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Palmblad J, Sohlberg E, Nilsson CC, Lindqvist H, Deneberg S, Ratcliffe P, Meinke S, Mörtberg A, Klimkowska M, Höglund P. Clinical and immunological features in ACKR1/DARC-associated neutropenia. Blood Adv 2024; 8:571-580. [PMID: 38039514 PMCID: PMC10837479 DOI: 10.1182/bloodadvances.2023010400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/12/2023] [Accepted: 10/27/2023] [Indexed: 12/03/2023] Open
Abstract
ABSTRACT ACKR1/DARC-associated neutropenia (NP; ADAN; Online Mendelian Inheritance in Man 611862), caused by a variation in the ACKR1/DARC gene (rs2814778), is common in persons of African or Middle Eastern descent. In a cohort of 66 genetically confirmed subjects with ADAN, we show that absolute neutrophil counts (ANCs) may occasionally be lower than previously recognized (0.1 × 109-0.49 × 109/L for 9% of the subjects), which is similar to ANCs in severe congenital NP (SCNP). ANCs often normalized during inflammation, even mild. Individuals with ADAN (of 327 observed person-years) showed no cases of myelodysplastic syndrome (MDS), which is frequently encountered in SCNP. Unexpectedly, 22% presented with autoantibodies to neutrophils, compared with <1% in controls. Compared with healthy donors, subjects with ADAN demonstrated significantly lower human cationic antimicrobial protein-18/pro-leucin leucin-37 plasma levels; higher levels of nonclassical, proinflammatory, 6-sulfo LacNac-expressing monocytes; and differentially expressed plasma levels of 28 of the 239 analyzed cytokines related to immunity/inflammation, cell signaling, neutrophil activation, and angiogenesis. Collectively, more severe neutropenia in ADAN than previously assumed may complicate differential diagnoses compared with other SCNPs, and various (auto)immune/inflammatory reactions with a distinct profile may be a cause or consequence of this hereditary neutropenia.
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Affiliation(s)
- Jan Palmblad
- The Hematology Center, Karolinska University Hospital Huddinge and Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ebba Sohlberg
- Center for Infectious Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Christer C. Nilsson
- The Hematology Center, Karolinska University Hospital Huddinge and Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Henric Lindqvist
- The Hematology Center, Karolinska University Hospital Huddinge and Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Deneberg
- The Hematology Center, Karolinska University Hospital Huddinge and Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Paul Ratcliffe
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Clinical Immunology and Transfusion Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Stephan Meinke
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anette Mörtberg
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Monika Klimkowska
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital and Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Höglund
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Clinical Immunology and Transfusion Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Ferrell K, Brown I, Amare A, McNeel TS, Buckman D, Jackson SH. Positive association between adiposity and inflammation in US adults: A cross-sectional study. Clin Obes 2024; 14:e12625. [PMID: 38035625 DOI: 10.1111/cob.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/28/2023] [Accepted: 06/23/2023] [Indexed: 12/02/2023]
Abstract
Identification of biomarkers involved in multifaceted obesity-related inflammatory processes paired with reliable anthropometric measures of visceral adiposity is important for developing epidemiologic screening tools. This retrospective observational study used linear regression models to examine the association between inflammation and visceral fat in a nationally representative sample of 10 655 US adults. Inflammation was measured using a cumulative inflammation index (CII) generated from white blood cell ratios and uric acid. Intra-abdominal adiposity was assessed using sagittal abdominal diameter (SAD). Overall, 67.7%, 18.3%, and 13.9% of adults sampled were normoglycemic, prediabetic, and diabetic, with mean SAD of 21.7 ± 0.11 cm, 24.2 ± 0.14 cm, 26.0 ± 0.18 cm and CII of 4.3 ± 0.05, 4.7 ± 0.09, 5.1 ± 0.09, respectively. For each unit increase in SAD, CII was 0.12 higher (95% CI 0.10, 0.14) in US adults who were normoglycemic, 0.09 higher (95% CI 0.07, 0.12) in prediabetics and 0.10 higher (95% CI 0.07, 0.14) in diabetics. The association between SAD and CII was independent of diabetes status. These findings demonstrate an independent association between adiposity and inflammation, supporting increased visceral fat is associated with increased visceral-associated inflammation. Future studies are needed to define and characterise obesity-related inflammatory mediators and their role in chronic disease risk such as diabetes.
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Affiliation(s)
- Koya Ferrell
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Isaiah Brown
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Abel Amare
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | | | - Dennis Buckman
- Information Management Services, Inc, Calverton, Maryland, USA
| | - Sharon H Jackson
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
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3
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Naccache R, Scemama U, El Ahmadi AA, Habert P, Zieleskiewicz L, Chaumoitre K, Michelet P, Varoquaux A, Di Bisceglie M. Can the use of whole-body CT be reduced in cases of kinetic-based polytrauma patients without a clinical severity criterion? A bi-center retrospective study. Eur J Radiol 2024; 171:111278. [PMID: 38157779 DOI: 10.1016/j.ejrad.2023.111278] [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: 10/25/2023] [Revised: 12/03/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To identify clinical and biological criteria predictive of significant traumatic injury in only kinetic-based polytrauma patients without clinical severity criteria. To propose a decisional algorithm to assist the emergency doctor in deciding whether or not to perform a WBCT in the above population. METHODS Retrospective bi-center study. 1270 patients with high velocity trauma without clinical severity criteria, for whom a WBCT was performed in 2017, were included. Patients with hemodynamic, respiratory or neurological severity criterion or those requiring pre-hospital resuscitation measures were excluded. Our primary endpoint was the identification of a significant lesion, i.e. any lesion that led to hospitalization > 24 h for monitoring or medico-surgical treatment. Data collected were age, sex, mechanism of injury, Glasgow Coma Scale score, number of symptomatic body regions, blood alcohol level, and neutrophil count. RESULTS Multivariate analysis found independent predictors of significant injury: fall > 5 m (OR: 14.36; CI: 2.3-283.4; p = 0.017), Glasgow score = 13 or 14 (OR: 4.40; CI:1.30-18.52; p = 0.027), presence of 2 symptomatic body regions (OR: 10.21; CI: 4.66-23.72; p = 0.05), positive blood alcohol level (OR: 2.81; CI: 1.13-7.33; p = 0.029) and neutrophilic leukocytosis (OR: 8.76; CI: 3.94-21.27; p = 0.01). A composite clinico-biological endpoint predictive of the absence of significant lesion was identified using a Classification and Regression Tree: number of symptomatic regions < 2, absence of Neutrophilic leukocytosis and negative blood alcohol concentration. CONCLUSION A simple triage algorithm was created with the objective of identifying, in high velocity trauma without clinical severity criteria, those without significant traumatic injury.
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Affiliation(s)
- Robin Naccache
- Department of Radiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Ugo Scemama
- Department of Radiology, Saint Joseph Hospital, Marseille, France
| | - Ahmed-Ali El Ahmadi
- Department of Radiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Paul Habert
- Department of Radiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France; CERIMED, Aix Marseille University, Marseille, France; LiiE, Aix Marseille University, Marseille France
| | - Laurent Zieleskiewicz
- Department of Anesthesiology and Critical Care, North Hospital, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, C2VN Marseille, France
| | - Kathia Chaumoitre
- Department of Radiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Pierre Michelet
- Department of Emergency, Timone Hospital, Assistance Publique Hôpitaux de Marseille, France
| | - Arthur Varoquaux
- Department of Radiology, Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Mathieu Di Bisceglie
- Department of Radiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France; CERIMED, Aix Marseille University, Marseille, France; LiiE, Aix Marseille University, Marseille France.
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4
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Fioredda F, Skokowa J, Tamary H, Spanoudakis M, Farruggia P, Almeida A, Guardo D, Höglund P, Newburger PE, Palmblad J, Touw IP, Zeidler C, Warren AJ, Dale DC, Welte K, Dufour C, Papadaki HA. The European Guidelines on Diagnosis and Management of Neutropenia in Adults and Children: A Consensus Between the European Hematology Association and the EuNet-INNOCHRON COST Action. Hemasphere 2023; 7:e872. [PMID: 37008163 PMCID: PMC10065839 DOI: 10.1097/hs9.0000000000000872] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/09/2023] [Indexed: 04/03/2023] Open
Abstract
Neutropenia, as an isolated blood cell deficiency, is a feature of a wide spectrum of acquired or congenital, benign or premalignant disorders with a predisposition to develop myelodysplastic neoplasms/acute myeloid leukemia that may arise at any age. In recent years, advances in diagnostic methodologies, particularly in the field of genomics, have revealed novel genes and mechanisms responsible for etiology and disease evolution and opened new perspectives for tailored treatment. Despite the research and diagnostic advances in the field, real world evidence, arising from international neutropenia patient registries and scientific networks, has shown that the diagnosis and management of neutropenic patients is mostly based on the physicians' experience and local practices. Therefore, experts participating in the European Network for the Innovative Diagnosis and Treatment of Chronic Neutropenias have collaborated under the auspices of the European Hematology Association to produce recommendations for the diagnosis and management of patients across the whole spectrum of chronic neutropenias. In the present article, we describe evidence- and consensus-based guidelines for the definition and classification, diagnosis, and follow-up of patients with chronic neutropenias including special entities such as pregnancy and the neonatal period. We particularly emphasize the importance of combining the clinical findings with classical and novel laboratory testing, and advanced germline and/or somatic mutational analyses, for the characterization, risk stratification, and monitoring of the entire spectrum of neutropenia patients. We believe that the wide clinical use of these practical recommendations will be particularly beneficial for patients, families, and treating physicians.
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Affiliation(s)
| | - Julia Skokowa
- Department of Oncology, Hematology, Immunology, Rheumatology, and Clinical Immunology, University Hospital Tübingen, Germany
| | - Hannah Tamary
- The Rina Zaizov Hematology/Oncology Division, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Michail Spanoudakis
- Department of Hematology, Warrington and Halton Teaching Hospitals NHS foundation Trust, Warrington, United Kingdom
| | - Piero Farruggia
- Pediatric Onco-Hematology, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Antonio Almeida
- Department of Hematology, Hospital da Luz Lisboa, Portugal
- Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Daniela Guardo
- Unit of Hematology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Petter Höglund
- Clinical Immunology and Transfusion Medicine Clinic, Karolinska University Hospital, Stockholm, Sweden
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jan Palmblad
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Ivo P. Touw
- Department of Hematology and Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Cornelia Zeidler
- Department of Oncology, Hematology, Immunology and Bone Marrow Transplantation, Hannover Medical School, Hannover, Germany
| | - Alan J. Warren
- Department of Hematology, University of Cambridge, United Kingdom
- Cambridge Institute for Medical Research, University of Cambridge, United Kingdom
- Wellcome Trust–Medical Research Council Stem Cell Institute, University of Cambridge, United Kingdom
| | | | - Karl Welte
- University Children’s Hospital Tübingen, Germany
| | - Carlo Dufour
- Unit of Hematology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Helen A. Papadaki
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, Heraklion, Greece
- Department of Hematology, University Hospital of Heraklion, Crete, Greece
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5
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Ghosh P, Campos VJ, Vo DT, Guccione C, Goheen-Holland V, Tindle C, Mazzini GS, He Y, Alexandrov LB, Lippman SM, Gurski RR, Das S, Yadlapati R, Curtius K, Sahoo D. AI-assisted discovery of an ethnicity-influenced driver of cell transformation in esophageal and gastroesophageal junction adenocarcinomas. JCI Insight 2022; 7:e161334. [PMID: 36134663 PMCID: PMC9675486 DOI: 10.1172/jci.insight.161334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Although Barrett's metaplasia of the esophagus (BE) is the only known precursor lesion to esophageal adenocarcinomas (EACs), drivers of cellular transformation in BE remain incompletely understood. We use an artificial intelligence-guided network approach to study EAC initiation and progression. Key predictions are subsequently validated in a human organoid model, in patient-derived biopsy specimens of BE, a case-control study of genomics of BE progression, and in a cross-sectional study of 113 patients with BE and EACs. Our model classified healthy esophagus from BE and BE from EACs in several publicly available gene expression data sets (n = 932 samples). The model confirmed that all EACs must originate from BE and pinpointed a CXCL8/IL8↔neutrophil immune microenvironment as a driver of cellular transformation in EACs and gastroesophageal junction adenocarcinomas. This driver is prominent in White individuals but is notably absent in African Americans (AAs). Network-derived gene signatures, independent signatures of neutrophil processes, CXCL8/IL8 expression, and an absolute neutrophil count (ANC) are associated with risk of progression. SNPs associated with changes in ANC by ethnicity (e.g., benign ethnic neutropenia [BEN]) modify that risk. Findings define a racially influenced immunological basis for cell transformation and suggest that BEN in AAs may be a deterrent to BE→EAC progression.
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Affiliation(s)
- Pradipta Ghosh
- Department of Cellular and Molecular Medicine
- Department of Medicine
- HUMANOID Center of Research Excellence, and
- Moores Comprehensive Cancer Center, UCSD, La Jolla, California, USA
| | - Vinicius J. Campos
- Department of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Caitlin Guccione
- Division of Biomedical Informatics, UCSD, La Jolla, California, USA
| | - Vanae Goheen-Holland
- Department of Cellular and Molecular Medicine
- HUMANOID Center of Research Excellence, and
| | - Courtney Tindle
- Department of Cellular and Molecular Medicine
- HUMANOID Center of Research Excellence, and
| | - Guilherme S. Mazzini
- Department of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Surgical Scienceas, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Yudou He
- Department of Cellular and Molecular Medicine
- Moores Comprehensive Cancer Center, UCSD, La Jolla, California, USA
| | - Ludmil B. Alexandrov
- Department of Cellular and Molecular Medicine
- Moores Comprehensive Cancer Center, UCSD, La Jolla, California, USA
| | - Scott M. Lippman
- Department of Medicine
- Moores Comprehensive Cancer Center, UCSD, La Jolla, California, USA
| | - Richard R. Gurski
- Department of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Surgical Scienceas, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Medical School of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Soumita Das
- HUMANOID Center of Research Excellence, and
- Department of Pathology and
| | | | - Kit Curtius
- Department of Medicine
- Moores Comprehensive Cancer Center, UCSD, La Jolla, California, USA
- Division of Biomedical Informatics, UCSD, La Jolla, California, USA
| | - Debashis Sahoo
- Moores Comprehensive Cancer Center, UCSD, La Jolla, California, USA
- Department of Pediatrics and
- Department of Computer Science and Engineering, Jacob’s School of Engineering, UCSD, California, La Jolla, USA
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6
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Oncologic Anthropology: An Interdisciplinary Approach to Understanding the Association Between Genetically Defined African Ancestry and Susceptibility for Triple Negative Breast Cancer. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Hu Y, Bien SA, Nishimura KK, Haessler J, Hodonsky CJ, Baldassari AR, Highland HM, Wang Z, Preuss M, Sitlani CM, Wojcik GL, Tao R, Graff M, Huckins LM, Sun Q, Chen MH, Mousas A, Auer PL, Lettre G, Tang W, Qi L, Thyagarajan B, Buyske S, Fornage M, Hindorff LA, Li Y, Lin D, Reiner AP, North KE, Loos RJF, Raffield LM, Peters U, Avery CL, Kooperberg C. Multi-ethnic genome-wide association analyses of white blood cell and platelet traits in the Population Architecture using Genomics and Epidemiology (PAGE) study. BMC Genomics 2021; 22:432. [PMID: 34107879 PMCID: PMC8191001 DOI: 10.1186/s12864-021-07745-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/26/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Circulating white blood cell and platelet traits are clinically linked to various disease outcomes and differ across individuals and ancestry groups. Genetic factors play an important role in determining these traits and many loci have been identified. However, most of these findings were identified in populations of European ancestry (EA), with African Americans (AA), Hispanics/Latinos (HL), and other races/ethnicities being severely underrepresented. RESULTS We performed ancestry-combined and ancestry-specific genome-wide association studies (GWAS) for white blood cell and platelet traits in the ancestrally diverse Population Architecture using Genomics and Epidemiology (PAGE) Study, including 16,201 AA, 21,347 HL, and 27,236 EA participants. We identified six novel findings at suggestive significance (P < 5E-8), which need confirmation, and independent signals at six previously established regions at genome-wide significance (P < 2E-9). We confirmed multiple previously reported genome-wide significant variants in the single variant association analysis and multiple genes using PrediXcan. Evaluation of loci reported from a Euro-centric GWAS indicated attenuation of effect estimates in AA and HL compared to EA populations. CONCLUSIONS Our results highlighted the potential to identify ancestry-specific and ancestry-agnostic variants in participants with diverse backgrounds and advocate for continued efforts in improving inclusion of racially/ethnically diverse populations in genetic association studies for complex traits.
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Affiliation(s)
- Yao Hu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephanie A Bien
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Katherine K Nishimura
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jeffrey Haessler
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Chani J Hodonsky
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Antoine R Baldassari
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heather M Highland
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zhe Wang
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Preuss
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Colleen M Sitlani
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | | | - Ran Tao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- The Vanderbilt Genetics Institute, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mariaelisa Graff
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura M Huckins
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Quan Sun
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ming-Huei Chen
- The Framingham Heart Study, National Heart, Lung and Blood Institute, Framingham, MA, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Framingham, MA, USA
| | - Abdou Mousas
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul L Auer
- School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Guillaume Lettre
- Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Weihong Tang
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lihong Qi
- School of Medicine, University of California Davis, Davis, CA, USA
| | | | - Steve Buyske
- Department of Statistics and Biostatistics, Rutgers University, Piscataway, NJ, USA
| | - Myriam Fornage
- Brown Foundation Institute for Molecular Medicine, the University of Texas Health Science Center, Houston, TX, USA
| | - Lucia A Hindorff
- Division of Genomic Medicine, NIH National Human Genome Research Institute, Bethesda, MD, USA
| | - Yun Li
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Genetics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Danyu Lin
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexander P Reiner
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Kari E North
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura M Raffield
- Department of Genetics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Christy L Avery
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles Kooperberg
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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8
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Williams BA, Mayer C, McCartney H, Devlin AM, Lamers Y, Vercauteren SM, Wu JK, Karakochuk CD. Detectable Unmetabolized Folic Acid and Elevated Folate Concentrations in Folic Acid-Supplemented Canadian Children With Sickle Cell Disease. Front Nutr 2021; 8:642306. [PMID: 33968971 PMCID: PMC8096995 DOI: 10.3389/fnut.2021.642306] [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: 12/15/2020] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy caused by a variant (rs344) in the HBB gene encoding the β-globin subunit of hemoglobin. Chronic hemolytic anemia and increased erythropoiesis and RBC turnover in individuals with SCD can result in increased needs for folate and other B-vitamins. We assessed B-vitamin status, and the distribution of folate forms, including unmetabolized folic acid (UMFA), in Canadian children with SCD supplemented with 1 mg/d folic acid (current routine practice). Non-fasted serum and plasma samples were analyzed for concentrations of folate, and vitamins B-2, B-6, and B-12. Eleven individuals (45% male; SCD type: HbSS n = 8, HbSC n = 2, HbSβ0-Thal n = 1), with a median (IQR) age of 14 (7, 18) years, were included. Total folate concentrations were 3-27 times above the deficiency cut-off (10 nmol/L), and 64% of children had elevated folate levels (>45.3 nmol/L). UMFA (>0.23 nmol/L) was detected in all children, and 36% of participants had elevated levels of UMFA (>5.4 nmol/L). All children were vitamin B-12 sufficient (>150 pmol/L), and the majority (55%) had sufficient B-6 status (>30 nmol/L). Among this sample of Canadian children with SCD, there was limited evidence of B-vitamin deficiencies, but UMFA was detectable in all children.
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Affiliation(s)
- Brock A Williams
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Cara Mayer
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Heather McCartney
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Angela M Devlin
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Yvonne Lamers
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Suzanne M Vercauteren
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Hematopathology, Department of Pathology and Laboratory Medicine, BC Children's Hospital, Vancouver, BC, Canada
| | - John K Wu
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
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9
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Scappaticcio L, Maiorino MI, Maio A, Esposito K, Bellastella G. Neutropenia in patients with hyperthyroidism: Systematic review and meta-analysis. Clin Endocrinol (Oxf) 2021; 94:473-483. [PMID: 32799342 DOI: 10.1111/cen.14313] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Neutropenia, a low absolute neutrophil count (ANC), may be a sign of new-onset hyperthyroidism. The aim of this systematic review and meta-analysis was to provide the most reliable estimates of prevalence, degree and response to treatments of neutropenia in the pure hyperthyroidism setting. METHODS A comprehensive literature search was performed in PubMed and Scopus databases for retrieving articles in English and non-English languages reporting ANC values/neutropenic cases at presentation and after therapy in patients with hyperthyroidism. A proportion meta-analysis was performed with DerSimonian and Laird method (random-effects model). Pooled data were presented with 95% confidence intervals (95% CI) and displayed in a forest plot. I2 statistic index was used to quantify the heterogeneity among the studies. Sensitivity analyses for the prevalence of neutropenia and the mean of ANC in hyperthyroid patients were performed by excluding the studies without full details. Trim and fill analysis and Egger's linear regression test were carried out to evaluate the publication bias. A two-sided P-value of <.05 was regarded as significant for all analyses. The National Heart, Lung and Blood Institute Quality Assessment Tool was used to evaluate the quality of studies included. RESULTS The literature search yielded 1880 studies of which 13 studies were included for systematic review and meta-analysis. Results of the meta-analysis demonstrated that the prevalence of neutropenia in newly diagnosed and untreated patients with Graves' hyperthyroidism was 10% (CI 5%-19%, I2 88.6%) and summary mean ANC value in neutropenic was 1.4 ± 0.3 × 109 /L. In all neutropenic patients under ATD therapy neutropenia resolved, thus without the worsening of the baseline ANC values or the development of agranulocytosis. The sensitivity analyses showed similar results as those of the main analyses. For all outcomes, the publication bias was not statistically significant or not calculable. CONCLUSIONS Graves' disease per se is associated with neutropenia in about 10% of cases. Neutropenia usually appears as a mild to moderate laboratory abnormality with no detectable consequences. Subnormal/mild neutropenia should not be regarded as a contraindication to use ATDs, and clinicians should know that treating hyperthyroidism they have a significant chance to normalize ANC too.
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Affiliation(s)
- Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, University of Campania "L. Vanvitelli", Naples, Italy
| | - Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, University of Campania "L. Vanvitelli", Naples, Italy
- Department of Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonietta Maio
- Department of Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Katherine Esposito
- Department of Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Bellastella
- Unit of Endocrinology and Metabolic Diseases, University of Campania "L. Vanvitelli", Naples, Italy
- Department of Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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10
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Mpofu R, Otwombe K, Mlisana K, Nchabeleng M, Allen M, Kublin J, McElrath MJ, Bekker LG, Churchyard G, Gray G, Laher F. Benign ethnic neutropenia in a South African population, and its association with HIV acquisition and adverse event reporting in an HIV vaccine clinical trial. PLoS One 2021; 16:e0241708. [PMID: 33481787 PMCID: PMC7822320 DOI: 10.1371/journal.pone.0241708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022] Open
Abstract
Benign ethnic neutropenia (BEN) is defined as a neutrophil count of <1.5×109 cells/L in healthy individuals and is more common in populations of certain ethnicities, e.g. African or Middle Eastern ethnicity. Neutrophil values are commonly included in eligibility criteria for research participation, but little is known about the relationship between BEN, HIV acquisition, and the occurrence of adverse events during clinical trials. We investigated these relationships using data from an HIV vaccine efficacy trial of healthy adults from 5 South African sites. We analysed data from the double-blind, placebo-controlled, randomized trial HVTN 503, and its follow-on study HVTN 503-S to assess the prevalence of BEN, its association with HIV infection, and adverse event reporting. These data were then compared with a time- and age-matched, non-pregnant cohort from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007–2008 in the United States (US). The 739 South African participants had a median age of 22.0 years (interquartile range = 20–26) and 56% (n = 412) were male. Amongst the US cohort of 845 participants, the median age was 26 (IQR: 21–30) and the majority (54%, 457/745) were also male. BEN was present at enrolment in 7.0% (n = 52) of South African participants (6% in the placebo group versus 8% in the vaccine group); 81% (n = 42) of those with BEN were male. Pretoria North had the highest prevalence of BEN (11.6%, 5/43), while Cape Town had the lowest (0.7%, 1/152). Participants with BEN had a lower median neutrophil count (1.3 vs. 3.2x109 cells/L; p<0.001) and BMI (20.8 vs. 22.3 kg/m2; p<0.001) when compared to those without BEN. A greater proportion of Black South Africans had neutrophil counts <1.5×109 cells/L compared to US non-Hispanic Whites from the NHANES cohort (7% [52/739] vs. 0.6% [3/540]; p<0.001). BEN did not increase the odds for HIV infection (adjusted odds ratio [aOR]: 1.364, 95% confidence interval [95% CI]: 0.625–2.976; p = 0.4351). However, female gender (aOR: 1.947, 95% CI: 1.265–2.996; p = 0.0025) and cannabis use (aOR: 2.192, 95% CI: 1.126–4.266; p = 0.0209) increased the odds of HIV acquisition. The incidence rates of adverse events were similar between participants in the placebo group with BEN, and those without: 12.1 (95% CI: 7.3–20.1) vs. 16.5 (95% CI: 14.6–18.7; p = 0.06) events per 100 person-years (py) were noted in the infections and infestations system organ class, respectively. The vaccine group had an event incidence rate of 19.7 (95% CI: 13.3–29.2) vs. 14.8 (95% CI: 13.0–16.8; p = 0.07) events per 100py in the group with, and without BEN, respectively. BEN is more prevalent in Black South Africans compared to US Non-Hispanic Whites. Our data do not support excluding populations from HIV vaccine trials because of BEN. BEN was not associated with increased risk for HIV infection or Adverse events on a vaccine trial. Predictors of HIV infection risk were females and cannabis use, underlying the continued importance of prevention programmes in focusing on these populations.
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Affiliation(s)
- Rephaim Mpofu
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Kennedy Otwombe
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Koleka Mlisana
- National Health Laboratory Service (NHLS), Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Johannesburg, South Africa
| | - Maphoshane Nchabeleng
- Mecru Clinical Research Unit, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Mary Allen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - James Kublin
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - M. Juliana McElrath
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | - Glenda Gray
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Fatima Laher
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
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11
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Noel JM, Jackson CW. ASHP Therapeutic Position Statement on the Use of Antipsychotic Medications in the Treatment of Adults with Schizophrenia and Schizoaffective Disorder. Am J Health Syst Pharm 2020; 77:2114-2132. [PMID: 32871013 PMCID: PMC7499485 DOI: 10.1093/ajhp/zxaa303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Jason M Noel
- University of Maryland School of Pharmacy, Baltimore, MD
| | - Cherry W Jackson
- Auburn University Harrison School of Pharmacy, Auburn, AL.,Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, School of Medicine, Birmingham, AL
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12
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Alkhaldy HY, A. Awan Z, Abouzaid AA, Elbahaie HM, Al Amoudi SM, Andarawi M, F Shehata S. The Prevalence of Isolated Neutropenia at High Altitude in Southern Saudi Arabia: Does Altitude Affect Leucocyte Count? Int J Gen Med 2020; 13:1373-1379. [PMID: 33299343 PMCID: PMC7721288 DOI: 10.2147/ijgm.s284133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Isolated neutropenia is a common problem in hematology practice. Benign ethnic neutropenia (BEN) is the common form of neutropenia worldwide and it affects mainly African and Middle Eastern ethnicities. Most cases of isolated mild and moderate neutropenia are benign and associated with no clinical significance. The aim of this study was to estimate the prevalence of isolated neutropenia at high-altitude southern Saudi Arabia. METHODS A large dataset of complete blood counts (CBCs) was analyzed for walk-in patients of both genders, of age ranges from 12 to 60 years doing blood tests at a commercial lab for high altitude - 2,270 meters above sea level - (HA) group, and from sea level SL group. Abnormal biochemical or CBC results were excluded before analysis. RESULTS For HA group, 3123 CBCs were analyzed and for SL group 18,427 CBCs were analyzed. The prevalence of mild neutropenia, defined as absolute neutrophil count (ANC) in the range of 1.0-.5× 109/L, was 12.4% (n=399) versus 5.6% (n=1025), while moderate neutropenia, defined as ANC of 0.5-1 × 109/L, was present 6% (n=191) versus 1.45% (n=269) in the high altitude and sea level groups, respectively. Severe neutropenia, defined as neutrophil count less than 0.5-1 × 109/L, was rare in both groups. CONCLUSION Isolated neutropenia is common in Saudis living at high altitude. While benign ethnic neutropenia (BEN) is thought to be the major contributing factor to this high prevalence, other factors including environmental factors and altitude are possible contributing factors along with underlying ethnic neutropenia.
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Affiliation(s)
- Husain Y Alkhaldy
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Research Center for Advanced Materials Science, King Khalid University, Abha, Saudi Arabia
| | - Zuhier A. Awan
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia
| | - Ahmed A Abouzaid
- Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia
- Department of Medical Biochemistry, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hossameldin M Elbahaie
- Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia
- Clinical Pathology Department, Suez Canal University, Ismailia, Egypt
| | - Saeed M Al Amoudi
- Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia
| | - Mohamed Andarawi
- Department of Pathology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Shehata F Shehata
- Department of Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
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13
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The DARC-null trait is associated with moderate modulation of NK cell profiles and unaltered cytolytic T cell profiles in black South Africans. PLoS One 2020; 15:e0242448. [PMID: 33211774 PMCID: PMC7676658 DOI: 10.1371/journal.pone.0242448] [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: 05/08/2020] [Accepted: 11/02/2020] [Indexed: 01/01/2023] Open
Abstract
The Duffy Antigen Receptor for Chemokines (DARC)-null trait, common among persons of African descent and associated with lower absolute neutrophil counts (ANCs), may be linked to increased risk to certain infections including HIV-1 but the underlying causes are poorly understood. We hypothesized that DARC-null-linked neutropenia may negatively impact neutrophil immunoregulatory modulation of other immune cells such as natural killer (NK) and CD8+ T cells leading to altered phenotype, functionality and homeostatic activity of these immune cells. HIV-1 uninfected (n = 20) and HIV-1 chronically infected (n = 19) participants were assessed using multi-parametric flow cytometry to determine NK and CD8+ T cell counts, phenotypic profiles, and cytokine production and degranulation. Annexin V and carboxyfluorescein succinimidyl ester (CFSE) staining were used to examine NK cell survival and NK cell and CD8+ T cell proliferation respectively. Participants were genotyped for the DARC-null polymorphism using allelic discrimination assays and ANCs were measured by full blood count. In HIV uninfected individuals, a reduction of total NK cell counts was noted in the absence of DARC and this correlated with lower ANCs. HIV uninfected DARC-null subjects displayed a less mature NK cell phenotype. However, this did not translate to differences in NK cell activation or effector functionality by DARC state. Whilst HIV-1 infected subjects displayed NK cell profiling that is typical of HIV infection, no differences were noted upon DARC stratification. Similarly, CD8+ T cells from HIV infected individuals displayed phenotypic and functional modulation that is characteristic of HIV infection, but profiling was unaffected by the DARC-null variant irrespective of HIV status. Overall, the data suggests that the DARC-null polymorphism and lower ANCs does not impede downstream cytolytic cell priming and functionality.
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14
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Bawua ASA, Ichihara K, Keatley R, Arko-Mensah J, Dei-Adomakoh Y, Ayeh-Kumi PF, Erasmus R, Fobil J. Establishing Ghanaian adult reference intervals for hematological parameters controlling for latent anemia and inflammation. Int J Lab Hematol 2020; 42:705-717. [PMID: 32881316 PMCID: PMC7754426 DOI: 10.1111/ijlh.13296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/12/2020] [Accepted: 06/30/2020] [Indexed: 12/18/2022]
Abstract
Background In Ghana, diagnostic laboratories rely on reference intervals (RIs) provided by manufacturers of laboratory analyzers which may not be appropriate. This study aimed to establish RIs for hematological parameters in adult Ghanaian population. Methods This cross‐sectional study recruited 501 apparently healthy adults from two major urban areas in Ghana based on the protocol by IFCC Committee for Reference Intervals and Decision Limits. Whole blood was tested for complete blood count (CBC) by Sysmex XN‐1000 analyzer, sera were tested for iron and ferritin by Beckman‐Coulter/AU480, for transferrin, vitamin‐B12, and folate was measured by Centaur‐XP/Siemen. Partitioning of reference values by sex and age was guided by “effect size” of between‐subgroup differences defined as standard deviation ratio (SDR) based on ANOVA. RIs were derived using parametric method with application of latent abnormal values exclusion method (LAVE), a multifaceted method of detecting subjects with abnormal results in related parameters. Results Using SDR ≥ 0.4 as a threshold, RIs were partitioned by sex for platelet, erythrocyte parameters except mean corpuscular constants, and iron markers. Application of LAVE had prominent effect on RIs for majority of erythrocyte and iron parameters. Global comparison of Ghanaian RIs revealed lower‐side shift of RIs for leukocyte and neutrophil counts, female hemoglobin and male platelet count, especially compared to non‐African countries. Conclusion The LAVE effect on many hematological RIs indicates the need for deliberate secondary exclusion for proper derivation of RIs. Obvious differences in Ghanaian RIs compared to other countries underscore the importance of country‐specific RIs for improved clinical decision‐making.
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Affiliation(s)
- Abigail S A Bawua
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Legon, Ghana
| | - Kiyoshi Ichihara
- Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | | | - John Arko-Mensah
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Legon, Ghana
| | - Yvonne Dei-Adomakoh
- Medlab Ghana Ltd. (A Member of Synlab), Accra, Ghana.,Department of Hematology, University of Ghana Medical School, College of Health Sciences, Korle-Bu, University of Ghana, Legon, Ghana
| | - Patrick F Ayeh-Kumi
- Department of Microbiology, University of Ghana Medical School, College of Health Sciences, Korle-Bu, University of Ghana, Legon, Ghana
| | - Rajiv Erasmus
- Division of Chemical Pathology, University of Stellenbosch, Cape Town, South Africa
| | - Julius Fobil
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Legon, Ghana
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15
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Palmblad J, Siersma V, Lind B, Bjerrum OW, Hasselbalch H, Andersen CL. Age-related prevalence and clinical significance of neutropenia - isolated or combined with other cytopenias: Real world data from 373 820 primary care individuals. Am J Hematol 2020; 95:521-528. [PMID: 32052479 DOI: 10.1002/ajh.25756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 12/25/2022]
Abstract
Neutropenia (NP), that is, an absolute blood neutrophil count (ANC) <1.5 g/L, accompanies various diseases. However, the clinical significance of NP, detected in routine complete blood cell counts (CBC) in primary care, is poorly characterized. Here, from a primary care resource with ANCs from >370 000 individuals, we identified and followed neutropenic subjects for the next 4 years for novel ICD-10 based diagnoses of viral infections and hematological malignancies (ie, previously identified major outcomes in NP individuals) in Danish nationwide health registers. Risk estimates were assessed for children/adolescents (1-18 years) and adults (19-90 years) in relation to NP severity, and for isolated NP, bi- or pancytopenias. We found that NP was observed in 4.9% of children and in 1.9% of adults. The lower the ANC, the likelier was a diagnosis of viral infections or hematological malignancies established during the ensuing 4 years. Among neutropenic children, unspecified viral infections predominated, followed by mononucleosis (with other cytopenias in only 7% and 25% of the cases, respectively). All NP children with acute leukemia presented with bi- or pancytopenia from start of follow-up. In NP adults, hepatitis, followed by HIV, were the most common infections, and acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDSs) the predominating hematological malignancies. Adult NP patients, subsequently diagnosed with hepatitis, HIV or AML, MDS, were bi- or pancytopenic in 42%, 47%, 90% and 91% of cases, respectively. Thus, presence of NP in even one CBC may be the first sign of a latent viral or hematological disorder requiring careful follow-up.
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Affiliation(s)
- Jan Palmblad
- Department of Hematology and MedicineThe Karolinska Institute at Karolinska University Hospital Huddinge Stockholm Sweden
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public HealthUniversity of Copenhagen Copenhagen Denmark
| | - Bent Lind
- Department of Clinical BiochemistryCopenhagen University Hospital Hvidovre Copenhagen Denmark
| | - Ole Weis Bjerrum
- Department of HematologyCopenhagen University Hospital Rigshospitalet Denmark
| | - Hans Hasselbalch
- Department of HematologyRoskilde University Hospital Herlev Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public HealthUniversity of Copenhagen Copenhagen Denmark
- Department of HematologyCopenhagen University Hospital Rigshospitalet Denmark
- Department of HematologyRoskilde University Hospital Herlev Denmark
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16
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Coates S, Wang D, Pierscionek T, Fernandes S, Djumanov D, Lorch U, Täubel J. Time- and Race-Specific Haematological Reference Intervals for Healthy Volunteer Trials: A Retrospective Analysis of Pooled Data From Multiple Phase I Trials. Front Pharmacol 2020; 11:314. [PMID: 32231575 PMCID: PMC7082321 DOI: 10.3389/fphar.2020.00314] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/03/2020] [Indexed: 01/12/2023] Open
Abstract
Most UK hospitals, laboratories, and research institutions use uniform reference intervals (RI) that do not take into account known diurnal and racial variation in total white blood cells (WBC) count and its constituent parameters. These risks of excluding potentially suitable ethnic minority volunteers from participating in phase I clinical trials could call into question the validity of a trial’s findings or limit its scientific applications and ability to accurately observe drug effects upon WBC parameters. This study pools data from multiple phase I trials, assesses the effects of race and time of day on WBC count, and compares it to the existing literature to establish race and time-specific RIs. A total 13,332 venous blood samples obtained from 7,157 healthy male and female volunteers at the time of screening or admission (predosing) who took part in 35 phase I trials over a period of seven years were pooled and the data were analyzed using generalised estimating equation models. Adjusted RI of total WBC count and its individual parameters were then calculated according to time of day (morning vs. evening) for both black and nonblack populations. This study indicates that black individuals on average had lower total WBC, neutrophil, monocyte, eosinophil, and basophil counts than individuals from nonblack racial groups. Black volunteers had higher mean lymphocyte counts relative to their nonblack counterparts. These differences were deemed statistically significant. Statistically significant increases in total WBC, neutrophil, lymphocyte, and monocyte counts were also observed over the course of daily sampling. Eosinophil counts decreased during this time period, but this finding was only statistically significant in the nonblack population. Despite an observed mild diurnal increase in basophil count in both populations, this was not considered statistically significant. This high-powered study adds significant weight to the known evidence for diurnal and racial variation in WBC parameters. Importantly, it proposes specific RIs that more precisely reflect race and time of day. These could ensure increased participation of black volunteers in clinical trials for improved population representation. Furthermore, the proposed RIs allow for more accurate postdose safety monitoring and reporting, and ensure improved monitoring of postdose WBC count changes.
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Affiliation(s)
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | | | | | - Jörg Täubel
- Richmond Pharmacology, London, United Kingdom.,Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, United Kingdom
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17
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Payne H, Lawrie D, Nieuwoudt M, Cotton MF, Gibb DM, Babiker A, Glencross D, Klein N. Comparison of Lymphocyte Subset Populations in Children From South Africa, US and Europe. Front Pediatr 2020; 8:406. [PMID: 32793531 PMCID: PMC7390891 DOI: 10.3389/fped.2020.00406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Typically, African healthcare providers use immunological reference intervals adopted from Europe and the United States (US). This may be inappropriate in a setting with many differences including exposure to different environmental stimuli and pathogens. We compared immunological reference intervals for children from Europe and the US with South African children to explore whether healthy children living in settings with high rates of infectious diseases have different baseline immunological parameters. Methodology: Blood was taken from 381 HIV-uninfected children aged between 2 weeks and 13 years of age from a Child Wellness Clinic in an informal settlement in Cape Town to establish local hematological and lymphocyte reference intervals for South African children. Flow-cytometry quantified percentage and absolute counts of the B-cells, NK-cells, and T-cells including activated, naïve, and memory subsets. These parameters were compared to three separate studies of healthy children in Europe and the US. Results: Increased activated T-cells, and natural killer cells were seen in the younger age-groups. The main finding across all age-groups was that the ratio of naïve/memory CD4 and CD8 T-cells reached a 1:1 ratio around the first decade of life in healthy South African children, far earlier than in resource-rich countries, where it occurs around the fourth decade of life. Conclusions: This is the largest data set to date describing healthy children from an African environment. These data have been used to create local reference intervals for South African children. The dramatic decline in the naïve/memory ratio of both CD4 and CD8 T-cells alongside increased activation markers may indicate that South African children are exposed to a wider range of environmental pathogens in early life than in resource-rich countries. These marked differences illustrate that reference intervals should be relevant to the population they serve. The implications for the developing pediatric immune system requires further investigation.
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Affiliation(s)
- Helen Payne
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Denise Lawrie
- National Health Laboratory Service, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Nieuwoudt
- Institute for Biomedical Engineering (IBE), Stellenbosch University, Stellenbosch, South Africa
| | - Mark Fredric Cotton
- Family Centre for Research With Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Diana M Gibb
- Clinical Trials Unit, Medical Research Council, London, United Kingdom
| | - Abdel Babiker
- Clinical Trials Unit, Medical Research Council, London, United Kingdom
| | - Debbie Glencross
- National Health Laboratory Service, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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18
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Steensma DP. The Clinical Challenge of Idiopathic Cytopenias of Undetermined Significance (ICUS) and Clonal Cytopenias of Undetermined Significance (CCUS). Curr Hematol Malig Rep 2019; 14:536-542. [DOI: 10.1007/s11899-019-00547-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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19
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Knackstedt SL, Georgiadou A, Apel F, Abu-Abed U, Moxon CA, Cunnington AJ, Raupach B, Cunningham D, Langhorne J, Krüger R, Barrera V, Harding SP, Berg A, Patel S, Otterdal K, Mordmüller B, Schwarzer E, Brinkmann V, Zychlinsky A, Amulic B. Neutrophil extracellular traps drive inflammatory pathogenesis in malaria. Sci Immunol 2019; 4:eaaw0336. [PMID: 31628160 PMCID: PMC6892640 DOI: 10.1126/sciimmunol.aaw0336] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/04/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022]
Abstract
Neutrophils are essential innate immune cells that extrude chromatin in the form of neutrophil extracellular traps (NETs) when they die. This form of cell death has potent immunostimulatory activity. We show that heme-induced NETs are essential for malaria pathogenesis. Using patient samples and a mouse model, we define two mechanisms of NET-mediated inflammation of the vasculature: activation of emergency granulopoiesis via granulocyte colony-stimulating factor production and induction of the endothelial cytoadhesion receptor intercellular adhesion molecule-1. Soluble NET components facilitate parasite sequestration and mediate tissue destruction. We demonstrate that neutrophils have a key role in malaria immunopathology and propose inhibition of NETs as a treatment strategy in vascular infections.
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Affiliation(s)
- Sebastian Lorenz Knackstedt
- Max Planck Institute for Infection Biology, Department of Cellular Microbiology, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Falko Apel
- Max Planck Institute for Infection Biology, Department of Cellular Microbiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Abu-Abed
- Max Planck Institute for Infection Biology, Microscopy Core Facility, Charitéplatz 1, 10117 Berlin, Germany
| | - Christopher A Moxon
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool L69 7BE, UK
| | | | - Bärbel Raupach
- Max Planck Institute for Infection Biology, Department of Cellular Microbiology, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Jean Langhorne
- Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - Renate Krüger
- Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Pneumology, Immunology and Intensive Care, Berlin, Germany
| | - Valentina Barrera
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Simon P Harding
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Aase Berg
- Stavanger University Hospital, Stavanger, Norway
| | - Sam Patel
- Maputo Central Hospital, Maputo, Mozambique
| | - Kari Otterdal
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Benjamin Mordmüller
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Universität Tübingen, Institut für Tropenmedizin, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Evelin Schwarzer
- Department of Oncology, University of Turin, Via Santena 5 bis, 10126 Turin, Italy
| | - Volker Brinkmann
- Max Planck Institute for Infection Biology, Microscopy Core Facility, Charitéplatz 1, 10117 Berlin, Germany
| | - Arturo Zychlinsky
- Max Planck Institute for Infection Biology, Department of Cellular Microbiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Borko Amulic
- Max Planck Institute for Infection Biology, Department of Cellular Microbiology, Charitéplatz 1, 10117 Berlin, Germany.
- University of Bristol, School of Cellular and Molecular Medicine, Bristol BS8 1TD, UK
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20
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Hereditary Susceptibility for Triple Negative Breast Cancer Associated With Western Sub-Saharan African Ancestry. Ann Surg 2019; 270:484-492. [DOI: 10.1097/sla.0000000000003459] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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21
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Atallah-Yunes SA, Ready A, Newburger PE. Benign ethnic neutropenia. Blood Rev 2019; 37:100586. [PMID: 31255364 DOI: 10.1016/j.blre.2019.06.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/09/2019] [Accepted: 06/20/2019] [Indexed: 01/30/2023]
Abstract
Benign ethnic neutropenia (BEN) is one of the most common causes of chronic neutropenia seen in individuals of African, Middle Eastern and West Indian descent, affecting many individuals worldwide. Despite its prevalence, many physicians are not familiar with this benign condition, resulting in unnecessary evaluation and testing for neutropenia in otherwise healthy individuals. Clinically, patients with BEN are at no increased risk of infection despite their neutropenia. Implications of this condition are highlighted in those patients receiving therapies that have a known side effect of neutropenia, most commonly chemotherapy agents. Studies have suggested that disparities in survival among those patients receiving chemotherapy between patients of European decent and African decent may be attributed to measured neutropenia in these populations, questioning whether BEN could be an influential factor. This review encompasses all aspects of benign ethnic neutropenia, providing information about this condition and helping to guide clinical decision-making as to when an aggressive work up and referral are indicated and when it is appropriate to monitor. Additionally, we review the role of genetic studies in identifying the genes related to BEN, summarize the theories that offer the most accepted mechanisms behind the condition, and address the importance of pursuing larger studies to assess the implication of BEN in oncology patients as well as patients taking neutropenia-causing medications.
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Affiliation(s)
- Suheil Albert Atallah-Yunes
- Department of Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01103, USA.
| | - Audrey Ready
- Department of Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01103, USA
| | - Peter E Newburger
- Departments of Pediatrics and Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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22
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Naidoo KK, Ngubane A, Gaza P, Moodley A, Ndung'u T, Thobakgale CF. Neutrophil Effector Functions Are Not Impaired in Duffy Antigen Receptor for Chemokines (DARC)-Null Black South Africans. Front Immunol 2019; 10:551. [PMID: 30972057 PMCID: PMC6443851 DOI: 10.3389/fimmu.2019.00551] [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: 12/03/2018] [Accepted: 02/28/2019] [Indexed: 12/23/2022] Open
Abstract
Neutrophils are well-recognized for their pathogen killing mechanisms and disorders of neutrophil count and function are associated with recurrent infections. The Duffy Antigen Receptor for Chemokines (DARC)-null genotype is predominant in sub-Saharan African ancestry populations and is the major genetic determinant of benign ethnic neutropenia which has been associated with increased risk of Human Immunodeficiency Virus (HIV)-1 acquisition and mother-to-child transmission. However, the impact of DARC-null-linked neutropenia on HIV disease progression remains controversial. While the DARC-null genotype is associated with low numbers of circulating neutrophils, the effects of the polymorphism on neutrophil functions is unknown. We investigated the impact of the DARC-null trait and lower absolute neutrophil counts (ANCs) on key neutrophil effector functions [proteolytic activity within the phagosome following Fc receptor-mediated phagocytosis, reactive oxygen species (ROS) production, and neutrophil extracellular trap (NET) formation] in 20 HIV negative and 22 HIV-1 chronically infected black South Africans. Phagosome maturation was measured by flow cytometry following Fc-mediated uptake of IgG opsonized beads; ROS production was measured by chemi-luminescence after activation of neutrophils with phorbol 12-myristate 13-acetate (PMA). Activated neutrophils were also visualized by fluorescent microscopy for NET quantification. Study subjects were genotyped for the DARC trait using TaqMan allelic discrimination assays and ANCs were measured by full blood count. As expected, the DARC-null polymorphism was highly prevalent in our participant cohort (69%) and was strongly associated with lower ANCs in uninfected (p = 0.0007) and HIV-1 infected (p = 0.03) subjects. We observed enhanced proteolytic activity within the phagosome in the absence of DARC at 10 min (p = 0.05 and p = 0.009) and 60 min (p = 0.05 and p = 0.07) in uninfected and HIV-1 infected subjects, respectively. ROS was unaffected by DARC trait irrespective of HIV status. Furthermore, formation of NETs was reduced in neutrophils from DARC-null subjects (p = 0.04) following prolonged in vitro stimulation, but only in HIV-1 infected subjects. The data indicate differential neutrophil function in the absence of DARC that may be moderately modulated by HIV-1 infection but overall, the data suggest that DARC-null trait is not deleterious to neutrophil effector functions in African populations.
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Affiliation(s)
- Kewreshini K Naidoo
- HIV Pathogenesis Programme, Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Ayanda Ngubane
- HIV Pathogenesis Programme, Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Pedzisai Gaza
- HIV Pathogenesis Programme, Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Amber Moodley
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Thumbi Ndung'u
- HIV Pathogenesis Programme, Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute (AHRI), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.,Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University, Cambridge, MA, United States.,Max Planck Institute for Infection Biology, Berlin, Germany
| | - Christina F Thobakgale
- HIV Pathogenesis Programme, Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.,School of Pathology, National Institute for Communicable Diseases, University of the Witwatersrand, Johannesburg, South Africa
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23
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A genome-wide association study in individuals of African ancestry reveals the importance of the Duffy-null genotype in the assessment of clozapine-related neutropenia. Mol Psychiatry 2019; 24:328-337. [PMID: 30647433 DOI: 10.1038/s41380-018-0335-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/13/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022]
Abstract
Individuals of African ancestry in the United States and Europe are at increased risk of developing schizophrenia and have poorer clinical outcomes. The antipsychotic clozapine, the only licensed medication for treatment-resistant schizophrenia, is under-prescribed and has high rates of discontinuation in individuals of African ancestry, due in part to increased rates of neutropenia. The genetic basis of lower neutrophil levels in those of African ancestry has not previously been investigated in the context of clozapine treatment. We sought to identify risk alleles in the first genome-wide association study of neutrophil levels during clozapine treatment, in 552 individuals with treatment-resistant schizophrenia and robustly inferred African genetic ancestry. Two genome-wide significant loci were associated with low neutrophil counts during clozapine treatment. The most significantly associated locus was driven by rs2814778 (β = -0.9, P = 4.21 × 10-21), a known regulatory variant in the atypical chemokine receptor 1 (ACKR1) gene. Individuals homozygous for the C allele at rs2814778 were significantly more likely to develop neutropenia and have to stop clozapine treatment (OR = 20.4, P = 3.44 × 10-7). This genotype, also termed "Duffy-null", has previously been shown to be associated with lower neutrophil levels in those of African ancestry. Our results indicate the relevance of the rs2814778 genotype for those taking clozapine and its potential as a pharmacogenetic test, dependent on the outcome of additional safety studies, to assist decision making in the initiation and on-going management of clozapine treatment.
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24
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Legge SE, Walters JT. Genetics of clozapine-associated neutropenia: recent advances, challenges and future perspective. Pharmacogenomics 2019; 20:279-290. [PMID: 30767710 PMCID: PMC6563116 DOI: 10.2217/pgs-2018-0188] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Clozapine is the only effective antipsychotic for treatment-resistant schizophrenia but remains widely under prescribed, at least in part due to its potential to cause agranulocytosis and neutropenia. In this article, we provide an overview of the current understanding of the genetics of clozapine-associated agranulocytosis and neutropenia. We now know that the genetic etiology of clozapine-associated neutropenia is complex and is likely to involve variants from several genes including HLA-DQB1, HLA-B and SLCO1B3/SLCO1B7. We describe recent findings relating to the Duffy-null genotype and its association with benign neutropenia in individuals with African ancestry. Further advances will come from sequencing studies, large, cross-population studies and in understanding the molecular mechanisms underlying these associations.
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Affiliation(s)
- Sophie E Legge
- MRC Centre for Neuropsychiatric Genetics & Genomics, Division of Psychological Medicine & Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK
| | - James Tr Walters
- MRC Centre for Neuropsychiatric Genetics & Genomics, Division of Psychological Medicine & Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK
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25
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Koen A, Jose L, Madhi SA, Fix A, Cryz S, Groome MJ. Neutrophil Counts in Healthy South African Infants: Implications for Enrollment and Adverse Event Grading in Clinical Trials in an African Setting. THE JOURNAL OF PEDIATRICS: X 2019; 1:100005. [PMID: 32734176 PMCID: PMC7376988 DOI: 10.1016/j.ympdx.2019.100005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/09/2019] [Accepted: 06/11/2019] [Indexed: 12/22/2022] Open
Abstract
Absolute neutrophil counts are used to assess eligibility and safety during clinical trials but the toxicity grading scale used can affect enrollment and reporting of adverse events. During a trial investigating a parenteral rotavirus vaccine in South Africa, we excluded otherwise healthy infants without HIV infection from participation owing to neutropenia. Trial registration ClinicalTrials.gov: NCT02109484.
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Affiliation(s)
- Anthonet Koen
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Jose
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Michelle J Groome
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
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26
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Yang Y, Guerra CM, Sumrani N. Effect of Age on Leukopenia Following Renal Transplantation at a Single Center. Prog Transplant 2018; 29:54-60. [DOI: 10.1177/1526924818817017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Leukopenia in renal transplant recipients occurs commonly within the first year following transplantation; however, literature on the effects of age on leukopenia is scarce. Design: A single-center, retrospective review was conducted on 141 recipients transplanted from January 2011 to December 2015. Transplant recipients were characterized by age <60 years (n = 94) or age 60 years and older (n = 47) for analysis. Results: A greater incidence of leukopenia was seen in the older cohort compared to the younger cohort (64% vs 55%). Of those patients who developed leukopenia, the older cohort (n = 30) had a higher incidence of hospitalization for leukopenia (30% vs 23%) but a lower incidence of hospitalization for infection (20% vs 25%) compared to the younger cohort (n = 52). Additionally, one month following mycophenolate mofetil (MMF) discontinuation, the older cohort had reduced recovery of their white blood cell count (+263.8% vs +272.5%) and experienced less recurrent leukopenic episodes (50% vs 67%) and rejection episodes (0% vs 22%) compared to the younger cohort, alluding to the need for less immunosuppression. Conclusions: Age at transplantation was not associated with the development of leukopenia; however, older patients had a higher incidence of leukopenia and hospitalization for leukopenia. Dose reduction or discontinuation of MMF should be considered in older kidney transplant recipients who develop leukopenia.
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Affiliation(s)
- Yanmen Yang
- Department of Pharmacy, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Christina M. Guerra
- Department of Pharmacy Practice, University of the Incarnate Word Feik School of Pharmacy, San Antonio, TX, USA
- Department of Surgery, Transplant Center, University of Texas Health Science Center, San Antonio, TX, USA
| | - Nabil Sumrani
- Department of Transplant, SUNY Downstate Medical Center, Brooklyn, NY, USA
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27
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Palmblad J, Höglund P. Ethnic benign neutropenia: A phenomenon finds an explanation. Pediatr Blood Cancer 2018; 65:e27361. [PMID: 30117263 DOI: 10.1002/pbc.27361] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 01/29/2023]
Abstract
Ethnic benign neutropenia (ENP) is the most common form of neutropenia (NP) worldwide, if an absolute blood neutrophil count (ANC) of < 1.5 G/L is used as definition. In 2009, ENP was associated with a gene variation in the ACKR1/DARC gene, the same variation that also confers the Duffy-null trait. In 2017, a novel mechanism for ENP was introduced, questioning if ENP is a true neutropenic state, when the body's total neutrophil count (TBNC) is concerned. Here, we summarize the current knowledge of ENP, asking (1) How well does the peripheral blood ANC predict the TBNC? (2) Can we improve methods for assessing TBNC? (3) Will estimates of TBNC predict infection propensity and reduce the need for further, costly workup?
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Affiliation(s)
- Jan Palmblad
- Department of Medicine Karolinska Institutet, The Hematology Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Petter Höglund
- Department of Medicine Karolinska Institutet, Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital Huddinge, and Center for Hematology and Regenerative Medicine (HERM), Stockholm, Sweden
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28
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Souto Filho JTD, Portugal RD, Nucci M. Effect of circadian variation on neutrophil mobilization to the peripheral blood in benign constitutional neutropenia. Exp Hematol 2018; 69:22-26. [PMID: 30367920 DOI: 10.1016/j.exphem.2018.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
Abstract
Benign constitutional neutropenia (BCN) is an asymptomatic condition characterized by mild chronic neutropenia in patients with no history of recurrent infections. Most patients are referred for further testing, increasing health care costs. We present an alternative form of assessment of individuals with BCN based on neutrophil circadian variation. The objective of this study was to evaluate whether circadian variations of neutrophil counts would result in neutrophil values higher than neutropenia threshold in individuals with BCN. Absolute neutrophil counts (ANCs) were evaluated in 102 patients with BCN (<1500 cells/μL) and 60 age- and sex-matched controls. Paired blood counts were performed in the early morning and in the early afternoon. We observed a significant difference between morning and afternoon ANC in BCN patients (879 cells/μL, 95% CI 745-1028, p < 0.001), as well as in the controls (619 cells/μL, 95% CI 443-796, p < 0.001). The ANC increase between the two evaluations was significantly greater in BCN patients compared with controls: 83% and 27%, respectively (p < 0.001). The ANC increment was higher in the groups with a lower morning ANC: 105%, 63%, and 27% in the <1000, 1000-1500, and >1500 cells/μL groups, respectively (p < 0.001). Of all BCN patients, 73% presented with >1500 cells/μL in the afternoon and 16% improved from the <1000 cells/μL to the 1000-1500 cells/μL category. In conclusion, neutrophil circadian variation measurement allows many BCN patients to be excluded from the neutropenia threshold. We identified a simple, easy, and feasible way to assess neutrophil reserve in patients with BCN with a potential reduction in costs of the assessment.
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Affiliation(s)
- João Tadeu Damian Souto Filho
- University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Faculdade de Medicina de Campos, Campos dos Goytacazes, Rio de Janeiro, Brazil; Instituto Federal de Educação, Ciência e Tecnologia Fluminense, Campos dos Gotyacazes, Rio de Janeiro, Brazil.
| | | | - Marcio Nucci
- University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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29
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Yao S, Hong CC, Ruiz-Narváez EA, Evans SS, Zhu Q, Schaefer BA, Yan L, Coignet MV, Lunetta KL, Sucheston-Campbell LE, Lee K, Bandera EV, Troester MA, Rosenberg L, Palmer JR, Olshan AF, Ambrosone CB. Genetic ancestry and population differences in levels of inflammatory cytokines in women: Role for evolutionary selection and environmental factors. PLoS Genet 2018; 14:e1007368. [PMID: 29879116 PMCID: PMC5991662 DOI: 10.1371/journal.pgen.1007368] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/18/2018] [Indexed: 01/09/2023] Open
Abstract
Selection pressure due to exposure to infectious pathogens endemic to Africa may explain distinct genetic variations in immune response genes. However, the impact of those genetic variations on human immunity remains understudied, especially within the context of modern lifestyles and living environments, which are drastically different from early humans in sub Saharan Africa. There are few data on population differences in constitutional immune environment, where genetic ancestry and environment are likely two primary sources of variation. In a study integrating genetic, molecular and epidemiologic data, we examined population differences in plasma levels of 14 cytokines involved in innate and adaptive immunity, including those implicated in chronic inflammation, and possible contributing factors to such differences, in 914 AA and 855 EA women. We observed significant differences in 7 cytokines, including higher plasma levels of CCL2, CCL11, IL4 and IL10 in EAs and higher levels of IL1RA and IFNα2 in AAs. Analyses of a wide range of demographic and lifestyle factors showed significant impact, with age, education level, obesity, smoking, and alcohol intake, accounting for some, but not all, observed population differences for the cytokines examined. Levels of two pro-inflammatory chemokines, CCL2 and CCL11, were strongly associated with percent of African ancestry among AAs. Through admixture mapping, the signal was pinpointed to local ancestry at 1q23, with fine-mapping analysis refined to the Duffy-null allele of rs2814778. In AA women, this variant was a major determinant of systemic levels of CCL2 (p = 1.1e-58) and CCL11 (p = 2.2e-110), accounting for 19% and 40% of the phenotypic variance, respectively. Our data reveal strong ancestral footprints in inflammatory chemokine regulation. The Duffy-null allele may indicate a loss of the buffering function for chemokine levels. The substantial immune differences by ancestry may have broad implications to health disparities between AA and EA populations.
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Affiliation(s)
- Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Edward A. Ruiz-Narváez
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Sharon S. Evans
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Qianqian Zhu
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Beverly A. Schaefer
- Department of Pediatric Hematology & Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
- Department of Pediatric Hematology & Oncology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, United States of America
| | - Li Yan
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Marie V. Coignet
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Kathryn L. Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | | | - Kelvin Lee
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Elisa V. Bandera
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Melissa A. Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, United States of America
| | - Julie R. Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, United States of America
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
- * E-mail:
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30
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Omuse G, Maina D, Mwangi J, Wambua C, Radia K, Kanyua A, Kagotho E, Hoffman M, Ojwang P, Premji Z, Ichihara K, Erasmus R. Complete blood count reference intervals from a healthy adult urban population in Kenya. PLoS One 2018; 13:e0198444. [PMID: 29879171 PMCID: PMC5991659 DOI: 10.1371/journal.pone.0198444] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are racial, ethnic and geographical differences in complete blood count (CBC) reference intervals (RIs) and therefore it is necessary to establish RIs that are population specific. Several studies have been carried out in Africa to derive CBC RIs but many were not conducted with the rigor recommended for RI studies hence limiting the adoption and generalizability of the results. METHOD By use of a Beckman Coulter ACT 5 DIFF CP analyser, we measured CBC parameters in samples collected from 528 healthy black African volunteers in a largely urban population. The latent abnormal values exclusion (LAVE) method was used for secondary exclusion of individuals who may have had sub-clinical diseases. The RIs were derived by both parametric and non-parametric methods with and without LAVE for comparative purposes. RESULTS Haemoglobin (Hb) levels were lower while platelet counts were higher in females across the 4 age stratifications. The lower limits for Hb and red blood cell parameters significantly increased after applying the LAVE method which eliminated individuals with latent anemia and inflammation. We adopted RIs by parametric method because 90% confidence intervals of the RI limits were invariably narrower than those by the non-parametric method. The male and female RIs for Hb after applying the LAVE method were 14.5-18.7 g/dL and 12.0-16.5 g/dL respectively while the platelet count RIs were 133-356 and 152-443 x10(3) per μL respectively. CONCLUSION Consistent with other studies from Sub-Saharan Africa, Hb and neutrophil counts were lower than Caucasian values. Our finding of higher Hb and lower eosinophil counts compared to other studies conducted in rural Kenya most likely reflects the strict recruitment criteria and healthier reference population after secondary exclusion of individuals with possible sub-clinical diseases.
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Affiliation(s)
- Geoffrey Omuse
- Department of Pathology, Aga Khan University Hospital Nairobi, Nairobi, Kenya
- Division of Chemical Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - Daniel Maina
- Department of Pathology, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | | | | | | | | | - Elizabeth Kagotho
- Department of Pathology, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Mariza Hoffman
- Division of Chemical Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - Peter Ojwang
- Department of Pathology, Maseno University, Maseno, Kenya
| | - Zul Premji
- Formerly of Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Rajiv Erasmus
- Division of Chemical Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
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Neutrophil, lymphocyte and platelet counts, and risk of prostate cancer outcomes in white and black men: results from the SEARCH database. Cancer Causes Control 2018; 29:581-588. [PMID: 29663110 DOI: 10.1007/s10552-018-1031-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 04/10/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Systemic inflammation, as measured by C-reactive protein, has been linked with poor prostate cancer (PC) outcomes, predominantly in white men. Whether other immune measures like white blood cell counts are correlated with PC progression and whether results vary by race is unknown. We examined whether complete blood count (CBC) parameters were associated with PC outcomes and whether these associations varied by race. METHODS Analyses include 1,826 radical prostatectomy patients from six VA hospitals followed through medical record review for biochemical recurrence (BCR). Secondary outcomes included castration-resistant PC (CRPC), metastasis, all-cause mortality (ACM), and PC-specific mortality (PCSM). Cox-proportional hazards were used to assess the associations between pre-operative neutrophils, lymphocytes, platelets, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) with each outcome. We used a Bonferroni-corrected p-value of 0.05/5 = 0.01 as the threshold for statistical significance. RESULTS Of 1,826 men, 794 (43%) were black and 1,032 (57%) white. Neutrophil count (p < 0.001), NLR (p < 0.001), and PLR (p < 0.001) were significantly lower, while lymphocyte count (p < 0.001) was significantly higher in black versus white men. After adjusting for clinicopathological features, no CBC measures were significantly associated with BCR. There were no interactions between CBC and race in predicting BCR. Similarly, no CBC values were significantly associated with CRPC, metastases, or PCSM either among all men or when stratified by race. However, higher neutrophil count was associated with higher ACM risk in white men (p = 0.004). CONCLUSION Pre-operative CBC measures were not associated with PC outcomes in black or white men undergoing radical prostatectomy, except for neutrophils-positive association with risk of ACM in white men. Whether circulating immune cell markers provide insight to the pathophysiology of PC progression or adverse treatment outcomes requires further study.
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Patchan K, Vyas G, Hackman AL, Mackowick M, Richardson CM, Love RC, Wonodi I, Sayer MA, Glassman M, Feldman S, Kelly DL. Clozapine in Reducing Aggression and Violence in Forensic Populations. Psychiatr Q 2018; 89:157-168. [PMID: 28643049 PMCID: PMC5930356 DOI: 10.1007/s11126-017-9521-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Popular media often portray people with a mental illness as being aggressive, violent, and incarcerated as a result of their behavior. Despite exaggeration in the media, risks for some aggressive behaviors are in fact higher in individuals with schizophrenia. This is often the case with influence of comorbid substance use disorders. It is essential that mental health professionals are aware of treatments that may help with attenuating and treating behaviors that contribute to violence, aggression and incarceration. This paper reviews violence and incarceration in individuals with schizophrenia as well as recommendations, guidelines and benefits for the use of clozapine in this population. Clozapine remains one of the most underutilized evidence-based medications available in the psychiatric arena in the United States. It is a viable and recommended option in the forensic population and it may be helpful on the path to recovery as well as bring substantial savings to the criminal justice system.
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Affiliation(s)
- Kathleen Patchan
- Department of Psychiatry, University of Maryland School of Medicine, 630 W Fayette St, Baltimore, MD, 21201, USA
| | - Gopal Vyas
- Spring Grove Hospital and Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD, 21228, USA
| | - Ann L Hackman
- Department of Psychiatry, University of Maryland School of Medicine, 630 W Fayette St, Baltimore, MD, 21201, USA
| | - Marie Mackowick
- Clifton T. Perkins Hospital Center, 8450 Dorsey Run Rd, Jessup, MD, 20794, USA
| | - Charles M Richardson
- Spring Grove Hospital and Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD, 21228, USA
| | - Raymond C Love
- School of Pharmacy, University of Maryland, 20 N Pine St, Baltimore, MD, 21201, USA
| | - Ikwunga Wonodi
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD, 21228, USA
| | - MacKenzie A Sayer
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD, 21228, USA
| | - Matthew Glassman
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD, 21228, USA
| | - Stephanie Feldman
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD, 21228, USA
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD, 21228, USA.
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33
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Corey SJ, Oyarbide U. New monogenic disorders identify more pathways to neutropenia: from the clinic to next-generation sequencing. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:172-180. [PMID: 29222253 PMCID: PMC5912212 DOI: 10.1182/asheducation-2017.1.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Neutrophils are the most common type of leukocyte in human circulating blood and constitute one of the chief mediators for innate immunity. Defined as a reduction from a normal distribution of values, neutropenia results from a number of congenital and acquired conditions. Neutropenia may be insignificant, temporary, or associated with a chronic condition with or without a vulnerability to life-threatening infections. As an inherited bone marrow failure syndrome, neutropenia may be associated with transformation to myeloid malignancy. Recognition of an inherited bone marrow failure syndrome may be delayed into adulthood. The list of monogenic neutropenia disorders is growing, heterogeneous, and bewildering. Furthermore, greater knowledge of immune-mediated and drug-related causes makes the diagnosis and management of neutropenia challenging. Recognition of syndromic presentations and especially the introduction of next-generation sequencing are improving the accuracy and expediency of diagnosis as well as their clinical management. Furthermore, identification of monogenic neutropenia disorders is shedding light on the molecular mechanisms of granulopoiesis and myeloid malignancies.
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Affiliation(s)
- Seth J Corey
- Department of Pediatrics, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | - Usua Oyarbide
- Department of Pediatrics, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
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34
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Rotimi CN, Bentley AR, Doumatey AP, Chen G, Shriner D, Adeyemo A. The genomic landscape of African populations in health and disease. Hum Mol Genet 2017; 26:R225-R236. [PMID: 28977439 PMCID: PMC6075021 DOI: 10.1093/hmg/ddx253] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 12/12/2022] Open
Abstract
A deeper appreciation of the complex architecture of African genomes is critical to the global effort to understand human history, biology and differential distribution of disease by geography and ancestry. Here, we report on how the growing engagement of African populations in genome science is providing new insights into the forces that shaped human genomes before and after the Out-of-Africa migrations. As a result of this human evolutionary history, African ancestry populations have the greatest genomic diversity in the world, and this diversity has important ramifications for genomic research. In the case of pharmacogenomics, for instance, variants of consequence are not limited to those identified in other populations, and diversity within African ancestry populations precludes summarizing risk across different African ethnic groups. Exposure of Africans to fatal pathogens, such as Plasmodium falciparum, Lassa Virus and Trypanosoma brucei rhodesiense, has resulted in elevated frequencies of alleles conferring survival advantages for infectious diseases, but that are maladaptive in modern-day environments. Illustrating with cardiometabolic traits, we show that while genomic research in African ancestry populations is still in early stages, there are already many examples of novel and African ancestry-specific disease loci that have been discovered. Furthermore, the shorter haplotypes in African genomes have facilitated fine-mapping of loci discovered in other human ancestry populations. Given the insights already gained from the interrogation of African genomes, it is imperative to continue and increase our efforts to describe genomic risk in and across African ancestry populations.
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Affiliation(s)
- Charles N. Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Amy R. Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Ayo P. Doumatey
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Guanjie Chen
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Daniel Shriner
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD 20892, USA
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35
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Dual role for atypical chemokine receptor 1 in myeloid cell hematopoiesis and distribution. Cell Mol Immunol 2017. [PMID: 29532789 DOI: 10.1038/cmi.2017.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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36
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Goswami R, Kakkar N, John MJ. Lower Total Leukocyte and Neutrophil Counts in Healthy Young Africans from Uganda. Indian J Hematol Blood Transfus 2017; 34:278-281. [PMID: 29622870 DOI: 10.1007/s12288-017-0866-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/18/2017] [Indexed: 12/26/2022] Open
Abstract
The total leukocyte count (TLC) is an important component of the complete blood count and influences many clinical decisions. The effect of race or ethnicity on TLC is not well known. The African population has been reported to have lower than normal TLC and neutrophil counts. In this study, thirty eight African students referred for medical check up to a tertiary care hospital were included. Complete blood count was done on a three part automated hematology analyzer. Blood smear examination and manual differential count was also done. The control group included 38 age and sex matched healthy individuals. Student t test was used to compare the differences between the groups. The mean TLC in African students (4.95 ± 1.09 × 109/l) was significantly lower (p < 0.0001) than that seen in the control group (7.42 ± 1.7 × 109/l). The mean neutrophil percentage was also lower (49 ± 7.5%) in African students compared to the control group (63.6 ± 9.8%) [p < 0.0001] while lymphocyte percentage was higher (45.2 ± 7.5%) in the African students as compared to the control group (31.0 ± 9.3%) [p < 0.0001]. Absolute neutrophil count was also lower (2.45 ± 0.76 × 109/l) in African students compared to the control group (4.76 ± 1.47 × 109/l) while absolute lymphocyte count was comparable (2.21 ± 0.5 × 109/l vs. 2.26 ± 0.72 × 109/l) [p = 0.7212]. This study has shown lower leukocyte and neutrophil counts in apparently healthy African individuals. Knowledge of this variation from normal white cell and neutrophil counts is important in avoiding unnecessary investigations and influencing therapeutic decisions in these individuals.
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Affiliation(s)
- Ritesh Goswami
- 1Department of Clinical Haematology, Hemato-oncology and Bone Marrow (Stem Cell) Transplantation, Christian Medical College & Hospital, Brown Road, Ludhiana, 141 008 Punjab India
| | - Naveen Kakkar
- 2Department of Pathology, Christian Medical College & Hospital, Ludhiana, 141 008 Punjab India
| | - M Joseph John
- 1Department of Clinical Haematology, Hemato-oncology and Bone Marrow (Stem Cell) Transplantation, Christian Medical College & Hospital, Brown Road, Ludhiana, 141 008 Punjab India
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37
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Duchene J, Novitzky-Basso I, Thiriot A, Casanova-Acebes M, Bianchini M, Etheridge SL, Hub E, Nitz K, Artinger K, Eller K, Caamaño J, Rülicke T, Moss P, Megens RTA, von Andrian UH, Hidalgo A, Weber C, Rot A. Atypical chemokine receptor 1 on nucleated erythroid cells regulates hematopoiesis. Nat Immunol 2017; 18:753-761. [PMID: 28553950 PMCID: PMC5480598 DOI: 10.1038/ni.3763] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/28/2017] [Indexed: 12/14/2022]
Abstract
Healthy individuals of African ancestry have neutropenia that has been linked with the variant rs2814778(G) of the gene encoding atypical chemokine receptor 1 (ACKR1). This polymorphism selectively abolishes the expression of ACKR1 in erythroid cells, causing a Duffy-negative phenotype. Here we describe an unexpected fundamental role for ACKR1 in hematopoiesis and provide the mechanism that links its absence with neutropenia. Nucleated erythroid cells had high expression of ACKR1, which facilitated their direct contact with hematopoietic stem cells. The absence of erythroid ACKR1 altered mouse hematopoiesis including stem and progenitor cells, which ultimately gave rise to phenotypically distinct neutrophils that readily left the circulation, causing neutropenia. Individuals with a Duffy-negative phenotype developed a distinct profile of neutrophil effector molecules that closely reflected the one observed in the ACKR1-deficient mice. Thus, alternative physiological patterns of hematopoiesis and bone marrow cell outputs depend on the expression of ACKR1 in the erythroid lineage, findings with major implications for the selection advantages that have resulted in the paramount fixation of the ACKR1 rs2814778(G) polymorphism in Africa.
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Affiliation(s)
- Johan Duchene
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
| | - Igor Novitzky-Basso
- Blood and Marrow Transplant Unit, Queen Elizabeth University Hospital, Glasgow UK
| | - Aude Thiriot
- Department of Microbiology and Immunobiology and Center for Immune Imaging, Harvard Medical School, Boston, MA, USA
- The Ragon Institute, Cambridge, MA, USA
| | - Maria Casanova-Acebes
- Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Mariaelvy Bianchini
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
| | - S. Leah Etheridge
- Centre for Immunology and Infection, Department of Biology, University of York, Heslington, York, UK
| | - Elin Hub
- Centre for Immunology and Infection, Department of Biology, University of York, Heslington, York, UK
| | - Katrin Nitz
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Katharina Artinger
- Centre for Immunology and Infection, Department of Biology, University of York, Heslington, York, UK
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Kathrin Eller
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jorge Caamaño
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Thomas Rülicke
- Institute of Laboratory Animal Science, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Paul Moss
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Remco T. A. Megens
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
- Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Ulrich H. von Andrian
- Department of Microbiology and Immunobiology and Center for Immune Imaging, Harvard Medical School, Boston, MA, USA
- The Ragon Institute, Cambridge, MA, USA
| | - Andres Hidalgo
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
- Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Christian Weber
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
- Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Antal Rot
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
- Centre for Immunology and Infection, Department of Biology, University of York, Heslington, York, UK
- Center for Advanced Studies, Ludwig-Maximilians-University, Munich, Germany
- Address from July 2017: William Harvey Research Institute, Queen Mary University of London. London, UK
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38
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Jain D, Hodonsky CJ, Schick UM, Morrison JV, Minnerath S, Brown L, Schurmann C, Liu Y, Auer PL, Laurie CA, Taylor KD, Browning BL, Papanicolaou G, Browning SR, Loos RJF, North KE, Thyagarajan B, Laurie CC, Thornton TA, Sofer T, Reiner AP. Genome-wide association of white blood cell counts in Hispanic/Latino Americans: the Hispanic Community Health Study/Study of Latinos. Hum Mol Genet 2017; 26:1193-1204. [PMID: 28158719 DOI: 10.1093/hmg/ddx024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/11/2017] [Indexed: 12/13/2022] Open
Abstract
Circulating white blood cell (WBC) counts (neutrophils, monocytes, lymphocytes, eosinophils, basophils) differ by ethnicity. The genetic factors underlying basal WBC traits in Hispanics/Latinos are unknown. We performed a genome-wide association study of total WBC and differential counts in a large, ethnically diverse US population sample of Hispanics/Latinos ascertained by the Hispanic Community Health Study and Study of Latinos (HCHS/SOL). We demonstrate that several previously known WBC-associated genetic loci (e.g. the African Duffy antigen receptor for chemokines null variant for neutrophil count) are generalizable to WBC traits in Hispanics/Latinos. We identified and replicated common and rare germ-line variants at FLT3 (a gene often somatically mutated in leukemia) associated with monocyte count. The common FLT3 variant rs76428106 has a large allele frequency differential between African and non-African populations. We also identified several novel genetic loci involving or regulating hematopoietic transcription factors (CEBPE-SLC7A7, CEBPA and CRBN-TRNT1) associated with basophil count. The minor allele of the CEBPE variant associated with lower basophil count has been previously associated with Amerindian ancestry and higher risk of acute lymphoblastic leukemia in Hispanics. Together, these data suggest that germline genetic variation affecting transcriptional and signaling pathways that underlie WBC development and lineage specification can contribute to inter-individual as well as ethnic differences in peripheral blood cell counts (normal hematopoiesis) in addition to susceptibility to leukemia (malignant hematopoiesis).
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Affiliation(s)
- Deepti Jain
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Chani J Hodonsky
- Department of Epidemiology, University of North Carolina Gillings School of Public Health, Chapel Hill, NC 27514, USA
| | - Ursula M Schick
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,The Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98195, USA
| | - Jean V Morrison
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Sharon Minnerath
- Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Lisa Brown
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Claudia Schurmann
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,The Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yongmei Liu
- Department of Epidemiology and Prevention, School of Medicine, Wake Forest University, Winston-Salem, NC 27101, USA
| | - Paul L Auer
- Department of Biostatistics, Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, WI 53201, USA
| | - Cecelia A Laurie
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences at Harbor-UCLA Medical Center, Torrance, CA 90502, USA.,Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Brian L Browning
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - George Papanicolaou
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD 20824, USA
| | - Sharon R Browning
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,The Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kari E North
- Department of Epidemiology, University of North Carolina Gillings School of Public Health, Chapel Hill, NC 27514, USA.,Department of Genetics, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Bharat Thyagarajan
- Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Cathy C Laurie
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Timothy A Thornton
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Tamar Sofer
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Alexander P Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98195, USA
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Kushnir M, Cohen HW, Billett HH. Persistent neutrophilia is a marker for an increased risk of venous thrombosis. J Thromb Thrombolysis 2017; 42:545-51. [PMID: 27383828 DOI: 10.1007/s11239-016-1398-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In patients with cancer and myeloproliferative disorders, leukocytosis has been associated with an increased venous thromboembolic (VTE) risk. Our goal was to determine whether persistent neutrophilia (PN), not associated with known causes such as malignancies, infections or steroids, is independently associated with VTE. All adult patients with >3 outpatient complete blood counts (CBCs) within 3 years were included. PN was defined as having an absolute neutrophil count >95 % (>2SD) of the population (≥7.8 × 10(9)/L) on at least three CBCs, at least 2 months apart. Separate analyses for neutrophil counts ≥9 × 10(9)/L and ≥10 × 10(9)/L were also performed. Blood counts from inpatients were excluded. Primary outcome was diagnosis of VTE, as determined by ICD-9 codes. Odds ratios were adjusted for diabetes, smoking, obesity, gender, and age. Charlson score was utilized as a morbidity measure. Data on 43,538 outpatients were collected. Although there was no association of VTE with neutrophil counts ≥7.8 × 10(9)/L, patients with ≥9.0 × 10(9)/L neutrophils were twice as likely to be diagnosed with VTE compared to those with normal neutrophil counts (OR 2.0, 95 % CI 1.3, 3.1; p = 0.003). Patients with neutrophil counts ≥10.0 × 10(9)/L were at an even higher risk (OR 2.3, 95 % CI 1.2, 4.8; p = 0.019). Charlson scores significantly modified this risk when incorporated into analysis. Elevated neutrophil counts are associated with an increased risk of venous thrombosis even when they are not due to cancer, infection or steroids. In patients with significant comorbidities, neutrophilia may be a marker of VTE risk.
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Affiliation(s)
- Margarita Kushnir
- Division of Hematology, Department of Oncology, Montefiore Medical Center and The Albert Einstein College of Medicine, 3411 Wayne Avenue, Bronx, NY, 10467, USA.
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Henny H Billett
- Division of Hematology, Department of Oncology, Montefiore Medical Center and The Albert Einstein College of Medicine, 3411 Wayne Avenue, Bronx, NY, 10467, USA
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40
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Abstract
PURPOSE OF REVIEW Neutropenia lasting for at least for 3 months and not attributable to drugs or a specific genetic, infectious, inflammatory, autoimmune or malignant cause is called chronic idiopathic neutropenia (CIN). CIN and autoimmune neutropenia (AIN) are very similar and overlapping conditions. The clinical consequences depend upon the severity of neutropenia, but it is not considered a premalignant condition. RECENT FINDINGS Long-term observational studies in children indicate that the disease often lasts for 3-5 years in children, then spontaneously remits, but it rarely remits in adult cases. The value of antineutrophil antibody testing in both children and adults is uncertain. Most recent data suggest that CIN and AIN are immune-mediated diseases, but there are no new clinical or genetic tests to aid in diagnosis. Treatment with granulocyte colony stimulating factor (G-CSF) is effective to increase blood neutrophils in almost all cases; this treatment is reserved, however, for patients with both neutropenia and evidence of recurrent fevers, inflammatory symptoms and infections. There is little or no evidence to indicate that G-CSF treatment predisposes to myeloid malignancies in this population. SUMMARY It is important to recognize CIN and AIN, the most common causes of chronic neutropenia in both children and adults. If the neutropenia is not severe, that is more than 0.5 × 10/l, most patients can be observed and not treated prophylactically with antibiotics or a growth factor. When neutropenia is severe, treatment with G-CSF is often beneficial.
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Affiliation(s)
- David C. Dale
- University of Washington, Department of Medicine, Seattle, WA
| | - Audrey Anna Bolyard
- Severe Chronic Neutropenia International Registry, University of Washington, Department of Medicine, Seattle, WA
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41
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Abstract
This review of hematology in Africa highlights areas of current practice and the immediate needs for development and clinical research. Acute hematological practice is dominated by anemia, sickle cell disease, and the need to provide a safe and rapidly available supply of blood. There is a growing need for specialist services for bleeding and coagulation, hematological malignancy, and palliative care. There are many areas of practice where straightforward measures could yield large gains in patient care. There is an urgent need for good clinical research to describe the epidemiology, natural history, and management of hematological diseases in Africa.
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Affiliation(s)
- Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar-es-Salaam, Tanzania
| | - David J Roberts
- Radcliffe Department of Medicine, University of Oxford, National Health Service Blood and Transplant, John Radcliffe Hospital, Oxford OX3 9BQ, UK.
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42
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Tricta F, Uetrecht J, Galanello R, Connelly J, Rozova A, Spino M, Palmblad J. Deferiprone-induced agranulocytosis: 20 years of clinical observations. Am J Hematol 2016; 91:1026-31. [PMID: 27415835 PMCID: PMC5129477 DOI: 10.1002/ajh.24479] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 11/09/2022]
Abstract
Use of the iron chelator deferiprone for treatment of iron overload in thalassemia patients is associated with concerns over agranulocytosis, which requires weekly absolute neutrophil counts (ANC). Here, we analyze all episodes of agranulocytosis (n = 161) and neutropenia (n = 250) during deferiprone use in clinical trials (CT) and postmarketing surveillance programs (PMSP). Rates of agranulocytosis and neutropenia in CT were 1.5% and 5.5%, respectively. Of the agranulocytosis cases, 61% occurred during the first 6 months of therapy and 78% during the first year. These events appeared to be independent of dose, and occurred three times more often in females than males. Their duration was not significantly shortened by use of G‐CSF. No patient with baseline neutropenia (n = 12) developed agranulocytosis during treatment, which raises questions about the validity of prior neutropenia as a contraindication to use. Only 1/7 novel neutropenia cases in CT progressed to agranulocytosis with continued treatment, indicating that neutropenia does not necessarily lead to agranulocytosis. The agranulocytosis fatality rate was 0% in CT and 15/143 (11%) in PMSP. Rechallenge with deferiprone produced agranulocytosis in 75% of patients in whom the event had already occurred, and in 10% with previous neutropenia. Weekly ANC monitoring allows early detection and interruption of therapy, but does not prevent agranulocytosis from occurring. Its relevance appears to decrease after the first year of therapy, when agranulocytosis occurs less often. Based upon analysis of data collected over the past 20 years, it appears that patient education may be the key to minimizing agranulocytosis‐associated risks during deferiprone therapy. Am. J. Hematol. 91:1026–1031, 2016. © 2016 The Authors. American Journal of Hematology Published by Wiley Periodicals, Inc.
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Affiliation(s)
| | - Jack Uetrecht
- Leslie Dan Faculty of PharmacyUniversity of TorontoToronto Ontario Canada
| | - Renzo Galanello
- Ospedale Regionale per la Microcitemia, ASL8, Cagliari Italy
| | | | | | | | - Jan Palmblad
- Departments of Medicine and HematologyKarolinska Institutet, Karolinska University Hospital HuddingeStockholm Sweden
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Tandeter H, Glick K, Moser A. Neutropenia and eosinophilia among Ethiopian immigrants to Israel: Familial or environmental? Eur J Gen Pract 2016; 22:213-218. [PMID: 27461131 DOI: 10.1080/13814788.2016.1206071] [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] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Due to trends of population movements, Israeli family physicians are treating increasing numbers of African immigrants from Ethiopia. These immigrants were found to have complete blood counts (CBC) that are different from other ethnic groups, with a higher prevalence of eosinophilia and neutropenia. OBJECTIVES To evaluate haematological findings in an attempt to define whether they behave as familial (genetic) or environmental. METHODS Retrospective chart review of 300 patients from a primary care clinic: 100 individuals of Ethiopian heritage born in Ethiopia (EE); 100 individuals of Ethiopian heritage born in Israel, whose parents were born in Ethiopia (EI), and a control group of 100 patients who were not of Ethiopian heritage (C). RESULTS Absolute eosinophilia (greater than 500/dl) was found in 13% of the EE study group significantly higher than the two other groups (P < 0.05), with no difference between EI and C. neutropenia (defined as less than 1500/dl) was found in 32% of EE group, 20% of EI, and 1% of C (P < 0.01). CONCLUSION On the one hand, findings point to a marked environmental influence on the eosinophilic response (most probably due to intestinal parasites present in immigrants from Ethiopia). On the other hand, a familial-genetic nature is probably the reason for the higher prevalence of neutropenia in this population, although some environmental influence may play a role. The knowledge of these findings may be useful for physicians treating people migrating from Africa.
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Affiliation(s)
- Howard Tandeter
- a Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care , Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Karina Glick
- b Department of Internal Medicine C , Ha'emek Medical Center , Afula , Israel
| | - Asher Moser
- c Department of Pediatric Hematology-Oncology , Soroka University Medical Center , Beer-Sheva , Israel
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Andersen CL, Tesfa D, Siersma VD, Sandholdt H, Hasselbalch H, Bjerrum OW, Felding P, Lind B, Olivarius NDF, Palmblad J. Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study. J Intern Med 2016; 279:566-75. [PMID: 26791682 DOI: 10.1111/joim.12467] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neutropenia, defined as an absolute blood neutrophil count (ANC) <1.5 G L(-1) , may accompany a variety of diseases. However, the clinical significance of neutropenia detected in a routine complete blood cell count is poorly understood. METHODS Using a primary care resource, comprising more than 370 000 individuals, we assessed the association with a number of previously recognized conditions as well as all-cause mortality in the 4 years following the identification of neutropenia. By matching laboratory data with Danish nationwide health registers, risk estimates were assessed. RESULTS Neutropenia was observed in approximately 1% of all individuals and was associated dose dependently with viral infections, haematological malignancies (but not autoimmune disorders or solid cancers) and mortality. Neutropenia was particularly associated with HIV, acute leukaemias and myelodysplastic syndromes. Odds ratios [95% confidence interval (CI)] for viral infections were 2.32 (1.84-2.91), 2.80 (2.20-3.57) and 4.77 (3.22-7.07) for subnormal (≥1.5-1.8 G L(-1) ), mild (≥1.0-1.5 G L(-1) ) and moderate-severe (≥0.0-1.0 G L(-1) ) neutropenic individuals, respectively (all P < 0.001). Likewise, odds ratios (95% CI) for haematological malignancies were 3.23 (2.35-4.45), 8.69 (6.58-11.47) and 46.03 (33.98-62.35 ), for the same neutropenia levels, respectively (all P < 0.001). Thus, the lower the ANC, the greater the likelihood of these diseases. The relative risk estimates observed for severe neutropenia corresponded to absolute risks of haematological malignancies and mortality from any cause of 40% and >50%, respectively. CONCLUSIONS Neutropenia is an ominous sign necessitating careful follow-up. The risk estimates presented here support focusing attention to viral diseases and haematological malignancies when neutropenia is observed.
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Affiliation(s)
- C L Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
| | - D Tesfa
- Departments of Hematology and Medicine, The Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - V D Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - H Sandholdt
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - H Hasselbalch
- Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
| | - O W Bjerrum
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - P Felding
- The Elective Laboratory of the Capital Region, Copenhagen, Denmark
| | - B Lind
- The Elective Laboratory of the Capital Region, Copenhagen, Denmark
| | - Niels de F Olivarius
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J Palmblad
- Departments of Hematology and Medicine, The Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
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Denic S, Narchi H, Al Mekaini LA, Al-Hammadi S, Al Jabri ON, Souid AK. Prevalence of neutropenia in children by nationality. BMC HEMATOLOGY 2016; 16:15. [PMID: 27213048 PMCID: PMC4875641 DOI: 10.1186/s12878-016-0054-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/14/2016] [Indexed: 01/15/2023]
Abstract
Background A high prevalence of neutropenia has been reported in several ethnic groups amongst whom many healthy individuals with low neutrophil counts undergo unnecessary investigations. This study aims to ascertain the prevalence of neutropenia (NP) in a large cohort of children from North African, Middle Eastern, and Asian countries residing in the United Arab Emirates. Methods Neutrophil counts of 26,542 children (one day to six years of age) from 86 countries were analyzed. The subjects were enrolled in the Well-Child-Care program of Ambulatory Health Services of Emirate of Abu Dhabi, United Arab Emirates. NP was defined as a neutrophil count <1.5 × 109/L and severe NP <0.5 × 109/L. Results The neutrophil counts reached a nadir in the fourth week of life and changed slightly from the age of six-months to six-years. The frequency of NP was (from West-to-East): North African Arabs 15.4 %, Green Crescent Arabs 9.8 %, Peninsular Arabs 10.9 %, Iranians 3.1 %, Afghanis 2.5 %, Pakistanis 5.6 %, Indians 10.2 %, and Filipinos 7.3 %. The frequency of severe NP in North African Arabs (Sudanese) was 2.8 %, Green Crescent and Peninsular Arabs ≤1 %, Indians 1.5 %, and Filipinos 1.8 %. In 12,703 Emirati children, the frequency of NP was 10.6 % similar to their adult counterparts. Conclusion The prevalence of childhood NP varied considerably by geoethnicity. Measures to prevent the inappropriate investigations of healthy children with benign neutropenia are proposed. Electronic supplementary material The online version of this article (doi:10.1186/s12878-016-0054-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Srdjan Denic
- Department of Medicine, College of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al-Ain, United Arab of Emirates
| | - Hassib Narchi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab of Emirates
| | - Lolowa A Al Mekaini
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab of Emirates
| | - Suleiman Al-Hammadi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab of Emirates
| | - Omar N Al Jabri
- Ambulatory Healthcare Services, Abu Dhabi, United Arab of Emirates
| | - Abdul-Kader Souid
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab of Emirates
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Abstract
Benign ethnic neutropenia (BEN) is an asymptomatic condition reported in adults of African and Middle Eastern descent. The clinical description in children is currently lacking. In our urban outpatient pediatric hematology clinic, the median neutrophil count of children with BEN was lower than previous reports in adults at 893×10 cells/L, but increased with older age. There was an equal male to female ratio and 24% of our BEN children reported ethnicities other than African or Middle Eastern. Children with BEN had a clinical course comparable with other healthy children including otherwise normal blood counts, except for mild anemia.
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Blood Group Antigens C, Lub and P1 May Have a Role in HIV Infection in Africans. PLoS One 2016; 11:e0149883. [PMID: 26900853 PMCID: PMC4764295 DOI: 10.1371/journal.pone.0149883] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Botswana is among the world's countries with the highest rates of HIV infection. It is not known whether or not this susceptibility to infection is due to genetic factors in the population. Accumulating evidence, however, points to the role of erythrocytes as potential mediators of infection. We therefore sought to establish the role, if any, of some erythrocyte antigens in HIV infection in a cross-section of the population. METHODS 348 (346 HIV-negative and 2 HIV-positive) samples were obtained from the National Blood Transfusion Service as residual samples, while 194 HIV-positive samples were obtained from the Botswana-Harvard HIV Reference Laboratory. Samples were grouped for twenty three antigens. Chi-square or Fischer Exact analyses were used to compare the frequencies of the antigens in the two groups. A stepwise, binary logistic regression was used to study the interaction of the various antigens in the light of HIV-status. RESULTS The Rh antigens C and E were associated with HIV-negative status, while blood group Jka, P1 and Lub were associated with HIV-positive status. A stepwise binary logistic regression analysis yielded group C as the most significant protective blood group while Lub and P1 were associated with significantly higher odds ratio in favor of HIV-infection. The lower-risk-associated group C was significantly lower in Africans compared to published data for Caucasians and might partially explain the difference in susceptibility to HIV-1. CONCLUSION The most influential antigen C, which also appears to be protective, is significantly lower in Africans than published data for Caucasians or Asians. On the other hand, there appear to be multiple antigens associated with increased risk that may override the protective role of C. A study of the distribution of these antigens in other populations may shed light on their roles in the HIV pandemic.
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Palmblad J, Nilsson CC, Höglund P, Papadaki HA. How we diagnose and treat neutropenia in adults. Expert Rev Hematol 2016; 9:479-87. [PMID: 26778239 DOI: 10.1586/17474086.2016.1142867] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neutropenias (NPs), being acute and often transient, or chronic, range from life-threatening conditions with very low absolute neutrophil blood counts (ANC) to disorders characterized by only mild NP and of no obvious significance for health. Many are caused by genetic variations/mutations, e.g. the benign familial NP and the chronic severe NPs (e.g. Kostmann disease). Some of the latter are associated with various bodily malformations. Many of the mild-to-moderate NPs are signs of underlying disorders that need specialized treatments (e.g. HIV, hepatitis, autoimmune disorders, the large granular lymphocyte syndrome). We provide here means for the evaluation of a previously unknown NP, suggest a triage and treatments.
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Affiliation(s)
- Jan Palmblad
- a Departments of Medicine and Hematology , The Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Christer C Nilsson
- a Departments of Medicine and Hematology , The Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Petter Höglund
- b Center for Hematology and Regenerative Medicine (HERM), Departments of Hematology and Clinical Immunology and Transfusion Medicine , Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Helen A Papadaki
- c Department of Hematology , University of Crete Medical School , Heraklion , Greece
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Davis MB, Walens A, Hire R, Mumin K, Brown AM, Ford D, Howerth EW, Monteil M. Distinct Transcript Isoforms of the Atypical Chemokine Receptor 1 (ACKR1)/Duffy Antigen Receptor for Chemokines (DARC) Gene Are Expressed in Lymphoblasts and Altered Isoform Levels Are Associated with Genetic Ancestry and the Duffy-Null Allele. PLoS One 2015; 10:e0140098. [PMID: 26473357 PMCID: PMC4608815 DOI: 10.1371/journal.pone.0140098] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022] Open
Abstract
The Atypical ChemoKine Receptor 1 (ACKR1) gene, better known as Duffy Antigen Receptor for Chemokines (DARC or Duffy), is responsible for the Duffy Blood Group and plays a major role in regulating the circulating homeostatic levels of pro-inflammatory chemokines. Previous studies have shown that one common variant, the Duffy Null (Fy-) allele that is specific to African Ancestry groups, completely removes expression of the gene on erythrocytes; however, these individuals retain endothelial expression. Additional alleles are associated with a myriad of clinical outcomes related to immune responses and inflammation. In addition to allele variants, there are two distinct transcript isoforms of DARC which are expressed from separate promoters, and very little is known about the distinct transcriptional regulation or the distinct functionality of these protein isoforms. Our objective was to determine if the African specific Fy- allele alters the expression pattern of DARC isoforms and therefore could potentially result in a unique signature of the gene products, commonly referred to as antigens. Our work is the first to establish that there is expression of DARC on lymphoblasts. Our data indicates that people of African ancestry have distinct relative levels of DARC isoforms expressed in these cells. We conclude that the expression of both isoforms in combination with alternate alleles yields multiple Duffy antigens in ancestry groups, depending upon the haplotypes across the gene. Importantly, we hypothesize that DARC isoform expression patterns will translate into ancestry-specific inflammatory responses that are correlated with the axis of pro-inflammatory chemokine levels and distinct isoform-specific interactions with these chemokines. Ultimately, this work will increase knowledge of biological mechanisms underlying disparate clinical outcomes of inflammatory-related diseases among ethnic and geographic ancestry groups.
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Affiliation(s)
- Melissa B. Davis
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
- Department of Molecular Biology and Biochemistry, Georgia Regents University–University of Georgia Medical Partnership, Athens, GA, United States of America
- * E-mail: (MD); (MM)
| | - Andrea Walens
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
| | - Rupali Hire
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
| | - Kauthar Mumin
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
| | - Andrea M. Brown
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
| | - DeJuana Ford
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
| | - Elizabeth W. Howerth
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, United States of America
| | - Michele Monteil
- Department of Molecular Biology and Biochemistry, Georgia Regents University–University of Georgia Medical Partnership, Athens, GA, United States of America
- * E-mail: (MD); (MM)
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Ngo S, Benhamou Y, Armengol G, Sauvêtre G, Cailleux-Talbot N, Massy N, Buchonnet G, Lévesque H. [Agranulocytosis related to fluindione: A case report]. Rev Med Interne 2015; 37:58-61. [PMID: 26096756 DOI: 10.1016/j.revmed.2015.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/25/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION While in most countries warfarin is the preferred anti-vitamin K, fluindione, a molecule with a prolonged half-life remains largely prescribed in France. Some of its side effects, including immuno-allergic complications, remain poorly understood. CASE REPORT A 77-year-old woman presented with a febrile severe neutropenia of immunoallergic mechanism with a favourable outcome associated with fluindione, introduced 25 days earlier for the treatment of atrial fibrillation. CONCLUSION This rare side effect is a reminder of the importance of biological monitoring in the first weeks following the introduction of fluindione and key diagnostic elements and therapeutic aspects of iatrogenic agranulocytosis.
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Affiliation(s)
- S Ngo
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - Y Benhamou
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Armengol
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Sauvêtre
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - N Cailleux-Talbot
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - N Massy
- Pharmacovigilance, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Buchonnet
- Hématologie biologique, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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