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Yousif TYE. Impact of Abnormal Leukocyte Count in the Pathophysiology of Sickle Cell Anemia. J Blood Med 2022; 13:673-679. [DOI: 10.2147/jbm.s378133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
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Patrolling monocytes scavenge endothelial-adherent sickle RBCs: a novel mechanism of inhibition of vaso-occlusion in SCD. Blood 2019; 134:579-590. [PMID: 31076443 DOI: 10.1182/blood.2019000172] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/02/2019] [Indexed: 12/23/2022] Open
Abstract
Painful vaso-occlusive crisis (VOC) is the most common complication of sickle cell disease (SCD). Increasing evidence suggests that vaso-occlusion is initiated by increased adherence of sickle red blood cells (RBCs) to the vascular endothelium. Thus, the mechanisms that remove endothelial-attached sickle RBCs from the microvasculature are expected to be critical for optimal blood flow and prevention of VOC in SCD. We hypothesized that patrolling monocytes (PMos), which protect against vascular damage by scavenging cellular debris, could remove endothelial-adherent sickle RBCs and ameliorate VOC in SCD. We detected RBC (GPA+)-engulfed material in circulating PMos of patients with SCD, and their frequency was further increased during acute crisis. RBC uptake by PMos was specific to endothelial-attached sickle, but not control, RBCs and occurred mostly through ICAM-1, CD11a, and CD18. Heme oxygenase 1 induction, by counteracting the cytotoxic effects of engulfed RBC breakdown products, increased PMo viability. In addition, transfusions, by lowering sickle RBC uptake, improved PMo survival. Selective depletion of PMos in Townes sickle mice exacerbated vascular stasis and tissue damage, whereas treatment with muramyl dipeptide (NOD2 ligand), which increases PMo mass, reduced stasis and SCD associated organ damage. Altogether, these data demonstrate a novel mechanism for removal of endothelial attached sickle RBCs mediated by PMos that can protect against VOC pathogenesis, further supporting PMos as a promising therapeutic target in SCD VOC.
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da Silveira Cavalcante L, Branch DR, Duong TT, Yeung RS, Acker JP, Holovati JL. The immune-stimulation capacity of liposome-treated red blood cells. J Liposome Res 2017; 28:173-181. [DOI: 10.1080/08982104.2017.1295991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Luciana da Silveira Cavalcante
- Canadian Blood Services Centre for Innovation, Edmonton, AB, Canada,
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada,
| | - Donald R. Branch
- Canadian Blood Services Centre for Innovation, Toronto, ON, Canada,
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada,
| | - Trang T. Duong
- The Hospital for Sick Children, Toronto, ON, Canada, and
| | - Rae S.M. Yeung
- The Hospital for Sick Children, Toronto, ON, Canada, and
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Jason P. Acker
- Canadian Blood Services Centre for Innovation, Edmonton, AB, Canada,
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada,
| | - Jelena L. Holovati
- Canadian Blood Services Centre for Innovation, Edmonton, AB, Canada,
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada,
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Tong TN, Burke-Murphy E, Sakac D, Pendergrast J, Cserti-Gazdewich C, Laroche V, Branch DR. Optimal conditions for the performance of a monocyte monolayer assay. Transfusion 2016; 56:2680-2690. [DOI: 10.1111/trf.13766] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/14/2016] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Tik Nga Tong
- Department of Laboratory Medicine and Pathobiology; Canadian Blood Services; Toronto, Ontario
- Centre for Innovation; Canadian Blood Services
| | | | | | | | | | | | - Donald R. Branch
- Department of Laboratory Medicine and Pathobiology; Canadian Blood Services; Toronto, Ontario
- Centre for Innovation; Canadian Blood Services
- University Health Network; Toronto, Ontario Canada
- Department of Medicine; University of Toronto
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Wun T. The Role of Inflammation and Leukocytes in the Pathogenesis of Sickle Cell Disease. Hematology 2016; 5:403-12. [DOI: 10.1080/10245332.2000.11746536] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Ted Wun
- Division of Hematology and Oncology, Department of Internal Medicine, UC Davis School of Medicine and the VA Northern California Health Care System, Sacramento, CA, USA
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Win N, Lee E, Needs M, Chia LW, Stasi R. Measurement of macrophage marker in hyperhaemolytic transfusion reaction: a case report. Transfus Med 2012; 22:137-41. [PMID: 22233101 DOI: 10.1111/j.1365-3148.2011.01131.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hyperhaemolytic transfusion reaction (HHTR) has been well described in patients with sickle cell disease (SCD). It is characterised by a decrease in haemoglobin concentration to levels below those before transfusion and a fall in the absolute reticulocyte count. As red blood cells (RBC) alloantibodies are typically not detected in post-transfusion samples in acute forms of HHTR, we have previously proposed that both the transfused and autologous RBCs cells (HbSS/reticulocytes) are destroyed by activated macrophages. CASE REPORTS We report a patient with SCD who presented with vaso-occlusive sickle cell crisis and developed a severe HHTR attributable to anti-Fy3. In addition to the usual supportive measures, the patient was treated with intravenous immunoglobulin (IVIG) and steroids. Serum ferritin levels were measured as an aspecific marker of macrophage activation. RESULTS Steroids and IVIG were effective in managing HHTR. Ferritin levels were high at the time of haemolysis, (>10000 µg L(-1)) whereas recovery and cessation of haemolysis correlated with a decrease in ferritin levels. CONCLUSION Serum ferritin values >10,000 µg L(-1) are considered pathognomic for conditions characterised by abnormal macrophage activation. In our case, serum ferritin levels correlate well with the disease activity and clinical response. This further supports our previous proposal that the activated macrophages play an important role in HHTR. Serum ferritin is a nonspecific marker of inflammation. A rapid specific bio-marker to measure the activity of macrophages in SCD in HHTR is desirable, and this area warrants further investigation.
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Affiliation(s)
- N Win
- Department of Red Cell Immunology (RCI), NHS-Blood and Transplant, Tooting Centre, London, UK.
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Ricerca BM, Di Girolamo A, Rund D. Infections in thalassemia and hemoglobinopathies: focus on therapy-related complications. Mediterr J Hematol Infect Dis 2009; 1:e2009028. [PMID: 21415996 PMCID: PMC3033166 DOI: 10.4084/mjhid.2009.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 12/26/2009] [Indexed: 02/07/2023] Open
Abstract
The clinical approach to thalassemia and hemoglobinopathies, specifically Sickle Cell Disease (SCD), based on transfusions, iron chelation and bone marrow transplantation has ameliorated their prognosis. Nevertheless, infections still may cause serious complications in these patients. The susceptibility to infections in thalassemia and SCD arises both from a large spectrum of immunological abnormalities and from exposure to specific infectious agents. Four fundamental issues will be focused upon as central causes of immune dysfunction: the diseases themselves; iron overload, transfusion therapy and the role of the spleen. Thalassemia and SCD differ in their pathogenesis and clinical course. It will be outlined how these differences affect immune dysfunction, the risk of infections and the types of most frequent infections in each disease. Moreover, since transfusions are a fundamental tool for treating these patients, their safety is paramount in reducing the risks of infections. In recent years, careful surveillance worldwide and improvements in laboratory tests reduced greatly transfusion transmitted infections, but the problem is not completely resolved. Finally, selected topics will be discussed regarding Parvovirus B19 and transfusion transmitted infections as well as the prevention of infectious risk postsplenectomy or in presence of functional asplenia.
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Affiliation(s)
| | - Arturo Di Girolamo
- Infectious Diseases Department, G. d’Annunzio University, Chieti-Pescara (Italy)
| | - Deborah Rund
- Hebrew University-Hadassah Medical Center, Ein Kerem, Jerusalem, Israel IL 91120
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Fendel R, Mordmüller B, Kreidenweiss A, Rudat A, Steur C, Ambrosch C, Kirstein M, Berdel WE, Kremsner PG, Brandts C. New method to quantify erythrophagocytosis by autologous monocytes. Cytometry A 2007; 71:258-64. [PMID: 17342773 DOI: 10.1002/cyto.a.20360] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anemia is the net result of decreased red blood cell (RBC) production and increased removal of RBCs. Replication and maturation of erythroid precursors and RBC lysis can be measured by standardized in vitro methods and surrogate markers, respectively. In contrast, erythrophagocytosis by autologous phagocytes is more difficult to quantify. METHODS We developed a method to assess erythrophagocytosis by autologous monocytes from 5 ml of whole blood. RBCs were labeled with carboxyfluorescein-diacetate-succinimidyl ester (CFDA-SE) and subsequently coincubated with autologous CD14(+) monocytes. Phagocytosis was quantified using flow cytometry. After standardization, the assay was validated in patients with severe malarial anemia (SMA), a condition that is associated with increased erythrophagocytosis. RESULTS After labeling, CFDA-SE was stably incorporated into RBCs and no significant leakage leading to contamination of nonlabeled cells was observed. Monocytes ingested opsonized, labeled RBCs seven times more than nonopsonized controls. Erythrophagocytosis was significantly higher in SMA than in healthy controls. CONCLUSIONS The established assay showed enhanced autoerythrophagocytosis associated with SMA and hence was able to detect clinically relevant erythrophagocytosis. This novel assay is well suited for rapid quantification of in vitro erythrophagocytosis by autologous monocytes.
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Affiliation(s)
- Rolf Fendel
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
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Wun T, Cordoba M, Rangaswami A, Cheung AW, Paglieroni T. Activated monocytes and platelet-monocyte aggregates in patients with sickle cell disease. CLINICAL AND LABORATORY HAEMATOLOGY 2002; 24:81-8. [PMID: 11985552 DOI: 10.1046/j.1365-2257.2002.00433.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Tumour necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) increase endothelial surface receptors that mediate the adherence of sickle erythrocytes to the endothelium. Increased circulating levels of these cytokines have been found in patients with sickle cell disease (SCD). Monocytes are a source of both of these inflammatory mediators; we therefore determined whether circulating monocytes were activated in SCD, as defined by intracellular expression of these cytokines. Blood was also assayed for the presence of platelet-monocyte aggregates (PMAs), as platelet adherence is one possible mechanism for monocyte activation. The median percentages of monocytes expressing intracellular TNF-alpha and IL-1beta in SCD patients were 6.8 (2.8-17.3) [median (range)] and 14.1 (1.3-44.8), respectively. In African-American controls the corresponding percentages were 0.3 (0.1-0.5) and 0.4 (0.1-3.0), and in Caucasians 0.2 (0.1-0.5) and 0.8 (0.8-1.9) (P < 0.001, Kruskal-Wallis). The mean percentage (+/- SD) of PMA was 14.0 +/- 8.3 for Caucasian controls, 25.7 +/- 7.3 for African-American controls, and 45.7 +/- 21.6 for patients with SCD (P < 0.001, RM ANOVA; P < 0.05, Newman-Keuls posthoc test). We conclude that there are increased circulating PMAs and monocyte activation in patients with SCD.
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Affiliation(s)
- Ted Wun
- Division of Hematology and Oncology, UC Davis School of Medicine, CA, USA.
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WUN TED, CORDOBA MIGUEL, RANGASWAMI ARUN, CHEUNG ANTHONYW, PAGLIERONI TERESA. Activated monocytes and platelet-monocyte aggregates in patients with sickle cell disease*. ACTA ACUST UNITED AC 2002. [DOI: 10.1046/j.1365-2257.2002.t01-1-00433.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Homozygous sickle cell disease (SCD) has a wide spectrum of clinical manifestations which varies from an almost asymptomatic condition to severe illness, despite the fact that all subjects with this disease have the same base change in their DNA. The source of this variation is partly environmental, but a large part of this variability can derive from the presence of genetic modulators which are not fully understood. It was postulated that some degree of immunodeficiency should be associated with this condition, but no deficiency, directly related to a given component of the immune system, was observed that could explain the high levels of recurrent infections presented by sickle cell disease patients. Reviewing data from the literature we suggest that the influence of the immune system in the variation of clinical manifestations presented by SCD patients is not related with any immunodeficiency but is rather the result of a chronic inflammatory condition.
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Affiliation(s)
- J A Chies
- Genetics Department, Universidade Federal do Rio Grande do Sul, Laboratory of Immunogenetics, Brazil.
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Wanachiwanawin W, Siripanyaphinyo U, Fucharoen S, Wasi P, Mawas F, Wiener E, Wickramasinghe SN. Activation of monocytes for the immune clearance of red cells in beta zero-thalassaemia/HbE. Br J Haematol 1993; 85:773-7. [PMID: 7918042 DOI: 10.1111/j.1365-2141.1993.tb03222.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We have recently provided evidence that IgG antibodies play a role in the destruction of red cells in thalassaemia syndromes. In order further to delineate factors involved in the clearance of thalassaemic cells, monocytes of 30 Thai patients with beta zero-thal/HbE (17 non-splenectomized and 13 splenectomized) and 16 normal controls were examined for their ability to bind and phagocytose normal red cells coated with IgG anti-Rh(D). In beta zero-thal/HbE, the mean number of red cells attached to the monocytes was approximately 3-fold greater than in normal controls and the number ingested 30% higher. Among the non-splenectomized patients, the number of red cells attached to and ingested by the monocytes, correlated inversely with mean basal Hb levels, suggesting that activation of mononuclear phagocytes for the immune clearance of red cells is a factor in determining the severity of the anaemia. As Fc-gamma-RI is of primary importance in the recognition of IgG-coated red cells by monocytes, leucocytes from 10 beta zero-thal/HbE patients (four non-splenectomized and six splenectomized) and five normal controls were investigated for their expression of Fc-gamma-RI by flow cytometry. In beta zero-thal/HbE there was an approximately 3-fold increase in the percentage of leucocytes expressing this receptor; the receptor was up-regulated on monocytes and induced on granulocytes. The up-regulation of Fc-gamma-RI in beta zero-thal/HbE is likely to be an important component in the activation of monocytes and in mediating their enhanced effector function towards antibody-coated cells.
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Affiliation(s)
- W Wanachiwanawin
- Department of Haematology, St Mary's Hospital Medical School, Imperial College of Science, Technology and Medicine, London, U.K
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Sokol RJ, Hudson G, Wales JM, James NT. Immune-mediated interactions during macrophage development in non-Hodgkin's lymphoma. ACTA ACUST UNITED AC 1992; 62:115-8. [PMID: 1355320 DOI: 10.1007/bf02899672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
As part of an investigation of mononuclear phagocytes in malignant lymphoma, measurement of immune-mediated erythrophagocytosis and rosette formation was carried out on cells grown in suspension culture at the monocyte (Day 0) and macrophage (Day 6) stages; the culture medium contained autologous serum. Cells were derived from 10 patients with untreated non-Hodgkin's lymphoma (NHL) and from 12 normal individuals. The results were subjected to Analysis of Variance and demonstrated a significant difference between the two groups with respect to erythrophagocytosis but not to rosette formation. In the NHL group, the proportion of erythrophagocytic cells showed no significant increase between the monocyte and macrophage stages (0.07 to 0.09), in contrast to the marked increase seen in the normal group (0.09 to 0.24). In a pilot investigation to examine the possible role of factors in the serum, cells derived from the NHL patients were cultured with serum from healthy donors; they showed no significant difference in the immune-mediated functions from those grown in autologous serum. Overall, the results provide further quantitative evidence of defective macrophage maturation in NHL, presumably reflecting the compromise of host defence mechanisms.
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Affiliation(s)
- R J Sokol
- Department of Medicine and Pharmacology, University of Sheffield, England, UK
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