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Münch AL, Jacobsen EM, Schulz A, Loichinger W, Wowra T, Schiefele L, Elsner J, Westhoff MA, Serra A, Strauss G, Schaarschmidt K, Cario H. Long-term haematological response and maintained immunological function after laparoscopic subtotal splenectomy in patients with hereditary spherocytosis. Eur J Haematol 2023; 111:777-786. [PMID: 37700575 DOI: 10.1111/ejh.14077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Subtotal or total splenectomy are recommended in severe and should be considered in intermediate forms of hereditary spherocytosis (HS). Data on laparoscopic subtotal splenectomy (LSTS) in HS patients are sparse. METHODS Thirty three patients with HS (median age 10.7 years (yrs), range 1.8-15.5) underwent LSTS. Baseline and follow-up investigation included haematological parameters, microscopic analysis of pitted erythrocytes (pitE), and B-cell subpopulations assessed by flow cytometry. Results were compared to those of non-splenectomised HS patients, HS patients after total splenectomy (TS), and healthy individuals. RESULTS After LSTS, haemoglobin levels were normalised in all patients. During median long-term follow-up of 3.9 yrs (range 1.1-14.9), only four patients presented mild anaemia. Despite re-growing of the remnant spleen none of the patients required a second surgical intervention. As compared to TS, PitE in LSTS patients were significantly lower and indicated normal to only moderately decreased spleen function. Relative but not absolute IgM memory B-cell counts were reduced in both LSTS and TS patients. CONCLUSIONS LSTS is effective for the treatment of patients with HS. A small remnant spleen is sufficient to provide adequate phagocytic function and to induce a pool of IgM memory B-cells.
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Affiliation(s)
- Alica L Münch
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Eva-Maria Jacobsen
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Ansgar Schulz
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Wolfgang Loichinger
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Tobias Wowra
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Lisa Schiefele
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Julia Elsner
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | | | | | | | | | - Holger Cario
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
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2
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Spherocytosis-Related L1340P Mutation in Ankyrin Affects Its Interactions with Spectrin. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010151. [PMID: 36676098 PMCID: PMC9864249 DOI: 10.3390/life13010151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
Previously, we reported a new missense mutation in the ANK1 gene that correlated with the hereditary spherocytosis phenotype. This mutation, resulting in L1340P substitution (HGMD CM149731), likely leads to the changes in the conformation of the ankyrin ZZUD domain important for ankyrin binding to spectrin. Here, we report the molecular and physiological effects of this mutation. First, we assessed the binding activity of human β-spectrin to the mutated ZZUDL1340P domain of ankyrin using two different experimental approaches-the study of association and dissociation responses of the spectrin-ankyrin binding domain and a sedimentation assay. In addition, we documented the changes in morphology caused by the overexpressed ankyrin ZZUD domain in human cell models. Our results prove the key role of the L1340 aa residue for the correct alignment of the ZZUD domain of ankyrin, which results in binding the latter with spectrin within the erythrocyte membrane. Replacing L1340 with a proline residue disrupts the spectrin-binding activity of ankyrin.
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3
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Wang WJ, Xie JD, Yao H, Ding ZX, Jiang AR, Ma L, Shen HJ, Chen SN. Identification of variants in 94 Chinese patients with hereditary spherocytosis by next-generation sequencing. Clin Genet 2023; 103:67-78. [PMID: 36203343 DOI: 10.1111/cge.14244] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 12/13/2022]
Abstract
Hereditary spherocytosis (HS) is the most common type of hereditary erythrocyte membrane disease and has varied phenotypic features and genetic patterns. We herein performed a retrospective study of 94 patients with HS and aimed to investigate the genetic variations and genotype-phenotype correlations using targeted next-generation sequencing. In 79/94 (84%) patients, 83 HS variants including 67 novel variants were identified. Pathogenic variants of SPTB, ANK1, SLC4A1, SPTA1, and EPB42 were found in 32/79(41%), 22/79(28%), 15/79 (19%), 8/79 (9%), and 3/79 (4%) of the patients respectively, revealing that SPTB is the most frequently mutated HS gene in Eastern China. Most SPTB and ANK1 gene variations were nonsense and frameshift variations. Missense variants were the main variant type of SLC4A1, SPTA1, and EPB42 genes. Interestingly, one SPTA1 variant (p. Arg1757Cys) showed an autosomal dominant inheritance pattern and one EPB42 variant (p. Gln377His) was apparent as a hotspot variation. Furthermore, genotype-phenotype analysis was performed among the five mutated gene groups. Besides the finding that patients with the SLC4A1 variant had the highest mean corpuscular hemoglobin levels, no clear correlations between genotype and phenotype were observed.
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Affiliation(s)
- Wen-Juan Wang
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China
| | - Jun-Dan Xie
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China
| | - Hong Yao
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China
| | - Zi-Xuan Ding
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China
| | - Ai-Rui Jiang
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China
| | - Liang Ma
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China
| | - Hong-Jie Shen
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China
| | - Su-Ning Chen
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China
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4
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A novel splicing mutation of ANK1 is associated with phenotypic heterogeneity of hereditary spherocytosis in a Chinese family. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166595. [PMID: 36336297 DOI: 10.1016/j.bbadis.2022.166595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
Hereditary spherocytosis (HS) is a common hematological genetic disorder that results in anemia, jaundice and splenomegaly. It is caused by mutations in the ANK1, SPTA, SPTB, SLC4A1 and EPB42 genes, which encode red blood cell membrane and skeletal proteins. Patients show high heterogeneity in phenotype and genotype and the genotype-phenotype correlation still requires clarification. Here, a novel splicing mutation (ANK1: c.4391-2 A>C) was identified by whole-exome sequencing (WES) and Sanger sequencing in a Chinese boy who exhibited a moderately severe HS phenotype. However, his father exhibited a mild phenotype, despite carrying the same HS-causing mutation. The function of the mutant ANK1 protein was analyzed by both bioinformatics and experimental analysis. The mutant protein (p.N1463Kfs*4) showed a different 3D-structure and altered subcellular localization, when compared with the wild-type ANK1 protein. These changes disrupted the normal cell membrane structure and resulted in spheroidized red blood cells. Amplification of cDNA from the son and his father revealed a difference in expression of the abnormal transcript produced by the splicing mutation. We proposed that the lower expression of the mutant allele may have contributed to the relatively mild symptoms of the father. Our study verified ANK1 c. c.4391-2 A>C as a novel pathogenic mutation that causes HS. We have also provided new insights into the interpretation of phenotypic variability within families, which could greatly improve the clinical diagnosis and genetic counseling of HS.
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5
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Stevens SR, Rasband MN. Pleiotropic Ankyrins: Scaffolds for Ion Channels and Transporters. Channels (Austin) 2022; 16:216-229. [PMID: 36082411 PMCID: PMC9467607 DOI: 10.1080/19336950.2022.2120467] [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: 01/31/2023] Open
Abstract
The ankyrin proteins (Ankyrin-R, Ankyrin-B, and Ankyrin-G) are a family of scaffolding, or membrane adaptor proteins necessary for the regulation and targeting of several types of ion channels and membrane transporters throughout the body. These include voltage-gated sodium, potassium, and calcium channels in the nervous system, heart, lungs, and muscle. At these sites, ankyrins recruit ion channels, and other membrane proteins, to specific subcellular domains, which are then stabilized through ankyrin's interaction with the submembranous spectrin-based cytoskeleton. Several recent studies have expanded our understanding of both ankyrin expression and their ion channel binding partners. This review provides an updated overview of ankyrin proteins and their known channel and transporter interactions. We further discuss several potential avenues of future research that would expand our understanding of these important organizational proteins.
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Affiliation(s)
- Sharon R. Stevens
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Matthew N. Rasband
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA,CONTACT Matthew N. Rasband Department of Neuroscience, Baylor College of Medicine, One Baylor Plaza, Houston, TX77030, USA
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6
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Génevaux F, Bertsch A, Wiederer L, Eber S. [Congenital hemolytic anemias due to erythrocyte membrane and enzyme defects]. Dtsch Med Wochenschr 2022; 147:1266-1276. [PMID: 36126925 DOI: 10.1055/a-1767-8423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Erythrocyte membrane and enzyme defects are the most common cause of congenital hemolytic anemias in the Central European population. Diagnostics include erythrocyte morphology, special biochemical tests such as osmotic fragility (AGLT) and EMA. For enzymopenic hemolytic anemias, cost-effective biochemical analysis remains the gold standard, supplemented by molecular genetic diagnostics when appropriate. Therapeutically, near complete splenectomy reduces hemolysis significantly for spherocytosis. The residual spleen at least provides a considerable phagocytic function and better response to immunisation and by inference possibly better protection against severe post-splenectomy infection. For pyruvate kinase deficiency, which is not so rare, a new molecular therapy (Mitapivat) is currently being introduced. In G6PD deficiency, there are very few drugs that cause hemolytic crisis. Sudden onset of hemoglobinuria is an early important hallmark of severe hemolytic crisis in G6PD deficiency and these patients should be hospitalized. Aplastic crises in the setting of parvovirus B19 infection occur in all congenital hemolytic anemias. Transfusion is not preventable in most cases. Iron-excreting treatment is required in the rare patients in need of chronic transfusion.
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7
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Trivedi AM, Dworsky ZD, Kim J, Yu JC, Kumar MM. Malnutrition from anorexia nervosa triggers severe complications of hereditary spherocytosis in an adolescent girl: A case report. Clin Case Rep 2022; 10:e05841. [PMID: 35662786 PMCID: PMC9165203 DOI: 10.1002/ccr3.5841] [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: 12/01/2021] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 11/24/2022] Open
Abstract
Hemolytic crises and aplastic crises in hereditary spherocytosis (HS) are most commonly triggered by viral infections. We present the case of an adolescent girl with HS who developed unexpected and life‐threatening complications of her inherited hemolytic anemia as a consequence of anorexia nervosa and severe malnutrition.
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Affiliation(s)
- Aditi M Trivedi
- Department of Pediatrics Rady Children's Hospital San Diego University of California San Diego San Diego California USA
| | - Zephyr D Dworsky
- Division of Pediatric Hospital Medicine Department of Pediatrics University of California San Diego and Rady Children's Hospital of San Diego San Diego California USA
| | - Jenny Kim
- Division of Pediatric Hematology/Oncology Department of Pediatrics University of California San Diego and Rady Children's Hospital of San Diego San Diego California USA
| | - Jennifer C Yu
- Division of Pediatric Hematology/Oncology Department of Pediatrics University of California San Diego and Rady Children's Hospital of San Diego San Diego California USA
| | - Maya M Kumar
- Division of Adolescent and Young Adult Medicine Department of Pediatrics University of California San Diego and Rady Children's Hospital of San Diego San Diego California USA
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8
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Fu P, Jiao YY, Chen K, Shao JB, Liao XL, Yang JW, Jiang SY. Targeted next-generation sequencing identifies a novel nonsense mutation in ANK1 for hereditary spherocytosis: A case report. World J Clin Cases 2022; 10:4923-4928. [PMID: 35801015 PMCID: PMC9198851 DOI: 10.12998/wjcc.v10.i15.4923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/23/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hereditary spherocytosis (HS) is characterized by anemia, jaundice, splenomegaly, and cholelithiasis, and is caused by abnormal genes encoding red blood cell membrane components. The most common mutations found in HS are in the ANK1 gene.
CASE SUMMARY A 4-mo-old girl was admitted to our hospital with pallor that had lasted for more than 2 mo. She presented with jaundice, anemia and splenomegaly. A heterozygous mutation of ANK1 (exon23: c.G2467T:p.E823X) was identified, and the mutation was determined to be autosomal dominant. This mutation is linked to the relatively serious anemia she had after birth; this anemia improved with age.
CONCLUSION The utilization of next-generation sequencing may assist with the accurate diagnosis of HS, especially in atypical cases.
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Affiliation(s)
- Pan Fu
- Department of Hematology and Oncology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Yang-Yang Jiao
- Department of Hematology and Oncology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Kai Chen
- Department of Hematology and Oncology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Jing-Bo Shao
- Department of Hematology and Oncology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Xue-Lian Liao
- Department of Hematology and Oncology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Jing-Wei Yang
- Department of Hematology and Oncology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Sha-Yi Jiang
- Department of Hematology and Oncology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
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9
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Vercellati C, Zaninoni A, Marcello AP, Fermo E, Fattizzo B, Giannotta JA, Bianchi P, Zanella A, Barcellini W. Changing trends of splenectomy in hereditary spherocytosis: The experience of a reference Centre in the last 40 years. Br J Haematol 2022; 198:912-915. [DOI: 10.1111/bjh.18106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Cristina Vercellati
- Hematology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Anna Zaninoni
- Hematology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Anna P. Marcello
- Hematology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Elisa Fermo
- Hematology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Bruno Fattizzo
- Hematology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Juri A. Giannotta
- Hematology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Paola Bianchi
- Hematology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Alberto Zanella
- Hematology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Wilma Barcellini
- Hematology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
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10
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Kalfa TA. Diagnosis and clinical management of red cell membrane disorders. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:331-340. [PMID: 34889366 PMCID: PMC8791164 DOI: 10.1182/hematology.2021000265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Heterogeneous red blood cell (RBC) membrane disorders and hydration defects often present with the common clinical findings of hemolytic anemia, but they may require substantially different management, based on their pathophysiology. An accurate and timely diagnosis is essential to avoid inappropriate interventions and prevent complications. Advances in genetic testing availability within the last decade, combined with extensive foundational knowledge on RBC membrane structure and function, now facilitate the correct diagnosis in patients with a variety of hereditary hemolytic anemias (HHAs). Studies in patient cohorts with well-defined genetic diagnoses have revealed complications such as iron overload in hereditary xerocytosis, which is amenable to monitoring, prevention, and treatment, and demonstrated that splenectomy is not always an effective or safe treatment for any patient with HHA. However, a multitude of variants of unknown clinical significance have been discovered by genetic evaluation, requiring interpretation by thorough phenotypic assessment in clinical and/or research laboratories. Here we discuss genotype-phenotype correlations and corresponding clinical management in patients with RBC membranopathies and propose an algorithm for the laboratory workup of patients presenting with symptoms and signs of hemolytic anemia, with a clinical case that exemplifies such a workup.
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MESH Headings
- Anemia, Hemolytic, Congenital/diagnosis
- Anemia, Hemolytic, Congenital/genetics
- Anemia, Hemolytic, Congenital/pathology
- Anemia, Hemolytic, Congenital/therapy
- Disease Management
- Elliptocytosis, Hereditary/diagnosis
- Elliptocytosis, Hereditary/genetics
- Elliptocytosis, Hereditary/pathology
- Elliptocytosis, Hereditary/therapy
- Erythrocyte Membrane/pathology
- Genetic Testing
- Humans
- Hydrops Fetalis/diagnosis
- Hydrops Fetalis/genetics
- Hydrops Fetalis/pathology
- Hydrops Fetalis/therapy
- Infant
- Male
- Mutation
- Spherocytosis, Hereditary/diagnosis
- Spherocytosis, Hereditary/genetics
- Spherocytosis, Hereditary/pathology
- Spherocytosis, Hereditary/therapy
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Affiliation(s)
- Theodosia A. Kalfa
- Correspondence Theodosia A. Kalfa, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7015, Cincinnati, OH 45229-3039; e-mail:
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11
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Gallen AF, Castro M, Hernandez-Machado A. Red blood cells in low Reynolds number flow: A vorticity-based characterization of shapes in two dimensions. SOFT MATTER 2021; 17:9587-9594. [PMID: 34651149 DOI: 10.1039/d1sm00559f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Studies on the mechanical properties of red blood cells improve the diagnosis of some blood-related diseases. Some existing numerical methods have successfully simulated the coupling between a fluid and red blood cells. This paper introduces an alternative phase-field model formulation of two-dimensional cells that solves the vorticity and stream function that simplifies the numerical implementation. We integrate red blood cell dynamics immersed in a Poiseuille flow and reproduce previously reported morphologies (slippers or parachutes). In the case of flow in a very wide channel, we discover a new metastable shape referred to as 'anti-parachute' that evolves into a horizontal slipper centered on the channel. This sort of metastable morphology may contribute to the dynamical response of the blood.
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Affiliation(s)
- Andreu F Gallen
- Departament Física de la Matèria Condensada, Universitat de Barcelona, E-08028 Barcelona, Spain.
| | - Mario Castro
- Instituto de Investigación Tecnológica (IIT), Universidad Pontificia Comillas, Madrid, E28015, Spain
| | - Aurora Hernandez-Machado
- Departament Física de la Matèria Condensada, Universitat de Barcelona, E-08028 Barcelona, Spain.
- Institute of Nanoscience and Nanotechnology (IN2UB), 08028 Barcelona, Spain
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12
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Glenthøj A, Brieghel C, Nardo‐Marino A, Wijk R, Birgens H, Petersen J. Facilitating EMA binding test performance using fluorescent beads combined with next‐generation sequencing. EJHAEM 2021; 2:716-728. [PMID: 35845192 PMCID: PMC9176113 DOI: 10.1002/jha2.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022]
Abstract
The eosin‐5′‐maleimide (EMA) binding test is widely used as diagnostic test for hereditary spherocytosis (HS), one of the most common haemolytic disorders in Caucasian populations. We recently described the advantages of replacing the use of healthy control blood samples with fluorescent beads in a modified EMA binding assay. In this study we further explore this novel approach. We performed targeted next‐generation sequencing, modified EMA binding test and osmotic gradient ektacytometry on consecutive individuals referred to our laboratory on the suspicion of HS. In total, 33 of 95 carried a (likely) pathogenic variant, and 24 had variants of uncertain significance (VUS). We identified a total 79 different (likely) pathogenic variants and VUS, including 43 novel mutations. Discarding VUS and recessive mutations in STPA1, we used the occurrence of (likely) pathogenic variants to generate a diagnostic threshold for our modified EMA binding test. Twenty‐one of 23 individuals with non‐SPTA1 (likely) pathogenic variants had EMA ≥ 43.6 AU, which was the optimal threshold in receiver operating characteristic (ROC) analysis. Accuracy was excellent at 93.4% and close to that of osmotic gradient ektacytometry (98.7%). In conclusion, we were able to simplify the EMA‐binding test by using rainbow beads as reference and (likely) pathogenic variants to define an accurate cut‐off value.
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Affiliation(s)
- Andreas Glenthøj
- Centre for Haemoglobinopathies Department of Haematology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Christian Brieghel
- Centre for Haemoglobinopathies Department of Haematology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Amina Nardo‐Marino
- Centre for Haemoglobinopathies Department of Haematology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Richard Wijk
- Central Diagnostic Laboratory‐Research University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Henrik Birgens
- Centre for Haemoglobinopathies Department of Haematology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Jesper Petersen
- Centre for Haemoglobinopathies Department of Haematology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
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13
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Hale J, An X, Guo X, Gao E, Papoin J, Blanc L, Hillyer CD, Gratzer W, Baines A, Mohandas N. αI-spectrin represents evolutionary optimization of spectrin for red blood cell deformability. Biophys J 2021; 120:3588-3599. [PMID: 34352252 PMCID: PMC8456306 DOI: 10.1016/j.bpj.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
Spectrin tetramers of the membranes of enucleated mammalian erythrocytes play a critical role in red blood cell survival in circulation. One of the spectrins, αI, emerged in mammals with enucleated red cells after duplication of the ancestral α-spectrin gene common to all animals. The neofunctionalized αI-spectrin has moderate affinity for βI-spectrin, whereas αII-spectrin, expressed in nonerythroid cells, retains ancestral characteristics and has a 10-fold higher affinity for βI-spectrin. It has been hypothesized that this adaptation allows for rapid make and break of tetramers to accommodate membrane deformation. We have tested this hypothesis by generating mice with high-affinity spectrin tetramers formed by exchanging the site of tetramer formation in αI-spectrin (segments R0 and R1) for that of αII-spectrin. Erythrocytes with αIIβI presented normal hematologic parameters yet showed increased thermostability, and their membranes were significantly less deformable; under low shear forces, they displayed tumbling behavior rather than tank treading. The membrane skeleton is more stable with αIIβI and shows significantly less remodeling under deformation than red cell membranes of wild-type mice. These data demonstrate that spectrin tetramers undergo remodeling in intact erythrocytes and that this is required for the normal deformability of the erythrocyte membrane. We conclude that αI-spectrin represents evolutionary optimization of tetramer formation: neither higher-affinity tetramers (as shown here) nor lower affinity (as seen in hemolytic disease) can support the membrane properties required for effective tissue oxygenation in circulation.
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Affiliation(s)
- John Hale
- The Red Cell Physiology Laboratory, The New York Blood Center, New York, New York.
| | - Xiuli An
- Membrane Biology Laboratory, The New York Blood Center, New York, New York
| | - Xinhua Guo
- Membrane Biology Laboratory, The New York Blood Center, New York, New York
| | - Erjing Gao
- The Red Cell Physiology Laboratory, The New York Blood Center, New York, New York
| | - Julien Papoin
- Nelkin Laboratory of Pediatric Oncology and Laboratory of Developmental Erythropoiesis, The Feinstein Institutes for Medical Research, Manhasset, New York
| | - Lionel Blanc
- Nelkin Laboratory of Pediatric Oncology and Laboratory of Developmental Erythropoiesis, The Feinstein Institutes for Medical Research, Manhasset, New York; Department of Molecular Medicine and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | | | - Walter Gratzer
- Randall Division of Cell and Molecular Biophysics, King's College London, London, United Kingdom
| | - Anthony Baines
- Department of Biosciences, University of Kent, Canterbury, United Kingdom
| | - Narla Mohandas
- The Red Cell Physiology Laboratory, The New York Blood Center, New York, New York
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14
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Simionato G, Hinkelmann K, Chachanidze R, Bianchi P, Fermo E, van Wijk R, Leonetti M, Wagner C, Kaestner L, Quint S. Red blood cell phenotyping from 3D confocal images using artificial neural networks. PLoS Comput Biol 2021; 17:e1008934. [PMID: 33983926 PMCID: PMC8118337 DOI: 10.1371/journal.pcbi.1008934] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/01/2021] [Indexed: 12/15/2022] Open
Abstract
The investigation of cell shapes mostly relies on the manual classification of 2D images, causing a subjective and time consuming evaluation based on a portion of the cell surface. We present a dual-stage neural network architecture for analyzing fine shape details from confocal microscopy recordings in 3D. The system, tested on red blood cells, uses training data from both healthy donors and patients with a congenital blood disease, namely hereditary spherocytosis. Characteristic shape features are revealed from the spherical harmonics spectrum of each cell and are automatically processed to create a reproducible and unbiased shape recognition and classification. The results show the relation between the particular genetic mutation causing the disease and the shape profile. With the obtained 3D phenotypes, we suggest our method for diagnostics and theragnostics of blood diseases. Besides the application employed in this study, our algorithms can be easily adapted for the 3D shape phenotyping of other cell types and extend their use to other applications, such as industrial automated 3D quality control.
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Affiliation(s)
- Greta Simionato
- Department of Experimental Physics, Saarland University, Campus E2.6, Saarbrücken, Germany
- Institute for Clinical and Experimental Surgery, Saarland University, Campus University Hospital, Homburg, Germany
| | - Konrad Hinkelmann
- Department of Experimental Physics, Saarland University, Campus E2.6, Saarbrücken, Germany
| | - Revaz Chachanidze
- Department of Experimental Physics, Saarland University, Campus E2.6, Saarbrücken, Germany
- CNRS, University Grenoble Alpes, Grenoble INP, LRP, Grenoble, France
| | - Paola Bianchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elisa Fermo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Richard van Wijk
- Department of Clinical Chemistry & Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc Leonetti
- CNRS, University Grenoble Alpes, Grenoble INP, LRP, Grenoble, France
| | - Christian Wagner
- Department of Experimental Physics, Saarland University, Campus E2.6, Saarbrücken, Germany
- Physics and Materials Science Research Unit, University of Luxembourg, Luxembourg City, Luxembourg
| | - Lars Kaestner
- Department of Experimental Physics, Saarland University, Campus E2.6, Saarbrücken, Germany
- Theoretical Medicine and Biosciences, Saarland University, Campus University Hospital, Homburg, Germany
| | - Stephan Quint
- Department of Experimental Physics, Saarland University, Campus E2.6, Saarbrücken, Germany
- Cysmic GmbH, Saarland University, Saarbrücken, Germany
- * E-mail:
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15
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Berrevoets MC, Bos J, Huisjes R, Merkx TH, van Oirschot BA, van Solinge WW, Verweij JW, Lindeboom MYA, van Beers EJ, Bartels M, van Wijk R, Rab MAE. Ektacytometry Analysis of Post-splenectomy Red Blood Cell Properties Identifies Cell Membrane Stability Test as a Novel Biomarker of Membrane Health in Hereditary Spherocytosis. Front Physiol 2021; 12:641384. [PMID: 33841180 PMCID: PMC8027126 DOI: 10.3389/fphys.2021.641384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/24/2021] [Indexed: 11/13/2022] Open
Abstract
Hereditary spherocytosis (HS) is the most common form of hereditary chronic hemolytic anemia. It is caused by mutations in red blood cell (RBC) membrane and cytoskeletal proteins, which compromise membrane integrity, leading to vesiculation. Eventually, this leads to entrapment of poorly deformable spherocytes in the spleen. Splenectomy is a procedure often performed in HS. The clinical benefit results from removing the primary site of destruction, thereby improving RBC survival. But whether changes in RBC properties contribute to the clinical benefit of splenectomy is unknown. In this study we used ektacytometry to investigate the longitudinal effects of splenectomy on RBC properties in five well-characterized HS patients at four different time points and in a case-control cohort of 26 HS patients. Osmotic gradient ektacytometry showed that splenectomy resulted in improved intracellular viscosity (hydration state) whereas total surface area and surface-to-volume ratio remained essentially unchanged. The cell membrane stability test (CMST), which assesses the in vitro response to shear stress, showed that after splenectomy, HS RBCs had partly regained the ability to shed membrane, a property of healthy RBCs, which was confirmed in the case-control cohort. In particular the CMST holds promise as a novel biomarker in HS that reflects RBC membrane health and may be used to asses treatment response in HS.
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Affiliation(s)
- M C Berrevoets
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - J Bos
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - R Huisjes
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - T H Merkx
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - B A van Oirschot
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - W W van Solinge
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - J W Verweij
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - M Y A Lindeboom
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - E J van Beers
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - M Bartels
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - R van Wijk
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - M A E Rab
- Central Diagnostic Laboratory-Research, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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16
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Red cell membrane disorders: structure meets function. Blood 2021; 136:1250-1261. [PMID: 32702754 DOI: 10.1182/blood.2019000946] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/06/2020] [Indexed: 12/12/2022] Open
Abstract
The mature red blood cell (RBC) lacks a nucleus and organelles characteristic of most cells, but it is elegantly structured to perform the essential function of delivering oxygen and removing carbon dioxide from all other cells while enduring the shear stress imposed by navigating small vessels and sinusoids. Over the past several decades, the efforts of biochemists, cell and molecular biologists, and hematologists have provided an appreciation of the complexity of RBC membrane structure, while studies of the RBC membrane disorders have offered valuable insights into structure-function relationships. Within the last decade, advances in genetic testing and its increased availability have made it possible to substantially build upon this foundational knowledge. Although disorders of the RBC membrane due to altered structural organization or altered transport function are heterogeneous, they often present with common clinical findings of hemolytic anemia. However, they may require substantially different management depending on the underlying pathophysiology. Accurate diagnosis is essential to avoid emergence of complications or inappropriate interventions. We propose an algorithm for laboratory evaluation of patients presenting with symptoms and signs of hemolytic anemia with a focus on RBC membrane disorders. Here, we review the genotypic and phenotypic variability of the RBC membrane disorders in order to raise the index of suspicion and highlight the need for correct and timely diagnosis.
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17
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Man Y, Maji D, An R, Ahuja SP, Little JA, Suster MA, Mohseni P, Gurkan UA. Microfluidic electrical impedance assessment of red blood cell-mediated microvascular occlusion. LAB ON A CHIP 2021; 21:1036-1048. [PMID: 33666615 PMCID: PMC8170703 DOI: 10.1039/d0lc01133a] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Alterations in the deformability of red blood cells (RBCs), occurring in hemolytic blood disorders such as sickle cell disease (SCD), contribute to vaso-occlusion and disease pathophysiology. There are few functional in vitro assays for standardized assessment of RBC-mediated microvascular occlusion. Here, we present the design, fabrication, and clinical testing of the Microfluidic Impedance Red Cell Assay (MIRCA) with embedded capillary network-based micropillar arrays and integrated electrical impedance measurement electrodes to address this need. The micropillar arrays consist of microcapillaries ranging from 12 μm to 3 μm, with each array paired with two sputtered gold electrodes to measure the impedance change of the array before and after sample perfusion through the microfluidic device. We define RBC occlusion index (ROI) and RBC electrical impedance index (REI), which represent the cumulative percentage occlusion and cumulative percentage impedance change, respectively. We demonstrate the promise of MIRCA in two common red cell disorders, SCD and hereditary spherocytosis. We show that the electrical impedance measurement reflects the microvascular occlusion, where REI significantly correlates with ROI that is obtained via high-resolution microscopy imaging of the microcapillary arrays. Further, we show that RBC-mediated microvascular occlusion, represented by ROI and REI, associates with clinical treatment outcomes and correlates with in vivo hemolytic biomarkers, lactate dehydrogenase (LDH) level and absolute reticulocyte count (ARC) in SCD. Impedance measurement obviates the need for high-resolution imaging, enabling future translation of this technology for widespread access, portable and point-of-care use. Our findings suggest that the presented microfluidic design and the integrated electrical impedance measurement provide a reproducible functional test for standardized assessment of RBC-mediated microvascular occlusion. MIRCA and the newly defined REI may serve as an in vitro therapeutic efficacy benchmark for assessing the clinical outcome of emerging RBC-modifying targeted and curative therapies.
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Affiliation(s)
- Yuncheng Man
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
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18
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Bernecker C, Lima MARBF, Ciubotaru CD, Schlenke P, Dorn I, Cojoc D. Biomechanics of Ex Vivo-Generated Red Blood Cells Investigated by Optical Tweezers and Digital Holographic Microscopy. Cells 2021; 10:552. [PMID: 33806520 PMCID: PMC7998599 DOI: 10.3390/cells10030552] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 12/16/2022] Open
Abstract
Ex vivo-generated red blood cells are a promising resource for future safe blood products, manufactured independently of voluntary blood donations. The physiological process of terminal maturation from spheroid reticulocytes to biconcave erythrocytes has not been accomplished yet. A better biomechanical characterization of cultured red blood cells (cRBCs) will be of utmost interest for manufacturer approval and therapeutic application. Here, we introduce a novel optical tweezer (OT) approach to measure the deformation and elasticity of single cells trapped away from the coverslip. To investigate membrane properties dependent on membrane lipid content, two culture conditions of cRBCs were investigated, cRBCPlasma with plasma and cRBCHPL supplemented with human platelet lysate. Biomechanical characterization of cells under optical forces proves the similar features of native RBCs and cRBCHPL, and different characteristics for cRBCPlasma. To confirm these results, we also applied a second technique, digital holographic microscopy (DHM), for cells laid on the surface. OT and DHM provided related results in terms of cell deformation and membrane fluctuations, allowing a reliable discrimination between cultured and native red blood cells. The two techniques are compared and discussed in terms of application and complementarity.
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Affiliation(s)
- Claudia Bernecker
- Clinical Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8036 Graz, Austria; (P.S.); (I.D.)
| | - Maria Augusta R. B. F. Lima
- CNR-IOM, National Research Council of Italy—Institute of Materials, Area Science Park, 34149 Trieste, Italy; (M.A.R.B.F.L.); (C.D.C.)
- Physics Department, University of Trieste, 34127 Trieste, Italy
| | - Catalin D. Ciubotaru
- CNR-IOM, National Research Council of Italy—Institute of Materials, Area Science Park, 34149 Trieste, Italy; (M.A.R.B.F.L.); (C.D.C.)
| | - Peter Schlenke
- Clinical Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8036 Graz, Austria; (P.S.); (I.D.)
| | - Isabel Dorn
- Clinical Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8036 Graz, Austria; (P.S.); (I.D.)
| | - Dan Cojoc
- CNR-IOM, National Research Council of Italy—Institute of Materials, Area Science Park, 34149 Trieste, Italy; (M.A.R.B.F.L.); (C.D.C.)
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19
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Stevens SR, Rasband MN. Ankyrins and neurological disease. Curr Opin Neurobiol 2021; 69:51-57. [PMID: 33485190 DOI: 10.1016/j.conb.2021.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
Ankyrins are scaffolding proteins widely expressed throughout the nervous system. Ankyrins recruit diverse membrane proteins, including ion channels and cell adhesion molecules, into specialized subcellular membrane domains. These domains are stabilized by ankyrins interacting with the spectrin cytoskeleton. Ankyrin genes are highly associated with a number of neurological disorders, including Alzheimer's disease, schizophrenia, autism spectrum disorders, and bipolar disorder. Here, we discuss ankyrin function and their role in neurological disease. We propose mutations in ankyrins contribute to disease through two primary mechanisms: 1) altered neuronal excitability by disrupting ion channel clustering at key excitable domains, and 2) altered neuronal connectivity via impaired stabilization of membrane proteins.
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Affiliation(s)
- Sharon R Stevens
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Matthew N Rasband
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
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20
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Barbarino F, Wäschenbach L, Cavalho-Lemos V, Dillenberger M, Becker K, Gohlke H, Cortese-Krott MM. Targeting spectrin redox switches to regulate the mechanoproperties of red blood cells. Biol Chem 2020; 402:317-331. [PMID: 33544503 DOI: 10.1515/hsz-2020-0293] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022]
Abstract
The mechanical properties of red blood cells (RBCs) are fundamental for their physiological role as gas transporters. RBC flexibility and elasticity allow them to survive the hemodynamic changes in the different regions of the vascular tree, to dynamically contribute to the flow thereby decreasing vascular resistance, and to deform during the passage through narrower vessels. RBC mechanoproperties are conferred mainly by the structural characteristics of their cytoskeleton, which consists predominantly of a spectrin scaffold connected to the membrane via nodes of actin, ankyrin and adducin. Changes in redox state and treatment with thiol-targeting molecules decrease the deformability of RBCs and affect the structure and stability of the spectrin cytoskeleton, indicating that the spectrin cytoskeleton may contain redox switches. In this perspective review, we revise current knowledge about the structural and functional characterization of spectrin cysteine redox switches and discuss the current lines of research aiming to understand the role of redox regulation on RBC mechanical properties. These studies may provide novel functional targets to modulate RBC function, blood viscosity and flow, and tissue perfusion in disease conditions.
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Affiliation(s)
- Frederik Barbarino
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University, Postfach 128, Universitätsstrasse 1, D-40225, Düsseldorf, Germany
| | - Lucas Wäschenbach
- Institute for Pharmaceutical and Medicinal Chemistry, Heinrich Heine University, Universitätsstrasse 1, D-40225, Düsseldorf, Germany
| | - Virginia Cavalho-Lemos
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University, Postfach 128, Universitätsstrasse 1, D-40225, Düsseldorf, Germany
| | - Melissa Dillenberger
- Biochemistry and Molecular Biology, Interdisciplinary Research Center, Justus Liebig University, D-35392, Giessen, Germany
| | - Katja Becker
- Biochemistry and Molecular Biology, Interdisciplinary Research Center, Justus Liebig University, D-35392, Giessen, Germany
| | - Holger Gohlke
- Institute for Pharmaceutical and Medicinal Chemistry, Heinrich Heine University, Universitätsstrasse 1, D-40225, Düsseldorf, Germany
- John von Neumann Institute for Computing (NIC), Jülich Supercomputing Centre (JSC), Institute of Biological Information Processing (IBI-7: Structural Biochemistry), Forschungszentrum Jülich GmbH, D-52425, Jülich, Germany
| | - Miriam M Cortese-Krott
- Myocardial Infarction Research Laboratory, Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University, Postfach 128, Universitätsstrasse 1, D-40225, Düsseldorf, Germany
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21
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Chai S, Jiao R, Sun X, Fu P, Zhao Q, Sang M. Novel nonsense mutation p. Gln264Ter in the ANK1 confirms causative role for hereditary spherocytosis: a case report. BMC MEDICAL GENETICS 2020; 21:223. [PMID: 33187473 PMCID: PMC7666488 DOI: 10.1186/s12881-020-01161-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022]
Abstract
Background Hereditary spherocytosis (HS) is the most common haemolytic anaemia caused by congenital membrane defects of red blood cells. The name derives from the presence of spherical red blood cells in the peripheral blood. Clinical manifestations of HS are anaemia, haemolytic jaundice, and large spleen, and infection can worsen the condition, often with cholelithiasis. HS is mainly caused by abnormal functions of the products of six genes. Splenectomy is the main treatment for HS. Case presentation Half a day after birth, the proband exhibited HS-related symptoms, with progressive aggravation. Routine examination in the outpatient department showed an increase in white blood cells and a decrease in red blood cells. His mother had HS and a partial splenectomy. We suspected that the infant might also have HS. Genomic DNA samples were extracted from the three members of the HS trio pedigree, and genomic whole-exome sequencing (WES) was performed. The three DNA samples were amplified by polymerase chain reaction (PCR), followed by Sanger sequencing to identify mutation sites. A novel nonsense heterozygous mutation, c.790C > T (p. Gln264Ter), in the ANK1 gene, which causes premature termination of translation, was found in this Chinese family with autosomal dominant HS. Conclusions This de novo nonsense mutation can cause the onset of HS in early childhood, with severe symptoms. Expanding the ANK1 genotype mutation spectrum will lay a foundation for the further application of mutation screening in genetic counselling.
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Affiliation(s)
- Senmao Chai
- Hubei Institute of Parkinson's Disease at Xiangyang No.1 People's Hospital, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Rong Jiao
- Department of New pediatric, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, China
| | - Xiaodong Sun
- Hubei Institute of Parkinson's Disease at Xiangyang No.1 People's Hospital, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Pan Fu
- Hubei Institute of Parkinson's Disease at Xiangyang No.1 People's Hospital, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Qiang Zhao
- Hubei Institute of Parkinson's Disease at Xiangyang No.1 People's Hospital, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Ming Sang
- Hubei Institute of Parkinson's Disease at Xiangyang No.1 People's Hospital, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.
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22
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Rothman JA, Stevens JL, Gray FL, Kalfa TA. How I approach hereditary hemolytic anemia and splenectomy. Pediatr Blood Cancer 2020; 67:e28337. [PMID: 32391969 DOI: 10.1002/pbc.28337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/19/2023]
Abstract
Hereditary hemolytic anemias (HHA) are a heterogeneous group of anemias associated with decreased red cell survival. While there can be clinical benefit of splenectomy in many cases, splenectomy is not appropriate for all types of HHA. Additionally, there are significant risks during and following splenectomy including surgical risks, postsplenectomy sepsis, and thrombotic complications. This review discusses the diagnostic approach to HHA as well as the role of splenectomy in the management. Surgical approaches and outcomes for total and partial splenectomy are discussed.
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Affiliation(s)
- Jennifer A Rothman
- Division of Pediatric Hematology/Oncology, Duke University, Durham, North Carolina
| | - Jenny L Stevens
- Division of Pediatric Surgery, Children's Hospital of New Orleans, New Orleans, Louisiana.,Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Fabienne L Gray
- Division of Pediatric Surgery, Children's Hospital of New Orleans, New Orleans, Louisiana.,Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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23
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Song F, Feng S, Shen X, Du M, Yin H, Liu R, Chen X. Next-Generation Sequencing Revealed Disease-Causing Variants in Two Genes in a Patient With Combined Features of Spherocytosis and Antley-Bixler Syndrome With Genital Anomalies and Disordered Steroidogenesis. Front Genet 2020; 11:976. [PMID: 32973886 PMCID: PMC7472872 DOI: 10.3389/fgene.2020.00976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/31/2020] [Indexed: 12/30/2022] Open
Abstract
Conventionally, patients with combined rare diseases are often difficult to diagnose. This is because some clinicians tend to consider the multiple disease symptoms as the presentation of a complicated “syndrome.” This pattern of thinking also confines their way of filtering pathogenic mutations. Some real pathogenic mutations might be ignored due to not covering all disease presentations. Here we report the case of a girl who was suffering from spherocytosis and Antley-Bixler syndrome with genital anomalies and disordered steroidogenesis. She remained undiagnosed even after targeted gene detection before. However, after performing next-generation sequencing and analyzing the sequencing data, we identified two mutations: c.2978T > A in ANK1 and c.1370G > A in POR. Our findings and experiences in diagnosing these mutations could contribute to the existing knowledge on the clinical and genetic diagnosis of patients with disease presentations in multiple systems.
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Affiliation(s)
- Fuying Song
- Department of Endocrinology, Capital Institute of Pediatrics, Beijing, China
| | - Shunqiao Feng
- Department of Hematology, Capital Institute of Pediatrics, Beijing, China
| | | | - Mu Du
- Department of Endocrinology, Capital Institute of Pediatrics, Beijing, China
| | - Hui Yin
- Department of Endocrinology, Capital Institute of Pediatrics, Beijing, China
| | - Rong Liu
- Department of Hematology, Capital Institute of Pediatrics, Beijing, China
| | - Xiaobo Chen
- Department of Endocrinology, Capital Institute of Pediatrics, Beijing, China
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24
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Hansen DL, Glenthøj A, Möller S, Biemond BJ, Andersen K, Gaist D, Petersen J, Frederiksen H. Prevalence of Congenital Hemolytic Disorders in Denmark, 2000-2016. Clin Epidemiol 2020; 12:485-495. [PMID: 32547240 PMCID: PMC7247725 DOI: 10.2147/clep.s250251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background Congenital red blood cell (RBC) disorders, such as hemoglobinopathies, are frequent worldwide but with large geographical variation. Growing migration has increased the number of patients with RBC disorders in formerly low prevalence countries, eg, Denmark. However, accurate prevalences are unknown. Methods Patients with a registered diagnosis of congenital hemolysis in the Danish National Patient Register between 1977 and 2016 were linked to a national laboratory database of RBC disorders and the Danish civil registration system. We calculate annual age- and sex-specific prevalences of the congenital hemolytic disorders from 2000 to 2016. Results Prevalences of all subtypes of congenital hemolytic disorders increased during the study period. The prevalence of hereditary spherocytosis increased 1.73 times between 2000 and 2015, from 10.2/105 persons to 17.7/105 persons. Alpha thalassemia trait had a prevalence of 0.5/105 persons in 2000, but increased 41 times to 19.2/105 persons in 2015. Beta thalassemia minor increased eightfold from 4.5/105 persons in 2000 to 34.9/105 persons in 2015. Likewise, sickle cell trait increased 11 times from 0.7/105 persons in 2000 to 8.1/105 persons in 2015, whereas sickle cell disease increased from 0.5/105 persons to 2.7/105 persons in 2015, a fivefold increase. Conclusion The prevalence of congenital RBC disorders in Denmark is increasing. The hemoglobinopathy traits now have prevalences as high as hereditary spherocytosis. These estimates of congenital hemolytic disorders in Denmark emphasize that inborn hemoglobin disorders are a public health concern, even in some formerly low prevalence countries.
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Affiliation(s)
- Dennis Lund Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Andreas Glenthøj
- Department of Hematology, Center for Hemoglobinopathies, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Odense University Hospital, Odense, Denmark
| | - Bart J Biemond
- Department of Hematology, Amsterdam University Medical Centre's, Amsterdam, Netherlands
| | - Kjeld Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Mental Health - Odense, Region of Southern Denmark, Odense, Denmark
| | - David Gaist
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Neurology Research Unit, Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Jesper Petersen
- Department of Hematology, Center for Hemoglobinopathies, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Henrik Frederiksen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Hematology, Odense University Hospital, Odense, Denmark
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25
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Tole S, Dhir P, Pugi J, Drury LJ, Butchart S, Fantauzzi M, Langer JC, Baker JM, Blanchette VS, Kirby-Allen M, Carcao MD. Genotype-phenotype correlation in children with hereditary spherocytosis. Br J Haematol 2020; 191:486-496. [PMID: 32436265 DOI: 10.1111/bjh.16750] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/27/2022]
Abstract
Hereditary spherocytosis (HS) is a common inherited haemolytic anaemia attributed to disturbances in five different red cell membrane proteins. We performed a retrospective study of 166 children with HS and describe the clinical phenotype according to the genotype. In 160/166 (97%) children with HS a disease-causing mutation was identified. Pathogenic variants in ANK1, SPTB, SLC4A1 and SPTA1 were found in 49%, 33%, 13% and 5% of patients. Children with SLC4A1-HS had the mildest phenotype, showing the highest haemoglobin (P < 0·001), lowest reticulocyte counts (P < 0·001) and lowest unconjugated bilirubin levels (P = 0·006), and none required splenectomy in childhood (P < 0·001). Conversely, children with autosomal recessive SPTA1-HS had the most severe clinical phenotype, with almost all patients undergoing splenectomy in early childhood. Patients with ANK1 and SPTB variants showed a similar clinical phenotype. Within each gene, variant type or location did not predict disease severity or likelihood of splenectomy. Among patients with a genetic diagnosis, 47 (29%) underwent splenectomy (23 partial; 24 total) while 57 (36%) underwent cholecystectomy. Total splenectomy led to greater improvements in haemoglobin (P = 0·02). Select use of genetic testing (especially in patients without a family history) may help predict clinical phenotype in childhood and guide family counselling.
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Affiliation(s)
- Soumitra Tole
- Department of Paediatrics, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Division of Haematology/Oncology, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | - Priya Dhir
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jakob Pugi
- Department of Paediatrics, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Sheila Butchart
- Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Fantauzzi
- Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacob C Langer
- Department of Surgery, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jillian M Baker
- Department of Paediatrics, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Victor S Blanchette
- Department of Paediatrics, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie Kirby-Allen
- Department of Paediatrics, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manuel D Carcao
- Department of Paediatrics, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
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26
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Svidnicki MCCM, Zanetta GK, Congrains-Castillo A, Costa FF, Saad STO. Targeted next-generation sequencing identified novel mutations associated with hereditary anemias in Brazil. Ann Hematol 2020; 99:955-962. [PMID: 32266426 PMCID: PMC7241966 DOI: 10.1007/s00277-020-03986-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/01/2020] [Indexed: 01/19/2023]
Abstract
Hereditary anemias are a group of heterogeneous disorders including hemolytic anemias and hyporegenerative anemias, as congenital dyserythropoietic anemia (CDA). Causative mutations occur in a wide range of genes leading to deficiencies in red cell production, structure, or function. The genetic screening of the main genes is important for timely diagnosis, since routine laboratory tests fail in a percentage of the cases, appropriate treatment decisions, and genetic counseling purposes. A conventional gene-by-gene sequencing approach is expensive and highly time-consuming, due to the genetic complexity of these diseases. To overcome this problem, we customized a targeted sequencing panel covering 35 genes previously associated to red cell disorders. We analyzed 36 patients, and potentially pathogenic variants were identified in 26 cases (72%). Twenty variants were novel. Remarkably, mutations in the SPTB gene (β-spectrin) were found in 34.6% of the patients with hereditary spherocytosis (HS), suggesting that SPTB is a major HS gene in the Southeast of Brazil. We also identified two cases with dominant HS presenting null mutations in trans with α-LELY in SPTA1 gene. This is the first comprehensive genetic analysis for hereditary anemias in the Brazilian population, contributing to a better understanding of the genetic basis and phenotypic consequences of these rare conditions in our population.
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Affiliation(s)
- M C C M Svidnicki
- Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas, (HEMOCENTRO/UNICAMP), Campinas, SP, Brazil. Rua Carlos Chagas, 480, Campinas, SP, 13083-878, Brazil.
| | - G K Zanetta
- Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas, (HEMOCENTRO/UNICAMP), Campinas, SP, Brazil. Rua Carlos Chagas, 480, Campinas, SP, 13083-878, Brazil
| | - A Congrains-Castillo
- Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas, (HEMOCENTRO/UNICAMP), Campinas, SP, Brazil. Rua Carlos Chagas, 480, Campinas, SP, 13083-878, Brazil
| | - F F Costa
- Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas, (HEMOCENTRO/UNICAMP), Campinas, SP, Brazil. Rua Carlos Chagas, 480, Campinas, SP, 13083-878, Brazil
| | - S T O Saad
- Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas, (HEMOCENTRO/UNICAMP), Campinas, SP, Brazil. Rua Carlos Chagas, 480, Campinas, SP, 13083-878, Brazil
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27
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Single-cell O 2 exchange imaging shows that cytoplasmic diffusion is a dominant barrier to efficient gas transport in red blood cells. Proc Natl Acad Sci U S A 2020; 117:10067-10078. [PMID: 32321831 PMCID: PMC7211990 DOI: 10.1073/pnas.1916641117] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Blood is routinely tested for gas-carrying capacity (total hemoglobin), but this cannot determine the speed at which red blood cells (RBCs) exchange gases. Such information is critical for evaluating the physiological fitness of RBCs, which have very limited capillary transit times (<1 s) for turning over substantial volumes of gas. We developed a method to quantify gas exchange in individual RBCs and used it to show that restricted diffusion, imposed by hemoglobin crowding, is a major barrier to gas flows. Consequently, hematological disorders manifesting a change in cell shape or hemoglobin concentration have uncharted implications on gas exchange, which we illustrate using inherited anemias. With its single-cell resolution, the method can identify physiologically inferior subpopulations, providing a clinically useful appraisal of blood quality. Disorders of oxygen transport are commonly attributed to inadequate carrying capacity (anemia) but may also relate to inefficient gas exchange by red blood cells (RBCs), a process that is poorly characterized yet assumed to be rapid. Without direct measurements of gas exchange at the single-cell level, the barriers to O2 transport and their relationship with hematological disorders remain ill defined. We developed a method to track the flow of O2 in individual RBCs by combining ultrarapid solution switching (to manipulate gas tension) with single-cell O2 saturation fluorescence microscopy. O2 unloading from RBCs was considerably slower than previously estimated in acellular hemoglobin solutions, indicating the presence of diffusional barriers in intact cells. Rate-limiting diffusion across cytoplasm was demonstrated by osmotically induced changes to hemoglobin concentration (i.e., diffusive tortuosity) and cell size (i.e., diffusion pathlength) and by comparing wild-type cells with hemoglobin H (HbH) thalassemia (shorter pathlength and reduced tortuosity) and hereditary spherocytosis (HS; expanded pathlength). Analysis of the distribution of O2 unloading rates in HS RBCs identified a subpopulation of spherocytes with greatly impaired gas exchange. Tortuosity imposed by hemoglobin was verified by demonstrating restricted diffusivity of CO2, an acidic gas, from the dissipative spread of photolytically uncaged H+ ions across cytoplasm. Our findings indicate that cytoplasmic diffusion, determined by pathlength and tortuosity, is a major barrier to efficient gas handling by RBCs. Consequently, changes in RBC shape and hemoglobin concentration, which are common manifestations of hematological disorders, can have hitherto unrecognized and clinically significant implications on gas exchange.
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28
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Lorenzo DN. Cargo hold and delivery: Ankyrins, spectrins, and their functional patterning of neurons. Cytoskeleton (Hoboken) 2020; 77:129-148. [PMID: 32034889 DOI: 10.1002/cm.21602] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 01/12/2023]
Abstract
The highly polarized, typically very long, and nonmitotic nature of neurons present them with unique challenges in the maintenance of their homeostasis. This architectural complexity serves a rich and tightly controlled set of functions that enables their fast communication with neighboring cells and endows them with exquisite plasticity. The submembrane neuronal cytoskeleton occupies a pivotal position in orchestrating the structural patterning that determines local and long-range subcellular specialization, membrane dynamics, and a wide range of signaling events. At its center is the partnership between ankyrins and spectrins, which self-assemble with both remarkable long-range regularity and micro- and nanoscale specificity to precisely position and stabilize cell adhesion molecules, membrane transporters, ion channels, and other cytoskeletal proteins. To accomplish these generally conserved, but often functionally divergent and spatially diverse, roles these partners use a combinatorial program of a couple of dozens interacting family members, whose code is not fully unraveled. In a departure from their scaffolding roles, ankyrins and spectrins also enable the delivery of material to the plasma membrane by facilitating intracellular transport. Thus, it is unsurprising that deficits in ankyrins and spectrins underlie several neurodevelopmental, neurodegenerative, and psychiatric disorders. Here, I summarize key aspects of the biology of spectrins and ankyrins in the mammalian neuron and provide a snapshot of the latest advances in decoding their roles in the nervous system.
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Affiliation(s)
- Damaris N Lorenzo
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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29
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Zhu F, Liang M, Xu L, Peng Z, Cai D, Wei X, Lin L, Shang X. A tetranucleotide deletion in the ANK1 gene causes hereditary spherocytosis; a case of misdiagnosis. Gene 2019; 726:144226. [PMID: 31669644 DOI: 10.1016/j.gene.2019.144226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
Abstract
Hereditary spherocytosis is a congenital red blood cell disorder. Typical clinical manifestations include anemia, jaundice and splenomegaly, which overlap with the thalassemia phenotype. Therefore, in high prevalence thalassemia regions, hereditary spherocytosis cases are often misdiagnosed. Here, a case once diagnosed as thalassemia, based on preliminary clinical examinations, underwent genetic testing in our laboratory, where analysis of globin gene mutations proved negative. We conducted both clinical and genetic analyses on the patient and his family. We collected clinical data, performed erythrocyte membrane protein analysis by SDS-PAGE and sequenced the ANK1 gene. We also investigated pathogenic mechanisms through cDNA sequencing and literature studies. From patient clinical data, we diagnosed the patient with moderate to severe hereditary spherocytosis, rather than thalassemia. SDS-PAGE data showed that Ankyrin protein expression was reduced. Sequencing of genomic DNA identified a frameshift mutation (ANK1:c.2394_2397del CAGT). cDNA sequencing showed that the expression of a mutant allele was significantly decreased. Our study corrected a clinical misdiagnosis and confirmed the diagnosis of hereditary spherocytosis in this patient. Identification of such causative mutations is important for accurate downstream patient therapy and is critically important for the prevention/detection of another affected birth. Additionally, the disruption of mRNA transcribed from the mutant allele resulted in a significant reduction in Ankyrin expression and was speculatively considered the pathogenic mechanism behind this mutation.
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Affiliation(s)
- Fei Zhu
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China; Southern Med Univ, Nanfang Hosp, Guangzhou, Guangdong, China
| | - Min Liang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Linlin Xu
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhiyong Peng
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China; Nanfang-Chunfu Children's Institute of Hematology, Taixin Hospital of DongGuan, GuangDong, China
| | - Decheng Cai
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaofeng Wei
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Li Lin
- Prenatal Diagnosis Center, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, China
| | - Xuan Shang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Genetics Testing Engineering Research Center, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Guangzhou, China.
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30
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Sun Q, Xie Y, Wu P, Li S, Hua Y, Lu X, Zhao W. Targeted next-generation sequencing identified a novel ANK1 mutation associated with hereditary spherocytosis in a Chinese family. ACTA ACUST UNITED AC 2019; 24:583-587. [PMID: 31390973 DOI: 10.1080/16078454.2019.1650873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Hereditary spherocytosis (HS) represents a group of congenital diseases characterized by sphere-shaped erythrocytes on peripheral blood smears. The typical clinical manifestations of HS include haemolysis, jaundice, splenomegaly, and gallstones. Ankyrin1, encoded by the ANK1 gene, is the predominant protein in red blood cells. Defects in ankyrin1 lead to a decrease in erythrocyte surface area, a spherical shape of erythrocytes and, in particular, loss of membrane elasticity and mechanical stability. The purpose of this study was to investigate a Chinese family with HS to determine the causative gene mutation and explore the genotype-phenotype correlation. Methods: A 4-year-old boy was diagnosed with HS based on typical clinical features. In addition, his father had a high possibility of HS. Targeted next-generation sequencing (NGS) followed by Sanger sequencing was performed in the proband and his parents. Results: One mutation in the ANK1 gene was recognized. c1801-1G > C in exon 17, which leads to splicing defects, was detected. To confirm the c1801-1G > C variant, samples from the proband and his parents were analysed by Sanger sequencing, and Sanger verification showed that this mutation was inherited from the father. Conclusion: The present study confirmed that a novel mutation in ANK1 may be causative of HS, which plays an important role in expanding the mutational spectrum of ANK1 mutations. This may contribute to accurate genetic counselling. And it is helpful for understanding the correlation of the genotype and phenotype.
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Affiliation(s)
- Qing Sun
- a Department of Pediatrics, Peking University First Hospital , Beijing , People's Republic of China
| | - Yao Xie
- a Department of Pediatrics, Peking University First Hospital , Beijing , People's Republic of China
| | - Penghui Wu
- a Department of Pediatrics, Peking University First Hospital , Beijing , People's Republic of China
| | - Shuo Li
- a Department of Pediatrics, Peking University First Hospital , Beijing , People's Republic of China
| | - Ying Hua
- a Department of Pediatrics, Peking University First Hospital , Beijing , People's Republic of China
| | - Xintian Lu
- a Department of Pediatrics, Peking University First Hospital , Beijing , People's Republic of China
| | - Weihong Zhao
- a Department of Pediatrics, Peking University First Hospital , Beijing , People's Republic of China
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31
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Barrera-Reyes PK, Tejero ME. Genetic variation influencing hemoglobin levels and risk for anemia across populations. Ann N Y Acad Sci 2019; 1450:32-46. [PMID: 31385320 DOI: 10.1111/nyas.14200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/30/2019] [Accepted: 07/05/2019] [Indexed: 01/19/2023]
Abstract
Hemoglobin (Hb) concentration is the outcome of the interaction between genetic variation and environmental factors, including nutritional status, sex, age, and altitude. Genetic diversity influencing this protein is complex and varies widely across populations. Variants related to abnormal Hb or altered characteristics of the erythrocytes increase the risk for anemia. The most prevalent are related to the inherited globin abnormalities affecting Hb production and structure. Malaria-endemic regions harbor the highest frequencies of variants associated with the most frequent monogenic diseases and the risk for nonnutritional anemia and are considered as public health problems. Variation in genes encoding for enzymes and membrane proteins in red blood cells also influence erythrocyte life span and risk for anemia. Most of these variants are rare. Interindividual variability of hematological parameters is also influenced by common genetic variation across the whole genome. Some of the identified variants are associated with Hb production, erythropoiesis, and iron metabolism. Specialized databases have been developed to organize and update the large body of available information on genetic variation related to Hb variation, their frequency, geographical distribution, and clinical significance. Our present review analyzed the underlying genetic factors that affect Hb concentrations, their clinical relevance, and geographical distribution across populations.
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Affiliation(s)
- Paloma K Barrera-Reyes
- Laboratorio de Nutrigenómica y Nutrigenética, Instituto Nacional de Medicina Genómica, Ciudad de, México, Mexico.,Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de, México, Mexico
| | - M Elizabeth Tejero
- Laboratorio de Nutrigenómica y Nutrigenética, Instituto Nacional de Medicina Genómica, Ciudad de, México, Mexico
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32
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Chonat S, Risinger M, Sakthivel H, Niss O, Rothman JA, Hsieh L, Chou ST, Kwiatkowski JL, Khandros E, Gorman MF, Wells DT, Maghathe T, Dagaonkar N, Seu KG, Zhang K, Zhang W, Kalfa TA. The Spectrum of SPTA1-Associated Hereditary Spherocytosis. Front Physiol 2019; 10:815. [PMID: 31333484 PMCID: PMC6617536 DOI: 10.3389/fphys.2019.00815] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/11/2019] [Indexed: 12/05/2022] Open
Abstract
Hereditary spherocytosis (HS) is the most common red blood cell (RBC) membrane disorder causing hereditary hemolytic anemia. Patients with HS have defects in the genes coding for ankyrin (ANK1), band 3 (SLC4A1), protein 4.2 (EPB42), and α (SPTA1) or β-spectrin (SPTB). Severe recessive HS is most commonly due to biallelic SPTA1 mutations. α-spectrin is produced in excess in normal erythroid cells, therefore SPTA1-associated HS ensues with mutations causing significant decrease of normal protein expression from both alleles. In this study, we systematically compared genetic, rheological, and protein expression data to the varying clinical presentation in eleven patients with SPTA1-associated HS. The phenotype of HS in this group of patients ranged from moderately severe to severe transfusion-dependent anemia and up to hydrops fetalis which is typically fatal if transfusions are not initiated before term delivery. The pathogenicity of the mutations could be corroborated by reduced SPTA1 mRNA expression in the patients’ reticulocytes. The disease severity correlated to the level of α-spectrin protein in their RBC cytoskeleton but was also affected by other factors. Patients carrying the low expression αLEPRA allele in trans to a null SPTA1 mutation were not all transfusion dependent and their anemia improved or resolved with partial or total splenectomy, respectively. In contrast, patients with near-complete or complete α-spectrin deficiency have a history of having been salvaged from fatal hydrops fetalis, either because they were born prematurely and started transfusions early or because they had intrauterine transfusions. They have suboptimal reticulocytosis or reticulocytopenia and remain transfusion dependent even after splenectomy; these patients require either lifetime transfusions and iron chelation or stem cell transplant. Comprehensive genetic and phenotypic evaluation is critical to provide accurate diagnosis in patients with SPTA1-associated HS and guide toward appropriate management.
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Affiliation(s)
- Satheesh Chonat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Mary Risinger
- College of Nursing, University of Cincinnati, Cincinnati, OH, United States
| | - Haripriya Sakthivel
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Omar Niss
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | | | - Loan Hsieh
- Division of Hematology, CHOC Children's Hospital and UC Irvine Medical Center, Orange, CA, United States
| | - Stella T Chou
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Janet L Kwiatkowski
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Eugene Khandros
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Matthew F Gorman
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, United States
| | - Donald T Wells
- Dell Children's Medical Center, Austin, TX, United States
| | - Tamara Maghathe
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Neha Dagaonkar
- Genomics Analysis Facility, Institute for Genomic Medicine, Columbia University, New York, NY, United States
| | - Katie G Seu
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kejian Zhang
- Coyote Bioscience Co., Ltd., San Jose, CA, United States
| | - Wenying Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Laboratory of Genetics and Genomics, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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33
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Choi HS, Choi Q, Kim JA, Im KO, Park SN, Park Y, Shin HY, Kang HJ, Kook H, Kim SY, Kim SJ, Kim I, Kim JY, Kim H, Park KD, Park KB, Park M, Park SK, Park ES, Park JA, Park JE, Park JK, Baek HJ, Seo JH, Shim YJ, Ahn HS, Yoo KH, Yoon HS, Won YW, Lee KS, Lee KC, Lee MJ, Lee SA, Lee JA, Lee JM, Lee JH, Lee JW, Lim YT, Jung HJ, Chueh HW, Choi EJ, Jung HL, Kim JH, Lee DS. Molecular diagnosis of hereditary spherocytosis by multi-gene target sequencing in Korea: matching with osmotic fragility test and presence of spherocyte. Orphanet J Rare Dis 2019; 14:114. [PMID: 31122244 PMCID: PMC6533652 DOI: 10.1186/s13023-019-1070-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/17/2019] [Indexed: 12/16/2022] Open
Abstract
Background Current diagnostic tests for hereditary spherocytosis (HS) focus on the detection of hemolysis or indirectly assessing defects of membrane protein, whereas direct methods to detect protein defects are complicated and difficult to implement. In the present study, we investigated the patterns of genetic variation associated with HS among patients clinically diagnosed with HS. Methods Multi-gene targeted sequencing of 43 genes (17 RBC membrane protein-encoding genes, 20 RBC enzyme-encoding genes, and six additional genes for the differential diagnosis) was performed using the Illumina HiSeq platform. Results Among 59 patients with HS, 50 (84.7%) had one or more significant variants in a RBC membrane protein-encoding genes. A total of 54 significant variants including 46 novel mutations were detected in six RBC membrane protein-encoding genes, with the highest number of variants found in SPTB (n = 28), and followed by ANK1 (n = 19), SLC4A1 (n = 3), SPTA1 (n = 2), EPB41 (n = 1), and EPB42 (n = 1). Concurrent mutations of genes encoding RBC enzymes (ALDOB, GAPDH, and GSR) were detected in three patients. UGT1A1 mutations were present in 24 patients (40.7%). Positive rate of osmotic fragility test was 86.8% among patients harboring HS-related gene mutations. Conclusions This constitutes the first large-scaled genetic study of Korean patients with HS. We demonstrated that multi-gene target sequencing is sensitive and feasible that can be used as a powerful tool for diagnosing HS. Considering the discrepancies of clinical and molecular diagnoses of HS, our findings suggest that molecular genetic analysis is required for accurate diagnosis of HS. Electronic supplementary material The online version of this article (10.1186/s13023-019-1070-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hyoung Soo Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Qute Choi
- Department of Laboratory Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jung-Ah Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Kyong Ok Im
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Si Nae Park
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoomi Park
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hee Young Shin
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Jin Kang
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hoon Kook
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seon Young Kim
- Department of Laboratory Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Soo-Jeong Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University College Medicine, Seoul, Republic of Korea
| | - Ji Yoon Kim
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Hawk Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kyung Duk Park
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Bae Park
- Department of Pediatrics, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Meerim Park
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sang Kyu Park
- Department of Pediatrics, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Eun Sil Park
- Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Jeong-A Park
- Department of Pediatrics, Inje University College of Medicine, Busan, Republic of Korea
| | - Jun Eun Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ji Kyoung Park
- Department of pediatrics, Inje University College of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jeong Ho Seo
- Department of Pediatrics, Pusan National University College of Medicine, Yangsan, Republic of Korea
| | - Ye Jee Shim
- Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Daegu, Republic of Korea
| | - Hyo Seop Ahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hoi Soo Yoon
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Young-Woong Won
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Kun Soo Lee
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Kwang Chul Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Mee Jeong Lee
- Department of Pediatrics, University of Dankook College of Medicine, Cheonan, Republic of Korea
| | - Sun Ah Lee
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Jun Ah Lee
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Jae Min Lee
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jae Hee Lee
- Department of Pediatrics, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Ji Won Lee
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Young Tak Lim
- Department of Pediatrics, Pusan National University College of Medicine, Yangsan, Republic of Korea
| | - Hyun Joo Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hee Won Chueh
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Eun Jin Choi
- Department of Pediatrics, Daegu Catholic University, Daegu, Republic of Korea
| | - Hye Lim Jung
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Dong Soon Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Huang TL, Sang BH, Lei QL, Song CY, Lin YB, Lv Y, Yang CH, Li N, Yang YH, Zhang XW, Tian X. A de novo ANK1 mutation associated to hereditary spherocytosis: a case report. BMC Pediatr 2019; 19:62. [PMID: 30777044 PMCID: PMC6379977 DOI: 10.1186/s12887-019-1436-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/12/2019] [Indexed: 01/04/2023] Open
Abstract
Background Hereditary spherocytosis (HS) is a type of hemolytic anemia caused by abnormal red cell membrane skeletal proteins with few unique clinical manifestations in the neonate and infant. An ANK1 gene mutation is the most common cause of HS. Case presentation The patient was a 11-month-old boy who suffered from anemia and needed a regular transfusion therapy at an interval of 2–3 months. Hematological investigations showed moderate anemia (Hb80 g/L). Red cells displayed microcytosis (MCV76.4 fl, MCH25.6 pg, MCHC335 g/L). The reticulocytes were elevated (4.8%) and the spherocytes were increased (10%). Direct antiglobulin test was negative. Biochemical test indicated a slight elevation of bilirubin, mainly indirect reacting (TBIL32.5 μmol/L, IBIL24 μmol/L). The neonatal HS ratio is 4.38, obviously up the threshold. Meanwhile, a de novo ANK1 mutation (exon 25:c.2693dupC:p.A899Sfs*11) was identified by next-generation sequencing (NGS). Thus, hereditary spherocytosis was finally diagnosed. Conclusions Gene detection should be considered in some hemolytic anemia which is difficult to diagnose by routine means. We identified a novel de novo ANK1 heterozygous frameshift mutation in a Yi nationality patient while neither of his parents carried this mutation. Electronic supplementary material The online version of this article (10.1186/s12887-019-1436-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ti-Long Huang
- Department of Hematology, Kunming Children's Hospital, Kunming, China
| | - Bao-Hua Sang
- Department of Hematology, Kunming Children's Hospital, Kunming, China
| | - Qing-Ling Lei
- Department of Hematology, Kunming Children's Hospital, Kunming, China
| | - Chun-Yan Song
- Department of Hematology, Kunming Children's Hospital, Kunming, China
| | - Yun-Bi Lin
- Department of Hematology, Kunming Children's Hospital, Kunming, China
| | - Yu Lv
- Department of Hematology, Kunming Children's Hospital, Kunming, China
| | - Chun-Hui Yang
- Department of Hematology, Kunming Children's Hospital, Kunming, China
| | - Na Li
- Department of Hematology, Kunming Children's Hospital, Kunming, China
| | - Yue-Huang Yang
- Department of Hematology, Kunming Children's Hospital, Kunming, China
| | - Xian-Wen Zhang
- Medical Faculty, Kunming University of Science and Technology, No.727 Jingming South Road, Kunming, 650500, China.
| | - Xin Tian
- Department of Hematology, Kunming Children's Hospital, Kunming, China.
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35
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Abstract
We report the unusual case of a patient found to have a low glycosylated haemoglobin (HbA1c) despite having recently been diagnosed with diabetes mellitus type 2. The patient, who was not anaemic, with no symptoms or family history of haematological conditions, was subsequently found to have an elevated reticulocyte count, inferring increased red cell turnover as the culprit for the discordant HbA1c result. A diagnosis of hereditary spherocytosis was made based on characteristic peripheral blood film appearances and confirmed by eosin-5-maleimide binding test. Exposure of an undiagnosed haemolytic anaemia by virtue of a low HbA1c is uncommon. However, conditions that distort HbA1c measurements are not infrequent. This case should serve to remind clinicians of the limitations of HbA1c in specified situations, and to remain vigilant when interpreting results.
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Affiliation(s)
- Emily Finan
- Department of Haematology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Joe Joseph
- Department of Haematology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
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36
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The fluid membrane determines mechanics of erythrocyte extracellular vesicles and is softened in hereditary spherocytosis. Nat Commun 2018; 9:4960. [PMID: 30470753 PMCID: PMC6251882 DOI: 10.1038/s41467-018-07445-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 10/30/2018] [Indexed: 12/31/2022] Open
Abstract
Extracellular vesicles (EVs) are widely studied regarding their role in cell-to-cell communication and disease, as well as for applications as biomarkers or drug delivery vehicles. EVs contain membrane and intraluminal proteins, affecting their structure and thereby likely their functioning. Here, we use atomic force microscopy for mechanical characterization of erythrocyte, or red blood cell (RBC), EVs from healthy individuals and from patients with hereditary spherocytosis (HS) due to ankyrin deficiency. While these EVs are packed with proteins, their response to indentation resembles that of fluid liposomes lacking proteins. The bending modulus of RBC EVs of healthy donors is ~15 kbT, similar to the RBC membrane. Surprisingly, whereas RBCs become more rigid in HS, patient EVs have a significantly (~40%) lower bending modulus than donor EVs. These results shed light on the mechanism and effects of EV budding and might explain the reported increase in vesiculation of RBCs in HS patients. Red blood cell disorders are often accompanied by increased release of extracellular vesicles (EVs), but their structural and mechanical properties are not fully understood. Here, the authors show that red blood cell EVs show liposome-like mechanical features and are softened in blood disorder patients.
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Starodubtseva MN, Mitsura EF, Starodubtsev IE, Chelnokova IA, Yegorenkov NI, Volkova LI, Kharin YS. Nano- and microscale mechanical properties of erythrocytes in hereditary spherocytosis. J Biomech 2018; 83:1-8. [PMID: 30503563 DOI: 10.1016/j.jbiomech.2018.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
Hereditary spherocytosis (HS), an erythrocyte membranopathy, is a heterogeneous disease, even at the level of the erythrocyte population. The paper aims at studying the mechanical properties (the Young's modulus, median and RMS roughness of friction force maps; fractal dimension, lacunarity and spatial distribution parameters of lateral force maps) of the cell surface layer of the erythrocytes of two different morphologies (discocytes and spherocytes) in HS using atomic force microscopy. The results of spatial-spectral and fractal analysis showed that the mechanical property maps of the HS spherocyte surface were more structurally homogeneous compared to the maps of HS discocytes. HS spherocytes also had a reduced RMS roughness and lacunarity of the mechanical property maps. The Young's modulus and averaged friction forces over the microscale HS spherocyte surface regions were approximately 20% higher than that of HS discocytes. The revealed significant difference at the nano- and microscales in the structural and mechanical properties of main (discoidal and spheroidal) morphological types of HS erythrocytes can potentially cause blood flow disturbance in the vascular system in HS.
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Affiliation(s)
- Maria N Starodubtseva
- Gomel State Medical University, Department of Medical and Biological Physics, Lange Str., 5, 246000 Gomel, Belarus; Radiobiology Institute of NAS of Belarus, Fedyuninskogo Str., 4, 246007 Gomel, Belarus.
| | - Ekaterina F Mitsura
- Republican Scientific and Practical Center for Radiation Medicine and Human Ecology, Ilyicha Str., 290, 246040 Gomel, Belarus
| | - Ivan E Starodubtsev
- Research Institute for Applied Problems of Mathematics and Informatics, Belarusian State University, Nezavisimosti Ave., 4, 220030 Minsk, Belarus
| | - Irina A Chelnokova
- Gomel State Medical University, Department of Medical and Biological Physics, Lange Str., 5, 246000 Gomel, Belarus; Radiobiology Institute of NAS of Belarus, Fedyuninskogo Str., 4, 246007 Gomel, Belarus
| | - Nikolai I Yegorenkov
- Gomel State Medical University, Department of Medical and Biological Physics, Lange Str., 5, 246000 Gomel, Belarus
| | - Lyudmila I Volkova
- Belarusian Medical Academy of Postgraduate Education, Brovki Str., 3, 220013 Minsk, Belarus
| | - Yuriy S Kharin
- Research Institute for Applied Problems of Mathematics and Informatics, Belarusian State University, Nezavisimosti Ave., 4, 220030 Minsk, Belarus
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38
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Peng GX, Yang WR, Zhao X, Jin LP, Zhang L, Zhou K, Li Y, Ye L, Li Y, Li JP, Fan HH, Song L, Yang Y, Xiong YZ, Wu ZJ, Wang HJ, Zhang FK. [The characteristic of hereditary spherocytosis related gene mutation in 37 Chinese hereditary spherocytisis patients]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 39:898-903. [PMID: 30486584 PMCID: PMC7342348 DOI: 10.3760/cma.j.issn.0253-2727.2018.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Indexed: 11/25/2022]
Abstract
Objective: To reveal the genetic characteristics of erythrocyte membrane protein in hereditary spherocytosis (HS) in China. Methods: Next-generation sequencing technology was used to detect mutations in genes of erythrocyte membrane proteins in 51 clinically diagnosed HS patients. The relationship between gene mutations and clinical phenotypes was analyzed. Results: Mutations in erythrocyte membrane protein genes were detected in 37 patients, including 17 with ANK1 mutations (17/37, 45.9%), 14 with SPTB mutations (14/37, 37.8%), and 5 with SLC4A1 mutations (5/37, 13.5%). One patient carried both heterozygous ANK1 mutation and SPTB mutation (1/37, 2.7%). SPTA1 and EPB42 mutation was not fou nd in any patient. Nonsense mutations (36.8%) and missense mutations (31.6%) were most common. Of the 38 mutations detected, 34 were novel mutations and have not been reported elsewhere (89.5%). Sixteen HS patients underwent parental genetic validation, 6 patients (37.5%) inherited gene mutation from parents and 10 (62.5%) were de novo. The peripheral blood cell parameters of HS patients were not related to the mutant genes and gene mutation types. However, it seems that HS patients with mild clinical status are prone to carry SPTB mutations while more patients with severe clinical status have ANK1 mutations. Conclusions: ANK1 and SPTB are the most common mutant genes in Chinese HS patients, mainly with missense mutations and nonsense mutations. There was no significant correlation between the mutation of HS related genes and the severity of HS.
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Affiliation(s)
- G X Peng
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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39
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Li H, Lu L, Li X, Buffet PA, Dao M, Karniadakis GE, Suresh S. Mechanics of diseased red blood cells in human spleen and consequences for hereditary blood disorders. Proc Natl Acad Sci U S A 2018; 115:9574-9579. [PMID: 30190436 PMCID: PMC6156670 DOI: 10.1073/pnas.1806501115] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In red blood cell (RBC) diseases, the spleen contributes to anemia by clearing the damaged RBCs, but its unique ability to mechanically challenge RBCs also poses the risk of inducing other pathogenic effects. We have analyzed RBCs in hereditary spherocytosis (HS) and hereditary elliptocytosis (HE), two typical examples of blood disorders that result in membrane protein defects in RBCs. We use a two-component protein-scale RBC model to simulate the traversal of the interendothelial slit (IES) in the human spleen, a stringent biomechanical challenge on healthy and diseased RBCs that cannot be directly observed in vivo. In HS, our results confirm that the RBC loses surface due to weakened cohesion between the lipid bilayer and the cytoskeleton and reveal that surface loss may result from vesiculation of the RBC as it crosses IES. In HE, traversing IES induces sustained elongation of the RBC with impaired elasticity and fragmentation in severe disease. Our simulations thus suggest that in inherited RBC disorders, the spleen not only filters out pathological RBCs but also directly contributes to RBC alterations. These results provide a mechanistic rationale for different clinical outcomes documented following splenectomy in HS patients with spectrin-deficient and ankyrin-deficient RBCs and offer insights into the pathogenic role of human spleen in RBC diseases.
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Affiliation(s)
- He Li
- Division of Applied Mathematics, Brown University, Providence, RI 02912
| | - Lu Lu
- Division of Applied Mathematics, Brown University, Providence, RI 02912
| | - Xuejin Li
- Division of Applied Mathematics, Brown University, Providence, RI 02912
| | - Pierre A Buffet
- Faculté de Médecine Université Paris Descartes, Institut National de la Transfusion Sanguine, Paris 75015, France
- Laboratory of Excellence GR-Ex "The Red Blood Cell: From Genesis to Death," Sorbonne Paris Cité, 75015 Paris, France
| | - Ming Dao
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139;
| | | | - Subra Suresh
- Nanyang Technological University, 639798, Singapore
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40
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Pollet H, Conrard L, Cloos AS, Tyteca D. Plasma Membrane Lipid Domains as Platforms for Vesicle Biogenesis and Shedding? Biomolecules 2018; 8:E94. [PMID: 30223513 PMCID: PMC6164003 DOI: 10.3390/biom8030094] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022] Open
Abstract
Extracellular vesicles (EVs) contribute to several pathophysiological processes and appear as emerging targets for disease diagnosis and therapy. However, successful translation from bench to bedside requires deeper understanding of EVs, in particular their diversity, composition, biogenesis and shedding mechanisms. In this review, we focus on plasma membrane-derived microvesicles (MVs), far less appreciated than exosomes. We integrate documented mechanisms involved in MV biogenesis and shedding, focusing on the red blood cell as a model. We then provide a perspective for the relevance of plasma membrane lipid composition and biophysical properties in microvesiculation on red blood cells but also platelets, immune and nervous cells as well as tumor cells. Although only a few data are available in this respect, most of them appear to converge to the idea that modulation of plasma membrane lipid content, transversal asymmetry and lateral heterogeneity in lipid domains may play a significant role in the vesiculation process. We suggest that lipid domains may represent platforms for inclusion/exclusion of membrane lipids and proteins into MVs and that MVs could originate from distinct domains during physiological processes and disease evolution.
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Affiliation(s)
- Hélène Pollet
- CELL Unit, de Duve Institute & Université Catholique de Louvain, UCL B1.75.05, Avenue Hippocrate, 75, B-1200 Brussels, Belgium.
| | - Louise Conrard
- CELL Unit, de Duve Institute & Université Catholique de Louvain, UCL B1.75.05, Avenue Hippocrate, 75, B-1200 Brussels, Belgium.
| | - Anne-Sophie Cloos
- CELL Unit, de Duve Institute & Université Catholique de Louvain, UCL B1.75.05, Avenue Hippocrate, 75, B-1200 Brussels, Belgium.
| | - Donatienne Tyteca
- CELL Unit, de Duve Institute & Université Catholique de Louvain, UCL B1.75.05, Avenue Hippocrate, 75, B-1200 Brussels, Belgium.
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41
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Li H, Papageorgiou DP, Chang HY, Lu L, Yang J, Deng Y. Synergistic Integration of Laboratory and Numerical Approaches in Studies of the Biomechanics of Diseased Red Blood Cells. BIOSENSORS 2018; 8:E76. [PMID: 30103419 PMCID: PMC6164935 DOI: 10.3390/bios8030076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 12/25/2022]
Abstract
In red blood cell (RBC) disorders, such as sickle cell disease, hereditary spherocytosis, and diabetes, alterations to the size and shape of RBCs due to either mutations of RBC proteins or changes to the extracellular environment, lead to compromised cell deformability, impaired cell stability, and increased propensity to aggregate. Numerous laboratory approaches have been implemented to elucidate the pathogenesis of RBC disorders. Concurrently, computational RBC models have been developed to simulate the dynamics of RBCs under physiological and pathological conditions. In this work, we review recent laboratory and computational studies of disordered RBCs. Distinguished from previous reviews, we emphasize how experimental techniques and computational modeling can be synergically integrated to improve the understanding of the pathophysiology of hematological disorders.
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Affiliation(s)
- He Li
- Division of Applied Mathematics, Brown University, Providence, RI 02912, USA.
| | - Dimitrios P Papageorgiou
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Hung-Yu Chang
- Division of Applied Mathematics, Brown University, Providence, RI 02912, USA.
| | - Lu Lu
- Division of Applied Mathematics, Brown University, Providence, RI 02912, USA.
| | - Jun Yang
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Yixiang Deng
- Division of Applied Mathematics, Brown University, Providence, RI 02912, USA.
- School of Engineering, Brown University, Providence, RI 02912, USA.
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42
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Meng LL, Yuan SM, Tu CF, Lin G, Lu GX, Tan YQ. Next-generation sequencing identified a novel SPTB frameshift insertion causing hereditary spherocytosis in China. Ann Hematol 2018; 98:223-226. [PMID: 29961904 DOI: 10.1007/s00277-018-3417-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Lan-Lan Meng
- Institute of Reproduction and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, 410078, Hunan, People's Republic of China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, Hunan, People's Republic of China
| | - Shi-Min Yuan
- Institute of Reproduction and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, 410078, Hunan, People's Republic of China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, Hunan, People's Republic of China
| | - Chao-Feng Tu
- Institute of Reproduction and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, 410078, Hunan, People's Republic of China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, Hunan, People's Republic of China
| | - Ge Lin
- Institute of Reproduction and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, 410078, Hunan, People's Republic of China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, Hunan, People's Republic of China
| | - Guang-Xiu Lu
- Institute of Reproduction and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, 410078, Hunan, People's Republic of China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, Hunan, People's Republic of China
| | - Yue-Qiu Tan
- Institute of Reproduction and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, 410078, Hunan, People's Republic of China. .,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410078, Hunan, People's Republic of China.
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43
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Shibuya A, Kawashima H, Tanaka M. Analysis of erythrocyte membrane proteins in patients with hereditary spherocytosis and other types of haemolytic anaemia. ACTA ACUST UNITED AC 2018; 23:669-675. [PMID: 29623813 DOI: 10.1080/10245332.2018.1455278] [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] [Indexed: 10/17/2022]
Abstract
OBJECTIVES In order to investigate the pathophysiology of erythrocyte membrane proteins, 10 patients (6 pre- and 4 post-splenectomy) with hereditary spherocytosis (HS) and other patients with haemolytic anaemia were examined. METHODS The membrane proteins were analysed by biochemical and mass spectrometry. RESULTS Reductions in the extracellular membrane of band 3 protein by eosin-5'-maleimide (EMA) binding test were greater in patients with pre-splenectomy HS than in patients with post-splenectomy HS, other types of haemolytic anaemia, and controls. Compared to patients with haemolytic anaemia and healthy controls, the band 3 protein of patients with HS pre- or post-splenectomy was more easily decomposed with N-glycosidase F and by mass spectrometry interactions with degraded low-molecular-weight spectrin and ankyrin. The resulting fragments were observed more frequently in pre-splenectomy than post-splenectomy HS. Haemoglobin-derived peptides were present in patients with haemoglobinopathy (Hb Evans, Hb Sabine) but not in those with haemolytic anaemia and healthy controls. CONCLUSION Haemolysis in patients with HS occurred because the fragile proteins in erythrocytes (band 3, spectrin, and ankyrin) collapsed due to compression during blood circulation in the spleen. Further, haemolysis in patients with haemoglobinopathy occurred owing to membrane damage due to combined spectrin, band 3 with denatured haemoglobin in the vessel during blood circulation.
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Affiliation(s)
- Atsushi Shibuya
- a Department of Biotechnology , Tokyo Denki University , Tokyo , Japan
| | - Hiroaki Kawashima
- a Department of Biotechnology , Tokyo Denki University , Tokyo , Japan
| | - Masato Tanaka
- a Department of Biotechnology , Tokyo Denki University , Tokyo , Japan
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44
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Tinning PW, Scrimgeour R, McConnell G. Widefield standing wave microscopy of red blood cell membrane morphology with high temporal resolution. BIOMEDICAL OPTICS EXPRESS 2018; 9:1745-1761. [PMID: 29675316 PMCID: PMC5905920 DOI: 10.1364/boe.9.001745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 05/10/2023]
Abstract
We report the first demonstration of widefield standing wave (SW) microscopy of fluorescently labelled red blood cells at high speeds that allow for the rapid imaging of membrane deformations. Using existing and custom MATLAB functions, we also present a method to generate 2D and 3D reconstructions of the SW data for improved visualization of the cell. We compare our technique with standard widefield epifluorescence imaging and show that the SW technique not only reveals more topographical information about the specimen but does so without increasing toxicity or the rate of photobleaching and could make this a powerful technique for the diagnosis or study of red blood cell morphology and biomechanical characteristics.
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Affiliation(s)
- Peter W Tinning
- Department of Physics, SUPA, University of Strathclyde, Glasgow, G4 ONG, UK
| | - Ross Scrimgeour
- Department of Physics, SUPA, University of Strathclyde, Glasgow, G4 ONG, UK
| | - Gail McConnell
- Department of Physics, SUPA, University of Strathclyde, Glasgow, G4 ONG, UK
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45
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An Infant With Unusually High Unconjugated Hyperbilirubinemia Due to Coexistence of Hereditary Spherocytosis and Gilbert Syndrome. J Pediatr Hematol Oncol 2018; 40:e127-e128. [PMID: 29200157 DOI: 10.1097/mph.0000000000001025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Hereditary spherocytosis is the most frequent congenital hemolytic anemia and is characterized with variable degree of anemia, jaundice, and splenomegaly. In the case of severe hyperbilirubinemia out of proportion with hemolysis, other causes of hyperbilirubinemia must be considered. Gilbert syndrome (GS) is an autosomal dominant disorder characterized with intermittent hyperbilirubinemia without any other sign and symptom of liver disease as a result of reduced activity of uridine diphosphate-glucuronyl transferase 1A1. The calculated rate of coexistence of these 2 diseases is 15 to 35/million births. Here we present a 21-month-old girl with hereditary spherocytosis diagnosed at the age of 40 days with hyperbilirubinemia out of proportion of hemolysis which led to diagnosis of GS. Thereby, the diagnosis of GS should be considered in unexplained unconjugated hyperbilirubinemia in different age groups, including infants and toddlers.
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46
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Guan H, Liang X, Zhang R, Wang H, Liu W, Zhang R, Yang J, Liu S. Identification of a de novo ANK1 mutation in a Chinese family with hereditary spherocytosis. Hematology 2017; 23:357-361. [PMID: 29099659 DOI: 10.1080/10245332.2017.1398210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Hongzai Guan
- Department of Clinical Hematology, The Medical College of Qingdao University, Qingdao, People’s Republic of China
| | - Xinping Liang
- Department of Clinical Hematology, The Medical College of Qingdao University, Qingdao, People’s Republic of China
| | - Rong Zhang
- Department of Clinical Laboratory, The Qingdao Central Hospital, Qingdao, People’s Republic of China
| | - Haiyan Wang
- Department of Blood Transfusion, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Wenmiao Liu
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Ru Zhang
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Jie Yang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Shiguo Liu
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
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Loniewska-Lwowska A, Koza K, Mendek-Czajkowska E, Wieszczy P, Adamowicz-Salach A, Branicka K, Witos I, Sapala-Smoczynska A, Jackowska T, Fabijanska-Mitek J. Diminished presentation of complement regulatory protein CD55 on red blood cells from patients with hereditary haemolytic anaemias. Int J Lab Hematol 2017; 40:128-135. [PMID: 28963754 DOI: 10.1111/ijlh.12752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/04/2017] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Hereditary haemolytic anaemias (HHA) encompass a heterogeneous group of anaemias characterized by decreased red blood cell survival. The aim of this study was to evaluate the status of red blood cell (RBC) surface molecules known or previously proposed to participate in preventing premature RBC clearance, analysing erythrocytes from patients with two types of HHA: hereditary spherocytosis (HS) and microcytosis. MATERIAL/METHODS Relative binding of five monoclonal antibodies (mAbs), anti-CD55, anti-CD59, anti-CD44, anti-CD47 and anti-CD58, was evaluated in erythrocytes of patients with HS and hereditary microcytosis, using flow cytometry. The amount of CD55 protein was assessed by semi-quantitative Western blots densitometry analysis. RESULTS The majority of both HS and microcytic patients demonstrated significant reduction of anti-CD55 binding by erythrocytes (average 23% and 19%, respectively, P < .001), with no concomitant anti-CD59-binding deficiency. Anti-CD44, anti-CD47 and anti-CD58 binding was within the healthy control range or was slightly decreased. CONCLUSIONS This study provides evidence supporting the presence of erythrocytes deficient in CD55 presentation in HS and hereditary microcytosis. Moreover, deficiency of CD55 antigen presentation on RBC does not correlate with the amount of CD55 in RBC membrane. Further studies using molecular techniques will clarify the exact participation of CD55 deficiency in premature RBC clearance in HHA.
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Affiliation(s)
- A Loniewska-Lwowska
- Department of Immunohaematology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - K Koza
- Department of Immunohaematology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - E Mendek-Czajkowska
- Outpatient Clinic for Congenital Anaemias, Institute of Haematology and Blood Transfusion, Warsaw, Poland
| | - P Wieszczy
- Department of Gastroenterology and Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Cancer Prevention, The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - A Adamowicz-Salach
- Department of Paediatrics, Haematology and Oncology, Medical University of Warsaw, Warsaw, Poland
| | - K Branicka
- Department of Immunohaematology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - I Witos
- Department of Immunohaematology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Sapala-Smoczynska
- Department of Paediatrics, Medical Centre of Postgraduate Education, Bielanski Hospital, Warsaw, Poland
| | - T Jackowska
- Department of Paediatrics, Medical Centre of Postgraduate Education, Bielanski Hospital, Warsaw, Poland
| | - J Fabijanska-Mitek
- Department of Immunohaematology, Centre of Postgraduate Medical Education, Warsaw, Poland
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48
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Yee J. Hyperkalemia: Inpatient PaniK. Adv Chronic Kidney Dis 2017; 24:267-271. [PMID: 29031351 DOI: 10.1053/j.ackd.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Narla J, Mohandas N. Red cell membrane disorders. Int J Lab Hematol 2017; 39 Suppl 1:47-52. [PMID: 28447420 DOI: 10.1111/ijlh.12657] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022]
Abstract
Significant advances have been made in our understanding of the structural basis for altered cell function in various inherited red cell membrane disorders with reduced red cell survival and resulting hemolytic anemia. The current review summarizes these advances as they relate to defining the molecular and structural basis for disorders involving altered membrane structural organization (hereditary spherocytosis [HS] and hereditary elliptocytosis [HE]) and altered membrane transport function (hereditary overhydrated stomatocytosis and hereditary xerocytosis). Mutations in genes encoding membrane proteins that account for these distinct red cell phenotypes have been identified. These molecular insights have led to improved understanding of the structural basis for altered membrane function in these disorders. Weakening of vertical linkage between the lipid bilayer and spectrin-based membrane skeleton leads to membrane loss in HS. In contrast, weakening of lateral linkages among different skeletal proteins leads to membrane fragmentation and decreased surface area in HE. The degrees of membrane loss and resultant increases in cell sphericity determine the severity of anemia in these two disorders. Splenectomy leads to amelioration of anemia by increasing the circulatory red cell life span of spherocytic red cells that are normally sequestered by the spleen. Disordered membrane cation permeability and resultant increase or decrease in red cell volume account for altered cellular deformability of hereditary overhydrated stomatocytosis and hereditary xerocytosis, respectively. Importantly, splenectomy is not beneficial in these two membrane transport disorders and in fact contraindicated due to severe postsplenectomy thrombotic complications.
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Affiliation(s)
- J Narla
- Regional Medical Center, San Jose, CA, USA
| | - N Mohandas
- New York Blood Center, New York, NY, USA
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50
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Kim Y, Park J, Kim M. Diagnostic approaches for inherited hemolytic anemia in the genetic era. Blood Res 2017; 52:84-94. [PMID: 28698843 PMCID: PMC5503903 DOI: 10.5045/br.2017.52.2.84] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 02/06/2023] Open
Abstract
Inherited hemolytic anemias (IHAs) are genetic diseases that present with anemia due to the increased destruction of circulating abnormal RBCs. The RBC abnormalities are classified into the three major disorders of membranopathies, hemoglobinopathies, and enzymopathies. Traditional diagnosis of IHA has been performed via a step-wise process combining clinical and laboratory findings. Nowadays, the etiology of IHA accounts for germline mutations of the responsible genes coding for the structural components of RBCs. Recent advances in molecular technologies, including next-generation sequencing, inspire us to apply these technologies as a first-line approach for the identification of potential mutations and to determine the novel causative genes in patients with IHAs. We herein review the concept and strategy for the genetic diagnosis of IHAs and provide an overview of the preparations for clinical applications of the new molecular technologies.
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Affiliation(s)
- Yonggoo Kim
- Department of Laboratory Medicine, Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joonhong Park
- Department of Laboratory Medicine, Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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