and renal damage in sickle cell disease by increasing fetal hemoglobin. However, because suboptimal adherence to hydroxyurea limits its effectiveness, understanding patient-specific barriers to hydroxyurea adherence could help improve adherence and health outcomes in patients with sickle cell disease. The aim of this single-site, prospective, IRB-approved study was to validate a 24-item patient- and caregiver-reported hydroxyurea treatment adherence questionnaire, the Hydroxyurea Evaluation of Adherence for Life (HEAL) scale. METHODS A sample of 24 adults with sickle cell disease and 16 caregivers of children with sickle cell disease completed the HEAL scale, and a subset of the original sample provided a second HEAL scale for test-retest reliability. HEAL scale results were validated against global adherence ratings from participants and health-care providers, records of access to pill bottles, and laboratory values for fetal hemoglobin and absolute neutrophil count. RESULTS AND DISCUSSION Results demonstrated excellent internal consistency for the HEAL Total score and eight (3-item) subscale scores (Dose, Remember, Plan, Cost, Understand, Effectiveness, Laboratory, and Pharmacy), as well as strong test-retest reliability for all HEAL scores except the Cost subscale. HEAL Total scores correlated significantly with validity measures, including global adherence ratings and lab values. The HEAL scale offers significant clinical potential for understanding adherence in individual sickle cell disease patients and significant research potential for characterizing adherence in persons with sickle cell disease who are treated with hydroxyurea.
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Affiliation(s)
- Isaac A Janson
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA
- Correspondence: Isaac A Janson, Indiana Hemophilia and Thrombosis Center, 8326 Naab Road, Indianapolis, IN, 46260, USA, Tel +1-317-871-0011, Fax +1-317-871-0010, Email
| | - Ellen M Bloom
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA
| | - Kisha C Hampton
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA
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Hardit V, Alvarez O, Ziga E, Alperstein W. Evolving Strategies in the Management of Sickle Cell Disease in the 21st Century and the Role of the Pediatrician. Pediatr Ann 2022; 51:e34-e39. [PMID: 35020514 DOI: 10.3928/19382359-20211211-01] [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: 11/20/2022]
Abstract
Sickle cell disease (SCD) is one of the most common genetic disorders in the United States. Once a fatal disease of childhood, the majority of patients born with SCD who live in a developed country will survive to adulthood (albeit with slightly shortened life spans). Despite numerous novel therapeutic advancements in recent years that serve to mitigate the symptoms associated with SCD, the only cure for SCD is a hematopoietic stem cell transplant. The overall survival for patients with a matched sibling donor transplant is greater than 90%. However, fewer than 20% of patients with SCD in the US have a 12/12 human leukocyte antigen (HLA) matched sibling donor. In contrast, most patients have at least one HLA haploidentical first-degree relative, which expands the donor pool for patients who have diseases amenable to stem cell transplantation such as SCD. [Pediatr Ann. 2022;51(1):e34-e39.].
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Mekelenkamp H, Smiers F, Camp N, Stubenrouch F, Lankester A, de Vries M. Decision making for hematopoietic stem cell transplantation in pediatric, adolescent, and young adult patients with a hemoglobinopathy-Shared or not? Pediatr Blood Cancer 2021; 68:e29099. [PMID: 34003573 DOI: 10.1002/pbc.29099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) offers an established curative option for sickle cell disease (SCD) and thalassemia patients but is associated with significant risks. Decision making is a complex process and shared decision making (SDM) could be a fitting approach in case of such preference-sensitive decisions. This study investigated what level of SDM is used in conversations with hemoglobinopathy patients and/or their caregivers considering HSCT as a curative treatment option. METHODS Longitudinal, descriptive study using the Observing-Patient-Involvement-in-Decision-Making scale (OPTION5 ) scale to determine the level of SDM in conversations with 26 hemoglobinopathy patients and/or their caregivers. RESULTS The total mean OPTION5 score was 43%, which is a moderate SDM approach. There was no difference between conversations with thalassemia patients and SCD patients. Conversations needing an interpreter scored worse than nontranslated conversations. The best scoring OPTION5 item was item 3: "informing about the various treatment options" (mean score 2.3 on scale 0-4). For OPTION5 item 4: "eliciting patients' preferences" a more skilled effort was measured for SCD patients compared to thalassemia patients. CONCLUSIONS The mean OPTION5 score of "moderate" was achieved mainly by giving information on available options, which is primarily a one-way communication. The SDM process can be improved by actively inviting patients to deliberate about options and including their elicited preferences in decision making.
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Affiliation(s)
- Hilda Mekelenkamp
- Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frans Smiers
- Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nomie Camp
- Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Arjan Lankester
- Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martine de Vries
- Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
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Hollist M, Au K, Morgan L, Shetty PA, Rane R, Hollist A, Amaniampong A, Kirmani BF. Pediatric Stroke: Overview and Recent Updates. Aging Dis 2021; 12:1043-1055. [PMID: 34221548 PMCID: PMC8219494 DOI: 10.14336/ad.2021.0219] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Abstract
Stroke can occur at any age or stage in life. Although it is commonly thought of as a disease amongst the elderly, it is important to highlight the fact that it also affects infants and children. In both populations, strokes have a high rate of morbidity and mortality. Arguably, it is more detrimental in the pediatric population given the occurrence at a younger age and therefore, a longer duration of disability, potentially over the entire lifespan. The high rate of morbidity and mortality in pediatrics is attributed to significant delays in diagnosis, as well as misdiagnosis. Acute stroke management is time dependent. Patients who receive acute treatment with either intravenous (IV) tissue plasminogen activator (tPA) or mechanical thrombectomy, have improved mortality and functional outcomes. Additionally, the earlier treatment is initiated, the higher the likelihood of preserving penumbra, restoring cerebral blood flow and potentially reversing symptoms, thereby limiting disability. Prompt identification is essential as it leads to improved patient care in such a narrow therapeutic window. It enhances the care received during hospitalization and reduces the risk of early stroke recurrence. Despite limited data and lack of large randomized clinical trials in pediatrics, both IV tPA and mechanical thrombectomy have been successfully used. Bridging the gap of acute stroke management in the pediatric population is an essential part of minimizing adverse outcomes. In this review, we discuss the epidemiology of pediatric stroke, the diverse etiologies, presentation as well as both acute and preventative management.
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Affiliation(s)
- Mary Hollist
- 1Memorial Healthcare Institute for Neurosciences, Owosso MI, USA
| | - Katherine Au
- 2George Washington University, School of Medicine & Health Sciences, Washington DC, USA
| | - Larry Morgan
- 3Bronson Neuroscience Center, Kalamazoo, MI, USA
| | - Padmashri A Shetty
- 4Ramaiah Medical College, M. S. Ramaiah Nagar, Bengaluru, Karnataka, India
| | - Riddhi Rane
- 7Texas A&M University College of Medicine, College Station, TX, USA
| | | | | | - Batool F Kirmani
- 7Texas A&M University College of Medicine, College Station, TX, USA.,8Endovascular Therapy & Interventional Stroke Program, Department of Neurology, CHI St. Joseph Health, Bryan, TX, USA
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Arbab Siyar N, Amiri Majd M, Baghdassarians A. The effectiveness of cognitive-behavioural therapy on emotional regulation and quality of life in children with Haemophilia. Haemophilia 2021; 27:599-605. [PMID: 33993585 DOI: 10.1111/hae.14155] [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: 02/10/2020] [Revised: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022]
Abstract
AND BACKGROUND DATA Haemophilia has known as an inherited bleeding disorder accompanied by remarkable pain, emotional distress, and impaired quality of life (QoL) and emotional regulation. Psychological interventions, such as cognitive-behavioural therapy (CBT), have cost-effectiveness to promote emotional well-being, QoL and emotional regulation; however, they have been scarcely used in the treatment of haemophilia. OBJECTIVES OF THE STUDY This research aimed at examining the effect of CBT on emotional regulation and QoL in children with haemophilia using quasi-experimental research with pretest and post-test design and a control group. METHOD 30 subjects were selected using convenient sampling and divided into two groups (n = 15). Both groups responded to the QoL questionnaire, the Persian version of the Pediatric Quality of Life Inventory (PedsQL) developed and the Cognitive Emotion Regulation Questionnaire (CERQ-k) in the pretest. The experimental group was then subjected to the CBT intervention through 9 sessions. The analysis of covariance was used for data analysis. RESULTS There was a significant increase in the QoL and emotion regulation in the experimental group than the control group. CONCLUSION The CBT training was effective to stop negative thinking and control their anger at school and also to adopt more appropriate strategies to deal efficaciously with concerns in social situations. Awareness about the thoughts, feelings and behaviours and being able to solve problems enables children to have better social relations and friendships with peers and also in other social situations. It also can increase the QoL and emotion regulation.
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Affiliation(s)
- Nikoo Arbab Siyar
- Department of General Psychology, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mojtaba Amiri Majd
- Department of Psychology, Faculty of Humanities Abhar Branch, Islamic Azad University, Abhar, Iran
| | - Anita Baghdassarians
- Department of Psychology, Central Tehran Branch, Islamic Azad University, Tehran, Iran
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Meier ER. What are the key considerations when prescribing pharmacotherapy for sickle cell anemia? Expert Opin Pharmacother 2020; 22:5-8. [PMID: 32955945 DOI: 10.1080/14656566.2020.1819238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Emily Riehm Meier
- Sickle Cell Research, Indiana Hemophilia and Thrombosis Center , Indianapolis, IN, USA
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Barriteau CM, Murdoch A, Gallagher SJ, Thompson AA. A patient-centered medical home model for comprehensive sickle cell care in infants and young children. Pediatr Blood Cancer 2020; 67:e28275. [PMID: 32277797 DOI: 10.1002/pbc.28275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The patient-centered medical home (PCMH) has been proposed as a model for comprehensive care coordination and delivery for children with sickle cell disease (SCD), yet little is known regarding the implementation of PCMH core concepts on adherence to preventative care measures, health care utilization, and parent satisfaction. PROCEDURE We implemented the newborn cohort clinic (NCC) to explore the application of the PCMH model for infants and children with SCD from birth to age 3 years in 2011. In July 2017, we conducted a retrospective chart review to evaluate subjects currently or previously followed in the clinic. We surveyed parents in the NCC to assess their satisfaction with their experience. RESULTS A total of 112 patients have been managed in the NCC. All patients received penicillin prophylaxis, while 70% and 73% of patients, respectively, received the 23-valent pneumococcal vaccine and an initial transcranial Doppler by age 36 months. Most (92 of 112) of the subjects utilized the emergency department (569 encounters), with 86% of encounters for fever or other sickle cell-related complications. The majority of parents indicated satisfaction with the clinic, with 71% saying clinic providers always or usually spent enough time with their child, listened carefully to them (81%) and were sensitive to family values and customs (77%). CONCLUSIONS A comprehensive sickle cell clinic as a component of a PCMH is feasible and can achieve high levels of preventative care. Parents are largely satisfied with this model of care.
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Affiliation(s)
- Christina M Barriteau
- Division of Hematology and Oncology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Alexandra Murdoch
- Division of Hematology and Oncology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Shannon J Gallagher
- Division of General Surgery, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, United States
| | - Alexis A Thompson
- Division of Hematology and Oncology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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Nobrega R, Sheehy KA, Lippold C, Rice AL, Finkel JC, Quezado ZMN. Patient characteristics affect the response to ketamine and opioids during the treatment of vaso-occlusive episode-related pain in sickle cell disease. Pediatr Res 2018; 83:445-454. [PMID: 28902183 DOI: 10.1038/pr.2017.197] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/31/2017] [Indexed: 01/31/2023]
Abstract
BackgroundN-methyl-D-aspartate receptor activation has been implicated in the pathobiology of inflammatory, nociceptive and neuropathic pain, opioid tolerance, opioid-induced hyperalgesia, and central sensitization. Some of those mechanisms underlie sickle cell disease(SCD)-associated pain.MethodsWe conducted an exploratory cohort study of SCD patients who during vaso-occlusive episodes (VOEs) received subanesthetic doses of the N-methyl-D-aspartate receptor antagonist, ketamine, as an adjunct to opioids. We sought to identify predictors of changes in pain scores and of the percentage of ketamine infusions associated with meaningful changes (≥20% reduction) in pain and opioid consumption.ResultsEight-five patients received 181 ketamine infusions for VOE-associated pain. Combined with opioids, ketamine yielded significant decrease in pain scores and opioid consumption. Ketamine administered to males and to younger patients yielded greater pain score decrease compared with females (P=0.013) and older patients (P=0.018). Fifty-four percent of infusions yielded meaningful reductions in pain scores, and in multivariate analysis, sex, age group, pain location, and infusion duration independently predicted pain score changes.ConclusionThis study suggests that in SCD patients admitted with VOE-associated pain, ketamine has age- and sex-dependent effects. These data can inform sample and effect size calculations for controlled trials to determine which SCD patients would benefit most from ketamine.
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Affiliation(s)
- Raissa Nobrega
- Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kathy A Sheehy
- Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Caroline Lippold
- Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Amy L Rice
- Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Julia C Finkel
- Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Zenaide M N Quezado
- Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC.,Pediatric Anesthesia and Critical Care, Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, Maryland
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Soupene E, Larkin SK, Kuypers FA. Featured Article: Depletion of HDL 3 high density lipoprotein and altered functionality of HDL 2 in blood from sickle cell patients. Exp Biol Med (Maywood) 2017; 242:1244-1253. [PMID: 28436274 DOI: 10.1177/1535370217706966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In sickle cell disease (SCD), alterations of cholesterol metabolism is in part related to abnormal levels and activity of plasma proteins such as lecithin cholesterol acyltransferase (LCAT), and apolipoprotein A-I (ApoA-I). In addition, the size distribution of ApoA-I high density lipoproteins (HDL) differs from normal blood. The ratio of the amount of HDL2 particle relative to the smaller higher density pre-β HDL (HDL3) particle was shifted toward HDL2. This lipoprotein imbalance is exacerbated during acute vaso-occlusive episodes (VOE) as the relative levels of HDL3 decrease. HDL3 deficiency in SCD plasma was found to relate to a slower ApoA-I exchange rate, which suggests an impaired ABCA1-mediated cholesterol efflux in SCD. HDL2 isolated from SCD plasma displayed an antioxidant capacity normally associated with HDL3, providing evidence for a change in function of HDL2 in SCD as compared to HDL2 in normal plasma. Although SCD plasma is depleted in HDL3, this altered capacity of HDL2 could account for the lack of difference in pro-inflammatory HDL levels in SCD as compared to normal. Exposure of human umbilical vein endothelial cells to HDL2 isolated from SCD plasma resulted in higher mRNA levels of the acute phase protein long pentraxin 3 (PTX3) as compared to incubation with HDL2 from control plasma. Addition of the heme-scavenger hemopexin protein prevented increased expression of PTX3 in sickle HDL2-treated cells. These findings suggest that ApoA-I lipoprotein composition and functions are altered in SCD plasma, and that whole blood transfusion may be considered as a blood replacement therapy in SCD. Impact statement Our study adds to the growing evidence that the dysfunctional red blood cell (RBC) in sickle cell disease (SCD) affects the plasma environment, which contributes significantly in the vasculopathy that defines the disease. Remodeling of anti-inflammatory high density lipoprotein (HDL) to pro-inflammatory entities can occur during the acute phase response. SCD plasma is depleted of the pre-β particle (HDL3), which is essential for stimulation of reverse cholesterol from macrophages, and the function of the larger HDL2 particle is altered. These dysfunctions are exacerbated during vaso-occlusive episodes. Interaction of lipoproteins with endothelium increases formation of inflammatory mediators, a process counteracted by the heme-scavenger hemopexin. This links hemolysis to lipoprotein-mediated inflammation in SCD, and hemopexin treatment could be considered. The use of RBC concentrates in transfusion therapy of SCD patients underestimates the importance of the dysfunctional plasma compartment, and transfusion of whole blood or plasma may be warranted.
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Affiliation(s)
- Eric Soupene
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA
| | - Sandra K Larkin
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA
| | - Frans A Kuypers
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA
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