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Pavan AR, Terroni B, Dos Santos JL. Endothelial dysfunction in Sickle Cell Disease: Strategies for the treatment. Nitric Oxide 2024; 149:7-17. [PMID: 38806107 DOI: 10.1016/j.niox.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/15/2024] [Accepted: 05/25/2024] [Indexed: 05/30/2024]
Abstract
Sickle Cell Anemia (SCA), is an inherited hemoglobinopathy characterized by the presence of an abnormal hemoglobin (HbS), being the most prevalent sickle cell disease (SCD). SCA is characterized by vascular endothelial dysfunction, which contributes significantly to various clinical conditions, including but not limited to pulmonary hypertension, priapism, cutaneous leg ulceration, and stroke. The pathophysiology of endothelial dysfunction (ED) in SCA is a multifaceted process involving a chronic inflammatory and hypercoagulable state. Key factors include hemolysis-associated elements like reduced arginine and nitric oxide (NO) availability, elevated levels of vascular adhesion molecules, the uncoupling effect of NO synthase, heightened arginase activity, an environment characterized by oxidative stress with the production of reactive oxygen and nitrogen species, and occurrences of ischemia-reperfusion injury, along with apolipoprotein A-1 depletion. The urgency for novel interventions addressing ED is evident. Presently, there is a focus on investigating small molecules that disrupt the arginine-nitric oxide pathway, exhibiting anti-inflammatory and antioxidant properties while diminishing levels of cellular and vascular adhesion molecules. In this mini-review article, we delve into the progress made in strategies for treating ED in SCD with the aim of cultivating insights for drug design.
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Affiliation(s)
- Aline Renata Pavan
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Araraquara, Brazil; São Paulo State University (UNESP), Institute of Chemistry, Araraquara, Brazil.
| | - Barbara Terroni
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Araraquara, Brazil
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2
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Obeagu EI, Obeagu GU. Malnutrition in sickle cell anemia: Prevalence, impact, and interventions: A Review. Medicine (Baltimore) 2024; 103:e38164. [PMID: 38758879 PMCID: PMC11098235 DOI: 10.1097/md.0000000000038164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/17/2024] [Indexed: 05/19/2024] Open
Abstract
Sickle Cell Anemia (SCA) is a hereditary hemoglobinopathy characterized by chronic hemolytic anemia, vaso-occlusive events, and a wide range of clinical complications. Malnutrition, often an underexplored aspect of this complex condition, plays a critical role in disease management and overall patient well-being. This publication provides a comprehensive review of the prevalence, impact, and interventions related to malnutrition in individuals with SCA. A thorough literature review reveals the multifaceted challenges faced by SCA patients in maintaining adequate nutrition. The pathophysiology of SCA, involving chronic inflammation, oxidative stress, and hypermetabolism, contributes to increased nutritional requirements and altered dietary patterns. Factors such as reduced appetite, nutrient malabsorption, dietary restrictions, and socioeconomic disparities further exacerbate the risk of malnutrition. Malnutrition is a prevalent issue among individuals with SCA, affecting patients of different age groups and disease severities. Nutritional deficiencies, including vitamins, minerals, and essential nutrients, are common in this population. The impact of malnutrition on disease outcomes is significant, with associations between nutrient status and complications such as pain crises, infections, and impaired quality of life. This paper also reviews nutritional interventions aimed at addressing malnutrition in SCA patients. While dietary counseling, supplementation, and personalized nutrition plans have shown promise in improving nutritional status, challenges such as patient adherence and access to healthcare must be addressed to optimize their effectiveness.
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3
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Obadina M, Wilson S, Derebail VK, Little J. Emerging Therapies and Advances in Sickle Cell Disease with a Focus on Renal Manifestations. KIDNEY360 2023; 4:997-1005. [PMID: 37254256 PMCID: PMC10371301 DOI: 10.34067/kid.0000000000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023]
Abstract
The underlying mechanisms of disease in sickle cell disease (SCD) contribute to a multifaceted nephropathy, commonly manifested as albuminuria. In severe SCD genotypes ( e.g. , Hemoglobin SS [HbSS]), albuminuria and CKD are major predictors of mortality in this population. Therefore, the monitoring and management of renal function is an intrinsic part of comprehensive care in SCD. Management of nephropathy in SCD can be accomplished with SCD-directed therapies and/or CKD-directed therapies. In the past 5 years, novel disease-modifying and palliative therapies have been approved in SCD to target aspects of the disease, such as anemia, inflammation, and vasculopathy. Along with conventional hydroxyurea and chronic transfusion, l -glutamine, crizanlizumab, and voxelotor have all been shown to mitigate some adverse effect of SCD, and their effect on nephropathy is being investigated. CKD-directed therapies such as renin-angiotensin-aldosterone system blockers have long been used in SCD nephropathy; however, more complete long-term studies on benefits are needed. Given the effect of renal disease on survival, further assessment of the mechanisms and efficacy of these SCD-directed or CKD-directed therapeutic agents is essential.
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Affiliation(s)
- Mofiyin Obadina
- Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Sam Wilson
- Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
- UNC Blood Research Center, University of North Carolina, Chapel Hill, North Carolina
| | - Vimal K. Derebail
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jane Little
- Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
- UNC Blood Research Center, University of North Carolina, Chapel Hill, North Carolina
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Morris CR, Kuypers FA, Hagar R, Larkin S, Lavrisha L, Saulys A, Vichinsky EP, Suh JH. Implications for the Metabolic Fate of Oral Glutamine Supplementation within Plasma and Erythrocytes of Patients with Sickle Cell Disease: A Pharmacokinetics Study. Complement Ther Med 2022; 64:102803. [PMID: 35032556 DOI: 10.1016/j.ctim.2022.102803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 11/13/2021] [Accepted: 01/10/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES L-Glutamine is FDA-approved for sickle cell disease (SCD), yet the mechanism(s)-of-action are poorly understood. We performed a pharmacokinetics (pK) study to determine the metabolic fate of glutamine supplementation on plasma and erythrocyte amino acids in patients with SCD. DESIGN A pK study was performed where patients with SCD fasting for >8hours received oral L-glutamine (10 grams). Blood was analyzed at baseline, 30/60/90minutes/2/3/4/8 hrs. A standardized diet was administered to all participants at 3 established time-points (after 2/5/7hrs). A subset of patients also had pK studies performed without glutamine supplementation to follow normal diurnal fluctuations in amino acids. SETTING Comprehensive SCD Center in Oakland, California RESULTS: Five patients with SCD were included, three of whom performed pK studies both with and without glutamine supplementation. Average age was 50.6 ± 5.6 years, 60% were female, 40% SS, 60% SC. Plasma glutamine levels increased significantly after oral glutamine supplementation, compared to minimal fluctuations with diet. Plasma glutamine concentration peaked within 30-minutes of ingestion (p=0.01) before decreasing to a plateau by 2-hours that remained higher than baseline by 8hours. Oral glutamine also increased plasma arginine concentration, which peaked by 4-hrs (p=0.03) and remained elevated through 8-hrs. Erythrocyte glutamine levels began to increase by 8-hours, while erythrocyte arginine concentration peaked at 4-hours. CONCLUSIONS Oral glutamine supplementation acutely improved glutamine and arginine bioavailability in both plasma and erythrocytes. This is the first study to demonstrate that glutamine therapy increases arginine bioavailability and may provide insight into shared mechanisms-of-action between these conditionally-essential amino acids.
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Affiliation(s)
- Claudia R Morris
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA; Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
| | - Frans A Kuypers
- Department of Hematology/Oncology, UCSF-Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Robert Hagar
- Department of Hematology/Oncology, UCSF-Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Sandra Larkin
- Department of Hematology/Oncology, UCSF-Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Lisa Lavrisha
- Department of Hematology/Oncology, UCSF-Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Augusta Saulys
- Department of Emergency Medicine, UCSF-Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Elliott P Vichinsky
- Department of Hematology/Oncology, UCSF-Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Jung H Suh
- Department of Hematology/Oncology, UCSF-Benioff Children's Hospital Oakland, Oakland, CA, USA
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5
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Abstract
Oxidative stress is an important contributor to the pathophysiology of sickle cell disease. The pathways involved are complex and interlinked. L-glutamine is an amino acid with myriad roles in the body, including the synthesis of antioxidants, such as reduced glutathione and the cofactors NAD(H) and NADP(H), as well as nitric oxide—so it has therapeutic potential as an antioxidant. However, the relative impact of L-glutamine on the redox environment in red blood cells in sickle cell disease is not fully understood, and there are few therapeutic trials in sickle cell disease. Following the FDA approval of L-glutamine for sickle cell disease, more research is still needed to understand its clinical effects and role in therapy.
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Affiliation(s)
- Alina Sadaf
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Charles T Quinn
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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6
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Ngo Um SS, Seungue J, Alima AY, Mbono R, Mbassi H, Chelo D, Koki PO. A cross sectional study of growth of children with sickle cell disease, aged 2 to 5 years in Yaoundé, Cameroon. Pan Afr Med J 2019; 34:85. [PMID: 31934228 PMCID: PMC6945666 DOI: 10.11604/pamj.2019.34.85.16432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/24/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Growth of children affected by Sickle Cell Disease (SCD) is not well described in sub-Saharan Africa despite the high prevalence of the disease. Few data are available in this context and on the issue using the World Health Organization growth norms. We therefore conduct the present study with the aim of describing the growth of affected children aged less than 5 years. We also assessed correlation of anthropometric parameters with disease severity criteria. Methods A cross-sectional study was conducted during a period of 8 months, at the Mother and Child Center of Yaoundé. The sample included 77 children with SCD aged 2 to 5 years old in steady state. Anthropometric measurements and socio-demographic data were collected and analyzed. All statistical tests were two-tailed with p<0.05 considered significant. Results Median age of study population was 3.67 years. Low weight, height and weight for height Z-scores (<-2SD) were observed in 4%, 4%, and 5% of children, respectively. Projection of these parameters were stackable on WHO curves. Regression analysis indicated an association of low height-for-age and of low Body Mass Index (BMI)-for-age with age. Conclusion This study demonstrates unexpectedly lower mean Z-score for weight, height and weight for height than reported while using WHO norms.
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Affiliation(s)
- Suzanne Sap Ngo Um
- Mother and Child Center of Yaoundé, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
| | | | | | - Ritha Mbono
- Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
| | - Hubert Mbassi
- Mother and Child Center of Yaoundé, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
| | - David Chelo
- Mother and Child Center of Yaoundé, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
| | - Paul Olivier Koki
- Mother and Child Center of Yaoundé, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
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Khan S, Damanhouri G, Jameel T, Ali A, Makki A, Khan S, AlAnsari I, Halawani S, Zahrani F, AlKazmi M, Ghita I. Impact of omega-3 fatty acids on calorie intake and certain anthropometric measurements in children with sickle cell disease in Saudi Arabia. Bioinformation 2019; 15:189-193. [PMID: 31354194 PMCID: PMC6637403 DOI: 10.6026/97320630015189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 01/09/2023] Open
Abstract
The nutritional status and growth in children with sickle cell disease is compromised due to intake of diet that is low in calories as well as deficient in nutrients. Growth stunting and a low body mass index have been observed in these children. Some children exhibit pica, which is an abnormal eating pattern by ingesting things other than food, like paper, wood etc. This also was found to correlate to lower hemoglobin values. Interventions with certain essential nutrients such as omega-3 fatty acids are known to benefit these children in terms of lowering their complications due to the disease. We therefore wished to see if omega-3 fatty acids exhibit positive effects on their nutritional intake and growth parameters too. Hence, we supplemented these children with omega-3 fatty acids for a period of six months. Both the male and female children with the disease significantly improved their calorific intake as well as body mass index. Also a lowering of pica status was distinctly observed.
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Affiliation(s)
- Shahida Khan
- Applied Nutrition Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Department of Medical Laboratory technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ghazi Damanhouri
- Applied Nutrition Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Department of Hematology, King Abdulaziz University hospital, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Tahir Jameel
- King Abdulaziz University hospital, Hematology department, Rabigh Branch, Kingdom of Saudi Arabia
| | - Ashraf Ali
- Applied Nutrition Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Department of Medical Laboratory technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmad Makki
- Applied Nutrition Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Department of Medical Laboratory technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Sarah Khan
- Applied Nutrition Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Diabetes Unit, King Edward Memorial Hospital, 489, Sardar Moodliar Road, Rasta Peth, Pune, India
| | - Ibtehal AlAnsari
- Applied Nutrition Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Saeed Halawani
- Department of Hematology and Immunology, Umm Al Qura University, Faculty of Medicine, Makkah, Kingdom of Saudi Arabia
| | - Fatma Zahrani
- Department of Pediatrics, King Abdulaziz University hospital,King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohammad AlKazmi
- Department of Hematology, Al-Noor Specialist hospital Makah, Kingdom of Saudi Arabia
| | - Ibrahim Ghita
- Department of Hematology, Al-Noor Specialist hospital Makah, Kingdom of Saudi Arabia
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8
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l-Glutamine for sickle cell anemia: more questions than answers. Blood 2018; 132:689-693. [PMID: 29895661 DOI: 10.1182/blood-2018-03-834440] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/11/2018] [Indexed: 11/20/2022] Open
Abstract
In 2017, the Food and Drug Administration approved 2 medications for sickle cell anemia (SCA): hydroxyurea for children and l-glutamine for children and adults. The approval of hydroxyurea was long overdue, but the approval of l-glutamine was a surprise to many. Any effective new treatment for SCA is a welcome advance, but there are few published studies of l-glutamine as a specific treatment for SCA. Accordingly, there are many unanswered questions about its efficacy, safety, and role in current therapy.
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9
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Willen SM, DeBaun MR. The Epidemiology and Management of Lung Diseases in Sickle Cell Disease: Lessons Learned from Acute and Chronic Lung Disease in Cystic Fibrosis. Pediatr Clin North Am 2018; 65:481-493. [PMID: 29803278 DOI: 10.1016/j.pcl.2018.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although sickle cell disease and cystic fibrosis are two of the most common monogenic diseases presenting in childhood worldwide, cystic fibrosis and sickle cell disease enjoy vastly different funding and collaborative research efforts. Pulmonary complications in cystic fibrosis have well established guidelines and multidisciplinary involvement focusing on comorbidities, routine monitoring, infectious complications, nutrition, and treatment recommendations. These guidelines can provide a framework on which to build knowledge of lung disease in sickle cell disease.
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Affiliation(s)
- Shaina M Willen
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael R DeBaun
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA.
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10
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Jagadeeswaran R, Rivers A. Evolving treatment paradigms in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:440-446. [PMID: 29222291 PMCID: PMC6142561 DOI: 10.1182/asheducation-2017.1.440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Sickle cell disease (SCD) is an inheritable hemoglobinopathy characterized by polymerization of hemoglobin S in red blood cells resulting in chronic hemolytic anemia, vaso-occlusive painful crisis, and multiorgan damage. In SCD, an increased reactive oxygen species (ROS) generation occurs both inside the red blood cells and inside the vascular lumen, which augment hemolysis and cellular adhesion. This review discusses the evolving body of literature on the role of ROS in the pathophysiology of SCD as well as some emerging therapeutic approaches to SCD with a focus on the reduction of ROS.
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Affiliation(s)
- Ramasamy Jagadeeswaran
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL; and
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL
| | - Angela Rivers
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL; and
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL
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11
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McGann PT, Nero AC, Ware RE. Clinical Features of β-Thalassemia and Sickle Cell Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1013:1-26. [PMID: 29127675 DOI: 10.1007/978-1-4939-7299-9_1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Sickle cell disease (SCD) and β-thalassemia are among the most common inherited diseases, affecting millions of persons globally. It is estimated that 5-7% of the world's population is a carrier of a significant hemoglobin variant. Without early diagnosis followed by initiation of preventative and therapeutic care, both SCD and β-thalassemia result in significant morbidity and early mortality. Despite great strides in the understanding of the molecular basis and pathophysiology of these conditions, the burden of disease remains high, particularly in limited resource settings. Current therapy relies heavily upon the availability and safety of erythrocyte transfusions to treat acute and chronic complications of these conditions, but frequent transfusions results in significant iron overload, as well as challenges from acquired infections and alloimmunization. Hydroxyurea is a highly effective treatment for SCD but less so for β-thalassemia, and does not represent curative therapy. As technology and use of cellular and gene therapies expand, SCD and thalassemia should be among the highest disease priorities.
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Affiliation(s)
- Patrick T McGann
- Division of Hematology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 11027, Cincinnati, OH, 45229, USA
| | - Alecia C Nero
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75063, USA
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 11027, Cincinnati, OH, 45229, USA.
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Loiselle K, Lee JL, Szulczewski L, Drake S, Crosby LE, Pai ALH. Systematic and Meta-Analytic Review: Medication Adherence Among Pediatric Patients With Sickle Cell Disease. J Pediatr Psychol 2015; 41:406-18. [PMID: 26384715 DOI: 10.1093/jpepsy/jsv084] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/13/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To provide a comprehensive summary (systematic review) of medication adherence rates by assessment method and medication type for pediatric patients with sickle cell disease (SCD), as well as identify important correlates for future research. METHODS Articles assessing medication adherence and published between 1982 and February 2015 (n = 49) were identified using electronic databases. A meta-analysis of 14 studies examining demographic, medical, and psychosocial factors and medication adherence was conducted. RESULTS Adherence rates ranged from 12% to 100% across all medications. Approximately 30% of studies reported associations between adherence and key demographic, medical, and psychosocial correlates. Mean effect sizes were small to moderate (r = .02-.53). CONCLUSIONS The wide range of adherence rates reported in the literature may be because of, in part, the use of variable assessment strategies. Future studies examining pediatric SCD adherence should incorporate key correlates with the goal of replication.
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Affiliation(s)
- Kristin Loiselle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Jennifer L Lee
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Lauren Szulczewski
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Sarah Drake
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Lori E Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
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13
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Manci EA, Hyacinth HI, Capers PL, Archer DR, Pitts S, Ghosh S, Patrickson J, Titford ME, Ofori-Acquah SF, Hibbert JM. High protein diet attenuates histopathologic organ damage and vascular leakage in transgenic murine model of sickle cell anemia. Exp Biol Med (Maywood) 2014; 239:966-974. [PMID: 24842894 PMCID: PMC4237702 DOI: 10.1177/1535370214531863] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Previous reports have shown that a high protein diet improves weight gain and decreases expression of inflammatory markers in weanling Berkeley transgenic sickle cell mice. The effect of this diet on the underlying histopathology, however, has not been studied. Age-matched, male C57BL/6 controls (n = 24), Berkley sickle mice (n = 31) and Townes sickle mice (n = 14) were randomized in a terminal experiment at weaning to isoenergetic diets, with either normal (20%) or high (35%) amount of energy from protein, by replacing dextrin. Tissue sampling for blinded histologic study and scoring of changes at baseline and after 3 months of feedings showed progressive siderosis and infarcts in spleen, kidney, and liver in all sickle groups, and no significant changes in age- and sex-matched normal controls. High-protein (35%) fed Berkeley sickle mice had significantly fewer (p < 0.01) infarcts in spleen (35.7% less), liver (12.5% less), and kidney (28.6% less) and lower histopathologic scores (p < 0.01) for chronic tissue injury in liver and spleen than matched normal-protein (20%) fed Berkeley sickle mice. In addition, high-protein fed Townes sickle mice had less vascular leakage (∼36%) in the heart, lungs, and brain and a better survival rate (21%) than matched normal-protein Townes sickle mice. This is the first report of histopathologic evidence that a high protein:calorie diet attenuates sickle cell related chronic organ injury in transgenic sickle cell mouse models.
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Affiliation(s)
- Elizabeth Ann Manci
- Centralized Pathology Unit for Study of Sickle Cell Disease, University of South Alabama Children’s and Women’s Hospital, Mobile, AL 33604, USA
| | - Hyacinth I Hyacinth
- Stroke Center, Department of Neuroscience, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Patrice L Capers
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - David R Archer
- Aflac Cancer Center, Department of Hematology and Bone Marrow Transplant, Emory University, Atlanta, GA 30322, USA
| | - Sydney Pitts
- Department of Anatomy and Neurobiology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Samit Ghosh
- Aflac Cancer Center, Department of Hematology and Bone Marrow Transplant, Emory University, Atlanta, GA 30322, USA
| | - John Patrickson
- Department of Anatomy and Neurobiology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Michael E Titford
- Centralized Pathology Unit for Study of Sickle Cell Disease, University of South Alabama Children’s and Women’s Hospital, Mobile, AL 33604, USA
| | - Solomon F Ofori-Acquah
- Aflac Cancer Center, Department of Hematology and Bone Marrow Transplant, Emory University, Atlanta, GA 30322, USA
| | - Jacqueline M Hibbert
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA
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14
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Mok E, Hankard R. Glutamine supplementation in sick children: is it beneficial? J Nutr Metab 2011; 2011:617597. [PMID: 22175008 PMCID: PMC3228321 DOI: 10.1155/2011/617597] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 09/28/2011] [Indexed: 12/14/2022] Open
Abstract
The purpose of this review is to provide a critical appraisal of the literature on Glutamine (Gln) supplementation in various conditions or illnesses that affect children, from neonates to adolescents. First, a general overview of the proposed mechanisms for the beneficial effects of Gln is provided, and subsequently clinical studies are discussed. Despite safety, studies are conflicting, partly due to different effects of enteral and parenteral Gln supplementation. Further insufficient evidence is available on the benefits of Gln supplementation in pediatric patients. This includes premature infants, infants with gastrointestinal disease, children with Crohn's disease, short bowel syndrome, malnutrition/diarrhea, cancer, severe burns/trauma, Duchenne muscular dystrophy, sickle cell anemia, cystic fibrosis, and type 1 diabetes. Moreover, methodological issues have been noted in some studies. Further mechanistic data is needed along with large randomized controlled trials in select populations of sick children, who may eventually benefit from supplemental Gln.
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Affiliation(s)
- Elise Mok
- INSERM Centre D'Investigation Clinique 802, Centre Hospitalier Universitaire de Poitiers, 86021 Poitiers Cedex, France
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Abstract
Finding a widely available cure for sickle cell anemia (HbSS) still remains a challenge one hundred years after its discovery as a genetically inherited disease. However, growing interest in the nutritional problems of the disease has created a body of literature from researchers seeking nutritional alternatives as a means of decreasing morbidity and improving quality of life among HbSS patients. This review demonstrates that over the past 30 years the role of protein/energy deficiency in HbSS has been more clearly defined via direct measurements, leading to the concept of a relative shortage of nutrients for growth and development, despite apparently adequate dietary intakes. Although there is still a paucity of data supporting the efficacy of macronutrient supplementation, it is becoming clearer that recommended dietary allowances (RDAs) for the general population are insufficient for the sickle cell patient. A similar shortage is likely to be true for micronutrient deficiencies, including recent findings of vitamin D deficiency that may be associated with incomplete ossification and bone disease, which are well known complications of HbSS disease. We conclude that there is need for more effort and resources to be dedicated to research (including supplementation studies of larger sample size) aimed at establishing specific RDAs for HbSS patients, much like the specific RDAs developed for pregnancy and growth within the general population.
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Affiliation(s)
- H.I. Hyacinth
- Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, USA
| | - B.E. Gee
- Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, USA
| | - J.M. Hibbert
- Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, USA
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Al-Saqladi AWM, Cipolotti R, Fijnvandraat K, Brabin BJ. Growth and nutritional status of children with homozygous sickle cell disease. ACTA ACUST UNITED AC 2009; 28:165-89. [PMID: 18727846 DOI: 10.1179/146532808x335624] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Poor growth and under-nutrition are common in children with sickle cell disease (SCD). This review summarises evidence of nutritional status in children with SCD in relation to anthropometric status, disease severity, body composition, energy metabolism, micronutrient deficiency and endocrine dysfunction. METHODS A literature search was conducted on the Medline/PUBMED, SCOPUS, SciELO and LILACS databases to July 2007 using the keywords sickle cell combined with nutrition, anthropometry, growth, height and weight, body mass index, and specific named micronutrients. RESULTS Forty-six studies (26 cross-sectional and 20 longitudinal) were included in the final anthropometric analysis. Fourteen of the longitudinal studies were conducted in North America, the Caribbean or Europe, representing 78.8% (2086/2645) of patients. Most studies were observational with wide variations in sample size and selection of reference growth data, which limited comparability. There was a paucity of studies from Africa and the Arabian Peninsula, highlighting a large knowledge gap for low-resource settings. There was a consistent pattern of growth failure among affected children from all geographic areas, with good evidence linking growth failure to endocrine dysfunction, metabolic derangement and specific nutrient deficiencies. CONCLUSIONS The monitoring of growth and nutritional status in children with SCD is an essential requirement for comprehensive care, facilitating early diagnosis of growth failure and nutritional intervention. Randomised controlled trials are necessary to assess the potential benefits of nutritional interventions in relation to growth, nutritional status and the pathophysiology of the disease.
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18
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Skillman HE, Wischmeyer PE. Nutrition Therapy in Critically Ill Infants and Children. JPEN J Parenter Enteral Nutr 2008; 32:520-34. [DOI: 10.1177/0148607108322398] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Heather E. Skillman
- From the Department of Clinical Nutrition, The Children's Hospital, Aurora, Colorado; and the Department of Anesthesiology, University of Colorado Health Sciences Center, Aurora, Colorado
| | - Paul E. Wischmeyer
- From the Department of Clinical Nutrition, The Children's Hospital, Aurora, Colorado; and the Department of Anesthesiology, University of Colorado Health Sciences Center, Aurora, Colorado
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Kato GJ. Novel small molecule therapeutics for sickle cell disease: nitric oxide, carbon monoxide, nitrite, and apolipoprotein A-I. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2008; 2008:186-92. [PMID: 19074079 PMCID: PMC2778246 DOI: 10.1182/asheducation-2008.1.186] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A hemolysis-linked subphenotype of sickle cell disease (SCD), characterized by pulmonary hypertension, stroke, priapism and leg ulcers, is associated with decreased nitric oxide bioavailability and vasculopathy. Vasculopathy appears to have a multifactorial etiology, including mechanisms primarily that involve deficient nitric oxide (NO) signaling, but also involving altered function of NO synthase related to substrate availability and cooperating factors such as apolipoproteins. Improved understanding of the vascular pathophysiology of SCD has led to new vascular targets for translational research in SCD. This growing vascular therapeutics field in SCD is complementary to the ongoing efforts to reduce the morbidity of vaso-occlusive pain crisis. This presentation will review the current biology and translational clinical development of novel small molecules targeting sickle cell vasculopathy. Strategies targeting the hemeoxygenase-carbon monoxide pathway, the arginine-NO synthase-cGMP-phosphodiesterase 5 pathway, the nitrate-nitrite-NO pathway, and the apolipoprotein A-I pathways will be reviewed. In this context, current clinical trials of inhaled NO, CO, nitrite, sildenafil and apoA-I mimetics will be discussed.
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Affiliation(s)
- Gregory J Kato
- Critical Care Medicine Department, Clinical Center and the Pulmonary and Vascular Medicine Branch, National Heart, Lung and Blood Institute, National Institute of Health, Bethesda, MD 20892-1476, USA
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Abstract
Bone involvement is the commonest clinical manifestation of sickle cell disease both in the acute setting such as painful vaso-occlusive crises, and as a source of chronic, progressive disability such as avascular necrosis. Management of these problems is often difficult because of the diagnostic imprecision of most laboratory and imaging investigations and because of the lack of evidence for most surgical procedures in sickle cell disease. This review first discusses the acute problems related to bone involvement in sickle cell disease, with particular reference to differentiating infection from infarction, and then describes the long-term effects of sickle cell disease on bone mineral density, growth, and chronic bone and joint damage.
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Affiliation(s)
- Antonio Almeida
- Department of Haematology, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK.
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