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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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Zaidi AU, Glaros AK, Lee S, Wang T, Bhojwani R, Morris E, Donohue B, Paulose J, Iorga ŞR, Nellesen D. A systematic literature review of frequency of vaso-occlusive crises in sickle cell disease. Orphanet J Rare Dis 2021; 16:460. [PMID: 34727959 PMCID: PMC8561926 DOI: 10.1186/s13023-021-02096-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Sickle cell disease (SCD) is a collection of rare inherited blood disorders affecting approximately 100,000 people in the U.S. and 20-25 million people globally. Individuals with SCD experience recurrent episodes of severe and unpredictable pain that are caused by vaso-occlusive crises (VOCs), a hallmark of the disease. VOCs are the primary cause of hospitalization in SCD, result in missed workdays and school days, and decrease quality of life (QoL). Although VOCs cause significant burden in the lives of individuals with SCD, there is no synthesis on the frequency of VOCs in the real world. This systematic literature review sought to identify literature describing the frequency of VOCs experienced by individuals with SCD in real-world settings. METHODS MEDLINE and 6 congresses were searched (date range: January 1, 2000 to June 30, 2020). Studies were reviewed independently by two researchers. Studies assessing frequency or prevalence of VOCs or VOC-related outcomes were included. RESULTS Of 1438 studies identified in the search, 52 met pre-specified inclusion and exclusion criteria. Reported frequency of VOCs varied widely ranging from a mean or median of 0 VOCs/year to 18.2 VOCs/year. The proportion of patients experiencing ≥ 3 VOCs/year ranged from 4 to 67% and the proportion of patients experiencing ≥ 5 VOCs/year ranged from 18 to 59%. Measures of VOC severity were limited, with 13 studies considering frequency of complicated VOCs and only 1 study reporting duration of VOC episodes. CONCLUSIONS This is the first study to systematically assess published evidence pertaining to VOCs in real-world settings. Reported VOC frequency in real-world settings varied widely, with a majority of studies only considering VOCs managed in an inpatient or outpatient setting. Studies that considered VOCs managed at home reported a higher frequency of VOCs, suggesting that many studies may underestimate the frequency of VOCs. This systematic literature review (SLR) highlights the need for consistent reporting of (1) self-reported VOCs, including those managed at home, (2) definitions of VOCs, (3) complicated VOCs, and (4) duration of VOC episodes in literature.
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Affiliation(s)
| | - Alexander K Glaros
- Children's Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mount Pleasant, MI, USA
| | - Soyon Lee
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Taiji Wang
- Analysis Group, Inc., 1010 El Camino Real, Suite 310, Menlo Park, CA, 94025, USA.
| | - Rhea Bhojwani
- Analysis Group, Inc., 1010 El Camino Real, Suite 310, Menlo Park, CA, 94025, USA
| | - Eric Morris
- Analysis Group, Inc., 1010 El Camino Real, Suite 310, Menlo Park, CA, 94025, USA
| | | | - Jincy Paulose
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Şerban R Iorga
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Dave Nellesen
- Analysis Group, Inc., 1010 El Camino Real, Suite 310, Menlo Park, CA, 94025, USA
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Jit BP, Mohanty PK, Purohit P, Das K, Patel S, Meher S, Mohanty JR, Sinha S, Behera RK, Das P. Association of fetal hemoglobin level with frequency of acute pain episodes in sickle cell disease (HbS-only phenotype) patients. Blood Cells Mol Dis 2018; 75:30-34. [PMID: 30597429 DOI: 10.1016/j.bcmd.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a Mendelian single gene disorder with highly variable phenotypic expression. In the present study, we analyzed the influence of HbF, alpha thalassemia and other hematological indices to determine their association with acute pain episodes. METHOD This case control study consisted of SCD subjects with HbS phenotype experiencing three or more acute pain episodes in last twelve months (cases) and without any episode of acute pain during last twelve months (controls). Hematological parameters, HbF, and presence of alpha thalassemia were assessed in all subjects. RESULTS A statistically significant difference between HbF levels (P < 0.025, χ2 test) and alpha thalassemia (P < 0.008, χ2 test) was observed between controls and cases group. Univariate analysis indicated that increased HbF levels > 25% (OR: 0.37, 95% CI: 0.18-0.77, P < 0.008) and presence of alpha thalassemia (OR: 0.53, 95% CI: 0.33-0.85, P < 0.009) provided protection, while multivariate analysis revealed significant protection was attributable only by higher HbF levels (OR: 0.39, 95% CI: 0.17-0.88, P < 0.025). Significantly higher HbF levels were observed only in the 11-20 age group of cases in comparison to controls (Student's t-test, P < 0.001). CONCLUSION Higher concentrations of HbF are associated with protection against frequent episodes of acute pain crisis in SCD patients.
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Affiliation(s)
- Bimal Prasad Jit
- School of Life Sciences, AIPH University, Bhubaneswar, Odisha, India; Sickle Cell Clinic and Molecular Biology Laboratory, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India
| | - Pradeep Kumar Mohanty
- Sickle Cell Clinic and Molecular Biology Laboratory, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India; Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India
| | - Prasanta Purohit
- Sickle Cell Clinic and Molecular Biology Laboratory, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India; Multidisciplinary Research Unit, Maharaja Krishna Chandra Gajapati Medical College, Berhampur, Odisha, India
| | - Kishalaya Das
- Sickle Cell Clinic and Molecular Biology Laboratory, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India
| | - Siris Patel
- Sickle Cell Clinic and Molecular Biology Laboratory, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India
| | - Satyabrata Meher
- Sickle Cell Clinic and Molecular Biology Laboratory, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India
| | | | - Shalini Sinha
- School of Life Sciences, AIPH University, Bhubaneswar, Odisha, India
| | - Rajendra Kumar Behera
- School of Life Sciences, Sambalpur University, Jyoti Vihar, Burla, Sambalpur, Odisha, India
| | - Padmalaya Das
- School of Life Sciences, AIPH University, Bhubaneswar, Odisha, India.
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Altinoz MA, Ince B. Hemoglobins emerging roles in mental disorders. Metabolical, genetical and immunological aspects. Int J Dev Neurosci 2017; 61:73-85. [PMID: 28694195 DOI: 10.1016/j.ijdevneu.2017.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/23/2017] [Accepted: 06/26/2017] [Indexed: 12/13/2022] Open
Abstract
Hemoglobin (Hb) expression in the central nervous system is recently shown. Cooccurences of mental disorders (mainly bipolar disorder (BD) and tic disorders) with β- or α-thalassemia trait or erythrocytosis were witnessed, which may be due to peripheral or central hypoxia/hyperoxia or haplotypal gene interactions. β-Globin genes reside at 11p15.5 close to tyrosine hydroxylase, dopamine receptor DRD4 and Brain Derived Neurotrophic Factor, which involve in psychiatric diseases. α-Globin genes reside at 16p13.3 which associates with BD, tic disorders, ATR-16 Syndrome and Rubinstein Taybi Syndrome (RTS). CREB-Binding Protein (CEBBP)-gene is mutated in RTS, which commonly associates with mood disorders. 16p13.3 region also contains GRIN2A gene encoding N-methyl-d-aspartate receptor-2A and SSTR5 (Somatostatin Receptor-5), again involving in mental disorders. We demonstrated a protective role of minor HbA2 against post-partum episodes in BD and association of higher minor HbF (fetal hemoglobin) levels with family history of psychosis in a BD-patient cohort. HbA2 increases in cardiac ischemia and in mountain dwellers indicating its likely protection against ischemia/hypoxia. HMGIY, a repressive transcription factor of δ-globin chain of HbA2 is increased in lymphocytes of schizophrenics. In autism, deletional mutations were found in BCL11A gene, which cause persistence of HbF at high levels in adulthood. Also, certain polymorphisms in BCL11A strongly associate with schizophrenia. Further, many drugs from anabolic steroids to antimalarial agents elevate HbF and may cause mania. We ascribe a protective role to HbA2 and a maladaptive detrimental role to HbF in psychopathology. We believe that future studies on hemoglobins may pave to discover novel pathogenesis mechanisms in mental disorders.
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Affiliation(s)
| | - Bahri Ince
- Department of Psychiatry, Bakirkoy Education and Research Hospital for Psychiatry, Turkey
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5
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Serjeant GR, Vichinsky E. Variability of homozygous sickle cell disease: The role of alpha and beta globin chain variation and other factors. Blood Cells Mol Dis 2017; 70:66-77. [PMID: 28689691 DOI: 10.1016/j.bcmd.2017.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/10/2017] [Accepted: 06/19/2017] [Indexed: 12/11/2022]
Abstract
The single base molecular substitution characterizing sickle cell haemoglobin, β6glu→val, might be expected to result in predictable haematological and clinical features. However, the disease manifests remarkable diversity believed to reflect the interaction with other genetic and environmental factors. Some of the genetic modifiers include the beta globin haplotypes, alpha thalassaemia, factors influencing the persistence of fetal haemoglobin and the effects of the environment are addressed in this review. It is concluded that much of the genetic data present conflicting results. Environmental factors such as climate and infections, and psychological, educational and social support mechanisms also influence expression of the disease. These interactions illustrate how the expression of a 'single gene' disorder may be influenced by a variety of other genetic and environmental factors.
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Affiliation(s)
- Graham R Serjeant
- Sickle Cell Trust (Jamaica), 14 Milverton Crescent, Kingston 6, Jamaica.
| | - Elliott Vichinsky
- Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, University of California San Francisco, 747 52nd Street, Oakland, CA 94609, United States.
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Upadhye DS, Jain DL, Trivedi YL, Nadkarni AH, Ghosh K, Colah RB. Neonatal Screening and the Clinical Outcome in Children with Sickle Cell Disease in Central India. PLoS One 2016; 11:e0147081. [PMID: 26785407 PMCID: PMC4718540 DOI: 10.1371/journal.pone.0147081] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/27/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a major health burden in India. The objective of the study was to establish a neonatal screening program and to understand the clinical course of children with SCD in central India. METHODS AND FINDINGS Pregnant mothers were screened for sickle hemoglobin using the solubility test. Babies were screened by high performance liquid chromatography if the mother was positive for sickle hemoglobin. The diagnosis was confirmed by molecular analysis. They received early prophylactic treatment and vaccination. Of 2134 newborns screened, 104 were sickle homozygous (SS), seven had sickle β-thalassemia (S-β thal) and 978 were sickle heterozygous (AS). The other hemoglobin abnormalities detected included HbS-δβ thalassemia-1, HbSD disease-2, HbE traits-5, β-thalassemia traits-4, alpha chain variants-3 and HbH disease-1.These babies were followed up regularly for hematological and clinical evaluation. Pain, severe anemia requiring blood transfusions and acute febrile illness were the major complications with 59.7, 45.1 and 42.6 cases per 100 person years. Fetal hemoglobin (HbF) levels were inversely associated with vaso-oclussive crisis (VOC) and severe anemia while presence of alpha thalassemia increased the rate of painful events and sepsis. Six early deaths occurred among the SS babies. CONCLUSION A systematic follow up of this first newborn SCD cohort in central India showed that 47% of babies presented within 1 year of age. In spite of the presence of the Arab-Indian haplotype many babies had severe manifestations.
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Affiliation(s)
- Dipti S. Upadhye
- National Institute of Immunohematology, (Indian Council of Medical Research), 13th floor, New Multistoried Building, K.E.M Hospital Campus, Parel, Mumbai, 400012, India
| | | | | | - Anita H. Nadkarni
- National Institute of Immunohematology, (Indian Council of Medical Research), 13th floor, New Multistoried Building, K.E.M Hospital Campus, Parel, Mumbai, 400012, India
| | - Kanjaksha Ghosh
- National Institute of Immunohematology, (Indian Council of Medical Research), 13th floor, New Multistoried Building, K.E.M Hospital Campus, Parel, Mumbai, 400012, India
| | - Roshan B. Colah
- National Institute of Immunohematology, (Indian Council of Medical Research), 13th floor, New Multistoried Building, K.E.M Hospital Campus, Parel, Mumbai, 400012, India
- * E-mail:
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Minniti CP, Kato GJ. Critical Reviews: How we treat sickle cell patients with leg ulcers. Am J Hematol 2016; 91:22-30. [PMID: 26257201 DOI: 10.1002/ajh.24134] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/23/2015] [Indexed: 12/22/2022]
Abstract
The past five decades have seen an improvement in the mortality and morbidity of sickle cell disease (SCD) because of prophylaxis against infectious complications, improved and expanded red cell transfusions, implementation of hydroxyurea therapy, and advances in supportive care. Now that the majority of patients in the western hemisphere reaches adulthood, end organ diseases are frequent, which include vasculopathic complications such as chronic leg ulcers. The management of patients with leg ulcers requires the hematologist to lead a team of health care professionals, and investigates the presence of associated, but potentially still occult signs of vasculopathy, such as pulmonary hypertension, renal disease, priapism and retinopathy. These complications may be asynchronous, and long term careful screening is indicated, in order to ensure early diagnosis and intervention. It is crucial to address both the immediate consequences of pain, infection and disability, and long term effects on quality of life, employment and stigma associated with chronic ulceration. Recent insights into their pathophysiology may have practical implications. We propose a holistic approach to the management of patients' physical and emotional problems and mechanisms of ulcers formation and delayed healing. An overview of topical and systemic therapies for chronic ulcers is given, with the understanding that wound care therapy is best left to the wound specialists, medical and surgical, with whom the hematologist must keep an open line of communication. In the absence of evidence-based guidelines, our opinion is based on both a critical review of the literature and our personal clinical and research experience.
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Affiliation(s)
- Caterina P. Minniti
- Division of Hematology-Oncology, Department of Medicine; Montefiore Medical Center; Bronx New York
| | - Gregory J. Kato
- Division of Hematology-Oncology, Department of Medicine and the Heart, Lung; Blood and Vascular Medicine Institute, University of Pittsburgh; Pittsburgh Pennsylvania
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Mtatiro SN, Makani J, Mmbando B, Thein SL, Menzel S, Cox SE. Genetic variants at HbF-modifier loci moderate anemia and leukocytosis in sickle cell disease in Tanzania. Am J Hematol 2015; 90:E1-4. [PMID: 25263325 PMCID: PMC4737118 DOI: 10.1002/ajh.23859] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/24/2014] [Indexed: 02/03/2023]
Abstract
Fetal hemoglobin (HbF) is a recognized modulator of sickle cell disease (SCD) severity. HbF levels are strongly influenced by genetic variants at three major genetic loci, Xmn1‐HBG2, HMIP‐2, and BCL11A, but the effect of these loci on the hematological phenotype in SCD, has so far not been investigated. In a cohort of individuals with SCD in Tanzania (HbSS and HbS/β° thalassemia, n = 726, aged 5 or older), HbF levels were positively correlated with hemoglobin, red blood cell (RBC) indices, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH), and negatively with white blood cell (WBC) and platelet counts (all P < 0.0001). We subsequently assessed the contribution of the three HbF modifier loci and detected diverse effects, including a reduction in anemia, leukocytosis, and thrombocytosis associated with certain HbF‐promoting alleles. The presence of the ‘T’ allele at Xmn1‐HBG2 led to a significant increase in hemoglobin (P = 9.8 × 10−3) but no changes in cellular hemoglobin content. Xmn1‐HBG2 ‘T’ also has a weak effect decreasing WBC (P = 0.06) and platelet (P = 0.06) counts. The BCL11A variant (rs11886868‐‘C’) increases hemoglobin (P = 2 × 10−3) and one of the HBS1L‐MYB variants decreases WBC values selectively (P = 2.3 × 10−4). The distinct pattern of effects of each variant suggests that both, disease alleviation through increased HbF production, and ‘pleiotropic’ effects on blood cells, are involved, affecting a variety of pathways. Am. J. Hematol. 90:E1–E4, 2015. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Siana Nkya Mtatiro
- Muhimbili Wellcome ProgrammeMuhimbili University of Health and Allied SciencesDar‐es‐Salaam Tanzania
- Department of Biological SciencesDar es Salaam University College of Education, Dar es Salaam Tanzania
| | - Julie Makani
- Muhimbili Wellcome ProgrammeMuhimbili University of Health and Allied SciencesDar‐es‐Salaam Tanzania
- Nuffield Department of MedicineUniversity of Oxford United Kingdom
| | - Bruno Mmbando
- Muhimbili Wellcome ProgrammeMuhimbili University of Health and Allied SciencesDar‐es‐Salaam Tanzania
| | - Swee Lay Thein
- Division of Cancer StudiesMolecular Haematology, King's College LondonLondon United Kingdom
- Department of Haematological MedicineKing's College Hospital NHS Foundation TrustLondon United Kingdom
| | - Stephan Menzel
- Division of Cancer StudiesMolecular Haematology, King's College LondonLondon United Kingdom
| | - Sharon E. Cox
- Muhimbili Wellcome ProgrammeMuhimbili University of Health and Allied SciencesDar‐es‐Salaam Tanzania
- Faculty of Epidemiology & Population HealthMRC International Nutrition Group, London School of Hygiene & Tropical MedicineLondon United Kingdom
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9
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Griffin PJ, Sebastiani P, Edward H, Baldwin CT, Gladwin M, Gordeuk V, Chui DH, Steinberg MH. The genetics of hemoglobin A2 regulation in sickle cell anemia. Am J Hematol 2014; 89:1019-23. [PMID: 25042611 PMCID: PMC4298130 DOI: 10.1002/ajh.23811] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 02/02/2023]
Abstract
Hemoglobin A2 , a tetramer of α- and δ-globin chains, comprises less than 3% of total hemoglobin in normal adults. In northern Europeans, single nucleotide polymorphisms (SNPs) in the HBS1L-MYB locus on chromosome 6q and the HBB cluster on chromosome 11p were associated with HbA2 levels. We examined the genetic basis of HbA2 variability in sickle cell anemia using genome-wide association studies. HbA2 levels were associated with SNPs in the HBS1L-MYB interval and SNPs in BCL11A. These effects are mediated by the association of these loci with γ-globin gene expression and fetal hemoglobin (HbF) levels. The association of polymorphisms downstream of the β-globin gene (HBB) cluster on chromosome 11 with HbA2 was not mediated by HbF. In sickle cell anemia, levels of HbA2 appear to be modulated by trans-acting genes that affect HBG expression and perhaps also elements within the β-globin gene cluster. HbA2 is expressed pancellularly and can inhibit HbS polymerization. It remains to be seen if genetic regulators of HbA2 can be exploited for therapeutic purposes.
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Affiliation(s)
- Paula J. Griffin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Paola Sebastiani
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Heather Edward
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Clinton T. Baldwin
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Mark Gladwin
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Victor Gordeuk
- Department of Medicine and Comprehensive Sickle Cell Center, University of Illinois, Chicago, IL
| | - David H.K. Chui
- Department of Medicine, Boston University School of Medicine, Boston, MA
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Fadugbagbe AO, Gurgel RQ, Mendonça CQ, Cipolotti R, dos Santos AM, Cuevas LE. Ocular manifestations of sickle cell disease. ACTA ACUST UNITED AC 2013; 30:19-26. [DOI: 10.1179/146532810x12637745451870] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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11
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Steinberg MH, Sebastiani P. Genetic modifiers of sickle cell disease. Am J Hematol 2012; 87:795-803. [PMID: 22641398 PMCID: PMC4562292 DOI: 10.1002/ajh.23232] [Citation(s) in RCA: 198] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 03/28/2012] [Accepted: 04/04/2012] [Indexed: 01/19/2023]
Abstract
Sickle cell anemia is associated with unusual clinical heterogeneity for a Mendelian disorder. Fetal hemoglobin concentration and coincident α thalassemia, both which directly affect the sickle erythrocyte, are the major modulators of the phenotype of disease. Understanding the genetics underlying the heritable subphenotypes of sickle cell anemia would be prognostically useful, could inform personalized therapeutics, and might help the discovery of new "druggable" pathophysiologic targets. Genotype-phenotype association studies have been used to identify novel genetic modifiers. In the future, whole genome sequencing with its promise of discovering hitherto unsuspected variants could add to our understanding of the genetic modifiers of this disease.
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Affiliation(s)
- Martin H. Steinberg
- Division of Hematology/Oncology, Department of Medicine, Boston University School of Medicine, Boston MA 02118 USA
| | - Paola Sebastiani
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
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12
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Cumming V, King L, Fraser R, Serjeant G, Reid M. Venous incompetence, poverty and lactate dehydrogenase in Jamaica are important predictors of leg ulceration in sickle cell anaemia. Br J Haematol 2008; 142:119-25. [PMID: 18477043 DOI: 10.1111/j.1365-2141.2008.07115.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- V Cumming
- Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Kingston, Jamaica, West Indies.
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Abstract
The ability to predict the phenotype of an individual with sickle cell anaemia would allow a reliable prognosis and could guide therapeutic decision making. Some risk factors for individual disease complications are known but are insufficiently precise to use for prognostic purposes; predicting the global disease severity is not yet possible. Genetic association studies, which attempt to link gene polymorphisms with selected disease subphenotypes, may eventually provide useful methods of foretelling the likelihood of certain complications and allow better individualized treatment.
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Affiliation(s)
- M H Steinberg
- Department of Medicine, Boston University School of Medicine and the Center of Excellence in Sickle Cell Disease, Boston Medical Center, 88 E. Newton Street, Boston, MA 02118, USA.
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