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Alnaqbi KA. A Rare Case of Multiple Bone Infarctions and Abnormal Pulmonary Function Tests in a Patient With Compound Heterozygous Hemoglobin S and Type 2 Hereditary Persistence of Fetal Hemoglobin. Cureus 2024; 16:e66395. [PMID: 39113817 PMCID: PMC11305617 DOI: 10.7759/cureus.66395] [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] [Accepted: 08/03/2024] [Indexed: 08/10/2024] Open
Abstract
Sickle cell disease (SCD) is a group of inherited blood disorders characterized by abnormal hemoglobin production, affecting individuals worldwide with varying prevalence across different populations. Manifestations vary, ranging from severe to mild. SCD is characterized by the presence of hemoglobin S (HbS), which distorts erythrocytes upon deoxygenation, leading to sickling. This results in hemolytic anemia, painful vaso-occlusive crises (VOC), and multiple organ damage, including bones, due to microinfarcts. Sickle cell trait (SCT), or carrier status, is not considered an SCD and often runs a benign course. We report a 44-year-old man of African descent presenting with a one-month history of pain in his ankles and feet. He had a prior diagnosis of sickle cell "trait" without previous VOC. Hematological indices were normal. Hemoglobin electrophoresis showed absent HbA, elevated HbS, elevated HbF, and normal HbA2. X-rays and MRI revealed bilateral bone infarction in diaphyses of right proximal and bilateral distal tibias. Molecular analysis of [Formula: see text]-globin revealed compound heterozygous hemoglobin S and type 2 deletion of persistence of fetal hemoglobin (HPFH). Pulmonary function tests revealed restrictive lung disease. A literature review from 1946 to May 2024 via PubMed, EMBASE, and Medline was performed, revealing two cases of HbS-HPFH with avascular necrosis affecting the femoral neck were briefly reported more than 60 years ago. Although pulmonary function tests in SCD typically show a mild restrictive pattern with decreased diffusion capacity and rarely an obstructive pattern, no cases of HbS-HPFH were identified. In conclusion, multiple bone infarctions are extremely rare in HbS-HPFH. Lung and bone diseases might be unrecognized in this unique disorder.
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Affiliation(s)
- Khalid A Alnaqbi
- Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
- Rheumatology, Tawam Hospital, Al Ain, ARE
- Medicine, Emirates Medical Association, Dubai, ARE
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2
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De La Hoz Polo M, Hudson VE, Adu J, Chakravorty S, Haque S. The many faces of sickle cell disease in children: complications in the appendicular skeleton. Pediatr Radiol 2024; 54:1437-1450. [PMID: 38740606 DOI: 10.1007/s00247-024-05913-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 05/16/2024]
Abstract
Sickle cell disease (SCD) is a hereditary red cell disorder with clinical manifestations secondary to sickling or crescent-shaped distortion of the red blood cells. Musculoskeletal complications of SCD are often the main causes for acute and chronic morbidities in children with manifestations including osteomyelitis, osteoporosis and osteonecrosis. This article aims to familiarise the paediatric radiologist with appendicular skeletal complications of SCD in the paediatric population and their imaging appearance.
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Affiliation(s)
| | - Victoria E Hudson
- Radiology Department, King's College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - John Adu
- Radiology Department, St George's University Hospital, London, UK
| | - Subarna Chakravorty
- Department of Paediatric Haematology, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Saira Haque
- Radiology Department, King's College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
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3
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von Brackel FN, Oheim R. Iron and bones: effects of iron overload, deficiency and anemia treatments on bone. JBMR Plus 2024; 8:ziae064. [PMID: 38957399 PMCID: PMC11215550 DOI: 10.1093/jbmrpl/ziae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/24/2024] [Accepted: 05/10/2024] [Indexed: 07/04/2024] Open
Abstract
Iron is a vital trace element and exerts opposing effects on bone in both iron overload and iron deficiency situations. Remarkably, iron supplementation through intravenous infusion in patients with iron deficiency can also have detrimental effects on bone in special cases. The diverse mechanisms underlying these effects and their manifestations contribute to the complexity of this relationship. Iron overload impacts both bone resorption and formation, accelerating bone resorption while reducing bone formation. These effects primarily result from the direct action of reactive oxygen species (ROS), which influence the proliferation, differentiation, and activity of both osteoclasts and osteoblasts differently. This imbalance favors osteoclasts and inhibits the osteoblasts. Simultaneously, multiple pathways, including bone morphogenic proteins, RANK ligand, and others, contribute to these actions, leading to a reduction in bone mass and an increased susceptibility to fractures. In contrast, iron deficiency induces low bone turnover due to energy and co-factor deficiency, both of which require iron. Anemia increases the risk of fractures in both men and women. This effect occurs at various levels, reducing muscular performance and, on the bone-specific level, decreasing bone mineral density. Crucially, anemia increases the synthesis of the phosphaturic hormone iFGF23, which is subsequently inactivated by cleavage under physiological conditions. Thus, iFGF23 levels and phosphate excretion are not increased. However, in specific cases where anemia has to be managed with intravenous iron treatment, constituents-particularly maltoses-of the iron infusion suppress the cleavage of iFGF23. As a result, patients can experience severe phosphate wasting and, consequently, hypophosphatemic osteomalacia. This condition is often overlooked in clinical practice and is often caused by ferric carboxymaltose. Ending iron infusions or changing the agent, along with phosphate and vitamin D supplementation, can be effective in addressing this issue.
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Affiliation(s)
- Felix N von Brackel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Ralf Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
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Tashkandi DA, Hanafy E, Alotaibi N, Abuharfel D, Alnijaidi A, Banjar AM, Abufara F, Riyad S, Alhalabi M, Alblowi N. Indicators for Osteomyelitis in Children With Sickle Cell Disease Admitted With Vaso-Occlusive Crises. Cureus 2024; 16:e68265. [PMID: 39238724 PMCID: PMC11375391 DOI: 10.7759/cureus.68265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is an autosomal recessive genetic disorder characterized by the presence of a mutated form of hemoglobin (Hb) known as sickle hemoglobin (HbS). Individuals with SCD are susceptible to a variety of osteoarticular complications. Osteomyelitis is a commonly seen infection affecting the tibia, diaphysis of the femur and humerus, and vertebras. AIM The aim of this study was to define the indicators suggesting the diagnosis of osteomyelitis in patients with SCD. METHODS This study is a descriptive, analytical, non-interventional, prospective study of pediatric patients with SCD admitted with vaso-occlusive crisis (VOC) and/or osteomyelitis, which were identified by laboratory and radiological features. Retrospective data was included for patients who met the inclusion criteria. The statistical analysis included a description of the primary and secondary outcomes in the cohort. RESULTS A total of 28 children were included in this study. Participants' ages ranged from 11 months to 13 years. Males represented the majority (64.3%) of the participants. The blood culture of most of the participants (89.3%) showed no growth; however, 7.1% had salmonella, and only 3.6% had Gram-positive cocci. Most cases (75%) had leukocytosis. Thrombocytosis was present mainly in patients with VOC (40%). CRP was 1-4.9 mg/dL, mainly in patients with osteomyelitis (50%). The ferritin level exceeded 5000 ng/mL in patients with osteomyelitis or both osteomyelitis and VOC (50%). Ultrasound examinations revealed no hip effusion in 24 of the 28 examined patients. A plain X-ray examination showed no abnormality in 24 out of the 28 examined cases; with MRI, three cases exhibited marrow edema with bone enhancement, two (66.7%) were complicated by osteomyelitis, and the last (33.3%) had osteomyelitis and VOC. Aspiration was performed only in seven of the 28 examined, of which six (85.7%) were complicated by osteomyelitis, while the last one (14.3%) had acute chest syndrome. CONCLUSION Based on the outcomes of this study, we recommend an individualized multidisciplinary examination (hematology, infectious disease, orthopedic surgery, and interventional radiology) for SCD patients with suspected osteomyelitis admitted with VOC, considering the entire clinical history and laboratory and MRI results.
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Affiliation(s)
| | - Ehab Hanafy
- Prince Sultan Oncology Center, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Norah Alotaibi
- Pediatrics, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Doha Abuharfel
- Pediatric Medicine, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Ali Alnijaidi
- Pediatrics, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | - Fadwa Abufara
- Pediatrics, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Shaima Riyad
- Hematology and Oncology, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Maisa Alhalabi
- Pediatrics, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Naif Alblowi
- Hematology and Oncology, Prince Sultan Oncology Center, King Salman Armed Forces Hospital, Tabuk, SAU
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Ita MI, Olesen P, Rosing M, Mørk M, Einarsson HB, Riis JJ. Spontaneous Extradural Hematoma in a Sickle Cell Anemia Patient with Hyperinflammation and Thrombotic Microangiopathy Successfully Treated with Eculizumab: A Case Report and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38378045 DOI: 10.1055/a-2271-8772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND The event of extradural hematoma in the absence of head trauma is a rare central nervous system complication of sickle cell disease. We report here a case of spontaneous extradural hematoma in a patient being treated for sickle cell vasoocclusive crisis complicated by hyperinflammation and thrombotic microangiopathy. The significance of inflammation as an integral component of the pathomechanism of vasoocclusive crisis in patients with sickle cell disease and the role of heme in activating the complement system's alternative pathway are highlighted in this case report. CASE PRESENTATION A teenage patient with sickle cell disease developed a spontaneous right parietal extradural hematoma while receiving treatment for sickle cell vasoocclusive crisis. The concurrent events of hyperinflammation, disseminated intravascular coagulation, hyperhemolysis syndrome, thrombotic microangiopathy, and refractory postoperative bleeding complicated this patient's clinical course after surgical evacuation of extradural hematoma. This patient was subsequently treated with eculizumab and improved in the days following. CONCLUSION Treatment with the anti-C5 monoclonal antibody eculizumab, which targets and inhibits terminal complement system activation, reversed the deleterious cascade of events in this patient with sickle cell disease.
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Affiliation(s)
- Michael Itak Ita
- Department of Neurological Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Pia Olesen
- Department of Neurological Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Maria Rosing
- Department of Neurological Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Mørk
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jens Jakob Riis
- Department of Neurological Surgery, Aalborg University Hospital, Aalborg, Denmark
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6
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Arcanjo GS, Souza MB, Domingos IF, Pereira-Martins DA, Falcão DA, Batista JV, Hatzlhofer BL, Diniz MV, Silva AP, Guaraná WL, Hazin MF, Araujo AS, Cunha AF, Saad SO, Costa FF, Lucena-Araujo AR, Bezerra MAC. BMP6 and VDR gene polymorphisms are associated with osteonecrosis in a sickle cell anaemia cohort. Br J Haematol 2024; 204:1507-1514. [PMID: 38323352 DOI: 10.1111/bjh.19329] [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: 11/08/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
The occurrence and severity of osteonecrosis in sickle cell anaemia (SCA) vary due to risk factors, including genetic modifiers. Bone morphogenetic proteins (BMPs), particularly BMP6, and the vitamin D receptor (VDR) play key roles in cartilage and bone metabolism, making them potential contributors to orthopaedic outcomes in SCA. Here, we evaluated the association of polymorphisms in BMP6 (rs3812163, rs270393 and rs449853) and VDR (FokI rs2228570 and Cdx2 rs11568820) genes with osteonecrosis risk in a Brazilian SCA cohort. A total of 177 unrelated SCA patients were selected. The AA genotype of BMP6 rs3812163 was independently associated with a lower osteonecrosis risk (p = 0.015; odds ratio (OR): 0.38; 95% confidence interval (CI): 0.18-0.83) and with the long-term cumulative incidence of osteonecrosis (p = 0.029; hazard ratio: 0.56, 95% CI: 0.34-0.94). The VDR rs2228570 TT genotype was independently associated with a lower osteonecrosis risk (p = 0.039; OR: 0.14; 95% CI: 0.02-0.90). In summary, our results provide evidence that BMP6 rs3812163 and the VDR rs2228570 might be implicated in osteonecrosis pathophysiology in SCA and might help identify individuals at high risk.
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Affiliation(s)
- Gabriela S Arcanjo
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Mariana B Souza
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Igor F Domingos
- Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Diego A Pereira-Martins
- Department of Hematology, Cancer Research Centre Groningen, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Diego A Falcão
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Jessica V Batista
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Betania L Hatzlhofer
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Madi V Diniz
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Alexsandro P Silva
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Werbson L Guaraná
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Manuela F Hazin
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Pernambuco, Brazil
| | - Aderson S Araujo
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Pernambuco, Brazil
| | - Anderson F Cunha
- Department of Genetics and Evolution, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Sara O Saad
- Hematology and Hemotherapy Center, State University of Campinas, Campinas, São Paulo, Brazil
| | - Fernando F Costa
- Hematology and Hemotherapy Center, State University of Campinas, Campinas, São Paulo, Brazil
| | | | - Marcos André C Bezerra
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Ledesma-Colunga MG, Passin V, Vujic Spasic M, Hofbauer LC, Baschant U, Rauner M. Comparison of the effects of high dietary iron levels on bone microarchitecture responses in the mouse strains 129/Sv and C57BL/6J. Sci Rep 2024; 14:4887. [PMID: 38418857 PMCID: PMC10902348 DOI: 10.1038/s41598-024-55303-2] [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: 10/11/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
Iron is an essential nutrient for all living organisms. Both iron deficiency and excess can be harmful. Bone, a highly metabolic active organ, is particularly sensitive to fluctuations in iron levels. In this study, we investigated the effects of dietary iron overload on bone homeostasis with a specific focus on two frequently utilized mouse strains: 129/Sv and C57BL/6J. Our findings revealed that after 6 weeks on an iron-rich diet, 129/Sv mice exhibited a decrease in trabecular and cortical bone density in both vertebral and femoral bones, which was linked to reduced bone turnover. In contrast, there was no evidence of bone changes associated with iron overload in age-matched C57BL/6J mice. Interestingly, 129/Sv mice exposed to an iron-rich diet during their prenatal development were protected from iron-induced bone loss, suggesting the presence of potential adaptive mechanisms. Overall, our study underscores the critical role of genetic background in modulating the effects of iron overload on bone health. This should be considered when studying effects of iron on bone.
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Affiliation(s)
- Maria G Ledesma-Colunga
- Department of Medicine III & Center for Healthy Aging, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Vanessa Passin
- Department of Medicine III & Center for Healthy Aging, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Maja Vujic Spasic
- Institute of Comparative Molecular Endocrinology, Ulm University, Ulm, Germany
| | - Lorenz C Hofbauer
- Department of Medicine III & Center for Healthy Aging, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Ulrike Baschant
- Department of Medicine III & Center for Healthy Aging, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Martina Rauner
- Department of Medicine III & Center for Healthy Aging, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
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Gollamudi J, Karkoska KA, Gbotosho OT, Zou W, Hyacinth HI, Teitelbaum SL. A bone to pick-cellular and molecular mechanisms of bone pain in sickle cell disease. FRONTIERS IN PAIN RESEARCH 2024; 4:1302014. [PMID: 38239327 PMCID: PMC10794347 DOI: 10.3389/fpain.2023.1302014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/04/2023] [Indexed: 01/22/2024] Open
Abstract
The bone is one of the most commonly affected organs in sickle cell disease (SCD). Repeated ischemia, oxidative stress and inflammation within the bone is largely responsible for promoting bone pain. As more individuals with SCD survive into adulthood, they are likely to experience a synergistic impact of both aging and SCD on their bone health. As bone health deteriorates, bone pain will likely exacerbate. Recent mechanistic and observational studies emphasize an intricate relationship between bone remodeling and the peripheral nervous system. Under pathological conditions, abnormal bone remodeling plays a key role in the propagation of bone pain. In this review, we first summarize mechanisms and burden of select bone complications in SCD. We then discuss processes that contribute to pathological bone pain that have been described in both SCD as well as non-sickle cell animal models. We emphasize the role of bone-nervous system interactions and pitfalls when designing new therapies especially for the sickle cell population. Lastly, we also discuss future basic and translational research in addressing questions about the complex role of stress erythropoiesis and inflammation in the development of SCD bone complications, which may lead to promising therapies and reduce morbidity in this vulnerable population.
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Affiliation(s)
- Jahnavi Gollamudi
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kristine A. Karkoska
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Oluwabukola T. Gbotosho
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Wei Zou
- Department of Medicine, Division of Bone and Mineral Diseases, and Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St. Louis, MO, United States
| | - Hyacinth I. Hyacinth
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Steven L. Teitelbaum
- Department of Medicine, Division of Bone and Mineral Diseases, and Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St. Louis, MO, United States
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Seiller J, Merle B, Fort R, Virot E, Poutrel S, Cannas G, Hot A, Chapurlat R. Prevalence of bone complications in young patients with sickle cell disease presenting low bone mineral density. Bone 2024; 178:116924. [PMID: 37783302 DOI: 10.1016/j.bone.2023.116924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/13/2023] [Accepted: 09/28/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Bone fragility in sickle cell disease (SCD) has been previously reported even in young patients, but the clinical consequences and specific management remain unclear. The objective of this study was to assess the prevalence of bone fragility in sickle cell patients and to evaluate the potential risk factors and associated complications. METHODS We conducted a single-center cross-sectional study. Bone mineral densitometry (BMD) at the lumbar spine and the hip, Vertebral Fracture Assessment (VFA) and biological measurements were performed in patients aged between 20 and 40 years. RESULTS One hundred and thirty-eight patients with sickle cell disease were included between June 2020 and December 2021. One hundred and one patients (73.2 %) were from Sub-Saharan Africa, 13 from North Africa (9.4 %), 11 from the Caribbean (7.9 %), 6 from the Indian Ocean. A Z-score < -2 was found in 43 patients (31.2 %) at the lumbar spine, in 4 patients (3 %) at the total hip, and in 5 patients (3.7 %) at the femoral neck. 59 patients (46.8 %) had vertebral deformities. Fragility fractures were recorded in 9 patients (10.8 %). Patients with low BMD had lower BMI (21.3 (19.0, 24.0) versus 24.0 (20.7, 26.1) Kg/m2, p = 0.003), lower osteonecrosis history (7 % versus 25.3 %, p = 0.011) and lower hemoglobin levels (9.0 (8.0, 10.0) versus 10.0 (9.0, 11.0) g/dL, p < 0.01). No association was found between history of fracture and low BMD. CONCLUSION Young patients with SCD commonly have low BMD at the lumbar spine, but the prevalence of fragility fracture was low. Low BMD - specifically at the spine - may not be tantamount to bone fragility.
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Affiliation(s)
- Julien Seiller
- Service de Rhumatologie et Pathologies osseuses, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | | | - Romain Fort
- Service de Médecine Interne et Immunologie clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Département d'Anesthésie Réanimation-Medecine Intensive, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Emilie Virot
- Service de Médecine Interne et Immunologie clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre de Référence Constitutif Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erytropoïese, Lyon, France
| | - Solene Poutrel
- Service de Médecine Interne et Immunologie clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre de Référence Constitutif Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erytropoïese, Lyon, France
| | - Giovanna Cannas
- Service de Médecine Interne et Immunologie clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre de Référence Constitutif Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erytropoïese, Lyon, France
| | - Arnaud Hot
- Service de Médecine Interne et Immunologie clinique, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre de Référence Constitutif Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erytropoïese, Lyon, France
| | - Roland Chapurlat
- Service de Rhumatologie et Pathologies osseuses, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France; INSERM UMR1033, Université de Lyon, Lyon, France
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10
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Kamimura S, Smith M, Vogel S, Almeida LEF, Thein SL, Quezado ZMN. Mouse models of sickle cell disease: Imperfect and yet very informative. Blood Cells Mol Dis 2024; 104:102776. [PMID: 37391346 PMCID: PMC10725515 DOI: 10.1016/j.bcmd.2023.102776] [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: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
The root cause of sickle cell disease (SCD) has been known for nearly a century, however, few therapies to treat the disease are available. Over several decades of work, with advances in gene editing technology and after several iterations of mice with differing genotype/phenotype relationships, researchers have developed humanized SCD mouse models. However, while a large body of preclinical studies has led to huge gains in basic science knowledge about SCD in mice, this knowledge has not led to the development of effective therapies to treat SCD-related complications in humans, thus leading to frustration with the paucity of translational progress in the SCD field. The use of mouse models to study human diseases is based on the genetic and phenotypic similarities between mouse and humans (face validity). The Berkeley and Townes SCD mice express only human globin chains and no mouse hemoglobin. With this genetic composition, these models present many phenotypic similarities, but also significant discrepancies that should be considered when interpreting preclinical studies results. Reviewing genetic and phenotypic similarities and discrepancies and examining studies that have translated to humans and those that have not, offer a better perspective of construct, face, and predictive validities of humanized SCD mouse models.
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Affiliation(s)
- Sayuri Kamimura
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Meghann Smith
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sebastian Vogel
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Luis E F Almeida
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Zenaide M N Quezado
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA; Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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11
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Santos M, Cunha B, Abreu V, Ferraciolli S, Godoy L, Murakoshi R, Amaral LLF, Conceição C. Imaging of pediatric skull lytic lesions: A review. J Neuroimaging 2024; 34:26-43. [PMID: 37933199 DOI: 10.1111/jon.13166] [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: 09/08/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023] Open
Abstract
Skull lesions in pediatric population are common findings on imaging and sometimes with heterogeneous manifestations, constituting a diagnostic challenge. Some lesions can be misinterpreted for their aggressiveness, as with larger lesions eroding cortical bone, containing soft tissue components, leading to excessive and, in some cases, invasive inappropriate etiological investigation. In this review, we present multiple several conditions that may present as skull lesions or pseudolesions, organized by groups (anatomic variants, congenital and development disorders, traumatic injuries, vascular issues, infectious conditions, and tumoral processes). Anatomic variants are common imaging findings that must be recognized by the neuroradiologist. Congenital malformations are rare conditions, such as aplasia cutis congenita and sinus pericranii, usually seen at earlier ages, the majority of which are benign findings. In case of trauma, cephalohematoma, growing skull fractures, and posttraumatic lytic lesions should be considered. Osteomyelitis tends to be locally aggressive and may mimic malignancy, in which cases, the clinical history can be the key to diagnosis. Vascular (sickle cell disease) and tumoral (aneurismal bone cyst, eosinophilic granuloma, metastases) lesions are relatively rare lesions but should be considered in the differential diagnosis, in the presence of certain imaging findings. The main difficulty is the differentiation between the benign and malignant nature; therefore, the main objective of this pictorial essay is to review the main skull lytic lesions found in pediatric age, describing the main findings in different imaging modalities (CT and MRI), allowing the neuroradiologist greater confidence in establishing the differential diagnosis, through a systematic and simple characterization of the lesions.
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Affiliation(s)
- Mariana Santos
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - Bruno Cunha
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - Vasco Abreu
- Neuroradiology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Suely Ferraciolli
- Neuroradiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luís Godoy
- Neuroradiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Neuroradiology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo Murakoshi
- Neuroradiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Neuroradiology and Head & Neck Department, Hospital Rede D'Or, São Paulo, Brazil
| | | | - Carla Conceição
- Neuroradiology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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12
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Maldonado LY, Bosques L, Cromer SJ, Azar SS, Yu EW, Burnett-Bowie SAM. Racial and Ethnic Disparities in Metabolic Bone Disease. Endocrinol Metab Clin North Am 2023; 52:629-641. [PMID: 37865478 DOI: 10.1016/j.ecl.2023.05.004] [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: 10/23/2023]
Abstract
Racial and ethnic disparities exist in the prevalence and management of osteoporosis, metastatic cancer, and sickle cell disease. Despite being the most common metabolic bone disease, osteoporosis remains underscreened and undertreated among Black women. Skeletal-related events in metastatic cancer include bone pain, pathologic fractures, and spinal cord compression. Disparities in screening for and treating skeletal-related events disproportionately affect Black patients. Metabolic bone disease contributes significantly to morbidity in sickle cell disease; however, clinical guidelines for screening and treatment do not currently exist. Clinical care recommendations are provided to raise awareness, close health care gaps, and guide future research efforts.
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Affiliation(s)
- Lauren Y Maldonado
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bigelow 730, Boston, MA 02114, USA; Department of Pediatrics, MassGeneral Hospital for Children and Harvard Medical School, 175 Cambridge Street, Boston, MA 02114, USA
| | - Linette Bosques
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bigelow 730, Boston, MA 02114, USA
| | - Sara J Cromer
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA
| | - Sharl S Azar
- Hematology and Medical Oncology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Yawkey 9-536, Boston, MA 02114, USA
| | - Elaine W Yu
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA
| | - Sherri-Ann M Burnett-Bowie
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA.
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13
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Murthy NS, Mahale RP, MVS KK. Primary Anterior Thoracic Wall Abscess with Osteomyelitis by Salmonella paratyphi A : Case Report. J Lab Physicians 2023; 15:613-615. [PMID: 37780877 PMCID: PMC10539062 DOI: 10.1055/s-0043-1768949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/04/2023] [Indexed: 10/03/2023] Open
Abstract
Salmonella enterica serovar Typhi and Paratyphi have been imputed in the causation of enteric fever. Cardiovascular and extraintestinal Salmonella infections have been documented among immunocompromised individuals. Rarely these pathogens are ascribed in the causation of extraintestinal infections among immunocompetent hosts due to hematogenous seeding. We report a case of anterior chest wall abscess with osteomyelitis in an immunocompetent adult by Salmonella paratyphi A without any prior predisposing conditions or gastrointestinal symptoms. The patient underwent incision and drainage of the loculated pus and the involved costochondral junction was curetted. Medical management was guided by automated antibiotic susceptibility testing. Patient responded well to treatment and was discharged with no residual morbidities. Prompt diagnosis complements appurtenant treatment and thereby averts defunct consequential sequelae.
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Affiliation(s)
- Neetha S. Murthy
- Department of Microbiology, JSS Academy of Higher Education and Research (AHER), Mysuru, Karnataka, India
| | - Rashmi P. Mahale
- Department of Microbiology, JSS Academy of Higher Education and Research (AHER), Mysuru, Karnataka, India
| | - Krishna Karthik MVS
- Department of Microbiology, JSS Academy of Higher Education and Research (AHER), Mysuru, Karnataka, India
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14
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Willimann R, Chougar C, Wolfe LC, Blanc L, Lipton JM. Defects in Bone and Bone Marrow in Inherited Anemias: the Chicken or the Egg. Curr Osteoporos Rep 2023; 21:527-539. [PMID: 37436584 DOI: 10.1007/s11914-023-00809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE OF REVIEW Recently, there has been an increasing number of studies on the crosstalk between the bone and the bone marrow and how it pertains to anemia. Here, we discuss four heritable clinical syndromes contrasting those in which anemia affects bone growth and development, with those in which abnormal bone development results in anemia, highlighting the multifaceted interactions between skeletal development and hematopoiesis. RECENT FINDINGS Anemia results from both inherited and acquired disorders caused by either impaired production or premature destruction of red blood cells or blood loss. The downstream effects on bone development and growth in patients with anemia often constitute an important part of their clinical condition. We will discuss the interdependence of abnormal bone development and growth and hematopoietic abnormalities, with a focus on the erythroid lineage. To illustrate those points, we selected four heritable anemias that arise from either defective hematopoiesis impacting the skeletal system (the hemoglobinopathies β-thalassemia and sickle cell disease) versus defective osteogenesis resulting in impaired hematopoiesis (osteopetrosis). Finally, we will discuss recent findings in Diamond Blackfan anemia, an intrinsic disorder of both the erythron and the bone. By focusing on four representative hereditary hematopoietic disorders, this complex relationship between bone and blood should lead to new areas of research in the field.
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Affiliation(s)
- Rachel Willimann
- Division of Hematology Oncology and Cellular Therapy, Steven and Alexandra Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Christina Chougar
- Division of Hematology Oncology and Cellular Therapy, Steven and Alexandra Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA
- Division of Pediatric Radiology, Steven and Alexandra Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Lawrence C Wolfe
- Division of Hematology Oncology and Cellular Therapy, Steven and Alexandra Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Lionel Blanc
- Division of Hematology Oncology and Cellular Therapy, Steven and Alexandra Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Jeffrey M Lipton
- Division of Hematology Oncology and Cellular Therapy, Steven and Alexandra Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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15
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Gaschignard J, Koehl B, Rees DC, Rincón-López E, Vanderfaeillie A, Pascault A, Allali S, Cela E, Odièvre MH, Hau I, Oliveira M, Guillaumat C, Brousse V, de Montalembert M, Navarro Gómez ML, Beldjoudi N, Bardon-Cancho EJ, Epalza C. Invasive Bacterial Infections in Children With Sickle Cell Disease: 2014-2019. Pediatrics 2023; 152:e2022061061. [PMID: 37767606 DOI: 10.1542/peds.2022-061061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at a high risk of invasive bacterial infections (IBI). Universal penicillin prophylaxis and vaccination, especially against Streptococcus pneumoniae, have deeply changed its epidemiology. Analysis of IBI in children with SCD in a post-13-valent pneumococcal vaccine era is limited. METHODS Twenty-eight pediatric hospitals from 5 European countries retrospectively collected IBI episodes in SCD children aged 1 month to 18 years between 2014 and 2019. IBI was defined as a positive bacterial culture or polymerase chain reaction from a normally sterile fluid: blood, cerebrospinal, joint, or pleural fluid and deep surgical specimen. RESULTS We recorded 169 IBI episodes. Salmonella spp. was the main isolated bacteria (n = 44, 26%), followed by Streptococcus pneumonia (Sp; n = 31, 18%) and Staphylococcus aureus (n = 20, 12%). Salmonella prevailed in osteoarticular infections and in primary bacteremia (45% and 23% of episodes, respectively) and Sp in meningitis and acute chest syndrome (88% and 50%, respectively). All Sp IBI occurred in children ≤10 years old, including 35% in children 5 to 10 years old. Twenty-seven (17%) children had complications of infection and 3 died: 2 because of Sp, and 1 because of Salmonella. The main risk factors for a severe IBI were a previous IBI and pneumococcal infection (17 Sp/51 cases). CONCLUSIONS In a post-13-valent pneumococcal vaccine era, Salmonella was the leading cause of bacteremia in IBI in children with SCD in Europe. Sp came second, was isolated in children ≤10 years old, and was more likely to cause severe and fatal cases.
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Affiliation(s)
- Jean Gaschignard
- Department of Pediatrics, Groupe Hospitalier Nord Essonne, Longjumeau, France
- IAME, INSERM 1137, Hôpital Bichat, Paris, France
| | - Bérengère Koehl
- Departments of Sickle Cell Disease, Hôpital Robert Debré
- Université de Paris-Cité, Paris, France
- INSERM U1134, Integrated Red Globule Biology, Paris, France
| | - David C Rees
- Red Cell Haematology Laboratory, School of Cancer and Pharmaceutical Sciences, King's College London and King's College Hospital, London, United Kingdom
| | - Elena Rincón-López
- Departments of Pediatrics
- Biomedical Research Networking Center on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Alice Pascault
- Departments of Sickle Cell Disease, Hôpital Robert Debré
| | - Slimane Allali
- General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Université Paris Cité
- Université de Paris-Cité, Paris, France
| | - Elena Cela
- Pediatric Hematology and Oncology Unit, Universidad Complutense de Madrid, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Isabelle Hau
- Department of Pediatrics, Centre Hospitalier Intercommunal, Créteil, France
| | - Marisa Oliveira
- Pediatric Hematology Unit, Hospital D. Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cécile Guillaumat
- Department of Pediatrics, Centre Hospitalier Sud Francilien, Corbeil-Essonne, France
| | - Valentine Brousse
- Departments of Sickle Cell Disease, Hôpital Robert Debré
- Université de Paris-Cité, Paris, France
- INSERM U1134, Integrated Red Globule Biology, Paris, France
| | - Mariane de Montalembert
- General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Université Paris Cité
- Université de Paris-Cité, Paris, France
| | - Maria Luisa Navarro Gómez
- Departments of Pediatrics
- Biomedical Research Networking Center on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Naima Beldjoudi
- Epidemiology and Clinical Research Department, GH Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Eduardo Jesus Bardon-Cancho
- Pediatric Hematology and Oncology Unit, Universidad Complutense de Madrid, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
- Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
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16
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Banait S, Banait T, Shukla S, Mane S, Jain J. Bilateral Humeral Head Avascular Necrosis: A Rare Presentation in Sickle Cell Trait. Cureus 2023; 15:e44006. [PMID: 37746483 PMCID: PMC10517089 DOI: 10.7759/cureus.44006] [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: 11/11/2022] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Sickle cell disease (SCD) affects millions of people worldwide. It is an autosomal recessive hemoglobinopathy that occurs due to a point mutation in the sixth codon that replaces glutamic acid with valine in the beta-globin chain. Avascular necrosis (AVN), also known as osteonecrosis, is one of its complications. In this report, we present a case of a 25-year-old female with sickle cell trait without any comorbidities who presented to us with pain in both shoulder joints for three months and was diagnosed with AVN in bilateral shoulder joints. Appropriate treatment can dramatically reduce pain and improve the quality of life for these patients. This case drew our attention due to its rare presentation.
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Affiliation(s)
- Shashank Banait
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (DMIHER), Wardha, IND
| | - Tanvi Banait
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (DMIHER), Wardha, IND
| | - Shivani Shukla
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Supriya Mane
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Jyoti Jain
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
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17
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Baghdadi S, Chern I, Hanstein R, Mehraban Alvandi L, Fornari E. Femoral Head Core Decompression and Bone Marrow Concentrate Injection in Pediatric Sickle-cell Related Avascular Necrosis. J Pediatr Orthop 2023; 43:e433-e439. [PMID: 37043417 DOI: 10.1097/bpo.0000000000002415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Femoral head avascular necrosis affects 10% to 40% of patients with sickle cell disease (SCD). The purpose of this study was to evaluate the results of femoral head core decompression and bone marrow aspirate concentrate (CD-BMAC) injection in pediatric patients with SCD. METHODS Eligible patients were enrolled in this retrospective study of patients undergoing CD-BMAC. Patients with SCD who were younger than 18 at the time of surgery and had >1 year of follow-up were included in this analysis. Hips were staged based on the Ficat system by 2 raters. The visual analog score for pain, hip outcome score, modified Harris hip score, and the University of California, Los Angeles activity score were used as patient-reported outcome measures preoperatively, at 5 to 9 months postoperatively, and final follow-up. Treatment failure was defined as total hip arthroplasty or visual analog score >3 at the final follow-up. RESULTS Twenty-three hips in 17 patients were included, with a median age at the time of surgery of 15.8 years (interquartile range: 13.1 to 17.8 y). Patients were followed for 4.25 ± 1.7 years. Ten hips showed a 1-stage increase in the Ficat stage at the final follow-up, whereas 11 retained the same stage, and 1 hip had a 1-stage regression. All patient-reported outcome measures showed significant improvement from the preoperative visit to short-term follow-up, but the preoperative to final follow-up improvement was not significant. Six treatment failures were recorded, including 3 total hip arthroplasties and 3 painful hips at the final follow-up. In a multivariate logistic regression model, only skeletal maturity (odds ratio = 16.2, 95% CI: 1.44-183.0, P = 0.024) and femoral head collapse (odds ratio = 12.0, 95% CI: 1.1-130.5, P = 0.041) were significant predictors of treatment failure. CONCLUSIONS In the largest study on pediatric SCD patients undergoing CD-BMAC, we found that CD-BMAC injection offers significant improvement in pain and functional outcomes in the short term, with a very low risk for complications. Skeletal maturity and femoral head collapse were significant predictors of treatment failure. Patients with a collapsed femoral head experienced functional deterioration over time after initial improvement, whereas precollapse hips maintained their functional improvement up to the latest follow-up. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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18
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Aprile A, Raggi L, Bolamperti S, Villa I, Storto M, Morello G, Marktel S, Tripodo C, Cappellini MD, Motta I, Rubinacci A, Ferrari G. Inhibition of FGF23 is a therapeutic strategy to target hematopoietic stem cell niche defects in β-thalassemia. Sci Transl Med 2023; 15:eabq3679. [PMID: 37256933 DOI: 10.1126/scitranslmed.abq3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/27/2023] [Indexed: 06/02/2023]
Abstract
Clinical evidence highlights a relationship between the blood and the bone, but the underlying mechanism linking these two tissues is not fully elucidated. Here, we used β-thalassemia as a model of congenital anemia with bone and bone marrow (BM) niche defects. We demonstrate that fibroblast growth factor 23 (FGF23) is increased in patients and mice with β-thalassemia because erythropoietin induces FGF23 overproduction in bone and BM erythroid cells via ERK1/2 and STAT5 pathways. We show that in vivo inhibition of FGF23 signaling by carboxyl-terminal FGF23 peptide is a safe and efficacious therapeutic strategy to rescue bone mineralization and deposition in mice with β-thalassemia, normalizing the expression of niche factors and restoring hematopoietic stem cell (HSC) function. FGF23 may thus represent a molecular link connecting anemia, bone, and the HSC niche. This study provides a translational approach to targeting bone defects and rescuing HSC niche interactions, with potential clinical relevance for improving HSC transplantation and gene therapy for hematopoietic disorders.
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Affiliation(s)
- Annamaria Aprile
- San Raffaele-Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Laura Raggi
- San Raffaele-Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- University of Milano Bicocca, 20126 Milan, Italy
| | - Simona Bolamperti
- Bone Metabolism Unit, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Endocrine and Osteometabolic Laboratory, Institute of Endocrine and Metabolic Sciences, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Isabella Villa
- Bone Metabolism Unit, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Endocrine and Osteometabolic Laboratory, Institute of Endocrine and Metabolic Sciences, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Mariangela Storto
- San Raffaele-Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gaia Morello
- Tumor Immunology Unit, Human Pathology Section, Department of Health Sciences, University of Palermo, 90134 Palermo, Italy
| | - Sarah Marktel
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Claudio Tripodo
- Tumor Immunology Unit, Human Pathology Section, Department of Health Sciences, University of Palermo, 90134 Palermo, Italy
- IFOM ETS, AIRC Institute of Molecular Oncology, 20139 Milan, Italy
| | - Maria Domenica Cappellini
- General Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Irene Motta
- General Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Alessandro Rubinacci
- Bone Metabolism Unit, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giuliana Ferrari
- San Raffaele-Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
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19
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Duarte M, Almeida Borges M, Kjöllerström P, Maia R. Sickle Cell Disease Diagnosis Uncovered by Incidental Radiograph Findings. J Pediatr Hematol Oncol 2023; 45:151. [PMID: 36730969 DOI: 10.1097/mph.0000000000002576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/22/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Mariana Duarte
- Paediatric Haematology Unit, Área de Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa, Central EPE, Portugal
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20
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Oyedeji CI, Hodulik KL, Telen MJ, Strouse JJ. Management of Older Adults with Sickle Cell Disease: Considerations for Current and Emerging Therapies. Drugs Aging 2023; 40:317-334. [PMID: 36853587 PMCID: PMC10979738 DOI: 10.1007/s40266-023-01014-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
People with sickle cell disease (SCD) are living longer than ever before, with the median survival increasing from age 14 years in 1973, beyond age 40 years in the 1990s, and as high as 61 years in recent cohorts from academic centers. Improvements in survival have been attributed to initiatives, such as newborn screening, penicillin prophylaxis, vaccination against encapsulated organisms, better detection and treatment of splenic sequestration, and improved transfusion support. There are an estimated 100,000 people living with SCD in the United States and millions of people with SCD globally. Given that the number of older adults with SCD will likely continue to increase as survival improves, better evidence on how to manage this population is needed. When managing older adults with SCD (defined herein as age ≥ 40 years), healthcare providers should consider the potential pitfalls of extrapolating evidence from existing studies on current and emerging therapies that have typically been conducted with participants at mean ages far below 40 years. Older adults with SCD have historically had little to no representation in clinical trials; therefore, more guidance is needed on how to use current and emerging therapies in this population. This article summarizes the available evidence for managing older adults with SCD and discusses potential challenges to using approved and emerging drugs in this population.
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Affiliation(s)
- Charity I Oyedeji
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.
- Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 315 Trent Dr., Suite 266, DUMC Box 3939, Durham, NC, 27710, USA.
| | - Kimberly L Hodulik
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Pharmacy, Duke University Hospital, Durham, NC, USA
| | - Marilyn J Telen
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - John J Strouse
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA
- Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 315 Trent Dr., Suite 266, DUMC Box 3939, Durham, NC, 27710, USA
- Division of Pediatric Hematology-Oncology, Duke University, Durham, NC, USA
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21
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Almarzooq O, Alhassan M, Alansari L, Alanazi T, Madan FH. Cemented Versus Uncemented Total Hip Arthroplasty in Sickle Cell Disease Patients: A Retrospective Study. Cureus 2023; 15:e36138. [PMID: 37065305 PMCID: PMC10101182 DOI: 10.7759/cureus.36138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Background and objective Sickle cell disease (SCD) can predispose patients to avascular necrosis (AVN) of the femoral head, resulting in severe disabling pain. Total hip arthroplasty (THA) is the leading treatment choice for end-stage arthritis caused by AVN. In this study, we aimed to compare complications associated with implant fixation with and without cement. Materials and methods We retrospectively analyzed 95 total hip implants in which 26 patients had staged bilateral THA. These surgeries were performed by four senior arthroplasty consultants between 2007 and 2018. Data were collected from the surgical logbook, physical files, and the electronic patient database (I-Seha, National Health Information System, Ministry of Health, Kingdom of Bahrain). Results The study included 95 hip implants in 69 patients. Forty-five (47%) were in males, and 50 (53%) were in females. Of these, 22 implants underwent revision (23%), two implants had periprosthetic infections (0.2%), two implants had periprosthetic fractures (0.2%), and 18 implants had implant loosening. We found that cemented THA was significantly associated with the development of implant loosening (p<0.001), small particle disease (p<0.001), and a higher revision rate (p<0.001). Conclusion We found that cemented THA in SCD patients led to a higher rate of aseptic implant loosening, mainly caused by osteolysis. Based on our findings, we recommend uncemented THA in SCD patients.
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Abreu VS, Xavier S, Santos M, Lopes da Silva R, Kjöllerström P, Conceição C. The sick(le) brain and spine: neuroimaging findings in paediatric patients with sickle cell disease. Clin Radiol 2023:S0009-9260(23)00081-8. [PMID: 36935257 DOI: 10.1016/j.crad.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
Sickle cell disease (SCD) is an autosomal recessive haemoglobinopathy, which manifests as multisystem ischaemia and infarction, as well as haemolytic anaemia. The morphological changes of red blood cells (RBCs) that promote ischaemia/infarction as the main multi-systemic manifestation, with associated vasculopathy, may also lead to haemorrhage and fat embolisation. Bone infarctions, whether of the skull or spine, are relatively common with subsequent increased infectious susceptibility. We present a broad spectrum of brain and spine imaging findings of SCD from a level III paediatric hospital in Lisbon, between 2010 and 2022. Our aim is to highlight brain and spine imaging findings from a serial review of multiple patients with SCD and respective neuroimaging characterisation.
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Affiliation(s)
- V Sousa Abreu
- Neuroradiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - S Xavier
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - M Santos
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - R Lopes da Silva
- Paediatric Neurology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - P Kjöllerström
- Paediatric Hematology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - C Conceição
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
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23
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Muacevic A, Adler JR, Saleh D, Habibullah N. Compound Heterogeneous Sickle Cell-B+ Thalassemia Incidentally Discovered Through Cytological Examination of a Fine-Needle Aspiration Specimen from an Aneurysmal Bone Cyst in a Young Child: A Case Report. Cureus 2023; 15:e33594. [PMID: 36779144 PMCID: PMC9910222 DOI: 10.7759/cureus.33594] [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] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
Sickle cell beta-thalassemia (S/β) is a rare inherited variant of sickling disorders, usually occurring due to the inheritance of two abnormal genes, namely, the sickle cell gene, and the beta-thalassemia gene. There are two types of sickle cell β-thalassemia: (S/β+) and (S/β0), based on a decrease or complete absence of beta-globin synthesis, respectively. Skeletal complications, such as osteonecrosis, osteomyelitis, and septic arthritis, are well-known sequelae in sickle cell patients due to vaso-occlusive events. Nevertheless, the occurrence of aneurysmal bone cysts in patients with sickle cell hemoglobinopathy is an exceptional phenomenon. Herein, we report a case of a young boy who presented with nonspecific clinical symptoms over a few years. The patient was referred to our institution as a case of short stature with recurrent joint pain. A clinical workup was done and an aneurysmal bone cyst (ABC) of the left humerus was discovered radiologically with incidental detection of sickle cells through cytological evaluation of the cyst fluid. Further clinical investigation, including molecular and additional laboratory tests, confirmed the diagnosis of compound heterogeneous sickle cell-B+ thalassemia. Unfortunately, neither was the underlying pathology detected nor was the precise clinical diagnosis attained at the outside primary healthcare facility.
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Rakutt MJ, Bracey DN, Cohen-Rosenblum A, Sculco PK, Sabatini FM, Jacobs CA, Duncan ST, Landy DC. Hemoglobinopathy is Associated With Total Hip Arthroplasty Indication Even Beyond Sickle Cell Anemia. Arthroplast Today 2022; 19:101062. [PMID: 36845292 PMCID: PMC9947981 DOI: 10.1016/j.artd.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022] Open
Abstract
Background The extent to which hemoglobinopathies other than sickle anemia (HbSS) are associated with hip osteonecrosis is unknown. Sickle cell trait (HbS), hemoglobin SC (HbSC), and sickle/β-thalassemia (HbSβTh) may also predispose to osteonecrosis of the femoral head (ONFH). We sought to compare the distributions of indications for a total hip arthroplasty (THA) in patients with and without specific hemoglobinopathies. Methods PearlDiver, an administrative claims database, was used to identify 384,401 patients aged 18 years or older undergoing a THA not for fracture from 2010 to 2020, with patients grouped by diagnosis code (HbSS N = 210, HbSC N = 196, HbSβTh N = 129, HbS N = 356). β-Thalassemia minor (N = 142) acted as a negative control, and patients without hemoglobinopathy as a comparison group (N = 383,368). The proportion of patients with ONFH was compared to patients without it by hemoglobinopathy groups using chi-squared tests before and after matching on age, sex, Elixhauser Comorbidity Index, and tobacco use. Results The proportion of patients with ONFH as the indication for THA was higher among those with HbSS (59%, P < .001), HbSC (80%, P < .001), HbSβTh (77%, P < .001), and HbS (19%, P < .001) but not with β-thalassemia minor (9%, P = .6) than the proportion of patients without hemoglobinopathy (8%). After matching, the proportion of patients with ONFH remained higher among those with HbSS (59% vs 21%, P < .001), HbSC (80% vs 34%, P < .001), HbSβTh (77% vs 26%, P < .001), and HbS (19% vs 12%, P < .001). Conclusions Hemoglobinopathies beyond sickle cell anemia were strongly associated with having osteonecrosis as the indication for THA. Further research is needed to confirm whether this modifies THA outcomes.
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Affiliation(s)
- Maxwell J. Rakutt
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA
| | - Daniel N. Bracey
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Anna Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, LA, USA
| | - Peter K. Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Franco M. Sabatini
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA
| | - Cale A. Jacobs
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA
| | - Stephen T. Duncan
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA
| | - David C. Landy
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA,Corresponding author. Department of Orthopaedic Surgery, University of Kentucky, 740 S. Limestone, Suite K-419, Lexington, KY 40513, USA. Tel.: +1 713 305 4266.
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25
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Grimbly C, Escagedo PD, Jaremko JL, Bruce A, Alos N, Robinson ME, Konji VN, Page M, Scharke M, Simpson E, Pastore YD, Girgis R, Alexander RT, Ward LM. Sickle cell bone disease and response to intravenous bisphosphonates in children. Osteoporos Int 2022; 33:2397-2408. [PMID: 35904681 PMCID: PMC9568449 DOI: 10.1007/s00198-022-06455-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/28/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED Children with sickle cell disease (SCD) have the potential for extensive and early-onset bone morbidity. This study reports on the diversity of bone morbidity seen in children with SCD followed at three tertiary centers. IV bisphosphonates were effective for bone pain analgesia and did not trigger sickle cell complications. INTRODUCTION To evaluate bone morbidity and the response to intravenous (IV) bisphosphonate therapy in children with SCD. METHODS We conducted a retrospective review of patient records from 2003 to 2019 at three Canadian pediatric tertiary care centers. Radiographs, magnetic resonance images, and computed tomography scans were reviewed for the presence of avascular necrosis (AVN), bone infarcts, and myositis. IV bisphosphonates were offered for bone pain management. Bone mineral density was assessed by dual-energy X-ray absorptiometry (DXA). RESULTS Forty-six children (20 girls, 43%) had bone morbidity at a mean age of 11.8 years (SD 3.9) including AVN of the femoral (17/46, 37%) and humeral (8/46, 17%) heads, H-shaped vertebral body deformities due to endplate infarcts (35/46, 76%), and non-vertebral body skeletal infarcts (15/46, 32%). Five children (5/26, 19%) had myositis overlying areas of AVN or bone infarcts visualized on magnetic resonance imaging. Twenty-three children (8/23 girls) received IV bisphosphonate therapy. They all reported significant or complete resolution of bone pain. There were no reports of sickle cell hemolytic crises, pain crises, or stroke attributed to IV bisphosphonate therapy. CONCLUSION Children with SCD have the potential for extensive and early-onset bone morbidity. In this series, IV bisphosphonates were effective for bone pain analgesia and did not trigger sickle cell complications.
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Affiliation(s)
- C Grimbly
- Department of Pediatrics, University of Alberta, 4-584 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 2R7, Canada.
- Women's and Children's Health Research Institute, Alberta, Canada.
| | - P Diaz Escagedo
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, QC, Canada
| | - J L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - A Bruce
- Department of Pediatrics, University of Alberta, 4-584 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 2R7, Canada
- Women's and Children's Health Research Institute, Alberta, Canada
| | - N Alos
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, QC, Canada
| | - M E Robinson
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - V N Konji
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - M Page
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - M Scharke
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - E Simpson
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Y D Pastore
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, QC, Canada
| | - R Girgis
- Department of Pediatrics, University of Alberta, 4-584 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 2R7, Canada
- Women's and Children's Health Research Institute, Alberta, Canada
| | - R T Alexander
- Department of Pediatrics, University of Alberta, 4-584 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 2R7, Canada
- Women's and Children's Health Research Institute, Alberta, Canada
| | - L M Ward
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Pediatric Bone Health Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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26
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Opara NU, Osuala EC, Nwagbara UI. Management of Salter-Harris Type 1 Fracture Complicated with Osteomyelitis in a Sickle Cell Disease Patient: A Case Report and Review of Literature. MEDICINES (BASEL, SWITZERLAND) 2022; 9:medicines9100050. [PMID: 36286583 PMCID: PMC9612152 DOI: 10.3390/medicines9100050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 02/05/2023]
Abstract
Salter-Harris fractures may occur due to a single injury or repetitive stress fractures on the extremities. Type I to III fractures are managed medically, while types IV and V, which are rare, are treated surgically. In the pediatric population, Salter-Harris I fractures of the distal tibia are commonly seen, and management of such fractures are well established in the literature. Despite the availability of a wide range of treatment for such fractures, osteonecrosis or avascular necrosis of the proximal femur can subsequently develop. Avascular necrosis is cell death secondary to metabolic disturbances, trauma, adverse effects of certain medications, or sickle cell disease. Avascular necrosis commonly affects the talus, humerus, or tibia in addition to the femoral head. Radiographic images are essential for prompt diagnosis and to minimize negative health outcomes in these patients. However, Salter-Harris I fracture in sickle cell patients can be very challenging due to these patients' vulnerability to bone infections and sickle cell crisis. In this case report, our patient with a history of sickle cell disease and with a diagnosis of Salter-Harris I fracture was treated with surgical intervention as type V, which is discussed in this article, and responded well to treatment. Thus, this case suggests a new approach to managing Salter-Harris I fractures complicated with osteomyelitis in sickle cell patients.
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Affiliation(s)
- Nnennaya U. Opara
- Department of Emergency Medicine, Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV 25304, USA
- Department of Health Administration, University of Phoenix, Phoenix, AZ 85040, USA
- Correspondence:
| | - Emmanuella C. Osuala
- Department of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal Westville Campus, Durban 4000, South Africa
| | - Ugochinyere I. Nwagbara
- Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban 4041, South Africa
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Abstract
Osteoporosis is a major public health problem with serious long-term complications. In children, the definition of osteoporosis is not only based on densitometric criteria but also takes into account vertebral and long bone fragility fractures. Several factors, such as long-term high-dose steroids, chronic inflammation, malnutrition, immobility, lack of sex steroids, and medication can reduce bone density and increase the risk for fragility fractures when left untreated. Also, genetic conditions can predispose to primary bone fragility disorders, with osteogenesis imperfecta being the most common. Furthermore, since the growing skeleton is at an increased rate of bone remodeling, the ability to heal long bone fractures and reshape vertebral fractures differentiates children from adults. The scope of this chapter is to review the risk factors of osteoporosis and fragility fractures and describe the commonest causes of primary and secondary osteoporosis and their management in children and young adults.
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Affiliation(s)
- Sophia D Sakka
- Department of Endocrinology and Diabetes, Evelina London Children's Hospital, London, UK; GKT School of Medical Education, King's College London, UK; Department of Endocrinology, Metabolism and Diabetes, First Department of Paediatrics, Athens University Medical School, 'Aghia Sophia Children's Hospital', Athens, Greece.
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28
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Pradhan-Sundd T, Kato GJ, Novelli EM. Molecular Mechanisms of Hepatic Dysfunction in Sickle Cell Disease: Lessons From The Townes Mouse Model. Am J Physiol Cell Physiol 2022; 323:C494-C504. [PMID: 35759437 PMCID: PMC9359658 DOI: 10.1152/ajpcell.00175.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Sickle cell disease (SCD) is an autosomal-recessive-genetic disorder that affects ~100,000 Americans and millions of people worldwide. Erythrocyte sickling, vaso-occlusion, sterile inflammation and hemolysis are the major pathophysiological pathways leading to liver injury in SCD. Although hepatic dysfunction affects up to 10-40% of SCD patients, therapeutic approaches to prevent liver injury in SCD are not known, and the molecular mechanisms promoting progressive liver injury in SCD remain poorly understood. Animal models have been beneficial in bridging the gap between preclinical and translational research in SCD. Recent advances in methodology have allowed the development of several humanized mouse models to address various aspects of SCD related liver diseases. This review provides an overview of current knowledge of the molecular mechanisms and potential therapeutic options of SCD associated liver dysfunction using the Townes mouse model.
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Affiliation(s)
- Tirthadipa Pradhan-Sundd
- Pittsburgh Heart, Liver and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - Enrico M Novelli
- Pittsburgh Heart, Liver and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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29
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Das BK, Wang L, Fujiwara T, Zhou J, Aykin-Burns N, Krager KJ, Lan R, Mackintosh SG, Edmondson R, Jennings ML, Wang X, Feng JQ, Barrientos T, Gogoi J, Kannan A, Gao L, Xing W, Mohan S, Zhao H. Transferrin receptor 1-mediated iron uptake regulates bone mass in mice via osteoclast mitochondria and cytoskeleton. eLife 2022; 11:73539. [PMID: 35758636 PMCID: PMC9352353 DOI: 10.7554/elife.73539] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 06/25/2022] [Indexed: 11/13/2022] Open
Abstract
Increased intracellular iron spurs mitochondrial biogenesis and respiration to satisfy high-energy demand during osteoclast differentiation and bone-resorbing activities. Transferrin receptor 1 (Tfr1) mediates cellular iron uptake through endocytosis of iron-loaded transferrin, and its expression increases during osteoclast differentiation. Nonetheless, the precise functions of Tfr1 and Tfr1-mediated iron uptake in osteoclast biology and skeletal homeostasis remain incompletely understood. To investigate the role of Tfr1 in osteoclast lineage cells in vivo and in vitro, we crossed Tfrc (encoding Tfr1)-floxed mice with Lyz2 (LysM)-Cre and Cathepsin K (Ctsk)-Cre mice to generate Tfrc conditional knockout mice in myeloid osteoclast precursors (Tfr1ΔLysM) or differentiated osteoclasts (Tfr1ΔCtsk), respectively. Skeletal phenotyping by µCT and histology unveiled a significant increase in trabecular bone mass with normal osteoclast number in long bones of 10-week-old young and 6-month-old adult female but not male Tfr1ΔLysM mice. Although high trabecular bone volume in long bones was observed in both male and female Tfr1ΔCtsk mice, this phenotype was more pronounced in female knockout mice. Consistent with this gender-dependent phenomena, estrogen deficiency induced by ovariectomy decreased trabecular bone mass in Tfr1ΔLysM mice. Mechanistically, disruption of Tfr1 expression attenuated mitochondrial metabolism and cytoskeletal organization in mature osteoclasts in vitro by attenuating mitochondrial respiration and activation of the Src-Rac1-WAVE regulatory complex axis, respectively, leading to decreased bone resorption with little impact on osteoclast differentiation. These results indicate that Tfr1-mediated iron uptake is specifically required for osteoclast function and is indispensable for bone remodeling in a gender-dependent manner.
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Affiliation(s)
- Bhaba K Das
- Long Beach VA Healthcare System, Southern California Institute for Research and Education, Long Beach, United States
| | - Lei Wang
- Department of Orthopedics, Anhui Medical University, Hefei, China
| | - Toshifumi Fujiwara
- Department of Orthopedic Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Jian Zhou
- Department of Orthopedics, Anhui Medical University, HeFei, China
| | - Nukhet Aykin-Burns
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Kimberly J Krager
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Renny Lan
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Samuel G Mackintosh
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Ricky Edmondson
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Michael L Jennings
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Xiaofang Wang
- Department of Biomedical Sciences, Texas A&M University, Dallas, United States
| | - Jian Q Feng
- Department of Biomedical Sciences, Texas A&M University, Dallas, United States
| | | | - Jyoti Gogoi
- Long Beach VA Healthcare System, Southern California Institute for Research and Education, Long Beach, United States
| | - Aarthi Kannan
- Long Beach VA Healthcare System, Southern California Institute for Research and Education, Long Beach, United States
| | - Ling Gao
- Long Beach VA Healthcare System, Southern California Institute for Research and Education, Long Beach, United States
| | - Weirong Xing
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, United States
| | - Subburaman Mohan
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, United States
| | - Haibo Zhao
- Long Beach VA Healthcare System, Southern California Institute for Research and Education, Long Beach, United States
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30
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Patel S, Dadnam C, Hewitson R, Thakur I, Morgan J. Fifteen-minute consultation: Recognition of sickle cell crises in the paediatric emergency department. Arch Dis Child Educ Pract Ed 2022; 107:169-174. [PMID: 33832961 DOI: 10.1136/archdischild-2020-321338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/04/2022]
Abstract
Children with sickle cell disease can develop life-threatening and painful crises that require prompt assessment and efficient management by healthcare professionals in the emergency or acute care setting. Due to migration patterns and improved survival rates in high-prevalence countries, there is an increased tendency to encounter these patients across the UK. These factors warrant regular revisions in sickle cell crisis management, along with education for medical personnel and patients to improve clinical care and patient management. The focus of this article is on the initial assessment and management of acute paediatric sickle cell complications in the emergency setting. Specific case studies, including acute pain crises, trauma, splenic sequestration, aplastic crises, acute chest syndrome, infection, avascular necrosis, osteomyelitis and stroke, are discussed. Due to the current COVID-19 pandemic, we have also reviewed specific concerns around this patient group.
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Affiliation(s)
- Shrina Patel
- General Medical Department, Morriston Hospital, Swansea, UK
| | - Christopher Dadnam
- Paediatric Emergency Department, Cardiff and Vale University Health Board, Cardiff, UK
| | - Rebecca Hewitson
- Paediatric Emergency Department, Cardiff and Vale University Health Board, Cardiff, UK
| | - Indu Thakur
- Paediatric Haematology Department, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jeff Morgan
- Paediatric Emergency Department, Cardiff and Vale University Health Board, Cardiff, UK
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31
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Aprile A, Sighinolfi S, Raggi L, Ferrari G. Targeting the Hematopoietic Stem Cell Niche in β-Thalassemia and Sickle Cell Disease. Pharmaceuticals (Basel) 2022; 15:ph15050592. [PMID: 35631417 PMCID: PMC9146437 DOI: 10.3390/ph15050592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/19/2023] Open
Abstract
In the last decade, research on pathophysiology and therapeutic solutions for β-thalassemia (BThal) and sickle cell disease (SCD) has been mostly focused on the primary erythroid defect, thus neglecting the study of hematopoietic stem cells (HSCs) and bone marrow (BM) microenvironment. The quality and engraftment of HSCs depend on the BM microenvironment, influencing the outcome of HSC transplantation (HSCT) both in allogeneic and in autologous gene therapy settings. In BThal and SCD, the consequences of severe anemia alter erythropoiesis and cause chronic stress in different organs, including the BM. Here, we discuss the recent findings that highlighted multiple alterations of the BM niche in BThal and SCD. We point out the importance of improving our understanding of HSC biology, the status of the BM niche, and their functional crosstalk in these disorders towards the novel concept of combined therapies by not only targeting the genetic defect, but also key players of the HSC–niche interaction in order to improve the clinical outcomes of transplantation.
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Affiliation(s)
- Annamaria Aprile
- San Raffaele-Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.S.); (L.R.)
- Correspondence: (A.A.); (G.F.)
| | - Silvia Sighinolfi
- San Raffaele-Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.S.); (L.R.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Laura Raggi
- San Raffaele-Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.S.); (L.R.)
- University of Milano Bicocca, 20126 Milan, Italy
| | - Giuliana Ferrari
- San Raffaele-Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.S.); (L.R.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
- Correspondence: (A.A.); (G.F.)
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32
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Lins CF, Salmon CEG, de Souza LA, Moraes RDS, Silva-Pinto AC, Matos MA, Nogueira-Barbosa MH. Six-point DIXON and Magnetic Resonance Spectroscopy Techniques in Quantifying Bone Marrow Fat in Sickle Cell Disease. Acad Radiol 2022; 29:e73-e81. [PMID: 34257024 DOI: 10.1016/j.acra.2021.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/21/2021] [Accepted: 06/04/2021] [Indexed: 01/30/2023]
Abstract
RATIONALE AND OBJECTIVES To compare bone marrow fat quantification using magnetic resonance spectroscopy (MRS) and six-point DIXON (6PD) techniques in patients with sickle cell disease (SCD) and healthy subjects. MATERIALS AND METHODS Prospective study, with 43 SCD patients (24 homozygous [SS], 19 double heterozygous [SC), and 41 healthy subjects paired by age, weight and sex with SCD patients. All participants underwent magnetic resonance imaging with 6PD and single voxel MRS in the L3 vertebral body. Pearson's correlation, ROC curve, and bland-altman analysis were performed, p-values ≤0.05 were considered statistically significant for all tests. RESULTS Significant linear correlation was found between fat fraction (FF) by 6PD and Total Lipids (TL) (r = 0.932; p < 0.001) and Saturated Lipids (SL) (r = 0.934; p < 0.001), in all subjects. Strong correlations were also identified considering subjects of the SS/SC subgroups. Despite high correlations, no significant difference was observed only between FF and SL in the SS subgroup (Bland-Altman analysis), indicating excellent agreement between the fat estimations in this specific situation. Significant differences were observed in all variables (FF, TL, SL) comparing the SCD and healthy subjects. The ROC curve between SCD and healthy subjects showed the following areas under the curve: FF(0.924) > TL(0.883) > SL(0.892). CONCLUSIONS The comparison between fat quantification by the 6PD with MRS demonstrated an excellent correlation in SCD patients, especially in the SS subgroup, which usually has a higher degree of hemolysis. The diagnostic performance of 6PD and MRS is similar, with advantages of shorter imaging processing time and larger studied area with the 6PD.
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Affiliation(s)
- Carolina Freitas Lins
- Bahiana School of Medicine and Public Health Salvador, Bahia, Brasil; Clínica Delfin Medicina Diagnóstica, Salvador, Bahia, Brasil; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto Medical School, USP Ribeirão Preto, Ribeirão Preto, São Paulo, Brasil; Ribeirão Preto Medical School Musculoskeletal Imaging Research Laboratory, São Paulo, Brasil.
| | - Carlos Ernesto Garrido Salmon
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto da Universidade de São Paulo (FFCLRP-USP). São Paulo, Brasil
| | | | | | - Ana Cristina Silva-Pinto
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto Medical School, USP Ribeirão Preto, Ribeirão Preto, São Paulo, Brasil
| | | | - Marcello H Nogueira-Barbosa
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto Medical School, USP Ribeirão Preto, Ribeirão Preto, São Paulo, Brasil; Ribeirão Preto Medical School Musculoskeletal Imaging Research Laboratory, São Paulo, Brasil; Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Missouri
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Walsh RB, Mwingwa A, Yongolo NM, Biswaro SM, Mwanswila MJ, Kelly C, Mmbaga BT, Mosha F, Gray WK, McIntosh E, Walker RW. The spectrum and burden of in-patient paediatric musculoskeletal diseases in Northern Tanzania. Paediatr Int Child Health 2022; 42:12-21. [PMID: 35452362 PMCID: PMC9397128 DOI: 10.1080/20469047.2022.2062561] [Citation(s) in RCA: 1] [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] [Indexed: 12/02/2022]
Abstract
BACKGROUND Musculoskeletal diseases (MSD) are a major contributor to the global burden of disease and disability, and disproportionally affect low- and middle-income countries; however, there is a dearth of epidemiological data. Affected children often face increased morbidity, social isolation and economic hardship. AIM To assess the spectrum and burden of paediatric MSD in children aged 5-18 years admitted to a major referral hospital in Tanzania. METHODS This was a retrospective cohort study of children aged 5-18 years admitted to Kilimanjaro Christian Medical Centre (KCMC) whose initial diagnosis was recognised as a musculoskeletal condition by the International Classification of Diseases-10 between 1 January and 31 December 2017. RESULTS During 2017, 163 cases of confirmed paediatric MSD were admitted to KCMC, representing 21.2% of all admissions of children aged 5-18 years (n = 769). Bone disease was the most common diagnosis. They comprised 106 (65.0%) traumatic fractures, 31 (19.0%) osteo-articular infections, 9 (5.5%) malunions and 3 (1.8%) pathological fractures. Congenital defects and rheumatic disease were relatively uncommon, accounting for only 6 (3.7%) and 4 (2.5%) MSD admissions, respectively. CONCLUSION The majority of cases of MSD were related to fractures, followed by osteo-articular infections, while recognised cases of rheumatic disease were rare. The study, although small, identified the sizeable burden and spectrum of paediatric MSD admitted to a hospital in Tanzania over a 12-month period and highlights the need for larger studies to inform the optimal allocation of health resources. ABBREVIATION CI: confidence interval; HIC: high-income countries; HIV: human immunodeficiency virus; ICD-10: International Classification of Diseases 10; IQR: interquartile range; JIA: juvenile idiopathic arthritis; KCMC: Kilimanjaro Christian Medical Centre; LMIC: low- and middle-income countries; MSD: musculoskeletal diseases: NAI: non-accidental injury; NIHR: National Institute for Health Research; PAFLAR: Paediatric Society of the African League Against Rheumatism; RTA: road traffic accidents; SCD: sickle cell disease; SLE: systemic lupus erythematosus; SSA: sub-Saharan Africa.
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Affiliation(s)
- Rebecca B. Walsh
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK,CONTACT Rebecca B. Walsh
| | - Anthony Mwingwa
- Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania,Department of Research, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Nateiya M. Yongolo
- Department of Research, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sanjura M. Biswaro
- Department of Research, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Manasseh Joel Mwanswila
- Department of Health Management Systems, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Clive Kelly
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Blandina T. Mmbaga
- Department of Research, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Faith Mosha
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - William K. Gray
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Richard W. Walker
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Batte A, Kasirye P, Baluku R, Kiguli S, Kalyesubula R, John CC, Schwaderer AL, Imel EA, Conroy AL. Mineral bone disorders and kidney disease in hospitalized children with sickle cell anemia. Front Pediatr 2022; 10:1078853. [PMID: 36819194 PMCID: PMC9932899 DOI: 10.3389/fped.2022.1078853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mineral bone disorders (MBD) are common in sickle cell anemia (SCA). Frequent vaso-occlusive crises (VOC) further impact MBD in children with SCA. We evaluated the prevalence of markers of SCA-related MBD (sMBD) in hospitalized children and assessed the relationship between sMBD and individual mineral abnormalities with kidney disease. METHODS We prospectively recruited 185 children with SCA hospitalized with a VOC. Serum measures of mineral bone metabolism (calcium, phosphate, parathyroid hormone, 25-hydroxy vitamin D, FGF23, osteopontin) were measured at enrollment. The primary outcome was markers of sMBD defined as a composite of hypocalcemia, hyperphosphatemia, hyperparathyroidism, or deficiency in 25-OH vitamin D. Secondary outcomes included individual abnormalities in mineral metabolism. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines were used to define SCA-associated acute kidney injury (AKI). AKI was further assessed using urine NGAL as a marker of tubular injury. Acute kidney disease (AKD) was defined as a composite of AKI, an eGFR < 90 ml/min per 1.73 m2 using the Cystatin C GFR equation, or evidence of structural injury (positive biomarker test or albuminuria). RESULTS The mean age of children was 8.9 years and 41.6% were female. The prevalence of sMBD was 47.6%, with hypocalcemia the most frequent abnormality (29.9%, 55/184) followed by hyperphosphatemia (20.7%, 38/184), hyperparathyroidism (8.7%, 16/185), and vitamin D deficiency (5.4%, 10/185). There was no association between sMBD and sKDIGO-defined AKI using serial changes in creatinine or when incorporating biomarkers to define AKI. However, the presence of AKD was associated with a 2.01-fold increased odds of sMBD (95% CI 1.05 to 3.83) and was driven by a decrease in eGFR (OR, 2.90 95% CI: 1.59 to 5.29). When evaluating individual mineral abnormalities, hypocalcemia was associated with AKD and low eGFR while hyperparathyroidism was associated with low eGFR, AKI and structural injury. Vitamin D deficiency was associated with structural kidney injury. Vitamin D deficiency, hyperparathryoidism, and increases in FGF23 and osteopontin predicted mortality (p < 0.05 for all). CONCLUSION MBD is common among children with SCA hospitalized with VOC. Biomarkers of kidney injury and bone health may help risk stratify children at risk of sMBD. Routine evaluation of sMBD in children with SCA may improve long-term bone health.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Philip Kasirye
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Reagan Baluku
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Kalyesubula
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Indianapolis, IN, United States
| | - Andrew L Schwaderer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Erik A Imel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Andrea L Conroy
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Indianapolis, IN, United States
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Leandro MP, Almeida ND, Hocevar LS, Sá CKCD, Souza AJD, Matos MA. Polimorfismos e necrose avascular em pacientes com doença falciforme – Uma revisão sistemática. REVISTA PAULISTA DE PEDIATRIA 2022. [DOI: 10.1590/1984-0462/2022/40/2021013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumo Objetivo: Estabelecer, de modo sistemático, se existe associação entre polimorfismos e a necrose avascular em pacientes com doença falciforme. Fontes de dados: A revisão, conduzida segundo as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) e registrada no International Prospective Register of Systematic Reviews (PROSPERO), foi baseada na busca de estudos nas bases de dados PubMed, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Virtual em Saúde (BVS) e na literatura cinza (Google Scholar e Open Gray) até junho de 2020. A análise da qualidade dos artigos foi baseada nos critérios do Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Síntese dos dados: Dez artigos foram selecionados nas bases de dados e dois incluídos por meio da busca manual, totalizando 12 estudos elencados. As amostras resultaram em 2.362 pacientes incluídos. Com base na iniciativa STROBE, sete estudos atenderam total e/ou parcialmente mais de 70% dos itens essenciais e dois atingiram menos que 60% deles, com variação geral de 86,4–54,5%. Os resultados mostram que os polimorfismos nos genes da proteína morfogenética óssea 6 (BMP6), da Klotho (KL) e da Anexina A2 (ANXA2) podem ter associação com osteonecrose no contexto da doença falciforme. Seis artigos estudaram o polimorfismo no gene da enzima MTHFR, mas apenas um obteve associação positiva. Os polimorfismos associados ao receptor DARC, ao gene ITGA4, ao CD36 e aos genes de proteínas trombofílicas não demonstraram associação em nenhum dos estudos. Conclusões: Os polimorfismos nos genes BMP6, KL e ANXA2 estão possivelmente associados com a necrose avascular em indivíduos com doença falciforme. Entretanto, para a confirmação dessas alterações genéticas como fatores de risco, é necessário que mais estudos com maior poder estatístico e com maior rigor metodológico sejam realizados.
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Leandro MP, Almeida ND, Hocevar LS, Sá CKCD, Souza AJD, Matos MA. Polymorphisms and avascular necrosis in patients with sickle cell disease – A systematic review. REVISTA PAULISTA DE PEDIATRIA 2022; 40:e2021013. [PMID: 35584416 PMCID: PMC9113627 DOI: 10.1590/1984-0462/2022/40/2021013in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
Objective: To systematically establish whether there is an association between polymorphisms and avascular necrosis in patients with sickle cell disease. Data source: The review, conducted according to PRISMA guidelines and registered with PROSPERO, was based on research of studies in PubMed, SciELO, LILACS, BVS databases and in the gray literature (Google Scholar and Open Gray) published until June 2020. The STROBE initiative was used to analyze the articles’ quality. Data synthesis: Ten articles were selected from the databases and two were included through manual search, totaling 12 studies. All samples gathered 2,362 patients. According to STROBE, seven studies fully and/or partially covered more than 70% of the essential items and two studies reached less than 60%, with an overall variation of 86.4–54.5%. The results indicate that polymorphisms in the genes of the bone morphogenetic protein 6 (BMP6), Klotho (KL) and Annexin A2 (ANXA2) may be associated with osteonecrosis in the context of sickle cell disease. Six articles addressed the polymorphism in the MTHFR enzyme gene, but only one found a positive association. Polymorphisms associated with the DARC receptor, the ITGA4 gene, CD36 and thrombophilia protein genes were not associated in any of the studies. Conclusions: The results indicate that the polymorphisms in BMP6, Klotho and ANXA2 genes may be associated with avascular necrosis in patients with sickle cell disease. However, in order to confirm these genetic changes as risk factors, further studies with greater statistical power and methodological rigor are needed.
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Mohzari YA, Alshuraim R, Asdaq SMB, Aljobair F, Alrashed A, Alsowaida YS, Alamer A, Al Munjem MF, Al Musawa MI, Hatata M, Alzaaqi MA, Binrokan A, Alajlan SA, Abraham I, Alamer A. Early oral switch to combined cefixime therapy for management of osteoarticular infections in pediatric sickle cell disease patients: A descriptive analysis. J Infect Public Health 2021; 15:1-6. [PMID: 34852307 DOI: 10.1016/j.jiph.2021.11.006] [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: 09/30/2021] [Revised: 10/31/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The treatment of osteoarticular infections in pediatric patients with sickle cell disease (SCD) is a challenging task for the practitioner. The aim of this study is to evaluate cefixime for the treatment of osteoarticular infections in pediatric SCD patients by retrospective design. METHODS This study was done in the pediatric hospital of King Saud Medical City, Riyadh, Saudi Arabia. The data was obtained from medical records of patients aged 1-16 years admitted between January 2019 to December 2020, diagnosed with SCD and received cefixime for the treatment of OI. A descriptive study for pediatric patients admitted between January 2019 to December 2020 diagnosed with sickle cell disease and diagnosed with osteoarticular infection. All patients were treated with cefixime. Medians and interquartile ranges (IQRs) were used for the descriptive analysis. RESULTS A total of 260 patients were screened, and 51 cases [osteomyelitis (OM), n = 43, and septic arthritis (SA), n = 8] met the inclusion criteria. The median age of OM patients was 7 years, with males making up 67.4% of the cohort. The median length of IV antibiotics and hospital stays were 10 days and 11 days, respectively. The median total duration of antibiotic use was 37 and 25 days for OM and SA, respectively. The treatment success rate was 88% in OM cases and 100% in SA patients. Readmission was noted in 39.5% of the OM patients, while only 25% of the SA patients were recorded for reinfection. CONCLUSION The study's findings revealed that Cefixime is a viable oral alternative for treating osteoarticular infection in pediatric SCD patients. Nonetheless, a prospective investigation is required to corroborate the findings of this study.
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Affiliation(s)
- Yahya A Mohzari
- Pharmaceutical Care Division, Clinical Pharmacy Section, King Saud Medical City, Riyadh, Saudi Arabia
| | - Renad Alshuraim
- Pharmaceutical Care Division, Clinical Pharmacy Section, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Fahad Aljobair
- Pediatric Infectious Disease Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alrashed
- Pharmaceutical Service Department, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yazed Saleh Alsowaida
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Amnah Alamer
- Department of Internal Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | | | - Mohammed I Al Musawa
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Muhannad Hatata
- Pharmacy Services Administration, Children's hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Meshal A Alzaaqi
- Maternity & Pediatric Hospital, KSMC, Riyadh, Kingdom Saudi Arabia
| | - Aljawharah Binrokan
- Pharmaceutical service Department, Children hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saleh Ahmad Alajlan
- Department of Pediatric Dentistry, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ivo Abraham
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Ahmad Alamer
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA; Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
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Alkindi S, Panjwani V, Al-Rahbi S, Al-Saidi K, Pathare AV. Iron Overload in Patients With Heavily Transfused Sickle Cell Disease-Correlation of Serum Ferritin With Cardiac T2 * MRI (CMRTools), Liver T2 * MRI, and R2-MRI (Ferriscan®). Front Med (Lausanne) 2021; 8:731102. [PMID: 34760898 PMCID: PMC8573209 DOI: 10.3389/fmed.2021.731102] [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: 06/26/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
The treatment of sickle cell disease (SCD) is mainly supportive, except for a minority, who receive bone marrow transplantation (BMT). Serum ferritin (SF) is routinely available but is notoriously unreliable as a tool for iron-overload assessment since it is an acute-phase reactant. Although blood transfusion is one of the most effective ways to deal with specific acute and chronic complications of SCD, this strategy is often associated with alloimmunization, iron overload, and hemolytic reactions. This study, thus, aims to evaluate iron overload in patients with SCD on chronic blood transfusions and specifically, correlate SF with the current standard of care of iron-overload assessment using MRI-based imaging techniques. Amongst a historic cohort of 58 chronically transfused patients with SCD, we were able to evaluate 44 patients who are currently alive and had multiple follow-up testing. Their mean age (±SD) was 35 (9) years and comprised of 68.2% of women. The studied iron-overload parameters included cardiac T2* MRI, liver iron concentration (LIC) by Liver T2* MRI, and serial SF levels. Additionally, in a smaller cohort, we also studied LIC by FerriScan© R2-MRI. Chronic blood transfusions were necessary for severe vaso-occlusive crisis (VOC) (38.6%), severe symptomatic anemia (38.6%), past history of stroke (15.9%), and recurrent acute chest syndrome (6.9%). About 14 (24%) patients among the original cohort died following SCD-related complications. Among the patients currently receiving chelation, 26 (96%) are on Deferasirox (DFX) [Jadenu® (24) or Exjade® (2)], with good compliance and tolerance. However, one patient is still receiving IV deferoxamine (DFO), in view of the significantly high systemic iron burden. In this evaluable cohort of 44 patients, the mean SF (±SD) reduced marginally from 4,311 to 4,230 ng/ml, mean Liver T2* MRI dropped from 12 to 10.3 mg/gm dry weight, while the mean cardiac T2*MRI improved from 36.8 to 39.5 ms. There was a mild to moderate correlation between the baseline and final values of SF ng/ml, r = 0.33, p = 0.01; Cardiac T2* MRI ms, r = 0.3, p = 0.02 and Liver T2* MRI mg/kg dry weight, r = 0.6, p < 0.001. Overall, there was a positive correlation between SF and Liver T2* MRI (Pearson's r = 0.78, p < 0.001). Cardiac T2*MRI increased with the decreasing SF concentration, showing a negative correlation which was statistically significant (Pearson's r = -0.6, p < 0.001). Furthermore, there was an excellent correlation between SF ng/ml and LIC by FerriScan© R2-MRI mg/g or mmol/kg (Spearmen's rho = -0.723, p < 0.008) in a small subset of patients (n = 14) who underwent the procedure. In conclusion, our study demonstrated a good correlation between serial SF and LIC by either Liver MRI T2* or by FerriScan© R2-MRI, even though SF is an acute-phase reactant. It also confirms the cardiac sparing effect in patients with SCD, even with the significant transfusion-related iron burden. About 14 (24%) patients of the original cohort died over the past 15 years, indicative of a negative impact of iron overload on disease morbidity and mortality.
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Affiliation(s)
- Salam Alkindi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman.,College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Vinodh Panjwani
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sarah Al-Rahbi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khalid Al-Saidi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anil V Pathare
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
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Griffith MS, Shaw KA, Hattaway JK, Schrader T. Core Decompression and Bone Marrow Aspirate Concentrate in the Treatment of Femoral Head Avascular Necrosis in Pediatric Sickle Cell Disease: Can We Improve Natural History? J Pediatr Orthop 2021; 41:604-609. [PMID: 34419981 DOI: 10.1097/bpo.0000000000001953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Femoral head avascular necrosis (AVN) affects between 10% and 41% of children with sickle cell disease (SCD), resulting in the development of proximal femoral deformity and residual hip pain in the majority of patients without treatment. There have been multiple adult studies published on the outcomes of core decompression with and without the use of bone marrow aspirate concentrate (BMAC) injection both in idiopathic and SCD-related AVN with promising results, however, few studies have reported on outcomes in skeletally immature patients. PURPOSE This study sought to report on a single surgeon's outcomes for core decompression with BMAC injection in pediatric patients with AVN of the femoral head secondary to underlying SCD. METHODS A single-center, retrospective review was performed for pediatric patients undergoing core decompression with BMAC injection for femoral head AVN in patients with SCD with a minimum of 12-month follow-up. Demographic, radiographic, and clinical variable were collected. Patients were subdivided based upon presence of open femoral physes at the time of surgery. Successful treatment was defined as the ability to return to activities without limitations. RESULTS A total of 13 patients (average age 14.1±2.8 y, 84.6% male, 6 skeletally immature and 7 skeletally mature) with 18 affected extremities were identified. Open physes were present in 50% of operative extremities. Skeletally immature patient demonstrated reconstitution of the femoral head in 78% of cases and 89% demonstrated regression of at least 1 Steinberg grade and none had progression. Skeletally immature patients were significantly more likely to return to activities (100% vs. 55.6%, P=0.023) and achieve a final Tonnis grade <2 (89% vs. 44%, P=0.046). CONCLUSION Core decompression appears to alter the natural history of AVN in skeletally immature patients with SCD. Skeletal immaturity was a positive prognostic factor for the ability to return to activities without pain and achieve a lower Tonnis grade at final follow-up.
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Affiliation(s)
| | | | | | - Timothy Schrader
- Children's Healthcare of Atlanta, Scottish Rite, Sandy Springs, GA
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Sickle cell disease promotes sex-dependent pathological bone loss through enhanced cathepsin proteolytic activity. Blood Adv 2021; 6:1381-1393. [PMID: 34547771 PMCID: PMC8905708 DOI: 10.1182/bloodadvances.2021004615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022] Open
Abstract
Age- and sex-dependent bone loss occurs in a Townes mouse model of SCD, with female mice more prone to trabecular bone loss. Reduced cathepsin activity leads to increased thickness and density of cortical and trabecular bone in the Townes mouse model of SCD.
Sickle cell disease (SCD) is the most common hereditary blood disorder in the United States. SCD is frequently associated with osteonecrosis, osteoporosis, osteopenia, and other bone-related complications such as vaso-occlusive pain, ischemic damage, osteomyelitis, and bone marrow hyperplasia known as sickle bone disease (SBD). Previous SBD models have failed to distinguish the age- and sex-specific characteristics of bone morphometry. In this study, we use the Townes mouse model of SCD to assess the pathophysiological complications of SBD in both SCD and sickle cell trait. Changes in bone microarchitecture and bone development were assessed by using high-resolution quantitative micro–computed tomography and the three-dimensional reconstruction of femurs from male and female mice. Our results indicate that SCD causes bone loss and sex-dependent anatomical changes in bone. SCD female mice in particular are prone to trabecular bone loss, whereas cortical bone degradation occurs in both sexes. We also describe the impact of genetic knockdown of cathepsin K– and E-64–mediated cathepsin inhibition on SBD.
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Okorie OO, Eyong ME, Ekrikpo UE, Ekanem EE. Testicular Volume in Children with Sickle Cell Anaemia in Uyo, a South-South Nigerian City. J Trop Pediatr 2021; 67:6375176. [PMID: 34561714 DOI: 10.1093/tropej/fmab083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Sickle cell anaemia (SCA) often presents in early childhood with repeated vaso-occlusive crisis that leads to ischaemia, infarction and fibrosis which may result in a reduction in expected testicular volume (TV) at puberty. METHOD This was a cross-sectional study of 95 children with SCA aged 1-18 years compared with 95 age-matched controls. Participants responded to an interviewer-administered questionnaire, with their anthropometric measurements taken, pubertal maturity assessed by Tanner staging and testicular ultrasonography done. Changes in TV across the ages were compared graphically and regression analyses were used to determine the factors independently associated with TV. A p-value of <0.05 was considered statistically significant. RESULTS In the prepubertal period, the haemoglobin SS (HbSS) participants had larger median ultrasound TV (MUSTV) compared to the haemoglobin AA (HbAA) controls (p = 0.001). This trend reversed in the pubertal period. On regression analysis, the frequency of testicular pain (p = 0.04), weight (p = 0.02) and pubic hair rating (p = 0.03) of the HbSS participants were significant predictors of increased TVs in the HbSS participants, irrespective of pubertal status. CONCLUSION The prepubertal MUSTV of the HbSS participants were higher than those of the HbAA controls, while the HbAA controls had higher MUSTV at puberty and beyond. The frequency of testicular pain episodes, pubic hair rating and weight were independent predictors of TV changes in the HbSS participants. Prevention of repeated vaso-occlusive crisis in the prepubertal period may help prevent the reduction in TV and possible hypogonadism. Lay summarySickle cell anaemia (SCA) causes repeated episodes of painful crisis and in boys, these may affect the way their testes grow. The study set out to document testicular sizes on a one-time basis in boys aged 1-18 years with SCA compared with controls of similar ages. The participants responded to structured questions assisted by the researchers and their body measurements were appropriately taken. Their level of sexual maturation was assessed according to the method by Tanner and the sizes of their testes were measured using an ultrasound machine. The research information was analysed and a statistical value less than 0.05 was taken to mean that there was a difference between the measured variables. The mid-testicular sizes of the SCA participants were noted to be higher than that of their controls during the prepubertal period while the non-SCA boys had higher sizes from puberty onwards. The frequency of testicular pain, weight and pubic hair stage of the SCA boys were important contributors to their increased testes sizes, irrespective of pubertal status. Efforts aimed at preventing painful crisis should start during early childhood to forestall future sexual challenges in adulthood.
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Affiliation(s)
- Obasi Onwuka Okorie
- Department of Paediatric, University of Uyo Teaching Hospital, Uyo, Nigeria/Paediatric Endocrinology Unit, Endocrine and Diabetes Centre in Al Jouf, Sakaka 520251, Saudi Arabia
| | - Michael Eteng Eyong
- Department of Paediatrics, University of Calabar/University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Udeme Ekpenyong Ekrikpo
- Department of Internal Medicine, University of Uyo/University of Uyo Teaching Hospital, Uyo 520003, Nigeria
| | - Emmanuel Eyo Ekanem
- Department of Paediatrics, University of Calabar/University of Calabar Teaching Hospital, Calabar 540271, Nigeria
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Ozdogu H, Boga C, Yeral M, Kozanoglu I, Gereklioglu C, Kocer NE. A Rare and Successfully Managed Complication of Stem Cell Transplantation in an Adult Patient With Sickle Cell Disease: Bone Marrow Necrosis. EXP CLIN TRANSPLANT 2021. [PMID: 34387156 DOI: 10.6002/ect.2021.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sickle cell disease is the most common genetic disorder in the Eastern Mediterranean region where our transplant center is located. Today, adult patients with sickle cell disease can also be successfully treated with allogeneic hematopoietic stem cell transplantation. Bone marrow necrosis is a rare and serious clinical condition. Herein, we present this complication for the first time in the literature, which developed in the course of allogeneic hematopoietic stem cell transplantation and was successfully managed with additional bone marrow support. The recognition, prevention, and management of this rare and potentially fatal complication, bone marrow necrosis, are vitally important, especially in regions with high prevalence of sickle cell disease.
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Affiliation(s)
- Hakan Ozdogu
- From the Department of Hematology, Adana Adult Bone Marrow Transplantation Center, Baskent University, Ankara, Turkey
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Edjlali M, Gobin‐Metteil M, Mélé N, Maïer B, Habibi A, Kauv P, Hosseini H, Mas J, Oppenheim C, Galactéros F, Bartolucci P, Calvet D. Transcranial color-coded duplex sonography reliably identifies intracranial vasculopathy in adult patients with sickle cell disease. Am J Hematol 2021; 96:961-967. [PMID: 33971039 DOI: 10.1002/ajh.26215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 11/08/2022]
Abstract
In order to prevent stroke, screening for disease-related intracranial vasculopathy using Doppler ultrasound is recommended in sickle-cell disease (SCD) children. How to screen such vasculopathy in adults remains largely unknown. The objective of this study was to assess whether transcranial color-coded duplex sonography (TCCD) is sensitive and specific enough to identify SCD adult patients with vasculopathy, compared with magnetic resonance angiography (MRA). Sickle cell disease adults followed in referral centers at high risk of vasculopathy were included in this study. Transcranial color-coded duplex sonography examination and 3-D time-of-flight MRA were performed on the same day. On MRA, vasculopathy was defined by the presence of at least one ≥50% arterial stenosis. On TCCD, vasculopathy was defined by a time-averaged mean of the maximum velocity (TAMx) stenotic/prestenotic ratio ≥ 3, an occlusion, or a Moyamoya pattern. Vasculopathy was also considered as present when TAMx ratio could not be calculated because of the presence of severe cervical lesions. Among 80 included patients, quality of MRA was insufficient in three patients. Among the 38 patients with vasculopathy on MRA, 37 had a vasculopathy according to TCCD criteria: TAMx ratio ≥ 3 or intracranial occlusion in 33 patients and cervical lesion in four patients. A Moyamoya pattern was identified with TCCD in all 17 patients with Moyamoya on MRA. Sensitivity and specificity of TCCD to identify patients with ≥50% vasculopathy on MRA were (n = 37/38) 97% and (n = 28/34) 82%, respectively. Positive and negative predictive values were (n = 37/43) 86% and (n = 28/29) 97%, respectively. Note, TCCD may be used to identify SCD adult patients with vasculopathy.
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Affiliation(s)
- Myriam Edjlali
- Service d'Imagerie, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
| | - Marie‐Pierre Gobin‐Metteil
- Service d'Imagerie, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
| | - Nicolas Mélé
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
| | - Benjamin Maïer
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
| | - Anoosha Habibi
- Sickle Cell Referral Center, Médecine Interne, Hôpital Henri‐Mondor, UPEC Créteil France
- INSERM U955, team 2, Laboratoire d'Excellence GRex Créteil France
| | - Paul Kauv
- Department of Imaging Henri‐Mondor Hospital, UPEC, Assistance Publique‐Hopitaux de Paris, Creteil Créteil France
| | - Hassan Hosseini
- Department of Neurology Henri‐Mondor Hospital, UPEC, Assistance Publique‐Hopitaux de Paris, Creteil Créteil France
| | - Jean‐Louis Mas
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
| | - Catherine Oppenheim
- Service d'Imagerie, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
| | - Frédéric Galactéros
- Sickle Cell Referral Center, Médecine Interne, Hôpital Henri‐Mondor, UPEC Créteil France
- INSERM U955, team 2, Laboratoire d'Excellence GRex Créteil France
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Médecine Interne, Hôpital Henri‐Mondor, UPEC Créteil France
- INSERM U955, team 2, Laboratoire d'Excellence GRex Créteil France
| | - David Calvet
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
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Giardullo L, Altomare A, Rotondo C, Corrado A, Cantatore FP. Osteoblast Dysfunction in Non-Hereditary Sclerosing Bone Diseases. Int J Mol Sci 2021; 22:ijms22157980. [PMID: 34360745 PMCID: PMC8348499 DOI: 10.3390/ijms22157980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 01/02/2023] Open
Abstract
A review of the available literature was performed in order to summarize the existing evidence between osteoblast dysfunction and clinical features in non-hereditary sclerosing bone diseases. It has been known that proliferation and migration of osteoblasts are concerted by soluble factors such as fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), transforming growth factor (TGF), bone morphogenetic protein (BMP) but also by signal transduction cascades such as Wnt signaling pathway. Protein kinases play also a leading role in triggering the activation of osteoblasts in this group of diseases. Post-zygotic changes in mitogen-activated protein kinase (MAPK) have been shown to be associated with sporadic cases of Melorheostosis. Serum levels of FGF and PDGF have been shown to be increased in myelofibrosis, although studies focusing on Sphingosine-1-phosphate receptor was shown to be strongly expressed in Paget disease of the bone, which may partially explain the osteoblastic hyperactivity during this condition. Pathophysiological mechanisms of osteoblasts in osteoblastic metastases have been studied much more thoroughly than in rare sclerosing syndromes: striking cellular mechanisms such as osteomimicry or complex intercellular signaling alterations have been described. Further research is needed to describe pathological mechanisms by which rare sclerosing non hereditary diseases lead to osteoblast dysfunction.
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Lins CF, Salmon CEG, de Souza LA, Moraes RDS, Silva-Pinto AC, Matos MA, Nogueira-Barbosa MH. Qualitative and quantitative magnetic resonance imaging evaluation of bone tissue vaso-occlusive events in patients with sickle cell disease. Bone 2021; 148:115961. [PMID: 33866047 DOI: 10.1016/j.bone.2021.115961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/20/2021] [Accepted: 04/11/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the association between bone changes due to vaso-occlusive events in sickle cell disease (SCD) revealed by conventional MRI sequences and the fat fraction obtained using a 6-point DIXON technique (FFdix), in an attempt to use quantitative data as a biomarker for bone complications. METHODS Cross-sectional study, with 48 SCD patients, 26-homozygous (HbSS), and 22-compound heterozygous (HbSC). Forty-eight healthy individuals paired by age, weight, and sex with SCD patients. All participants underwent lumbar spine and pelvis MRI. Conventional sequences: bone complications related to vaso-occlusive events-femoral head avascular necrosis, bone infarctions, "H"-shaped vertebrae, bone marrow necrosis. Six-point DIXON technique: quantitative evaluation of the bone marrow at pre-established sites (lumbar vertebrae, sacrum, iliacs, femoral heads, greater femoral trochanters, femoral necks). Pearson's correlation, ROC curve, and binary logistic regression analysis were performed. RESULTS The most frequent findings in the SCD group included femoral head avascular necrosis (75%), bone infarctions (58.3%), "H"-shaped vertebrae (58.3%), and typical imaging findings of bone marrow necrosis (8.3%). Cortical bone thickness in the proximal femoral diaphysis in patients with SCD was moderately negatively correlated with FFdix in lumbar vertebrae, iliacs, femoral necks, and first sacral vertebrae. The ROC curves and odds ratios demonstrated excellent performance of FFdix in all the evaluated anatomical sites and identified patients having bone complications. CONCLUSIONS FFdix could serve as a potential biomarker in SCD because of its association with bone complications secondary to vaso-occlusive events in patients with SCD, especially in femoral heads, femoral necks, and iliacs.
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Affiliation(s)
- Carolina Freitas Lins
- Bahiana School of Medicine and Public Health (EBMSP), Av. Dom João VI, 275, Brotas, Salvador, Bahia, Brazil; Clínica Delfin Medicina Diagnóstica, Av. Antônio Carlos Magalhães, 442, Pituba, Salvador, Bahia, Brazil; Ribeirão Preto Medical School, USP Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Campus Universitário s/n - Monte Alegre, Ribeirão Preto, SP, Brazil; Ribeirão Preto Medical School Musculoskeletal Imaging Research Laboratory, Brazil.
| | - Carlos Ernesto Garrido Salmon
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto da Universidade de São Paulo (FFCLRP-USP), Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Luana Amorim de Souza
- Bahiana School of Medicine and Public Health (EBMSP), Av. Dom João VI, 275, Brotas, Salvador, Bahia, Brazil
| | - Roberta de Souza Moraes
- Centro Universitário Maurício de Nassau (UNINASSAU), Rua dos Maçons, 364, Pituba, Salvador, Bahia, Brazil
| | - Ana Cristina Silva-Pinto
- Ribeirão Preto Medical School, USP Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Campus Universitário s/n - Monte Alegre, Ribeirão Preto, SP, Brazil
| | - Marcos Almeida Matos
- Bahiana School of Medicine and Public Health (EBMSP), Av. Dom João VI, 275, Brotas, Salvador, Bahia, Brazil
| | - Marcello H Nogueira-Barbosa
- Ribeirão Preto Medical School, USP Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Campus Universitário s/n - Monte Alegre, Ribeirão Preto, SP, Brazil; Ribeirão Preto Medical School Musculoskeletal Imaging Research Laboratory, Brazil; Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, MO, United States
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Ledesma-Colunga MG, Weidner H, Vujic Spasic M, Hofbauer LC, Baschant U, Rauner M. Shaping the bone through iron and iron-related proteins. Semin Hematol 2021; 58:188-200. [PMID: 34389111 DOI: 10.1053/j.seminhematol.2021.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/18/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023]
Abstract
Well-controlled iron levels are indispensable for health. Iron deficiency is the most common cause of anemia, whereas iron overload, either hereditary or secondary due to disorders of ineffective erythropoiesis, causes widespread organ failure. Bone is particularly sensitive to fluctuations in systemic iron levels as both iron deficiency and overload are associated with low bone mineral density and fragility. Recent studies have shown that not only iron itself, but also iron-regulatory proteins that are mutated in hereditary hemochromatosis can control bone mass. This review will summarize the current knowledge on the effects of iron on bone homeostasis and bone cell activities, and on the role of proteins that regulate iron homeostasis, i.e. hemochromatosis proteins and proteins of the bone morphogenetic protein pathway, on bone remodeling. As disorders of iron homeostasis are closely linked to bone fragility, deeper insights into common regulatory mechanisms may provide new opportunities to concurrently treat disorders affecting iron homeostasis and bone.
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Affiliation(s)
- Maria G Ledesma-Colunga
- Divisions of Endocrinology and Molecular Bone Biology, Department of Medicine III & University Center for Healty Aging, Technische Universität Dresden, Dresden, Germany
| | - Heike Weidner
- Divisions of Endocrinology and Molecular Bone Biology, Department of Medicine III & University Center for Healty Aging, Technische Universität Dresden, Dresden, Germany
| | - Maja Vujic Spasic
- Institute of Comparative Molecular Endocrinology, Ulm University, Ulm, Germany
| | - Lorenz C Hofbauer
- Divisions of Endocrinology and Molecular Bone Biology, Department of Medicine III & University Center for Healty Aging, Technische Universität Dresden, Dresden, Germany
| | - Ulrike Baschant
- Divisions of Endocrinology and Molecular Bone Biology, Department of Medicine III & University Center for Healty Aging, Technische Universität Dresden, Dresden, Germany
| | - Martina Rauner
- Divisions of Endocrinology and Molecular Bone Biology, Department of Medicine III & University Center for Healty Aging, Technische Universität Dresden, Dresden, Germany.
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Plasmodium falciparum goes bananas for sex. Mol Biochem Parasitol 2021; 244:111385. [PMID: 34062177 DOI: 10.1016/j.molbiopara.2021.111385] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022]
Abstract
The sexual blood stages of the human malaria parasite Plasmodium falciparum undergo a remarkable transformation from a roughly spherical shape to an elongated crescent or "falciform" morphology from which the species gets its name. In this review, the molecular events that drive this spectacular shape change are discussed and some questions that remain regarding the mechanistic underpinnings are posed. We speculate on the role of the shape changes in promoting sequestration and release of the developing gametocyte, thereby facilitating parasite survival in the host and underpinning transmission to the mosquito vector.
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El-Jawhari JJ, Ganguly P, Jones E, Giannoudis PV. Bone Marrow Multipotent Mesenchymal Stromal Cells as Autologous Therapy for Osteonecrosis: Effects of Age and Underlying Causes. Bioengineering (Basel) 2021; 8:69. [PMID: 34067727 PMCID: PMC8156020 DOI: 10.3390/bioengineering8050069] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 12/21/2022] Open
Abstract
Bone marrow (BM) is a reliable source of multipotent mesenchymal stromal cells (MSCs), which have been successfully used for treating osteonecrosis. Considering the functional advantages of BM-MSCs as bone and cartilage reparatory cells and supporting angiogenesis, several donor-related factors are also essential to consider when autologous BM-MSCs are used for such regenerative therapies. Aging is one of several factors contributing to the donor-related variability and found to be associated with a reduction of BM-MSC numbers. However, even within the same age group, other factors affecting MSC quantity and function remain incompletely understood. For patients with osteonecrosis, several underlying factors have been linked to the decrease of the proliferation of BM-MSCs as well as the impairment of their differentiation, migration, angiogenesis-support and immunoregulatory functions. This review discusses the quality and quantity of BM-MSCs in relation to the etiological conditions of osteonecrosis such as sickle cell disease, Gaucher disease, alcohol, corticosteroids, Systemic Lupus Erythematosus, diabetes, chronic renal disease and chemotherapy. A clear understanding of the regenerative potential of BM-MSCs is essential to optimize the cellular therapy of osteonecrosis and other bone damage conditions.
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Affiliation(s)
- Jehan J El-Jawhari
- Department of Biosciences, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK
- Clinical Pathology Department, Mansoura University, Mansoura 35516, Egypt
| | - Payal Ganguly
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (P.G.); (E.J.); (P.V.G.)
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (P.G.); (E.J.); (P.V.G.)
| | - Peter V Giannoudis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (P.G.); (E.J.); (P.V.G.)
- Academic Department of Trauma and Orthopedic, School of Medicine, University of Leeds, Leeds LS2 9JT, UK
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Person A, Janitz E, Thapa M. Pediatric Bone Marrow: Normal and Abnormal MRI Appearance. Semin Roentgenol 2021; 56:325-337. [PMID: 34281683 DOI: 10.1053/j.ro.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Huang ZD, Wang CX, Shi TB, Wu BJ, Chen Y, Li WB, Fang XY, Zhang WM. Salmonella Osteomyelitis in Adults: A Systematic Review. Orthop Surg 2021; 13:1135-1140. [PMID: 33942967 PMCID: PMC8274199 DOI: 10.1111/os.12912] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/01/2020] [Accepted: 11/29/2020] [Indexed: 12/04/2022] Open
Abstract
The aim of this systematic review was to characterize the clinical features of adults with Salmonella osteomyelitis and summarize diagnosis and treatment methods to provide guidance for clinicians. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. We conducted a literature search in the PubMed, EMBASE, and Cochrane Library databases. Article screening and data extraction were performed by two reviewers individually. All the included studies were independently evaluated by two reviewers using the Methodological Index for Non‐Randomized Studies (MINORS) criteria. A total of 67 articles published between 1970 and 2019 were selected, which include 69 patients with an average age of 47.5 years (range, 18–79).The majority of cases (47.76%) occurred in immunocompetent adults without common risk factors. Aspiration and biopsy cultures were all positive in Salmonella osteomyelitis patients who underwent aspiration or biopsy. All infections were monomicrobial, and a total of 12 different serotypes were identified. The three most commonly reported Salmonella serotypes were Salmonella typhi (19 cases), Salmonella typhimurium (12 cases), and Salmonella enteritidis (11 cases). Only 12 of the 67 cases in our data (17.91%) had diarrhea symptoms, and 44 of the 67 cases (65.67%) had fever symptoms. Fifty‐nine of the 67 cases (88.06%) had local inflammatory manifestations, such as erythema, swelling, and tenderness in the affected area. The commonly reported involved sites were the vertebrae, femur, and tibia. Antibiotic therapy alone was utilized in 30 cases, and 24 patients (80.00%) were eventually cured. In total, 75.68% of patients achieved satisfactory results after treatment with surgery and antibiotics. Third‐generation cephalosporins were most commonly utilized, and antibiotic treatment was administered for an average of 11.3 weeks (95% CI, 8.31–14.37 weeks). Salmonella osteomyelitis should be considered in patients without any common risk factors. Aspiration or biopsy can facilitate the identification of pathogens to guide antibiotic choice. Empirical therapy with a third‐generation cephalosporin is recommended until the susceptibility of the strain is determined.
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Affiliation(s)
- Zi-da Huang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chao-Xin Wang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Teng-Bin Shi
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bai-Jian Wu
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yang Chen
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Bo Li
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xin-Yu Fang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Ming Zhang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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