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Chambliss C, Stiles JK, Gee BE. Neuregulin-1 attenuates hemolysis- and ischemia induced-cerebrovascular inflammation associated with sickle cell disease. J Stroke Cerebrovasc Dis 2023; 32:106912. [PMID: 36473396 PMCID: PMC10448832 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES Individuals with sickle cell disease (SCD) are at severely heightened risk for cerebrovascular injury and acute cerebrovascular events, including ischemic and hemorrhagic stroke, potentially leading to impaired development and life-long physical and cognitive disabilities. Cerebrovascular injury specific to SCD includes inflammation caused by underlying conditions of chronic hemolysis and reduced cerebrovascular perfusion. The objectives of this study were to investigate whether expression of neuregulin-1β (NRG-1), an endogenous neuroprotective polypeptide, is increased in SCD or experimental conditions mimicking the hemolysis and ischemic conditions of SCD, and to determine if treatment with exogenous NRG-1 reduces markers of cerebrovascular inflammation. MATERIALS AND METHODS Plasma and brain-specific NRG-1 levels were measured in transgenic SCD mice. Endogenous NRG-1 levels and response to experimental conditions of excess heme and ischemia were measured in cultured human brain microvascular cells and astrocytes. Pre-treatment with NRG-1 was used to determine NRG-1's ability to ameliorate resultant cerebrovascular inflammation. RESULTS Plasma and brain-specific NRG-1 were elevated in transgenic SCD mice compared to healthy controls. Neuregulin-1 expression was significantly increased in cultured human microvascular cells and astrocytes exposed to excess heme and ischemia. Pre-treatment with NRG-1 reduced inflammatory chemokine (CXCL-1 and CXCL-10) and adhesion molecule (ICAM-1 and VCAM-1) expression and increased pro-angiogenic factors (VEGF-A) in microvascular cells and astrocytes exposed to excess heme and ischemia. CONCLUSIONS Elevated NRG-1 in SCD is likely a protective endogenous response to ongoing cerebrovascular insults caused by chronic hemolysis and reduced cerebrovascular perfusion. Administration of NRG-1 to reduce cerebrovascular inflammation may be therapeutically beneficial in SCD and warrants continued investigation.
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Affiliation(s)
- Christopher Chambliss
- Pediatrics Institute, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, United States; Aflac Cancer and Blood Disorders Center, 2015 Uppergate Drive, Atlanta, GA 30322, United States; Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, United States.
| | - Jonathan K Stiles
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, United States.
| | - Beatrice E Gee
- Pediatrics Institute, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, United States; Aflac Cancer and Blood Disorders Center, 2015 Uppergate Drive, Atlanta, GA 30322, United States; Children's Healthcare of Atlanta, 35 Jesse Hill Jr Drive SE, Atlanta, GA 30303, United States; Department of Pediatrics, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, United States
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2
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Decreased parasite burden and altered host response in children with sickle cell anemia and severe anemia with malaria. Blood Adv 2021; 5:4710-4720. [PMID: 34470050 PMCID: PMC8759120 DOI: 10.1182/bloodadvances.2021004704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/21/2021] [Indexed: 11/20/2022] Open
Abstract
Plasmodium falciparum malaria causes morbidity and mortality in African children with sickle cell anemia (SCA), but comparisons of host responses to P falciparum between children with SCA (homozygous sickle cell disease/hemoglobin SS [HbSS]) and normal hemoglobin genotype/hemoglobin AA (HbAA) are limited. We assessed parasite biomass and plasma markers of inflammation and endothelial activation in children with HbAA (n = 208) or HbSS (n = 22) who presented with severe anemia and P falciparum parasitemia to Mulago Hospital in Kampala, Uganda. Genotyping was performed at study completion. No child had known SCA at enrollment. Children with HbSS did not differ from children with HbAA in peripheral parasite density, but had significantly lower sequestered parasite biomass. Children with HbSS had greater leukocytosis but significantly lower concentrations of several plasma inflammatory cytokines, including tumor necrosis factor α (TNF-α). In contrast, children with HbSS had threefold greater concentrations of angiopoietin-2 (Angpt-2), a marker of endothelial dysregulation associated with mortality in severe malaria. Lower TNF-α concentrations were associated with increased risk of postdischarge mortality or readmission, whereas higher Angpt-2 concentrations were associated with increased risk of recurrent clinical malaria. Children with SCA have decreased parasite sequestration and inflammation but increased endothelial dysregulation during severe anemia with P falciparum parasitemia, which may ameliorate acute infectious complications but predispose to harmful long-term sequelae.
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Elenga N, Celicourt D, Muanza B, Elana G, Hocquelet S, Tarer V, Maillard F, Sibille G, Divialle Doumdo L, Petras M, Tressières B, Etienne-Julan M. Dengue in hospitalized children with sickle cell disease: A retrospective cohort study in the French departments of America. J Infect Public Health 2019; 13:186-192. [PMID: 31548164 DOI: 10.1016/j.jiph.2019.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/18/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To describe the characteristics of dengue in sickle cell children and try to identify risk factors of severity. METHODS In this retrospective study, we describe the evolution according to genotype (SS or SC and controls) and severity. RESULTS AND CONCLUSIONS From 2005 to 2013, 106 hospitalizations for dengue fever were recorded, 35 SS genotype, 35 SC and 36 without SCD or any other chronic disease. The clinical evolution was quite different. During hospitalization, SC patients were more likely to develop multiorgan failure (31.4% versus 25.7% for SS, and 0% for controls, p=0.001), or acute pulmonary complications than patients without SC sickle cell disease (14.3% versus 8.6% for SS, and 0% for controls, p=0.03). Level 3 analgesic treatment was more frequent in SC patients (22.9% versus 3% for SS, and 0% for controls, p<0.001). Patients with SC sickle cell disease had a higher proportion of severe forms of dengue (57.1% versus 37.1% for SS, and 0% for controls, p<0.001) than patients without SC sickle cell disease. Transfer in intensive care unit was required for most SC patients (22.9% versus 3% for SS, and 0% for controls, p=0.005).Fatal episodes were more frequent in SC patients than in patients without SC sickle cell disease (5 deaths versus 1 for SS and 0 for controls, p=0.02). Thirty-three patients (47.1%) were diagnosed as having severe dengue (13 SS and 20 SC). On univariate analysis, age >10 years, acute pulmonary complications, multiorgan failure, severe anemia requiring transfusion, use of antibiotic treatment, need for treatment with morphine, and longer hospital stay were statistically more frequent in severe dengue-associated cases. Multiple logistic regression analysis showed that HbSC genotype and acute pulmonary complications, were significantly associated with severe dengue. In the multivariate model, the area of the ROC curve was 0.831. Children with SC genotype, typically thought to have less severe disease, actually had a higher rate of severe dengue and death than those with SS genotype.
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Affiliation(s)
- Narcisse Elenga
- Service de Médecine et Chirurgie Pédiatrique, Centre Hospitalier de Cayenne, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana; Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana.
| | - Donald Celicourt
- Service de Pédiatrie, Maison de la Mère et de l'Enfant, CHU de la Martinique, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana; Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana
| | - Blandine Muanza
- Service de Pédiatrie, pôle Parents-Enfants, CHU de Pointe-à-Pitre/Abymes, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana; Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana
| | - Gisèle Elana
- Service de Médecine et Chirurgie Pédiatrique, Centre Hospitalier de Cayenne, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana; Service de Pédiatrie, pôle Parents-Enfants, CHU de Pointe-à-Pitre/Abymes, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana
| | - Sévérine Hocquelet
- Service de Pédiatrie, pôle Parents-Enfants, CHU de Pointe-à-Pitre/Abymes, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana
| | - Vanessa Tarer
- Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana
| | - Frédéric Maillard
- Service de Pédiatrie, pôle Parents-Enfants, CHU de Pointe-à-Pitre/Abymes, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana; Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana
| | - Gérard Sibille
- Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana; Service de Pédiatrie, CH de la Basse-Terre, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana
| | - Lydia Divialle Doumdo
- Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana; Unité Transversale de la Drépanocytose, pôle Parents-Enfants, CHU de Pointe-à-Pitre/Abymes, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana
| | - Marie Petras
- Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana; Unité Transversale de la Drépanocytose, pôle Parents-Enfants, CHU de Pointe-à-Pitre/Abymes, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana
| | - Benoit Tressières
- Centre d'Investigation Clinique Antilles-Guyane, Inserm CIC 1424, French Guiana
| | - Maryse Etienne-Julan
- Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana; Unité Transversale de la Drépanocytose, pôle Parents-Enfants, CHU de Pointe-à-Pitre/Abymes, Centre de référence de la drépanocytose aux Antilles-Guyane, French Guiana; UMR Inserm 1134/Université des Antilles-Guyane, French Guiana
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4
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Kossorotoff M, De Montalembert M, Brousse V, Lasne D, Curis E, Smadja DM, Lacroix R, Bertil S, Masson E, Desguerre I, Bonnet D, Gaussem P. CD34+ Hematopoietic Stem Cell Count Is Predictive of Vascular Event Occurrence in Children with Sickle Cell Disease. Stem Cell Rev Rep 2019; 14:694-701. [PMID: 29931411 DOI: 10.1007/s12015-018-9835-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Sickle cell disease (SCD) complications mostly result from vascular dysfunction, concerning systemic microvasculature and cerebral large vessels. The aim of this cohort study was to identify potential circulating biomarkers predictive for further vascular event occurrence in pediatric SCD. METHODS We consecutively enrolled 108 children with SCD at steady state, aged 3-18 years old (median 9.8 years). Hematology, coagulation, hemolysis, endothelial, platelet and vascular activation parameters were recorded at inclusion. Neurovascular and systemic vascular events were prospectively recorded during a mean follow-up period of 27 months. RESULTS Patients at steady state displayed significantly higher hemolysis and platelet activation markers, higher leukocyte, CD34+ hematopoietic stem cell and microvesicle counts, and a pro-coagulant profile compared to controls matched for age and ethnicity. Circulating endothelial cell or nucleosome level did not differ. During the follow-up period, 36 patients had at least one neurovascular (n = 12) or systemic vascular event (n = 25). In a multivariate model, high CD34+ cell count was the best predictor for the occurrence of a vascular event (OR 1.2 for 1000 cell/mL increase, 95% CI [1.049-1.4], p = 0.013, sensitivity 53%, specificity 84% for a threshold of 8675 cells/mL). CONCLUSION CD34+ cell count at steady state is a promising biomarker of further vascular event in children with SCD.
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Affiliation(s)
- Manoelle Kossorotoff
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France. .,AP-HP, Child Neurology, French center for pediatric stroke, Hôpital Universitaire Necker-Enfants malades, 149 rue de Sèvres, 75015, Paris, France.
| | - Mariane De Montalembert
- AP-HP, Pediatric Sickle Cell Clinic, Hôpital Universitaire Necker-Enfants malades and Laboratory of Excellence, GR-Ex, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Valentine Brousse
- AP-HP, Pediatric Sickle Cell Clinic, Hôpital Universitaire Necker-Enfants malades and Laboratory of Excellence, GR-Ex, Paris, France
| | - Dominique Lasne
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France.,AP-HP, Laboratoire d'hématologie, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Emmanuel Curis
- Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Laboratoire de biomathématiques, plateau iB2, Faculté de Pharmacie, Paris, France
| | - David M Smadja
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,AP-HP, Service d'hématologie biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Romaric Lacroix
- Inserm UMR-S1076, UFR de Pharmacie, Aix Marseille Université, Marseille, France
| | - Sebastien Bertil
- AP-HP, Service d'hématologie biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Elodie Masson
- Inserm UMR-S1076, UFR de Pharmacie, Aix Marseille Université, Marseille, France
| | - Isabelle Desguerre
- AP-HP, Child Neurology, French center for pediatric stroke, Hôpital Universitaire Necker-Enfants malades, 149 rue de Sèvres, 75015, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Damien Bonnet
- Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,AP-HP, M3C-Necker, Cardiologie Congénitale et Pédiatrique, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Pascale Gaussem
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,AP-HP, Service d'hématologie biologique, Hôpital Européen Georges Pompidou, Paris, France
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5
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Tahhan AS, Hammadah M, Mohamed-Kelli H, Kim JH, Sandesara PB, Alkhoder A, Kaseer B, Gafeer MM, Topel M, Hayek SS, O’Neal WT, Obideen M, Ko YA, Liu C, Hesaroieh I, Mahar E, Vaccarino V, Waller EK, Quyyumi AA. Circulating Progenitor Cells and Racial Differences. Circ Res 2018; 123:467-476. [PMID: 29930146 PMCID: PMC6202175 DOI: 10.1161/circresaha.118.313282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
RATIONALE Blacks compared with whites have a greater risk of adverse cardiovascular outcomes. Impaired regenerative capacity, measured as lower levels of circulating progenitor cells (CPCs), is a novel determinant of adverse outcomes; however, little is known about racial differences in CPCs. OBJECTIVE To investigate the number of CPCs, PC-mobilizing factors, PC mobilization during acute myocardial infarction and the predictive value of CPC counts in blacks compared with whites. METHODS AND RESULTS CPCs were enumerated by flow cytometry as CD45med+ blood mononuclear cells expressing CD34+, CD133+, VEGF2R+, and CXCR4+ epitopes in 1747 subjects, mean age 58.4±13, 55% male, and 26% self-reported black. Patients presenting with acute myocardial infarction (n=91) were analyzed separately. Models were adjusted for relevant clinical variables. SDF-1α (stromal cell-derived factor-1α), VEGF (vascular endothelial growth factor), and MMP-9 (matrix metallopeptidase-9) levels were measured (n=561), and 623 patients were followed for median of 2.2 years for survival analysis. Blacks were younger, more often female, with a higher burden of cardiovascular risk, and lower CPC counts. Blacks had fewer CD34+ cells (-17.6%; [95% confidence interval (CI), -23.5% to -11.3%]; P<0.001), CD34+/CD133+ cells (-15.5%; [95% CI, -22.4% to -8.1%]; P<0.001), CD34+/CXCR4+ cells (-17.3%; [95% CI, -23.9% to -10.2%]; P<0.001), and CD34+/VEGF2R+ cells (-27.9%; [95% CI, -46.9% to -2.0%]; P=0.04) compared with whites. The association between lower CPC counts and black race was not affected by risk factors or cardiovascular disease. Results were validated in a separate cohort of 411 patients. Blacks with acute myocardial infarction had significantly fewer CPCs compared with whites ( P=0.02). Blacks had significantly lower plasma MMP-9 levels ( P<0.001) which attenuated the association between low CD34+ and black race by 19% (95% CI, 13%-33%). However, VEGF and SDF-1α levels were not significantly different between the races. Lower CD34+ counts were similarly predictive of mortality in blacks (hazard ratio, 2.83; [95% CI, 1.12-7.20]; P=0.03) and whites (hazard ratio, 1.79; [95% CI, 1.09-2.94]; P=0.02) without significant interaction. CONCLUSIONS Black subjects have lower levels of CPCs compared with whites which is partially dependent on lower circulating MMP-9 levels. Impaired regenerative capacity is predictive of adverse outcomes in blacks and may partly account for their increased risk of cardiovascular events.
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Affiliation(s)
- Ayman Samman Tahhan
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Muhammad Hammadah
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Heval Mohamed-Kelli
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Jeong Hwan Kim
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Ayman Alkhoder
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Belal Kaseer
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Mohamad Mazen Gafeer
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Matthew Topel
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Salim S Hayek
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Wesley T O’Neal
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Malik Obideen
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Chang Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Iraj Hesaroieh
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Ernestine Mahar
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Edmund K. Waller
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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Antwi-Boasiako C, Frimpong E, Gyan B, Kyei-Baafour E, Sey F, Dzudzor B, Abdul-Rahman M, Dankwah GB, Otu KH, Ndanu TA, Campbell AD, Ekem I, Donkor ES. Elevated Proangiogenic Markers are Associated with Vascular Complications within Ghanaian Sickle Cell Disease Patients. Med Sci (Basel) 2018; 6:E53. [PMID: 29954157 PMCID: PMC6164085 DOI: 10.3390/medsci6030053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 01/19/2023] Open
Abstract
: Sickle cell disease (SCD) is an inherited blood disorder that can result in vasculopathy and end organ damage. Angiogenesis has been implicated as a key contributing factor to vascular mediated tissue injury in SCD. The relative plasma levels of angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), and vascular endothelial growth factor (VEGF) greatly influence angiogenesis. Dysregulation of these growth factors, leading to a pro-angiogenic state in SCD patients, has been documented in the developed world but there is very little data in Africa. There is the need, therefore, for studies in Ghanaian SCD patients. The aim of this study was to assess plasma levels of Ang-1, Ang-2, and VEGF in homozygous (HbSS) SCD patients with or without complications and healthy controls (HbAA) in Ghana. The study was a case-control study involving 544 participants: 396 HbSS SCD patients and 148 HbAA healthy controls. The study was conducted at the Center for Clinical Genetics (Sickle Cell Clinic) and Accra Area Blood Centre for National Blood transfusion at the Korle-Bu Teaching Hospital, Accra, Ghana. The plasma levels of Ang-1, Ang-2, and VEGF of study participants were measured with a double sandwich enzyme-linked immunosorbent assay (ELISA) technique. Complete blood count (CBC) was measured with an autoanalyser. The mean plasma Ang-1, Ang-2, and VEGF were significantly higher in HbSS SCD patients with or without complications than healthy controls (p < 0.001). The Ang-2/Ang-1 ratio was significantly lower in the controls than the HbSS patients (p < 0.001). The Ang-2/Ang-1 ratio was higher in the HbSS patients with leg ulcers as compared with patients with other complications and healthy controls (p < 0.001). There were higher leucocyte counts in HbSS patients than healthy controls. Overall, there was elevated plasma levels of Ang-1, Ang-2, and VEGF in SCD patients. The higher Ang-2/Ang-1 plasma levels in patients with leg ulcers suggests a possible ongoing angiogenesis and response to inflammatory stimuli. The study provides a first report on plasma levels of angiopoietin-1, angiopoietin-2, and vascular endothelial growth factors in homozygous sickle cell disease patients in Ghana.
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Affiliation(s)
| | - Emmanuel Frimpong
- School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Ben Gyan
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
| | - Eric Kyei-Baafour
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
| | - Fredericka Sey
- Sickle Cell Clinic, Korle-Bu Teaching Hospital, Accra, Ghana.
| | - Bartholomew Dzudzor
- School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana.
| | - Mubarak Abdul-Rahman
- School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana.
| | - Gifty B Dankwah
- School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana.
| | - Kate H Otu
- Department of Nursing and Midwifery, Greenhills School of Health Sciences, Accra, Ghana.
| | - Tom A Ndanu
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
| | - Andrew D Campbell
- Center for Cancer and Blood Disorder, Hematology Children's National Medical Center, George Washington School of Medicine and Health Sciences, Washington, DC 20052, USA.
| | - Ivy Ekem
- School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Eric S Donkor
- School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana.
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Adly AAM, El-Sherif NH, Ismail EAR, El-Zaher YA, Farouk A, El-Refaey AM, Wahba MS. Vascular Dysfunction in Patients With Young β-Thalassemia. Clin Appl Thromb Hemost 2014; 21:733-44. [DOI: 10.1177/1076029614541515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We aimed to study the endothelial dysfunction among children and adolescents with transfusion-dependent β-thalassemia using von Willebrand factor antigen (VWF:Ag) and flow cytometric analysis of circulating CD144+ endothelial microparticles (EMPs) and endothelial progenitor cells (CD34+VEGFR2+) and assess their relation to iron overload, erythropoietin and chelation therapy as well as echocardiographic parameters and carotid intima–media thickness. The VWF:Ag, EMPs, and CD34+VEGFR2+ cells were significantly higher among patients with β-thalassemia than controls ( P < .001). The type of chelation and patients’ compliance did not influence the results. No significant correlations were found between the studied vascular markers. Patients with evident heart disease had higher VWF: Ag, EMPs, and CD34+VEGFR2+ cells than those without. Carotid intima–media thickness was increased among patients but not correlated with vascular markers. We suggest that procoagulant EMPs and VWF: Ag are involved in cardiovascular complications in patients with young β-thalassemia. CD34+VEGFR2+ cells were further increased in response to tissue injury contributing to reendothelialization and neovascularization.
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Affiliation(s)
| | | | | | - Yosra Abd El-Zaher
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amal Farouk
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohammed Samy Wahba
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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8
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Gee BE. Biologic complexity in sickle cell disease: implications for developing targeted therapeutics. ScientificWorldJournal 2013; 2013:694146. [PMID: 23589705 PMCID: PMC3621302 DOI: 10.1155/2013/694146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 01/29/2013] [Indexed: 01/01/2023] Open
Abstract
Current therapy for sickle cell disease (SCD) is limited to supportive treatment of complications, red blood cell transfusions, hydroxyurea, and stem cell transplantation. Difficulty in the translation of mechanistically based therapies may be the result of a reductionist approach focused on individual pathways, without having demonstrated their relative contribution to SCD complications. Many pathophysiologic processes in SCD are likely to interact simultaneously to contribute to acute vaso-occlusion or chronic vasculopathy. Applying concepts of systems biology and network medicine, models were developed to show relationships between the primary defect of sickle hemoglobin (Hb S) polymerization and the outcomes of acute pain and chronic vasculopathy. Pathophysiologic processes such as inflammation and oxidative stress are downstream by-products of Hb S polymerization, transduced through secondary pathways of hemolysis and vaso-occlusion. Pain, a common clinical trials endpoint, is also complex and may be influenced by factors outside of sickle cell polymerization and vascular occlusion. Future sickle cell research needs to better address the biologic complexity of both sickle cell disease and pain. The relevance of individual pathways to important sickle cell outcomes needs to be demonstrated in vivo before investing in expensive and labor-intensive clinical trials.
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Affiliation(s)
- Beatrice E Gee
- Department of Pediatrics, Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310-1495, USA.
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