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Kumari A, Chauhan G, Chaudhuri PK, Kumari S, Prasad A. Genetic Variants Associated with the Risk of Stroke in Sickle Cell Anemia: Systematic Review and Meta-Analysis. Hemoglobin 2024; 48:101-112. [PMID: 38637280 DOI: 10.1080/03630269.2024.2340685] [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: 09/22/2023] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
Sickle cell anemia (SCA) is the most common cause of stroke in children. As it is a rare disease, studies investigating the association with complications like stroke in SCD have small sample sizes. Here, we performed a systematic review and meta-analysis of the studies exploring an association of genetic variants with stroke to get a better indication of their association with stroke. PubMed and Google Scholar were searched to identify studies that had performed an association analysis of genetic variants for the risk of stroke in SCA patients. After screening of eligible studies, summary statistics of association analysis with stroke and other general information were extracted. Meta-analysis was performed using the fixed effect method on the tool METAL and forest plots were plotted using the R program. The random effect model was performed as a sensitivity analysis for loci where significant heterogeneity was observed. 407 studies were identified using the search term and after screening 37 studies that cumulatively analyzed 11,373 SCA patients were included. These 37 studies included a total of 2,222 SCA patients with stroke, predominantly included individuals of African ancestry (N = 16). Three of these studies performed whole exome sequencing while 35 performed single nucleotide-based genotyping. Though the studies reported association with 132 loci, meta-analyses could be performed only for 12 loci that had data from two or more studies. After meta-analysis we observed that four loci were significantly associated with risk for stroke: -α3.7 kb Alpha-thalassemia deletion (P = 0.00000027), rs489347-TEK (P = 0.00081), rs2238432-ADCY9 (P = 0.00085), rs11853426-ANXA2 (P = 0.0034), and rs1800629-TNF (P = 0.0003396). Ethnic representation of regions with a high prevalence of SCD like the Mediterranean basin and India needs to be improved for genetic studies on associated complications like stroke. Larger genome-wide collaborative studies on SCD and associated complications including stroke need to be performed.
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Affiliation(s)
- Aradhana Kumari
- Department of Genetics and Genomics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Ganesh Chauhan
- Department of Genetics and Genomics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- Central Research Facility, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Partha Kumar Chaudhuri
- Department of Paediatrics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sushma Kumari
- Department of Transfusion Medicine and Blood Centre, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Anupa Prasad
- Department of Genetics and Genomics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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Connes P. Blood rheology and vascular function in sickle cell trait and sickle cell disease: From pathophysiological mechanisms to clinical usefulness. Clin Hemorheol Microcirc 2024; 86:9-27. [PMID: 38073384 DOI: 10.3233/ch-238122] [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] [Indexed: 02/24/2024]
Abstract
Sickle cell disease (SCD) is an autosomal recessive disorder. Although the molecular mechanisms at the origin of SCD have been well characterized, its clinical expression is highly variable. SCD is characterized by blood rheological abnormalities, increased inflammation and oxidative stress, and vascular dysfunction. Individuals with only one copy of the mutated β-globin gene have sickle cell trait (SCT) and are usually asymptomatic. The first part of this review focuses on the biological responses of SCT carriers during exercise and on the effects of combined SCT and diabetes on vascular function, several biomarkers and clinical complications. The second part of the review focuses on SCD and shows that the magnitude of red blood cell (RBC) rheological alterations is highly variable from one patient to another, and this variability reflects the clinical and hematological variability: patients with the less deformable RBCs have high hemolytic rate and severe anemia, and are prone to develop leg ulcers, priapism, cerebral vasculopathy, glomerulopathy or pulmonary hypertension. In contrast, SCD patients characterized by the presence of more deformable RBCs (but still rigid) are less anemic and may exhibit increased blood viscosity, which increases the risk for vaso-occlusive events. Several genetic and cellular factors may modulate RBC deformability in SCD: co-existence of α-thalassemia, fetal hemoglobin level, oxidative stress, the presence of residual mitochondria into mature RBCs, the activity of various non-selective cationic ion channels, etc. The last part of this review presents the effects of hydroxyurea and exercise training on RBC rheology and other biomarkers in SCD.
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Affiliation(s)
- Philippe Connes
- Laboratory LIBM EA7424, University of Lyon 1, "Vascular Biology and Red Blood Cell" Team, Lyon, France
- Laboratory of Excellence Labex GR-Ex, Paris, France
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Mawson AR. Understanding health disparities affecting people of West Central African descent in the United States: An evolutionary perspective. Evol Appl 2023; 16:963-978. [PMID: 37216026 PMCID: PMC10197229 DOI: 10.1111/eva.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/19/2023] [Accepted: 04/02/2023] [Indexed: 05/24/2023] Open
Abstract
Human populations adapting to diverse aspects of their environment such as climate and pathogens leave signatures of genetic variation. This principle may apply to people of West Central African descent in the United States, who are at increased risk of certain chronic conditions and diseases compared to their European counterparts. Less well known is that they are also at reduced risk of other diseases. While discriminatory practices in the United States continue to affect access to and the quality of healthcare, the health disparities affecting African Americans may also be due in part to evolutionary adaptations to the original environment of sub-Saharan Africa, which involved continuous exposure to the vectors of potentially lethal endemic tropical diseases. Evidence is presented that these organisms selectively absorb vitamin A from the host, and its use in parasite reproduction contributes to the signs and symptoms of the respective diseases. These evolutionary adaptations included (1) sequestering vitamin A away from the liver to other organs, to reduce accessibility to the invaders; and (2) reducing the metabolism and catabolism of vitamin A (vA), causing it to accumulate to subtoxic concentrations and weaken the organisms, thereby reducing the risk of severe disease. However, in the environment of North America, lacking vA-absorbing parasites and with a mainly dairy-based diet that is high in vA, this combination of factors is hypothesized to lead to the accumulation of vA and to increased sensitivity to vA as a toxin, which contribute to the health disparities affecting African Americans. vA toxicity is linked to numerous acute and chronic conditions via mitochondrial dysfunction and apoptosis. Subject to testing, the hypothesis suggests that the adoption of traditional or modified West Central African-style diets that are low in vA and high in vA-absorbing fiber hold promise for disease prevention and treatment, and as a population-based strategy for health maintenance and longevity.
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Affiliation(s)
- Anthony R. Mawson
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health SciencesJackson State UniversityJacksonMississippiUSA
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Mou J, Zhou H, Feng Z, Huang S, Wang Z, Zhang C, Wang Y. A Case-Control Study of the Factors Associated with Anemia in Chinese Children Aged 3-7 years Old. Anemia 2023; 2023:8316658. [PMID: 36993943 PMCID: PMC10042633 DOI: 10.1155/2023/8316658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/30/2022] [Accepted: 10/13/2022] [Indexed: 03/31/2023] Open
Abstract
Background Anemia in children is still an important public problem in China and can have a profound impact on the physical and mental health of children. The purpose of this study was to explore the risk factors for anemia among Chinese children aged 3-7 years old and to provide some basis for the prevention and control of anemia. Methods A matched case-control study was conducted and 1104 children (552 cases and 552 controls) were recruited in this study. Cases were children who were diagnosed with anemia by the doctor of physical examination and checked by one deputy chief physician of pediatrics, and controls were healthy children without anemia. Data were collected using a self-designed structured questionnaire. Univariable and multivariable analyses were used to identify independent determinants of anemia. P values less than 0.05 were used to declare statistical significance. Results In the multivariable analyses, maternal anemia before or during pregnancy and lactation (OR = 2.14, 95% CI: 1.10∼4.15; OR = 2.86, 95% CI: 1.66∼4.94; OR = 2.51, 95% CI: 1.13∼5.60), gestational weeks (OR = 0.72, 95% CI: 0.53∼0.96), having G6PD deficiency or thalassemia (OR = 8.12, 95% CI: 2.00∼33.04; OR = 36.25, 95% CI: 10.40∼126.43), having cold and cough in previous two weeks (OR = 1.56, 95% CI: 1.04∼2.34), family income (OR = 0.80, 95% CI: 0.65∼0.97), and being a picky eater (OR = 1.80, 95% CI: 1.20∼2.71) were determinants of anemia in children aged 3-7 years old. Conclusions Some of the identified factors are modifiable and could be targeted to reduce childhood anemia. More emphasis should be given by the concerned bodies to intervene in the anemia problem by improving the maternal health education, screening for disease-related anemia, requesting medical services in a timely manner, improving the economic status of households, promoting dietary habits, and improving sanitation and hygiene practices.
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Affiliation(s)
- Jinsong Mou
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
| | - Haishan Zhou
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
| | - Zhangui Feng
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
| | - Shiya Huang
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
| | - Zhaohui Wang
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
| | - Chaoyu Zhang
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
| | - Yudong Wang
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
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Dai Y, Hu L. HSPB1 overexpression improves hypoxic-ischemic brain damage by attenuating ferroptosis in rats through promoting G6PD expression. J Neurophysiol 2022; 128:1507-1517. [PMID: 36321738 DOI: 10.1152/jn.00306.2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Heat-shock protein B (HSPB1) has a neuroprotective effect on brain injury and is a negative regulator of ferroptosis. Therefore, we infer that HSPB1 plays a protective role in hypoxic-ischemic (HI) brain damage by inhibiting ferroptosis. A neonatal rat model of hypoxic-ischemic (HI) brain damage was established. HSPB1 overexpression plasmid and the negative control were injected into the lateral ventricle of rats 48 h before HI brain damage surgery. HSPB1 and glucose-6-phosphate dehydrogenase (G6PD) levels, infarction rate, iron accumulation, apoptosis, and ferroptosis-related markers were estimated with the assistance of qRT-PCR, 2,3,5-triphenyl tetrazolium chloride (TTC) staining, Prussian blue staining, iron assay kit, TUNEL staining, and Western blot. In vitro, after transfection, HSPB1 and G6PD levels, oxygen-glucose deprivation (OGD)-mediated hippocampal neuron cell viability, apoptosis, iron content, and ferroptosis-related markers were assessed using qRT-PCR, MTT, flow cytometry, iron assay kit, and Western blot. HSPB1 and G6PD were overexpressed in the hippocampus tissues of HI rats. High expression of HSPB1 in HI rats lessened infarction rate and ferritin level, hindered iron accumulation and apoptosis, and promoted GPX4, SLC7A11, and TFR1 levels. In OGD-mediated hippocampal neuron cells, HSPB1 upregulation intensified the viability and repressed apoptosis and ferroptosis, whereas G6PD silencing reversed the effects of HSPB1 upregulation. We documented that HSPB1 overexpression unleashes neuroprotective effects via modulating G6PD expression, which offers a novel target for the prevention and treatment of HI brain damage.NEW & NOTEWORTHY HSPB1 and G6PD were overexpressed in the hippocampus tissues of HI rats. High expression of HSPB1 in HI rats mitigated infarction rate and iron accumulation. HSPB1 overexpression reduced ferritin level, attenuated apoptosis, yet augmented GPX4, SLC7A11, and TFR1 levels in the hippocampus tissues of HI rats. G6PD deletion impaired the protective role of HSPB1 overexpression against HI brain damage-induced ferroptosis.
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Affiliation(s)
- Yi Dai
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, People's Republic of China
| | - Lan Hu
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, People's Republic of China
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Determinants of severity in sickle cell disease. Blood Rev 2022; 56:100983. [PMID: 35750558 DOI: 10.1016/j.blre.2022.100983] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
Sickle cell disease is a very variable condition, with outcomes ranging from death in childhood to living relatively symptom free into the 8th decade. Much of this variability is unexplained. The co-inheritance of α thalassaemia and factors determining HbF levels significantly modify the phenotype, but few other significant genetic variants have been identified, despite extensive studies. Environmental factors are undoubtedly important, with socio-economics and access to basic medical care explaining the huge differences in outcomes between many low- and high-income countries. Exposure to cold and windy weather seems to precipitate acute complications in many people, although these effects are unpredictable and vary with geography. Many studies have tried to identify prognostic factors which can be used to predict outcomes, particularly when applied in infancy. Overall, low haemoglobin, low haemoglobin F percentage and high reticulocytes in childhood are associated with worse outcomes, although again these effects are fairly weak and inconsistent.
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Martella M, Campeggio M, Pulè G, Wonkam A, Menzato F, Munaretto V, Viola G, Da Costa SP, Reggiani G, Araujo A, Cumbà D, Liotta G, Sainati L, Riccardi F, Colombatti R. Distribution of HbS Allele and Haplotypes in a Multi-Ethnic Population of Guinea Bissau, West Africa: Implications for Public Health Screening. Front Pediatr 2022; 10:826262. [PMID: 35463879 PMCID: PMC9021572 DOI: 10.3389/fped.2022.826262] [Citation(s) in RCA: 3] [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: 11/30/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sickle Cell Disease (SCD) is an inherited condition that is widespread globally and especially in malaria-endemic West African countries. Limited epidemiological data on SCD are available for Guinea Bissau, where newborn screening is not yet implemented, routine diagnosis is not available, and care is case directed. METHODS Dried blood spots were collected from children accessing two hospitals managed by Italian Non-Governmental Organizations in the capital city of Bissau and sent to Padova for Hemoglobin (Hb) quantification through HPLC and molecular analysis. Beta globin gene analysis was performed in all; and Hb haplotype of the HbSS and HbSA patients was performed in South Africa. One hundred samples belonging to the most frequent ethnic groups were randomly selected for detection of G6PD mutations. RESULTS Samples from 848 consecutive children (498 males and 350 females, mean age 6.8 years) accessing the two hospitals were analyzed: 6.95% AS (4.42% allelic frequency), 0.94% SS, and 0.23% AC. 376G G6PD allelic frequency was 24%; 14.8% in AS individuals. The Senegal haplotype was the most prevalent (31%), and the proposition of chromosomes with the atypical haplotype was surprisingly high (56%). CONCLUSION Our study demonstrates a significant frequency of the HbS allele in the population of Guinea Bissau supporting the implementation of screening strategies. The differences among ethnic groups can help guide targeted interventions for SCD awareness campaigns and determine priority areas for public health interventions. The pilot analysis on haplotypes reveals a large proportion of the atypical haplotype, which may be indicative of a genetically heterogeneous population.
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Affiliation(s)
- Maddalena Martella
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Mimma Campeggio
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Gift Pulè
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Federica Menzato
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Vania Munaretto
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Giampietro Viola
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | | | - Giulia Reggiani
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | | | | | | | - Laura Sainati
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Fabio Riccardi
- Università di Tor Vergata, Rome, Italy.,Aid, Health and Development Onlus, Rome, Italy
| | - Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy.,Aid, Health and Development Onlus, Rome, Italy
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8
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Kirkham FJ, Lagunju IA. Epidemiology of Stroke in Sickle Cell Disease. J Clin Med 2021; 10:4232. [PMID: 34575342 PMCID: PMC8469588 DOI: 10.3390/jcm10184232] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 12/18/2022] Open
Abstract
Sickle cell disease is the most common cause of stroke in childhood, both ischaemic and haemorrhagic, and it also affects adults with the condition. Without any screening or preventative treatment, the incidence appears to fall within the range 0.5 to 0.9 per 100 patient years of observation. Newborn screening with Penicillin prophylaxis and vaccination leading to reduced bacterial infection may have reduced the incidence, alongside increasing hydroxyurea prescription. Transcranial Doppler screening and prophylactic chronic transfusion for at least an initial year has reduced the incidence of stroke by up to 10-fold in children with time averaged mean of the maximum velocity >200 cm/s. Hydroxyurea also appears to reduce the incidence of first stroke to a similar extent in the same group but the optimal dose remains controversial. The prevention of haemorrhagic stroke at all ages and ischaemic stroke in adults has not yet received the same degree of attention. Although there are fewer studies, silent cerebral infarction on magnetic resonance imaging (MRI), and other neurological conditions, including headache, epilepsy and cognitive dysfunction, are also more prevalent in sickle cell disease compared with age matched controls. Clinical, neuropsychological and quantitative MRI screening may prove useful for understanding epidemiology and aetiology.
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Affiliation(s)
- Fenella Jane Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, 30 Guilford Street, London WC1N 1EH, UK
- Child Health, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton SO16 6YD, UK
- Paediatric Neurosciences, King’s College Hospital, London SE5 9RS, UK
| | - Ikeoluwa A. Lagunju
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan PMB 3017, Nigeria;
- Department of Paediatrics, University College Hospital, Ibadan PMB 5116, Nigeria
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Ojewunmi OO, Adeyemo TA, Oyetunji AI, Benn Y, Ekpo MG, Iwalokun BA. Association of alpha-thalassemia and Glucose-6-Phosphate Dehydrogenase deficiency with transcranial Doppler ultrasonography in Nigerian children with sickle cell anemia. J Clin Lab Anal 2021; 35:e23802. [PMID: 33938598 PMCID: PMC8183942 DOI: 10.1002/jcla.23802] [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: 12/27/2020] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022] Open
Abstract
Background Stroke is a devastating complication of sickle cell anemia (SCA) and can be predicted through abnormally high cerebral blood flow velocity using transcranial Doppler Ultrasonography (TCD). The evidence on the role of alpha‐thalassemia and glucose‐6‐phosphate dehydrogenase (G6PD) deficiency in the development of stroke in children with SCA is conflicting. Thus, this study investigated the association of alpha‐thalassemia and G6PD(A−) variant with abnormal TCD velocities among Nigerian children with SCA. Methods One hundred and forty‐one children with SCA were recruited: 72 children presented with normal TCD (defined as the time‐averaged mean of the maximum velocity: < 170 cm/s) and 69 children with abnormal TCD (TAMMV ≥ 200 cm/s). Alpha‐thalassemia (the α‐3.7 globin gene deletion) was determined by multiplex gap‐PCR, while G6PD polymorphisms (202G > A and 376A > G) were genotyped using restriction fragment length polymorphism—polymerase chain reaction. Results The frequency of α‐thalassemia trait in the children with normal TCD was higher than those with abnormal TCD: 38/72 (52.8%) [α‐/ α α: 41.7%, α ‐/ α ‐: 11.1%] versus 21/69 (30.4%) [α‐/ α α: 27.5%, α ‐/ α ‐: 2.9%], and the odds of abnormal TCD were reduced in the presence of the α‐thalassemia trait [Odds Ratio: 0.39, 95% confidence interval: 0.20–0.78, p = 0.007]. However, the frequencies of G6PDA− variant in children with abnormal and normal TCD were similar (11.6% vs. 15.3%, p = 0.522). Conclusion Our study reveals the protective role of α‐thalassemia against the risk of abnormal TCD in Nigerian children with SCA.
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Affiliation(s)
- Oyesola Oyewole Ojewunmi
- Sickle Cell Foundation Nigeria, Surulere, Lagos, Nigeria.,School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Titilope Adenike Adeyemo
- Department of Haematology & Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Yewande Benn
- Sickle Cell Foundation Nigeria, Surulere, Lagos, Nigeria
| | | | - Bamidele Abiodun Iwalokun
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
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10
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Denton CC, Shah P, Suriany S, Liu H, Thuptimdang W, Sunwoo J, Chalacheva P, Veluswamy S, Kato R, Wood JC, Detterich JA, Khoo MCK, Coates TD. Loss of alpha-globin genes in human subjects is associated with improved nitric oxide-mediated vascular perfusion. Am J Hematol 2021; 96:277-281. [PMID: 33247606 PMCID: PMC10653668 DOI: 10.1002/ajh.26058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023]
Abstract
Alpha thalassemia is a hemoglobinopathy due to decreased production of the α-globin protein from loss of up to four α-globin genes, with one or two missing in the trait phenotype. Individuals with sickle cell disease who co-inherit the loss of one or two α-globin genes have been known to have reduced risk of morbid outcomes, but the underlying mechanism is unknown. While α-globin gene deletions affect sickle red cell deformability, the α-globin genes and protein are also present in the endothelial wall of human arterioles and participate in nitric oxide scavenging during vasoconstriction. Decreased production of α-globin due to α-thalassemia trait may thereby limit nitric oxide scavenging and promote vasodilation. To evaluate this potential mechanism, we performed flow-mediated dilation and microvascular post-occlusive reactive hyperemia in 27 human subjects (15 missing one or two α-globin genes and 12 healthy controls). Flow-mediated dilation was significantly higher in subjects with α-trait after controlling for age (P = .0357), but microvascular perfusion was not different between groups. As none of the subjects had anemia or hemolysis, the improvement in vascular function could be attributed to the difference in α-globin gene status. This may explain the beneficial effect of α-globin gene loss in sickle cell disease and suggests that α-globin gene status may play a role in other vascular diseases.
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Affiliation(s)
- Christopher C. Denton
- Division of Hematology/Oncology, Department of Pediatrics, Childrenʼs Hospital Los Angeles, Los Angeles, California
| | - Payal Shah
- Division of General Pediatrics, Childrenʼs Hospital Los Angeles, Los Angeles, California
| | - Silvie Suriany
- Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Honglei Liu
- Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Wanwara Thuptimdang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - John Sunwoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - Patjanaporn Chalacheva
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - Saranya Veluswamy
- Division of Hematology/Oncology, Department of Pediatrics, Childrenʼs Hospital Los Angeles, Los Angeles, California
| | - Roberta Kato
- Division of Pulmonology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - John C. Wood
- Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Jon A. Detterich
- Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Michael C. K. Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - Thomas D. Coates
- Division of Hematology/Oncology, Department of Pediatrics, Childrenʼs Hospital Los Angeles, Los Angeles, California
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Alpha thalassemia, but not β S-globin haplotypes, influence sickle cell anemia clinical outcome in a large, single-center Brazilian cohort. Ann Hematol 2021; 100:921-931. [PMID: 33586016 DOI: 10.1007/s00277-021-04450-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Alpha thalassemia and beta-globin haplotype are considered classical genetic disease modifiers in sickle cell anemia (SCA) causing clinical heterogeneity. Nevertheless, their functional impact on SCA disease emergence and progression remains elusive. To better understand the role of alpha thalassemia and beta-globin haplotype in SCA, we performed a retrospective study evaluating the clinical manifestations of 614 patients. The univariate analysis showed that the presence of alpha-thalassemia -3.7-kb mutation (αα/-α and -α/-α) decreased the risk of stroke development (p = 0.046), priapism (p = 0.033), and cholelithiasis (p = 0.021). Furthermore, the cumulative incidence of stroke (p = 0.023) and cholelithiasis (p = 0.006) was also significantly lower for patients carrying the alpha thalassemia -3.7-kb mutation. No clinical effects were associated with the beta-globin haplotype analysis, which could be explained by the relatively homogeneous haplotype composition in our cohort. Our results reinforce that alpha thalassemia can provide protective functions against hemolysis-related symptoms in SCA. Although, several genetic modifiers can impact the inflammatory state of SCA patients, the alpha thalassemia mutation remains one of the most recurrent genetic aberration and should therefore always be considered first.
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Varied Age of First Presentation of Sickle Cell Disease: Case Presentations and Review. Case Rep Med 2021; 2021:8895020. [PMID: 33628264 PMCID: PMC7884135 DOI: 10.1155/2021/8895020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/23/2021] [Accepted: 01/30/2021] [Indexed: 11/17/2022] Open
Abstract
Sickle cell disease is a multisystem condition characterized by hemolytic anemia and vasoocclusion. Not only are the symptoms of the first presentation but also the ages of presentation are very variable. Following three case reports, different causes of possible late presentation are discussed. Many factors are responsible for the age at which sickle cell disease is diagnosed: doctor's delay (unfamiliarity with the disease), patient's delay (education and financial position of the parents, cultural factors), high- versus low-resource country (availability of newborn screening), fetal hemoglobin, reticulocyte count, and genetic modulators, such as SCD genotype, alpha-thalassemia, fetal hemoglobin concentration, and G6PD deficiency. The individual course of sickle cell disease depends on (epi) genetic and environmental properties and the underlying interactions. In further studies, the role of each factor should be evaluated more deeply, and its use as a marker of disease severity or activity should be assessed.
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Chamouine A, Saandi T, Muszlak M, Larmaraud J, Lambrecht L, Poisson J, Balicchi J, Pissard S, Elenga N. High fetal hemoglobin level is associated with increased risk of cerebral vasculopathy in children with sickle cell disease in Mayotte. BMC Pediatr 2020; 20:302. [PMID: 32563256 PMCID: PMC7305627 DOI: 10.1186/s12887-020-02187-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Understanding the genetics underlying the heritable subphenotypes of sickle cell anemia, specific to each population, would be prognostically useful and could inform personalized therapeutics.The objective of this study was to describe the genetic modulators of sickle cell disease in a cohort of pediatric patients followed up in Mayotte. Methods This retrospective cohort study analyzed clinical and biological data, collected between January1st2007 and December 31st2017, in children younger than 18 years. Results We included 185 children with 72% SS, 16% Sβ0-thalassemia and 12% Sβ + thalassemia. The average age was 9.5 years; 10% of patients were lost to follow up. The Bantu haplotype was associated with an increase in hospitalizations and transfusions. The alpha-thalassemic mutation was associated with a decrease of hemolysis biological parameters (anemia, reticulocytes), and a decrease of cerebral vasculopathy. The Single Nucleotide Polymorphisms BCL11A rs4671393, BCL11A rs11886868, BCL11A rs1427407 and HMIP rs9399137 were associated with the group of children with HbF > 10%. Patients with HbF > 10% presented a significant risk of early onset of cerebral vasculopathy. Conclusions The most remarkable result of our study was the association of SNPs with clinically relevant phenotypic groups. BCL11A rs4671393, BCL11A rs11886868, BCL11A rs1427407 and HMIP rs9399137 were correlated with HbF > 10%, a group that has a higher risk of cerebral vasculopathy and should be oriented towards the hemolytic sub-phenotype.
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Affiliation(s)
- Abdourahim Chamouine
- Pediatric Unit, Mamoudzou General Hospital, 1, Rue de l'Hopital, BP 4, 97600, Mamoudzou, Mayotte, France.
| | - Thoueiba Saandi
- Pediatric Unit, Mamoudzou General Hospital, 1, Rue de l'Hopital, BP 4, 97600, Mamoudzou, Mayotte, France
| | - Mathias Muszlak
- Pediatric Unit, Mamoudzou General Hospital, 1, Rue de l'Hopital, BP 4, 97600, Mamoudzou, Mayotte, France
| | - Juliette Larmaraud
- Pediatric Unit, Mamoudzou General Hospital, 1, Rue de l'Hopital, BP 4, 97600, Mamoudzou, Mayotte, France
| | - Laurent Lambrecht
- Pediatric Unit, Mamoudzou General Hospital, 1, Rue de l'Hopital, BP 4, 97600, Mamoudzou, Mayotte, France
| | - Jean Poisson
- Pediatric Unit, Mamoudzou General Hospital, 1, Rue de l'Hopital, BP 4, 97600, Mamoudzou, Mayotte, France
| | - Julien Balicchi
- Pediatric Unit, Mamoudzou General Hospital, 1, Rue de l'Hopital, BP 4, 97600, Mamoudzou, Mayotte, France
| | - Serge Pissard
- APHP, GHU H Mondor, departement de genetique, INSERM-IMRB U955eq2/GREx, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
| | - Narcisse Elenga
- Pediatric Medicine and Surgery, Cayenne General Hospital, Cayenne, French Guiana, France
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Olatunya OS. Poverty and severity of childhood sickle cell disease. Br J Haematol 2020; 190:819-821. [PMID: 32525576 DOI: 10.1111/bjh.16816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Oladele Simeon Olatunya
- Department of Paediatrics, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria
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15
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Valente-Frossard TNS, Cruz NRC, Ferreira FO, Belisario AR, Pereira BM, Gomides AFDF, Resende GAD, Carlos AM, Moraes-Souza H, Velloso-Rodrigues C. Polymorphisms in genes that affect the variation of lipid levels in a Brazilian pediatric population with sickle cell disease: rs662799 APOA5 and rs964184 ZPR1. Blood Cells Mol Dis 2019; 80:102376. [PMID: 31670185 DOI: 10.1016/j.bcmd.2019.102376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/10/2019] [Accepted: 10/16/2019] [Indexed: 12/31/2022]
Abstract
This cross-sectional study investigated associations between SNPs in metabolizing lipid genes, alpha-thalassemia and laboratory parameters in two forms of sickle cell disease (SCD), sickle cell anemia (SCA) and hemoglobin SC disease (HbSC) in a pediatric population. Among the groups SCA and HbSC was found a higher proportion of increased triglycerides (TG) in SCA. High levels of TG were significantly associated with lower hemoglobin (p = 0.006) and HDL-C (p = 0.037), higher white blood cell count (p = 0.027), LDH (p = 0.004) and bilirubins (p < 0.05) in SCD. Patients with HDL-C ≤40 mg/dL had higher markers hemolytic levels. Therapy of HU significantly influenced several hematological and biochemical parameters but not lipid fractions. Genotypes of the APOA5 rs662799 were not associated with lipid levels. The G-risk allele rs964184/ZPRI ZNF259/ZPR1 gene (GC + GG genotypes) was associated with increased levels of TG in children ≥10 years old (p = 0.045) and the atherogenic ratio TG/HDL-C (p = 0.032) in SCD. The use of HU improves levels of hemolysis and inflammation markers in SCD with high TG and, while not interfering with lipid levels, seems to overlap the effect of the G-risk allele in on them. This study reported for the first time that rs964184 SNP could be a genetic modifier of TG in SCD.
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Affiliation(s)
- Thaisa Netto Souza Valente-Frossard
- Departments of Basic Science of Life, Institute of Life Sciences, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Nilcemar Rodrigues Carvalho Cruz
- Departments of Nutrition, Institute of Life Sciences, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Fernanda Oliveira Ferreira
- Departments of Basic Science of Life, Institute of Life Sciences, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | | | - Brisa Machado Pereira
- Departments of Basic Science of Life, Institute of Life Sciences, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Antônio Frederico de Freitas Gomides
- Departments of Basic Science of Life, Institute of Life Sciences, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | | | - Aline Menezes Carlos
- Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil; Uberaba Regional Blood Center, Uberaba, Minas Gerais, Brazil
| | - Helio Moraes-Souza
- Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil; Uberaba Regional Blood Center, Uberaba, Minas Gerais, Brazil
| | - Cibele Velloso-Rodrigues
- Departments of Basic Science of Life, Institute of Life Sciences, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil.
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Gueye Tall F, Martin C, Ndour EHM, Renoux C, Ly ID, Connes P, Gueye PM, Diallo RN, Diagne I, Diop PA, Cissé A, Lopez Sall P, Joly P. Combined and differential effects of alpha-thalassemia and HbF-quantitative trait loci in Senegalese hydroxyurea-free children with sickle cell anemia. Pediatr Blood Cancer 2019; 66:e27934. [PMID: 31322815 DOI: 10.1002/pbc.27934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/16/2019] [Accepted: 07/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Our objective was to investigate the combined and differential effects of alpha-thalassemia -3.7 kb deletion and HbF-promoting quantitative trait loci (HbF-QTL) in Senegalese hydroxyurea (HU)-free children and young adults with sickle cell anemia (SCA). PROCEDURE Steady-state biological parameters and vaso-occlusive crises (VOC) requiring emergency admission were recorded over a 2-year period in 301 children with SCA. The age of the first hospitalized VOC was also recorded. These data were correlated with the alpha-globin and HbF-QTL genotypes. For the latter, three different genetic loci were studied (XmnI, rs7482144; BCL11A, rs1427407; and the HBS1L-MYB region, rs28384513) and a composite score was calculated, ranging from zero (none of these three polymorphisms) to six (all three polymorphisms at the homozygous state). RESULTS A positive clinical impact of the HbF-QTL score on VOC rate, HbF, leucocytes, and C-reactive protein levels was observed only for patients without alpha-thalassemia deletion. Conversely, combination of homozygous -3.7 kb deletion with three to six HbF-QTL was associated with a higher VOC rate. The age of the first hospitalized VOC was delayed for patients with one or two alpha-thalassemia deletions and at least two HbF-QTL. CONCLUSION Alpha-thalassemia -3.7 kb deletion and HbF-QTL are modulating factors of SCA clinical severity that interact with each other. They should be studied and interpreted together and not separately, at least in HU-free children.
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Affiliation(s)
- Fatou Gueye Tall
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal.,Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
| | - Cyril Martin
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France
| | - El Hadji Malick Ndour
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal.,Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
| | - Céline Renoux
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,UF "Biochimie des pathologies érythrocytaires", Laboratoire de Biochimie et Biologie moléculaire Grand-Est, Groupement hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Indou Déme Ly
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal.,Service universitaire de Pédiatrie-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France.,Institut Universitaire de France, Paris, France
| | - Papa Madieye Gueye
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Rokhaya Ndiaye Diallo
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Ibrahima Diagne
- Service universitaire de Pédiatrie-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal.,UFR des sciences de la santé - Université Gaston Berger, Saint-Louis, Sénégal
| | - Pape Amadou Diop
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Aynina Cissé
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Philomène Lopez Sall
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal.,Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
| | - Philippe Joly
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France.,UF "Biochimie des pathologies érythrocytaires", Laboratoire de Biochimie et Biologie moléculaire Grand-Est, Groupement hospitalier Est, Hospices Civils de Lyon, Bron, France
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17
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The clinical impact of glucose-6-phosphate dehydrogenase deficiency in patients with sickle cell disease. Curr Opin Hematol 2019; 25:494-499. [PMID: 30239377 DOI: 10.1097/moh.0000000000000455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Glucose-6-phosphate dehydrogenase (G6PD) deficiency and sickle cell disease (SCD) cause hemolysis, often occurring in individuals of African descent. These disorders co-occur frequently, and possibly interact, altering clinical outcomes in SCD. However, epidemiological investigations of SCD with G6PD deficiency have produced variable results. This contribution reviews the available data about the interaction of G6PD deficiency and SCD. RECENT FINDINGS Overall, G6PD deficiency contributes few, if any, effects to laboratory values and clinical outcomes in SCD patients, but may impact transfusion efficacy. This observation is most likely because of the relatively increased G6PD activity in the young red blood cell (RBC) population seen in SCD patients with or without G6PD deficiency. In addition, G6PD deficiency possibly interacts with other genetic modifiers, such as α thalassemia, hemoglobin F levels and SCD haplotype. SUMMARY Although G6PD deficiency is relatively common, it does not appear to clinically impact patients with SCD. Nonetheless, it is important to evaluate G6PD status in patients with SCD to avoid the use of medications that may cause hemolysis. Future studies evaluating the clinical impact of transfusions from G6PD-deficient RBC donors would be of the greatest benefit to the current literature.
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18
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Hirtz D, Kirkham FJ. Sickle Cell Disease and Stroke. Pediatr Neurol 2019; 95:34-41. [PMID: 30948147 DOI: 10.1016/j.pediatrneurol.2019.02.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 01/04/2023]
Abstract
Cerebral infarction is a common complication of sickle cell disease and may manifest as overt stroke or cognitive impairment associated with "silent" cerebral infarction on magnetic resonance imaging. Vasculopathy may be diagnosed on transcranial Doppler or magnetic resonance angiography. The risk factors in sickle cell disease for cognitive impairment, overt ischemic stroke, silent cerebral infarction, overt hemorrhagic stroke, and vasculopathy defined by transcranial Doppler or magnetic resonance angiography overlap, with severe acute and chronic anemia, acute chest crisis, reticulocytosis, and low oxygen saturation reported with the majority. However, there are differences reported in different cohorts, which may reflect age, geographic location, or neuroimaging techniques, for example, magnetic resonance imaging field strength. Regular blood transfusion reduces, but does not abolish, the risk of neurological complications in children with sickle cell disease and either previous overt stroke or silent cerebral infarction or abnormal transcranial Doppler. There are relatively few data on the use of hydroxyurea or other management strategies. Early assessment of the risk of neurocognitive complications is likely to become increasingly important in the management of sickle cell disease.
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Affiliation(s)
- Deborah Hirtz
- University of Vermont School of Medicine, Burlington, Vermont
| | - Fenella J Kirkham
- Developmental Neurosciences Section and Biomedical Research Unit, Clinical and Experimental Sciences, University of Southampton, UCL Great Ormond Street Institute of Child Health, London, UK.
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19
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Guilliams KP, Fields ME, Dowling MM. Advances in Understanding Ischemic Stroke Physiology and the Impact of Vasculopathy in Children With Sickle Cell Disease. Stroke 2019; 50:266-273. [PMID: 30661504 PMCID: PMC6385587 DOI: 10.1161/strokeaha.118.020482] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/28/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Kristin P Guilliams
- From the Department of Neurology (K.P.G.), Washington University School of Medicine, St Louis, MO
- Department of Pediatrics (K.P.G., M.E.F.), Washington University School of Medicine, St Louis, MO
| | - Melanie E Fields
- Department of Pediatrics (K.P.G., M.E.F.), Washington University School of Medicine, St Louis, MO
| | - Michael M Dowling
- Department of Pediatrics and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (M.M.D.)
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20
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Wu X, Fu R, Tang Y, Shi L, Rong X, Guo J, Li J, Shen Q. Intravenous Thrombolysis for Stroke Patients with G6PD Deficiency. J Stroke Cerebrovasc Dis 2018; 27:2026-2031. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/10/2018] [Accepted: 02/28/2018] [Indexed: 11/16/2022] Open
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van Beers EJ, van Wijk R. Oxidative stress in sickle cell disease; more than a DAMP squib. Clin Hemorheol Microcirc 2018; 68:239-250. [PMID: 29614635 DOI: 10.3233/ch-189010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sickle cell disease (SCD) is a monogenetic disorder marked by hemolytic anemia and vaso-occlusive complications. The hallmark of SCD is the intracellular polymerization of sickle hemoglobin (HbS) after deoxygenation, and the subsequent characteristic shape change (sickling) of red cells. Vaso-occlusion occurs after endothelial activation, expression of adhesion molecules and subsequent adhesion of leucocytes and sickle erythrocytes to the vascular wall. Here we review how oxidative stress from various sources influences this process. Emerging evidence points towards a dominant mechanism in which innate immune receptors, such as Toll like receptor 4, activate nicotinamide adenine dinucleotide phosphate (NADPH) oxidases to produce reactive oxygen species (ROS) which in turn enables downstream pro-inflammatory signaling and subsequent endothelial activation. By serving as an iron donor for the Fenton reaction, heme radically increases the amount of ROS further, thereby increasing the signal originating from the innate immune receptor and downstream effects of innate immune receptor activation. In SCD this results in the production of pro-inflammatory cytokines, endothelial activation and leucocyte adhesion, and eventually vaso-occlusion. Any intervention to stop this cascade, including Toll like receptor blockade, NADPH oxidase inhibition, ROS reduction, heme scavenging, iron chelation, or anti-adhesion molecule antibodies has been successfully used in pre-clinical studies and holds promise for patients with SCD.
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Affiliation(s)
- Eduard J van Beers
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard van Wijk
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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22
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Renoux C, Joly P, Faes C, Mury P, Eglenen B, Turkay M, Yavas G, Yalcin O, Bertrand Y, Garnier N, Cuzzubbo D, Gauthier A, Romana M, Möckesch B, Cannas G, Antoine-Jonville S, Pialoux V, Connes P. Association between Oxidative Stress, Genetic Factors, and Clinical Severity in Children with Sickle Cell Anemia. J Pediatr 2018; 195:228-235. [PMID: 29449005 DOI: 10.1016/j.jpeds.2017.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/13/2017] [Accepted: 12/08/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the associations between several sickle cell disease genetic modifiers (beta-globin haplotypes, alpha-thalassemia, and glucose-6-phosphate dehydrogenase deficiency) and the level of oxidative stress and to evaluate the association between oxidative stress and the rates of vaso-occlusive events. STUDY DESIGN Steady-state oxidative and nitrosative stress markers, biological variables, genetic modulators, and vaso-occlusive crisis events requiring emergency admissions were measured during a 2-year period in 62 children with sickle cell anemia (58 SS and 4 Sβ0). Twelve ethnic-matched children without sickle cell anemia also participated as healthy controls (AA) for oxidative and nitrosative stress level measurement. RESULTS Oxidative and nitrosative stress were greater in patients with sickle cell anemia compared with control patients, but the rate of vaso-occlusive crisis events in sickle cell anemia was not associated with the level of oxidative stress. The presence of alpha-thalassemia, but not glucose-6-phosphate dehydrogenase deficiency or beta-globin haplotype, modulated the level of oxidative stress in children with sickle cell anemia. CONCLUSION Mild hemolysis in children with alpha-thalassemia may limit oxidative stress and could explain the protective role of alpha-thalassemia in hemolysis-related sickle cell complications.
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Affiliation(s)
- Céline Renoux
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; Department of Biochemistry on Red Blood Cell Disease, Biologie Est Center, Hospices Civils de Lyon, Lyon, France
| | - Philippe Joly
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; Department of Biochemistry on Red Blood Cell Disease, Biologie Est Center, Hospices Civils de Lyon, Lyon, France
| | - Camille Faes
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Pauline Mury
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Buse Eglenen
- School of Medicine, Koç University, Istanbul, Turkey
| | - Mine Turkay
- School of Medicine, Koç University, Istanbul, Turkey
| | - Gokce Yavas
- School of Medicine, Koç University, Istanbul, Turkey
| | - Ozlem Yalcin
- School of Medicine, Koç University, Istanbul, Turkey
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Nathalie Garnier
- Institute of Pediatric Hematology and Oncology (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Daniela Cuzzubbo
- Institute of Pediatric Hematology and Oncology (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Alexandra Gauthier
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; Institute of Pediatric Hematology and Oncology (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Marc Romana
- Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; UMR Inserm 1134, Ricou Hospital, Academic Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe
| | - Berenike Möckesch
- Laboratory ACTES EA3596, University of French West Indies, Pointe-à-Pitre, Guadeloupe
| | - Giovanna Cannas
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; Internal Medicine, Hématology, Edouard Herriot Hospital, Lyon, France
| | | | - Vincent Pialoux
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; French University Institute (IUF), Paris, France
| | - Philippe Connes
- Inter-University Laboratory of Human Movement Biology (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Team, University Claude Bernard Lyon, Villeurbanne, France; Laboratory of Excellence on Red Blood Cell (Labex GR-Ex), PRES Sorbonne, Paris, France; French University Institute (IUF), Paris, France.
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Belisário AR, Silva CM, Velloso-Rodrigues C, Viana MB. Genetic, laboratory and clinical risk factors in the development of overt ischemic stroke in children with sickle cell disease. Hematol Transfus Cell Ther 2018; 40:166-181. [PMID: 30057991 PMCID: PMC6003005 DOI: 10.1016/j.bjhh.2017.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 08/30/2017] [Indexed: 12/22/2022] Open
Abstract
Cerebrovascular disease, particularly stroke, is one of the most severe clinical complications associated with sickle cell disease and is a significant cause of morbidity in both children and adults. Over the past two decades, considerable advances have been made in the understanding of its natural history and enabled early identification and treatment of children at the highest risk. Transcranial Doppler screening and regular blood transfusions have markedly reduced the risk of stroke in children. However, transcranial Doppler has a limited positive predictive value and the pathophysiology of cerebrovascular disease is not completely understood. In this review, we will focus on the current state of knowledge about risk factors associated with ischemic stroke in patients with sickle cell disease. A search of PubMed was performed to identify studies. Full texts of the included articles were reviewed and data were summarized in a table. The coinheritance of alpha-thalassemia plays a protective role against ischemic stroke. The influence of other genetic risk factors is controversial, still preliminary, and requires confirmatory studies. Recent advances have established the reticulocyte count as the most important laboratory risk factor. Clinical features associated with acute hypoxemia as well as silent infarcts seem to influence the development of strokes in children. However, transcranial Doppler remains the only available clinical prognostic tool to have been validated. If our understanding of the many risk factors associated with stroke advances further, it may be possible to develop useful tools to detect patients at the highest risk early, improving the selection of children requiring intensification therapy.
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Affiliation(s)
- André Rolim Belisário
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Lagoa Santa, MG, Brazil
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Brewin J, Kaya B, Chakravorty S. How I manage sickle cell patients with high transcranial doppler results. Br J Haematol 2017; 179:377-388. [DOI: 10.1111/bjh.14850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- John Brewin
- Department of Haematology; King's College London; London UK
| | - Banu Kaya
- Department of Haematology; Royal London Hospital; London UK
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25
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Renoux C, Connes P, Nader E, Skinner S, Faes C, Petras M, Bertrand Y, Garnier N, Cuzzubbo D, Divialle-Doumdo L, Kebaïli K, Renard C, Gauthier A, Etienne-Julan M, Cannas G, Martin C, Hardy-Dessources MD, Pialoux V, Romana M, Joly P. Alpha-thalassaemia promotes frequent vaso-occlusive crises in children with sickle cell anaemia through haemorheological changes. Pediatr Blood Cancer 2017; 64. [PMID: 28097791 DOI: 10.1002/pbc.26455] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sickle cell anaemia (SCA) is a severe hereditary haemoglobinopathy characterised by haemorheological abnormalities, which play a role in the occurrence of several acute and chronic clinical complications. While βS -haplotypes and alpha-thalassaemia modulate SCA clinical severity, their effects on blood rheology have been incompletely described. The aim of this study was to test the effects of these genetic modifiers on the haemorheological properties and clinical complication of children with SCA. PROCEDURE Steady-state haemorheological profile, biological parameters, βS -haplotypes, alpha-globin status, vaso-occlusive crisis (VOC) and acute chest syndrome frequencies were analysed in 128 children (aged 5 to 18 years) with SCA. RESULTS Patients with alpha-thalassaemia showed increased red blood cell (RBC) deformability and aggregation compared to those without. Median VOC rate was higher in patients with homozygous alpha-thalassaemia compared to those with a normal alpha genotype. Conversely, the haemorheological profile and clinical complications were not influenced by the βS -haplotypes in our study. CONCLUSION Our results demonstrate that alpha-thalassaemia is associated with higher risk for VOC events in children with SCA, which may be due in part to its effects on RBC deformability and aggregation.
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Affiliation(s)
- Céline Renoux
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France.,UF Pathologie moléculaire du globule rouge, Hôpital Edouard Herriot, Lyon, France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France.,Institut Universitaire de France, Paris, France
| | - Elie Nader
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France
| | - Sarah Skinner
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France
| | - Camille Faes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France
| | - Marie Petras
- Unité Transversale de la Drépanocytose, Centre Hospitalier Universitaire, Pointe-à-Pitre, Guadeloupe, France
| | - Yves Bertrand
- Institut d'hématologie et d'oncologie pédiatrique (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Nathalie Garnier
- Institut d'hématologie et d'oncologie pédiatrique (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Daniela Cuzzubbo
- Institut d'hématologie et d'oncologie pédiatrique (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Lydia Divialle-Doumdo
- Unité Transversale de la Drépanocytose, Centre Hospitalier Universitaire, Pointe-à-Pitre, Guadeloupe, France
| | - Kamila Kebaïli
- Institut d'hématologie et d'oncologie pédiatrique (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Cécile Renard
- Institut d'hématologie et d'oncologie pédiatrique (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Alexandra Gauthier
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France.,Institut d'hématologie et d'oncologie pédiatrique (IHOP), Hospices Civils de Lyon, Lyon, France
| | - Maryse Etienne-Julan
- Unité Transversale de la Drépanocytose, Centre Hospitalier Universitaire, Pointe-à-Pitre, Guadeloupe, France
| | - Giovanna Cannas
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France.,Clinique de Médecine Ambulatoire/Hématologie Hôpital Edouard Herriot, Lyon, France
| | - Cyril Martin
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France
| | - Marie-Dominique Hardy-Dessources
- Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France.,UMR Inserm 1134, Hôpital Ricou, Centre Hospitalier Universitaire, Pointe-à-Pitre, Guadeloupe, France
| | - Vincent Pialoux
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France.,Institut Universitaire de France, Paris, France
| | - Marc Romana
- Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France.,UMR Inserm 1134, Hôpital Ricou, Centre Hospitalier Universitaire, Pointe-à-Pitre, Guadeloupe, France
| | - Philippe Joly
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, COMUE, Lyon, France.,Laboratoire d'Excellence sur le globule rouge (Labex GR-Ex), Paris, France.,UF Pathologie moléculaire du globule rouge, Hôpital Edouard Herriot, Lyon, France
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Gueye Tall F, Martin C, Malick Ndour EH, Déme Ly I, Renoux C, Chillotti L, Veyrenche N, Connes P, Madieye Gueye P, Ndiaye Diallo R, Lacan P, Diagne I, Amadou Diop P, Cissé A, Lopez Sall P, Joly P. Genetic Background of the Sickle Cell Disease Pediatric Population of Dakar, Senegal, and Characterization of a Novel Frameshift β-Thalassemia Mutation [HBB: c.265_266del; p.Leu89Glufs*2]. Hemoglobin 2017; 41:89-95. [DOI: 10.1080/03630269.2017.1339610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fatou Gueye Tall
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe ‘Biologie Vasculaire et du Globule Rouge,’ Université Claude Bernard Lyon 1, COMUE Lyon, France
- Centre Hospitalier National d’Enfants Albert-Royer, Dakar, Sénégal
| | - Cyril Martin
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe ‘Biologie Vasculaire et du Globule Rouge,’ Université Claude Bernard Lyon 1, COMUE Lyon, France
- Laboratoire d’Excellence sur le Globule Rouge (Labex GR-Ex), Paris, France
| | - El Hadji Malick Ndour
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
- Centre Hospitalier National d’Enfants Albert-Royer, Dakar, Sénégal
| | - Indou Déme Ly
- Centre Hospitalier National d’Enfants Albert-Royer, Dakar, Sénégal
- Service Universitaire de Pédiatrie-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Céline Renoux
- UF Pathologie Moléculaire du Globule Rouge, Laboratoire de Biochimie et Biologie Moléculaire Grand-Est, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe ‘Biologie Vasculaire et du Globule Rouge,’ Université Claude Bernard Lyon 1, COMUE Lyon, France
| | - Louis Chillotti
- UF Pathologie Moléculaire du Globule Rouge, Laboratoire de Biochimie et Biologie Moléculaire Grand-Est, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Veyrenche
- UF Pathologie Moléculaire du Globule Rouge, Laboratoire de Biochimie et Biologie Moléculaire Grand-Est, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe ‘Biologie Vasculaire et du Globule Rouge,’ Université Claude Bernard Lyon 1, COMUE Lyon, France
- Laboratoire d’Excellence sur le Globule Rouge (Labex GR-Ex), Paris, France
- Institut Universitaire de France, Paris, France
| | - Papa Madieye Gueye
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Rokhaya Ndiaye Diallo
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Philippe Lacan
- UF Pathologie Moléculaire du Globule Rouge, Laboratoire de Biochimie et Biologie Moléculaire Grand-Est, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ibrahima Diagne
- Service Universitaire de Pédiatrie-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
- UFR des Sciences de la Santé, Université Gaston Berger, Saint-Louis, Sénégal
| | - Pape Amadou Diop
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Aynina Cissé
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Philomène Lopez Sall
- Laboratoire de Biochimie Pharmaceutique-FMPO, Université Cheikh Anta Diop, Dakar, Sénégal
- Centre Hospitalier National d’Enfants Albert-Royer, Dakar, Sénégal
| | - Philippe Joly
- UF Pathologie Moléculaire du Globule Rouge, Laboratoire de Biochimie et Biologie Moléculaire Grand-Est, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe ‘Biologie Vasculaire et du Globule Rouge,’ Université Claude Bernard Lyon 1, COMUE Lyon, France
- Laboratoire d’Excellence sur le Globule Rouge (Labex GR-Ex), Paris, France
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27
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Meier ER, Fasano RM, Levett PR. A systematic review of the literature for severity predictors in children with sickle cell anemia. Blood Cells Mol Dis 2017; 65:86-94. [DOI: 10.1016/j.bcmd.2017.01.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/27/2017] [Accepted: 01/28/2017] [Indexed: 12/19/2022]
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28
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Associations of α-thalassemia and BCL11A with stroke in Nigerian, United States, and United Kingdom sickle cell anemia cohorts. Blood Adv 2017; 1:693-698. [PMID: 28868518 DOI: 10.1182/bloodadvances.2017005231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Alpha-thalassemia and the BCL11A rs1427407 T allele are commonly observed in sickle cell anemia (SCA) patients and are associated with reduced hemolysis and higher hemoglobin F levels, respectively. We investigated whether a high-risk genetic profile, defined as SCA patients who did not inherit either α-thalassemia or the BCL11A rs1427407 T allele, had stronger associations with clinical and laboratory variables than the individual genetic components in the University of Ibadan cohort (n=249). We then replicated our findings in SCA cohorts from the University of Illinois at Chicago (UIC)(n=260) and Walk-Treatment of Pulmonary Hypertension and Sickle cell disease with Sildenafil Therapy (Walk-PHaSST)(n=387). High-risk was associated with higher reticulocytes (15.0% vs. 7.8%, P=0.08) and stroke history (6% vs. 1%, P=0.02) than standard risk patients and these associations were more significant than the individual genetic components in the University of Ibadan cohort. These findings were replicated in high-risk patients from UIC and Walk-PHaSST for reticulocytes (UIC: 13.5% vs. 11.8%, P=0.03; Walk-PHaSST: 9.6% vs. 8.2%, P=0.0003) and stroke history (UIC: 32% vs. 22%, P=0.07; Walk-PHaSST: 14% vs. 7%, P=0.01). On combined analysis, high-risk had strong associations with increased markers of hemolysis (hemoglobin β= -0.29, 95%CI: -0.50 to -0.09; P=0.006; reticulocyte% β=2.29, 95%CI: 1.31 to 3.25; P=1x10-5) and stroke history (OR=2.0, 95%CI: 1.3 to 3.0; P=0.0002), but no association with frequent vaso-occlusive crises (≥3/year). A high-risk genetic profile is associated with increased hemolysis and stroke history in three independent cohorts. This profile may help identify patients to prioritize for hydroxyurea and for closer monitoring strategies for stroke.
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29
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Kato GJ, Steinberg MH, Gladwin MT. Intravascular hemolysis and the pathophysiology of sickle cell disease. J Clin Invest 2017; 127:750-760. [PMID: 28248201 DOI: 10.1172/jci89741] [Citation(s) in RCA: 410] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Hemolysis is a fundamental feature of sickle cell anemia that contributes to its pathophysiology and phenotypic variability. Decompartmentalized hemoglobin, arginase 1, asymmetric dimethylarginine, and adenine nucleotides are all products of hemolysis that promote vasomotor dysfunction, proliferative vasculopathy, and a multitude of clinical complications of pulmonary and systemic vasculopathy, including pulmonary hypertension, leg ulcers, priapism, chronic kidney disease, and large-artery ischemic stroke. Nitric oxide (NO) is inactivated by cell-free hemoglobin in a dioxygenation reaction that also oxidizes hemoglobin to methemoglobin, a non-oxygen-binding form of hemoglobin that readily loses heme. Circulating hemoglobin and heme represent erythrocytic danger-associated molecular pattern (eDAMP) molecules, which activate the innate immune system and endothelium to an inflammatory, proadhesive state that promotes sickle vaso-occlusion and acute lung injury in murine models of sickle cell disease. Intravascular hemolysis can impair NO bioavailability and cause oxidative stress, altering redox balance and amplifying physiological processes that govern blood flow, hemostasis, inflammation, and angiogenesis. These pathological responses promote regional vasoconstriction and subsequent blood vessel remodeling. Thus, intravascular hemolysis represents an intrinsic mechanism for human vascular disease that manifests clinical complications in sickle cell disease and other chronic hereditary or acquired hemolytic anemias.
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30
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Wonkam A. Is there a role for pharmacogenetics in the treatment of sickle cell disease? Pharmacogenomics 2017; 18:321-325. [PMID: 28244809 DOI: 10.2217/pgs-2016-0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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31
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Belisário AR, Rodrigues Sales R, Evelin Toledo N, Velloso-Rodrigues C, Maria Silva C, Borato Viana M. Glucose-6-Phosphate Dehydrogenase Deficiency in Brazilian Children With Sickle Cell Anemia is not Associated With Clinical Ischemic Stroke or High-Risk Transcranial Doppler. Pediatr Blood Cancer 2016; 63:1046-9. [PMID: 26840990 DOI: 10.1002/pbc.25924] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke is a severe complication of sickle cell anemia (SCA). The role of glucose-6-phosphate dehydrogenase (G6PD) deficiency in the development of stroke in children with SCA is controversial. PROCEDURE The aim of this study was to investigate the association of clinical ischemic stroke, high-risk transcranial Doppler measurements (TCD), and hematological features with molecular variants usually linked to G6PD deficiency or with the biochemical activity of G6PD in a cohort of 395 Brazilian children with SCA. G6PD activity was quantitatively determined using an enzymatic-colorimetric assay. G6PD mutations were determined by PCR-RFLP and sequencing. Clinical and hematological data were retrieved from the children's records. RESULTS The prevalence of molecularly defined deficiency (hereafter, molecular deficiency) was 4.3% (95% confidence interval: 2.3-6.3%). The mean G6PD activity was 16.88 U/g hemoglobin (Hb) (standard error of the mean [SEM] 0.28) in the group without G6PD molecular deficiency and 8.43 (SEM 1.01) U/g Hb in the group with G6PD A(-) molecular deficiency. G6PD molecular deficiency was not associated with any hematological features. No effects of G6PD molecular deficiency on clinical ischemic stroke or high-risk TCD were detected. The mean G6PD activity was similar in children who had clinical ischemic stroke and in those without stroke. Similar results were obtained in analyses comparing children who had high-risk TCD and those without high-risk TCD. CONCLUSIONS Our study demonstrated that G6PD molecular deficiency was not associated either with clinical ischemic stroke or high-risk TCD. Similarly, we found no associations between G6PD enzyme activity and stroke or high-risk TCD. Small sample size precludes definitive conclusions.
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Affiliation(s)
- André Rolim Belisário
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Lagoa Santa, Minas Gerais, Brasil.,Faculdade de Medicina/NUPAD, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil
| | | | | | - Cibele Velloso-Rodrigues
- Departamento Básico-Área de Saúde, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brasil
| | - Célia Maria Silva
- Serviço de Pesquisa, Fundação Hemominas, Belo Horizonte, Minas Gerais, Brasil
| | - Marcos Borato Viana
- Faculdade de Medicina/NUPAD, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil
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32
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Quinn CT. Minireview: Clinical severity in sickle cell disease: the challenges of definition and prognostication. Exp Biol Med (Maywood) 2016; 241:679-88. [PMID: 27013545 PMCID: PMC4871738 DOI: 10.1177/1535370216640385] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Sickle cell disease (SCD) is a monogenic, yet highly phenotypically variable disease with multisystem pathology. This manuscript provides an overview of many of the known determinants, modifiers, and correlates of disease severity in SCD. Despite this wealth of data, modeling the variable and multisystem pathology of SCD continues to be difficult. The current status of prediction of specific adverse outcomes and global disease severity in SCD is also reviewed, highlighting recent successes and ongoing challenges.
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Affiliation(s)
- Charles T Quinn
- Division of Hematology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45220, USA
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33
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Connes P, Alexy T, Detterich J, Romana M, Hardy-Dessources MD, Ballas SK. The role of blood rheology in sickle cell disease. Blood Rev 2015; 30:111-8. [PMID: 26341565 DOI: 10.1016/j.blre.2015.08.005] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 07/17/2015] [Accepted: 08/20/2015] [Indexed: 01/29/2023]
Abstract
Studies performed in the last decades have highlighted the need to better understand the contribution of the endothelium, vascular function, oxidative stress, inflammation, coagulation, hemolysis and vascular adhesion mechanisms to the pathophysiology of acute vaso-occlusive like events and chronic organ damages in sickle cell disease (SCD). Although SCD is a hemorheological disease, a few works focused on the contribution of blood viscosity, plasma viscosity, red blood cell deformability and aggregation in the pathophysiology of SCD. After a brief description of basic hemorheology, the present review focuses on the role of the hemorheological abnormalities in the causation of several SCD complications, mainly in sickle cell anemia and hemoglobin (Hb) SC disease. Several genetic and cellular modulators of blood rheology in SCD are discussed, as well as unresolved questions and perspectives.
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Affiliation(s)
- Philippe Connes
- Inserm UMR 1134, Hôpital Ricou, CHU de Pointe-à-Pitre, 97157 Pointe-à-Pitre, Guadeloupe; Laboratory of Excellence GR-Ex «The red cell: from genesis to death», PRES Sorbonne Paris Cité, 75015 Paris, France; Institut Universitaire de France, Paris, France; Laboratoire CRIS EA647, Section "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.
| | - Tamas Alexy
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA; Section of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA
| | - Jon Detterich
- Children's Hospital Los Angeles, Division of Cardiology, USA
| | - Marc Romana
- Inserm UMR 1134, Hôpital Ricou, CHU de Pointe-à-Pitre, 97157 Pointe-à-Pitre, Guadeloupe; Laboratory of Excellence GR-Ex «The red cell: from genesis to death», PRES Sorbonne Paris Cité, 75015 Paris, France
| | - Marie-Dominique Hardy-Dessources
- Inserm UMR 1134, Hôpital Ricou, CHU de Pointe-à-Pitre, 97157 Pointe-à-Pitre, Guadeloupe; Laboratory of Excellence GR-Ex «The red cell: from genesis to death», PRES Sorbonne Paris Cité, 75015 Paris, France
| | - Samir K Ballas
- Department of Medicine, Cardeza Foundation for Hematologic Research, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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