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Boulassel MR, Al-Rubkhi K, Al-Qasabi J, El-Ghamry I, Khan H, Panjwani V, Qureshi RN, Al-Mamari S, Al-Qarni Z, Al-Kindi M, Al-Nabhani A, Al-Gharibi K, Wali Y, Pathare A. Impact of splenectomy on circulating microparticles in patients with sickle cell anemia. Int J Lab Hematol 2024; 46:141-147. [PMID: 37661331 DOI: 10.1111/ijlh.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/14/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Circulating microparticles (MP) are being described as potential biomarkers for disease activity in a variety of conditions including sickle cell anemia (SCA). However, relatively little is known about the influence of spleen status on MP levels in patients with SCA. METHODS Using a prospective study design we characterize circulating MP in 144 patients with SCA in steady state by assessing their cellular origin and their relationships to spleen status defined by clinical and imaging findings. In addition, MP levels were studied according to demographic characteristics, clinical status, treatment modalities, and other hematological and biochemical parameters. Absolute plasma concentrations of MP were determined by flow cytometry. RESULTS Patients with SCA displayed a 10-fold increase in levels of MP derived from red blood cell (RBC) and platelets (PLT) when compared to their healthy counterparts (p < 0.0001). Splenectomized patients with SCA have more pronounced levels of MPRBC and MPPLT, and remained elevated after several weeks of follow-up. Levels of MP were not significantly associated with spleen removal procedures, age, gender, clinical severity score, hydroxyurea therapy, hemoglobin F, and co-existence of glucose-6-phosphate dehydrogenase deficiency. CONCLUSION Collectively, these results suggest that splenectomy affects circulating levels of MP regardless of the known SCA modifiers and correlates.
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Affiliation(s)
- Mohamed-Rachid Boulassel
- Department of Allied Health Sciences, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Khoula Al-Rubkhi
- Department of Allied Health Sciences, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Jamal Al-Qasabi
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Islam El-Ghamry
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Hammad Khan
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Vinodh Panjwani
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Rizwan Nabi Qureshi
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Sahimah Al-Mamari
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Zahra Al-Qarni
- Department of Microbiology & Immunology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Mohamed Al-Kindi
- Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Abdulrahman Al-Nabhani
- Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Khalaf Al-Gharibi
- Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Yasser Wali
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Anil Pathare
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
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Hamali HA. Hypercoagulability in Sickle Cell Disease: A Thrombo-Inflammatory Mechanism. Hemoglobin 2023; 47:205-214. [PMID: 38189099 DOI: 10.1080/03630269.2023.2301026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
Sickle cell disease (SCD) is a group of inherited disorders characterized by the presence of abnormal hemoglobin S. Patients with SCD suffer from frequent episodes of anemia, chronic hemolysis, pain crisis, and vaso-occlusion. Additionally, SCD is associated with diverse and serious clinical complications, including thrombosis, which can lead to organ failure, increased morbidity, and eventually, mortality. SCD is known to be a hypercoagulable condition, and the cause of hypercoagulability is multifactorial, with the molecular basis of hemoglobin S being the main driver. The presence of hemoglobin S induces sickling of the RBCs and their subsequent hemolysis, as well as oxidative stress. Both of these processes can alter the hemostatic system, through the activation of platelets, coagulation system, and fibrinolysis, as well as depletion of coagulation inhibitors. These changes can also induce the formation of microvesicles and expression of tissue factor, leading to activation of WBCs, endothelial cell damage, and inflammatory response. Understanding the various factors that drive hypercoagulability as a thrombo-inflammatory mechanism in SCD can help provide explanations for the pathogenesis and other complications of the disease.
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Affiliation(s)
- Hassan A Hamali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia
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Elsayh KI, Saad K, Hetta HF, Youssef MAM, Embaby MM, Mohamed IL, Abdel-Aziz SM, Zahran ZAM, Elhoufey A, Ghandour AMA, Zahran AM. Impact of hydroxyurea on lymphocyte subsets in children with sickle cell anemia. Pediatr Res 2023; 93:918-923. [PMID: 34897281 DOI: 10.1038/s41390-021-01892-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/27/2021] [Accepted: 11/13/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hydroxyurea (HU) has beneficial effects in the management of sickle cell anemia (SCA), but there is a paucity of data on the effect of HU on immune cells in SCA. Herein we aimed to evaluate the effect of HU on immune profiles of Egyptian children with SCA. METHODS This was a controlled prospective cohort study conducted in 30 children with SCA and 30 healthy age-matched controls. Flow cytometry was used to evaluate lymphocyte profiles, including CD8+ T, CD19+ B, CD3+, CD4+, natural killer (NK), NK T, T helper 1 (Th1), Th2, T cytotoxic (Tc1), and Tc2 cells, prior to and after 1 year of treatment with HU. RESULTS HU treatment led to significant increases in hemoglobin (Hb), red blood cell, and hematocrit counts and a significant decrease in the percentage of sickle Hb, with subsequent improvement in SCA complications. Compared with baseline values, CD3+, CD4+, Th1, and CD8+ T cells were significantly increased, while NK, Th2, and Tc2 cells were significantly decreased, with a resulting increase in the Th1/Th2 and Tc1/Tc2 ratios. CONCLUSIONS HU has the beneficial effect of restoring the abnormally elevated immune parameters in children with SCA. IMPACT Hydroxyurea treatment restores the abnormal immune parameters in children with sickle cell anemia. HU treatment led to significantly increased CD3+, CD4+, Th1, and CD8+ T cells, while NK, Th2, and Tc2 cells were significantly decreased, with a resulting increase in the Th1/Th2 and Tc1/Tc2 ratios. Our study showed the impact of HU therapy on immune parameters in children with SCA.
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Affiliation(s)
- Khalid I Elsayh
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Khaled Saad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mervat A M Youssef
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mostafa M Embaby
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ismail L Mohamed
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Safwat M Abdel-Aziz
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Amira Elhoufey
- Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt
- Department of Community Health Nursing, Alddrab University College, Jazan University, Jazan, Saudi Arabia
| | - Aliaa M A Ghandour
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Asmaa M Zahran
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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4
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Lamarre Y, Nader E, Connes P, Romana M, Garnier Y. Extracellular Vesicles in Sickle Cell Disease: A Promising Tool. Bioengineering (Basel) 2022; 9:bioengineering9090439. [PMID: 36134985 PMCID: PMC9495982 DOI: 10.3390/bioengineering9090439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 12/12/2022] Open
Abstract
Sickle cell disease (SCD) is the most common hemoglobinopathy worldwide. It is characterized by an impairment of shear stress-mediated vasodilation, a pro-coagulant, and a pro-adhesive state orchestrated among others by the depletion of the vasodilator nitric oxide, by the increased phosphatidylserine exposure and tissue factor expression, and by the increased interactions of erythrocytes with endothelial cells that mediate the overexpression of adhesion molecules such as VCAM-1, respectively. Extracellular vesicles (EVs) have been shown to be novel actors involved in SCD pathophysiological processes. Medium-sized EVs, also called microparticles, which exhibit increased plasma levels in this pathology, were shown to induce the activation of endothelial cells, thereby increasing neutrophil adhesion, a key process potentially leading to the main complication associated with SCD, vaso-occlusive crises (VOCs). Small-sized EVs, also named exosomes, which have also been reported to be overrepresented in SCD, were shown to potentiate interactions between erythrocytes and platelets, and to trigger endothelial monolayer disruption, two processes also known to favor the occurrence of VOCs. In this review we provide an overview of the current knowledge about EVs concentration and role in SCD.
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Affiliation(s)
- Yann Lamarre
- Université Paris Cité and Université des Antilles, Inserm, BIGR, F-75015 Paris, France
| | - Elie Nader
- Laboratoire Inter-Universitaire de Biologie de la Motricité EA7424, Team “Vascular Biology and Red Blood Cell”, Université Claude Bernard Lyon 1, Université de Lyon, 69622 Lyon, France
| | - Philippe Connes
- Laboratoire Inter-Universitaire de Biologie de la Motricité EA7424, Team “Vascular Biology and Red Blood Cell”, Université Claude Bernard Lyon 1, Université de Lyon, 69622 Lyon, France
| | - Marc Romana
- Université Paris Cité and Université des Antilles, Inserm, BIGR, F-75015 Paris, France
| | - Yohann Garnier
- Université Paris Cité and Université des Antilles, Inserm, BIGR, F-75015 Paris, France
- Correspondence: ; Tel.: +590-590-891530
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Forté S, De Luna G, Abdulrehman J, Fadiga N, Pestrin O, Pham Hung d’Alexandry d’Orengiani AL, Aneke JC, Guillet H, Budhram D, Habibi A, Ward R, Bartolucci P, Kuo KHM. Thromboprophylaxis Reduced Venous Thromboembolism in Sickle Cell Patients with Central Venous Access Devices: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11051193. [PMID: 35268283 PMCID: PMC8910838 DOI: 10.3390/jcm11051193] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 12/16/2022] Open
Abstract
Sickle cell disease (SCD) induces a chronic prothrombotic state. Central venous access devices (CVADs) are commonly used for chronic transfusions and iron chelation in this population. CVADs are an additional venous thromboembolism (VTE) risk factor. The role of thromboprophylaxis in this setting is uncertain. The objectives are: (1) to determine whether thromboprophylaxis reduces VTE risk in SCD patients with CVAD and (2) to explore characteristics associated with VTE risk. We identified adults with SCD and CVAD intended for chronic use (≥3 months) at two comprehensive SCD centers. Thromboprophylaxis presence; type; intensity; and patient-, catheter-, and treatment-related VTE risk factors were recorded. Among 949 patients, 49 had a CVAD (25 without and 24 with VTE prophylaxis). Thromboprophylaxis type and intensity varied widely. Patients without thromboprophylaxis had higher VTE rates (rate ratio (RR) = 4.0 (95% confidence interval: 1.2−12.6), p = 0.02). Hydroxyurea was associated with lower VTE rates (RR = 20.5 (6.4−65.3), p < 0.001). PICC lines and Vortex and Xcela Power implantable devices were associated with higher rates compared with Port-a-Cath (RR = 5.8 (1.3−25.9), p = 0.02, and RR = 58.2 (15.0−225.0), p < 0.001, respectively). Thromboprophylaxis, hydroxyurea, and CVAD subtype were independently associated with VTE. The potentially protective role of thromboprophylaxis and hydroxyurea for VTE prevention in patients with SCD and CVAD merits further exploration.
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Affiliation(s)
- Stéphanie Forté
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Gonzalo De Luna
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Créteil, France; (G.D.L.); (A.-L.P.H.d.d.); (H.G.); (A.H.); (P.B.)
| | - Jameel Abdulrehman
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Nafanta Fadiga
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Olivia Pestrin
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Anne-Laure Pham Hung d’Alexandry d’Orengiani
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Créteil, France; (G.D.L.); (A.-L.P.H.d.d.); (H.G.); (A.H.); (P.B.)
| | - John Chinawaeze Aneke
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Henri Guillet
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Créteil, France; (G.D.L.); (A.-L.P.H.d.d.); (H.G.); (A.H.); (P.B.)
| | - Dalton Budhram
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Anoosha Habibi
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Créteil, France; (G.D.L.); (A.-L.P.H.d.d.); (H.G.); (A.H.); (P.B.)
| | - Richard Ward
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Créteil, France; (G.D.L.); (A.-L.P.H.d.d.); (H.G.); (A.H.); (P.B.)
- Laboratoire D’Excellence, GRex, Institut Mondor, INSERM U955 Equipe 2, 94000 Créteil, France
| | - Kevin H. M. Kuo
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
- Correspondence:
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6
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Nader E, Garnier Y, Connes P, Romana M. Extracellular Vesicles in Sickle Cell Disease: Plasma Concentration, Blood Cell Types Origin Distribution and Biological Properties. Front Med (Lausanne) 2021; 8:728693. [PMID: 34490315 PMCID: PMC8417591 DOI: 10.3389/fmed.2021.728693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/30/2021] [Indexed: 01/08/2023] Open
Abstract
Prototype of monogenic disorder, sickle cell disease (SCD) is caused by a unique single mutation in the β-globin gene, leading to the production of the abnormal hemoglobin S (HbS). HbS polymerization in deoxygenated condition induces the sickling of red blood cells (RBCs), which become less deformable and more fragile, and thus prone to lysis. In addition to anemia, SCD patients may exhibit a plethora of clinical manifestations ranging from acute complications such as the frequent and debilitating painful vaso-occlusive crisis to chronic end organ damages. Several interrelated pathophysiological processes have been described, including impaired blood rheology, increased blood cell adhesion, coagulation, inflammation and enhanced oxidative stress among others. During the last two decades, it has been shown that extracellular vesicles (EVs), defined as cell-derived anucleated particles delimited by a lipid bilayer, and comprising small EVs (sEVs) and medium/large EVs (m/lEVs); are not only biomarkers but also subcellular actors in SCD pathophysiology. Plasma concentration of m/lEVs, originated mainly from RBCs and platelets (PLTs) but also from the other blood cell types, is higher in SCD patients than in healthy controls. The concentration and the density of externalized phosphatidylserine of those released from RBCs may vary according to clinical status (crisis vs. steady state) and treatment (hydroxyurea). Besides their procoagulant properties initially described, RBC-m/lEVs may promote inflammation through their effects on monocytes/macrophages and endothelial cells. Although less intensely studied, sEVs plasma concentration is increased in SCD and these EVs may cause endothelial damages. In addition, sEVs released from activated PLTs trigger PLT-neutrophil aggregation involved in lung vaso-occlusion in sickle mice. Altogether, these data clearly indicate that EVs are both biomarkers and bio-effectors in SCD, which deserve further studies.
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Affiliation(s)
- Elie Nader
- Laboratoire Inter-Universitaire de Biologie de la Motricité EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Laboratoire d'Excellence du Globule Rouge, PRES Sorbonne, Paris, France
| | - Yohann Garnier
- Laboratoire d'Excellence du Globule Rouge, PRES Sorbonne, Paris, France.,Université des Antilles, UMR_S1134, BIGR, Pointe-à-Pitre, France.,Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France
| | - Philippe Connes
- Laboratoire Inter-Universitaire de Biologie de la Motricité EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Laboratoire d'Excellence du Globule Rouge, PRES Sorbonne, Paris, France
| | - Marc Romana
- Laboratoire d'Excellence du Globule Rouge, PRES Sorbonne, Paris, France.,Université des Antilles, UMR_S1134, BIGR, Pointe-à-Pitre, France.,Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France
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7
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Sayad B, Karimi M, Rahimi Z. Sickle cell disease and COVID-19: Susceptibility and severity. Pediatr Blood Cancer 2021; 68:e29075. [PMID: 34061431 PMCID: PMC8209850 DOI: 10.1002/pbc.29075] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 12/25/2022]
Abstract
We surveyed published papers and an international sickle cell disease (SCD) registry to detect susceptibility and clinical course of coronavirus disease 2019 (COVID-19) in SCD patients. COVID-19 presentation was mild in children and moderate in many SCD adults. Regarding increased comorbidities with age, it seems severe COVID-19 to be more common in older SCD patients. Although the overall outcome of COVID-19 was favorable in SCD children, a high rate of pediatric intensive care unit admission should be considered in managing these patients. To explain COVID-19 outcome in SCD patients, the possible benefits of hydroxyurea therapy could be considered. The obtained results should be interpreted, considering low cases from sub-Saharan people, younger age of SCD patients compared to general population, a bias toward registry of the more severe form of disease, the effect of pre-existing comorbidities with multisystem organ damage, and the role of health socio-economic determinants.
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Affiliation(s)
- Babak Sayad
- Infectious Diseases Research CenterKermanshah University of Medical SciencesKermanshahIran
| | - Mehran Karimi
- Hematology Research CenterShiraz University of Medical SciencesShirazIran
| | - Zohreh Rahimi
- Department of Clinical Biochemistry, Medical SchoolKermanshah University of Medical SciencesKermanshahIran,Medical Biology Research CenterKermanshah University of Medical SciencesKermanshahIran
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8
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Elsherif L, Scott LC, Wichlan D, Jones SK, Mathias JG, Shen JH, Smeltzer MP, Ataga KI. Hydroxyurea therapy decreases coagulation and endothelial activation in sickle cell disease: a Longitudinal Study. Br J Haematol 2021; 194:e71-e73. [PMID: 34231209 DOI: 10.1111/bjh.17650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Laila Elsherif
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lara C Scott
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Wichlan
- Division of Hematology, University of North Carolina, Chapel Hill, NC, USA
| | - Susan K Jones
- Division of Hematology, University of North Carolina, Chapel Hill, NC, USA.,Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Joacy G Mathias
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica H Shen
- Division of Hematology, University of North Carolina, Chapel Hill, NC, USA.,School of Dentistry, Temple University, Philadelphia, PA, USA
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics and Environmental Health, The University of Memphis, Memphis, TN, USA
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
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9
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ADAMTS-13-VWF axis in sickle cell disease patients. Ann Hematol 2021; 100:375-382. [PMID: 33404693 DOI: 10.1007/s00277-020-04385-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Sickle cell disease (SCD) comprises a group of genetic disorders characterized by the presence of the hemoglobin (Hb) S in homozygosis or in heterozygosis with some other Hb variant or in interaction with thalassemia. SCD is characterized by a very complex pathophysiology, which determines a wide variability of clinical manifestations, including a chronic state of hypercoagulability responsible for the increased risk of thromboembolic events. ADAMTS13 and von Willebrand factor (VWF) play an important role in arterial and venous thrombosis. Thus, the aim of this study was to understand how the ADAMTS13-VWF axis behaves in sickle cell disease, as well as whether there is an association of these markers with the use of hydroxyurea (HU). This is a cross-sectional study conducted with 40 patients diagnosed with SCD and 40 healthy individuals. The analysis of the ADAMTS13-VWF axis was comparatively performed between groups of patients and controls and, afterwards, between patients with SCD who were users and non-users of HU. ADAMTS13 activity, ADAMTS13 activity/VWF:Ag, and ADAMTS13:Ag/VWF:Ag ratios were significantly lower and VWF:Ag levels significantly higher in SCD patients when compared to the controls. There was no statistically significant difference in ADAMTS13:Ag and VWF collagen binding (VWF:CB) levels between the groups evaluated. Among the categories of HU use, there was no statistically significant difference in any of the evaluated markers. As a conclusion, we could observe that the ADAMTS13-VWF axis is altered in SCD when compared to healthy individuals and that there is no association between these markers and the use of HU.
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Ladeira VS, de Oliveira Toledo SL, Ferreira LGR, Oliveira MM, Silva APF, de Oliveira WV, Duarte RCF, Renó CDO, Dusse LMS, Dos Santos HL, Carvalho MDG, Pinheiro MDB, Rios DRA. Thrombin generation in vivo and ex vivo in sickle cell disease patients. Thromb Res 2020; 197:165-171. [PMID: 33221576 DOI: 10.1016/j.thromres.2020.10.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022]
Abstract
Activation of coagulation is an important hallmark of sickle cell disease (SCD) and it is believed that hypercoagulability plays a role to the disease pathophysiology. Studies have sought to identify how hemostatic biomarkers are expressed in SCD, however, the results are inconclusive. In this context, our objective was to evaluate the thrombin generation in vivo and ex vivo in SCD patients and the association between these biomarkers and the use of HU. This cross-sectional study was carried out with patients diagnosed with SCD, users or not of Hydroxyurea (HU), and healthy individuals as controls. D dimer (D-Di) was evaluated by ELISA and (TGT) thrombin generation test by CAT method. D-Di plasma levels were significantly higher in SCD patients when compared to the controls. TGT parameters such as peak, ETP and normalized ETP at low TF concentration and time-to-peak, peak, ETP and normalized ETP values at high TF concentration were lower in SCD patients than in controls. In contrast, the normalized activated protein C sensitivity ratio (nAPCsr) was higher in patients compared to controls, indicating resistance to the action of this natural anticoagulant. Regarding the use of HU, comparing users and non-users of this drug, no difference was observed in D-Di levels and in most TGT parameters. Our data analyzed together allow us to conclude that patients with SCD present a state of hypercoagulability in vivo due to the higher levels of D-Di and resistance to APC assessed ex vivo which is consistent with the coagulation imbalance described in SCD patients.
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Affiliation(s)
- Valéria Sutana Ladeira
- Universidade Federal de São João del-Rei, Campus Centro Oeste Dona Lindu, Brazil; Fundação Hemominas, Minas Gerais, Brazil
| | | | | | - Marina Mendes Oliveira
- Universidade Federal de São João del-Rei, Campus Centro Oeste Dona Lindu, Brazil; Fundação Hemominas, Minas Gerais, Brazil
| | | | | | | | | | | | | | - Maria das Graças Carvalho
- Universidade Federal de São João del-Rei, Campus Centro Oeste Dona Lindu, Brazil; Faculdade de Farmácia, Universidade Federal de Minas Gerais, Brazil
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11
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Role of the coagulation system in the pathogenesis of sickle cell disease. Blood Adv 2020; 3:3170-3180. [PMID: 31648337 DOI: 10.1182/bloodadvances.2019000193] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 09/16/2019] [Indexed: 01/12/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited monogenic red blood cell disorder affecting millions worldwide. SCD causes vascular occlusions, chronic hemolytic anemia, and cumulative organ damage such as nephropathy, pulmonary hypertension, pathologic heart remodeling, and liver necrosis. Coagulation system activation, a conspicuous feature of SCD that causes chronic inflammation, is an important component of SCD pathophysiology. The key coagulation factor, thrombin (factor IIa [FIIa]), is both a central protease in hemostasis and thrombosis and a key modifier of inflammation. Pharmacologic or genetic reduction of circulating prothrombin in Berkeley sickle mice significantly improves survival, ameliorates vascular inflammation, and results in markedly reduced end-organ damage. Accordingly, factors both upstream and downstream of thrombin, such as the tissue factor-FX complex, fibrinogen, platelets, von Willebrand factor, FXII, high-molecular-weight kininogen, etc, also play important roles in SCD pathogenesis. In this review, we discuss the various aspects of coagulation system activation and their roles in the pathophysiology of SCD.
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12
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Olatunya OS, Lanaro C, Longhini AL, Penteado CFF, Fertrin KY, Adekile A, Saad STO, Costa FF. Red blood cells microparticles are associated with hemolysis markers and may contribute to clinical events among sickle cell disease patients. Ann Hematol 2019; 98:2507-2521. [DOI: 10.1007/s00277-019-03792-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023]
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13
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Red blood cells modulate structure and dynamics of venous clot formation in sickle cell disease. Blood 2019; 133:2529-2541. [PMID: 30952675 DOI: 10.1182/blood.2019000424] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/14/2019] [Indexed: 12/29/2022] Open
Abstract
Sickle cell disease (SCD) is associated with chronic activation of coagulation and an increased risk of venous thromboembolism. Erythrocyte sickling, the primary pathologic event in SCD, results in dramatic morphological changes in red blood cells (RBCs) because of polymerization of the abnormal hemoglobin. We used a mouse model of SCD and blood samples from sickle patients to determine if these changes affect the structure, properties, and dynamics of sickle clot formation. Sickling of RBCs and a significant increase in fibrin deposition were observed in venous thrombi formed in sickle mice. During ex vivo clot contraction, the number of RBCs extruded from sickle whole blood clots was significantly reduced compared with the number released from sickle cell trait and nonsickle clots in both mice and humans. Entrapment of sickled RBCs was largely factor XIIIa-independent and entirely mediated by the platelet-free cellular fraction of sickle blood. Inhibition of phosphatidylserine, but not administration of antisickling compounds, increased the number of RBCs released from sickle clots. Interestingly, whole blood, but not plasma clots from SCD patients, was more resistant to fibrinolysis, indicating that the cellular fraction of blood mediates resistance to tissue plasminogen activator. Sickle trait whole blood clots demonstrated an intermediate phenotype in response to tissue plasminogen activator. RBC exchange in SCD patients had a long-lasting effect on normalizing whole blood clot contraction. Furthermore, RBC exchange transiently reversed resistance of whole blood sickle clots to fibrinolysis, in part by decreasing platelet-derived PAI-1. These properties of sickle clots may explain the increased risk of venous thromboembolism observed in SCD.
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14
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Ogunsile FJ, Naik R, Lanzkron S. Overcoming challenges of venous thromboembolism in sickle cell disease treatment. Expert Rev Hematol 2019; 12:173-182. [PMID: 30773073 DOI: 10.1080/17474086.2019.1583554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a common comorbid condition found in sickle cell disease (SCD) and is associated with increased mortality for adults with SCD. The pathophysiology that leads to the thrombophilic state in SCD has been previously reviewed; however, evidence-based guidelines to aid in diagnosis, prevention, and management of VTE are lacking. Areas covered: This review article will cover the pathophysiology underlying the hypercoagulable state, the epidemiology of VTE, and management strategies of VTE in SCD. Expert opinion: Providers should have a high suspicion for diagnosing VTE to help reduce morbidity and mortality in the SCD population. Unlike other thrombophilias, the risk of life-threatening anemia while being treated with anticoagulation is compounded with the potential complications surrounding red blood cell transfusions in this population (i.e. alloimmunization, hyperhemolysis) and this provides another complexity to managing VTE in this population. Clinical trials evaluating the risk and benefit of treatment and treatment duration are needed.
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Affiliation(s)
- Foluso Joy Ogunsile
- a Department of Hematology , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Rakhi Naik
- a Department of Hematology , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Sophie Lanzkron
- a Department of Hematology , Johns Hopkins School of Medicine , Baltimore , MD , USA
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15
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Toledo SLDO, Guedes JVM, Alpoim PN, Rios DRA, Pinheiro MDB. Sickle cell disease: Hemostatic and inflammatory changes, and their interrelation. Clin Chim Acta 2019; 493:129-137. [PMID: 30825426 DOI: 10.1016/j.cca.2019.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 12/23/2022]
Abstract
Sickle cell disease, the most common genetic blood disorder in the world, has high clinical variability, negatively impacts quality of life and contributes to early mortality. Sickled erythrocytes cause blood flow obstruction, hemolysis, and several hemostatic changes that promote coagulation. These events, in turn, induce chronic inflammation, characterized by elevated plasma levels of pro-inflammatory markers, which aggravates the already unfavorable state of the circulatory system. Empirical evidence indicates that the hemostatic and inflammatory systems continuously interact with each other and thereby further propagate the hypercoagulability and inflammatory conditions. In this review article, we discuss the pathophysiological aspects of sickle cell disease and the hemostatic and inflammatory changes that underlie its pathogenesis.
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Affiliation(s)
- Sílvia L de O Toledo
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil
| | - João V M Guedes
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil
| | - Patrícia N Alpoim
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais (MG), Brazil
| | - Danyelle R A Rios
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil
| | - Melina de B Pinheiro
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil.
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16
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Faes C, Sparkenbaugh EM, Pawlinski R. Hypercoagulable state in sickle cell disease. Clin Hemorheol Microcirc 2018; 68:301-318. [DOI: 10.3233/ch-189013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Camille Faes
- Interuniversity Laboratory of Human Movement Biology EA7424, Vascular biology and Red Blood Cell Team, University Claude Bernard Lyon1, Villeurbanne, France; Laboratory of Excellence “GR-Ex, ” Paris, France
| | - Erica M. Sparkenbaugh
- McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rafal Pawlinski
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Romana M, Connes P, Key NS. Microparticles in sickle cell disease. Clin Hemorheol Microcirc 2018; 68:319-329. [DOI: 10.3233/ch-189014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Marc Romana
- Unité Biologie Intégrée du Globule Rouge, Université des Antilles, Inserm 1134, laboratoire d’Excellence GR-Ex, Paris, France
| | - Philippe Connes
- Unité Biologie Intégrée du Globule Rouge, Université des Antilles, Inserm 1134, laboratoire d’Excellence GR-Ex, Paris, France
- Laboratoire LIBM EA7424, Equipe « Biologie Vasculaire et du Globule Rouge», Université Claude Bernard Lyon 1, Villeurbanne, France
- Institut Universitaire de France, Paris, France
| | - Nigel S. Key
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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18
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Larsen ML, Pedersen OH, Hvas AM, Niekerk PBVK, Bønløkke S, Kristensen SD, Grove EL. Once- versus twice-daily aspirin treatment in patients with essential thrombocytosis. Platelets 2018; 30:322-328. [DOI: 10.1080/09537104.2018.1430356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mads Lamm Larsen
- Centre of Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Oliver Heidmann Pedersen
- Centre of Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Centre of Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Søren Bønløkke
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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19
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Bern MM. Extracellular vesicles: how they interact with endothelium, potentially contributing to metastatic cancer cell implants. Clin Transl Med 2017; 6:33. [PMID: 28933058 PMCID: PMC5607152 DOI: 10.1186/s40169-017-0165-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/13/2017] [Indexed: 02/07/2023] Open
Abstract
Extracellular vesicles (EV) are blebs of cellular membranes, which entrap small portions of subjacent cytosol. They are released from a variety of cells, circulate in the blood for an unknown length of time and come to rest on endothelial surfaces. They contribute to an array of physiologic pathways, the complexity of which is still being investigated. They contribute to metastatic malignant cell implants and tumor-related angiogenesis, possibly abetted by the tissue factor that they carry. It is thought that the adherence of the EV to endothelium is dependent upon a combination of their P-selectin glycoprotein ligand-1 and exposed phosphatidylserine, the latter of which is normally hidden on the inner bilayer of the intact cellular membrane. This manuscript reviews what is known about EV origins, their clearance from the circulation and how they contribute to malignant cell implants upon endothelium surfaces and subsequent tumor growth.
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Affiliation(s)
- Murray M Bern
- University of New Mexico Comprehensive Cancer Center, 1201 Camino de Salud, Albuquerque, NM, 87131, USA.
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20
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Abstract
Sickle cell disease (SCD) is a hematologic disorder caused by a well-characterized point mutation in the β-globin gene. Abnormal polymerization of hemoglobin tetramers results in the formation of sickle red blood cells that leads to vascular occlusions, hemolytic anemia, vascular inflammation and cumulative, multiple organ damage. Ongoing activation of coagulation is another hallmark of SCD. Recent studies strongly suggested that hypercoagulation in SCD is not just a secondary event but contributes directly to the disease pathophysiology. In this article we summarize mechanisms leading to the activation of coagulation, review data indicating direct contribution of coagulation to the pathology of SCD and, we discuss the anticoagulation as a possible treatment strategy to attenuate the disease progression.
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Affiliation(s)
- E Sparkenbaugh
- University of North Carolina, School of Medicine, Division of Hematology and Oncology, Chapel Hill, NC, USA
| | - R Pawlinski
- University of North Carolina, School of Medicine, Division of Hematology and Oncology, Chapel Hill, NC, USA
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21
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Garnier Y, Ferdinand S, Connes P, Garnier M, Etienne-Julan M, Lemonne N, Romana M. Decrease of externalized phosphatidylserine density on red blood cell-derived microparticles in SCA patients treated with hydroxycarbamide. Br J Haematol 2017; 182:448-451. [DOI: 10.1111/bjh.14810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yohann Garnier
- Unité Biologie Intégrée du Globule Rouge; laboratoire d'Excellence GR-Ex; Université des Antilles; Inserm; Paris France
| | - Séverine Ferdinand
- Unité Biologie Intégrée du Globule Rouge; laboratoire d'Excellence GR-Ex; Université des Antilles; Inserm; Paris France
| | - Philippe Connes
- Unité Biologie Intégrée du Globule Rouge; laboratoire d'Excellence GR-Ex; Université des Antilles; Inserm; Paris France
- Laboratoire LIBM EA7424; Equipe “Biologie vasculaire et du globule rouge”; laboratoire d'Excellence GR-Ex; Université de Lyon; Lyon France
- Institut Universitaire de France; Paris France
| | - Marie Garnier
- Unité Biologie Intégrée du Globule Rouge; laboratoire d'Excellence GR-Ex; Université des Antilles; Inserm; Paris France
| | - Maryse Etienne-Julan
- Unité Transversale de la Drépanocytose; Hôpital Ricou; CHU de Pointe-à-Pitre Guadeloupe
| | - Nathalie Lemonne
- Unité Transversale de la Drépanocytose; Hôpital Ricou; CHU de Pointe-à-Pitre Guadeloupe
| | - Marc Romana
- Unité Biologie Intégrée du Globule Rouge; laboratoire d'Excellence GR-Ex; Université des Antilles; Inserm; Paris France
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22
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Abstract
Blood from patients with sickle cell disease contains microparticles (MP) derived from multiple cell sources, including red cells, platelets, monocytes and endothelial cells. MPs are of great interest because of their disease associations, their status as promising biomarkers, and the intercellular communications they mediate. To illustrate the likelihood of their relevance in sickle cell disease, we discuss the nature of MP, their profiling in sickle disease, some caveats relevant to their detection, their roles in supporting coagulation and the disparate influences they may exert upon the pathobiology of sickle cell disease.
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Affiliation(s)
- Robert P Hebbel
- Division of Haematology-Oncology-Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nigel S Key
- Division of Haematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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23
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Noubouossie D, Key NS, Ataga KI. Coagulation abnormalities of sickle cell disease: Relationship with clinical outcomes and the effect of disease modifying therapies. Blood Rev 2015; 30:245-56. [PMID: 26776344 DOI: 10.1016/j.blre.2015.12.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 12/31/2022]
Abstract
Sickle cell disease (SCD) is a hypercoagulable state. Patients exhibit increased platelet activation, high plasma levels of markers of thrombin generation, depletion of natural anticoagulant proteins, abnormal activation of the fibrinolytic system, and increased tissue factor expression, even in the non-crisis "steady state." Furthermore, SCD is characterized by an increased risk of thrombotic complications. The pathogenesis of coagulation activation in SCD appears to be multi-factorial, with contributions from ischemia-reperfusion injury and inflammation, hemolysis and nitric oxide deficiency, and increased sickle RBC phosphatidylserine expression. Recent studies in animal models suggest that activation of coagulation may contribute to the pathogenesis of SCD, but the data on the contribution of coagulation and platelet activation to SCD-related complications in humans are limited. Clinical trials of new generations of anticoagulants and antiplatelet agents, using a variety of clinical endpoints are warranted.
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Affiliation(s)
- Denis Noubouossie
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, USA
| | - Nigel S Key
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, USA
| | - Kenneth I Ataga
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, USA.
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24
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Piccin A, Murphy C, Eakins E, Kunde J, Corvetta D, Di Pierro A, Negri G, Guido M, Sainati L, Mc Mahon C, Smith OP, Murphy W. Circulating microparticles, protein C, free protein S and endothelial vascular markers in children with sickle cell anaemia. J Extracell Vesicles 2015; 4:28414. [PMID: 26609806 PMCID: PMC4658688 DOI: 10.3402/jev.v4.28414] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Circulating microparticles (MP) have been described in sickle cell anaemia (SCA); however, their interaction with endothelial markers remains unclear. We investigated the relationship between MP, protein C (PC), free protein S (PS), nitric oxide (NO), endothelin-1 (ET-1) and adrenomedullin (ADM) in a large cohort of paediatric patients. METHOD A total of 111 children of African ethnicity with SCA: 51 in steady state; 15 in crises; 30 on hydroxyurea (HU) therapy; 15 on transfusion; 17 controls (HbAA) of similar age/ethnicity. MP were analysed by flow cytometry using: Annexin V (AV), CD61, CD42a, CD62P, CD235a, CD14, CD142 (tissue factor), CD201 (endothelial PC receptor), CD62E, CD36 (TSP-1), CD47 (TSP-1 receptor), CD31 (PECAM), CD144 (VE-cadherin). Protein C, free PS, NO, pro-ADM and C-terminal ET-1 were also measured. RESULTS Total MP AV was lower in crisis (1.26×10(6) ml(-1); 0.56-2.44×10(6)) and steady state (1.35×10(6) ml(-1); 0.71-3.0×10(6)) compared to transfusion (4.33×10(6) ml(-1); 1.6-9.2×10(6), p<0.01). Protein C levels were significantly lower in crisis (median 0.52 IU ml(-1); interquartile range 0.43-0.62) compared with all other groups: HbAA (0.72 IU ml(-1); 0.66-0.82, p<0.001); HU (0.67 IU ml(-1); 0.58-0.77, p<0.001); steady state (0.63 IU ml(-1); 0.54-0.70, p<0.05) and transfusion (0.60 IU ml(-1); 0.54-0.70, p<0.05). In addition, levels were significantly reduced in steady state (0.63 IU ml(-1); 0.54-0.70) compared with HbAA (0.72 IU ml(-1); 0.66-0.80, p<0.01). PS levels were significantly higher in HbAA (0.85 IU ml(-1); 0.72-0.97) compared with crisis (0.49 IU ml(-1); 0.42-0.64, p<0.001), HU (0.65 IU ml(-1); 0.56-0.74, p<0.01) and transfusion (0.59 IU ml(-1); 0.47-0.71, p<0.01). There was also a significant difference in crisis patients compared with steady state (0.49 IU ml(-1); 0.42-0.64 vs. 0.68 IU ml(-1); 0.58-0.79, p<0.05). There was high correlation (R>0.9, p<0.05) between total numbers of AV-positive MP (MP AV) and platelet MP expressing non-activation platelet markers. There was a lower correlation between MP AV and MP CD62P (R=0.73, p<0.05) (platelet activation marker), and also a lower correlation between percentage of MP expressing CD201 (%MP CD201) and %MP CD14 (R=0.627, p<0.001). %MP CD201 was higher in crisis (11.6%) compared with HbAA (3.2%, p<0.05); %MP CD144 was higher in crisis (7.6%) compared with transfusion (2.1%, p<0.05); %CD14 (0.77%) was higher in crisis compared with transfusion (0.0%, p<0.05) and steady state (0.0%, p<0.01); MP CD14 was detectable in a higher number of samples (92%) in crisis compared with the rest (40%); %MP CD235a was higher in crisis (17.9%) compared with transfusion (8.9%), HU (8.7%) and steady state (9.9%, p<0.05); %CD62E did not differ significantly across the groups and CD142 was undetectable. Pro-ADM levels were raised in chest crisis: 0.38 nmol L(-1) (0.31-0.49) versus steady state: 0.27 nmol L(-1) (0.25-0.32; p<0.01) and control: 0.28 nmol L(-1) (0.27-0.31; p<0.01). CT-proET-1 levels were reduced in patients on HU therapy: 43.6 pmol L(-1) (12.6-49.6) versus control: 55.1 pmol L(-1) (45.2-63.9; p<0.05). NO levels were significantly lower in chest crisis (19.3 mmol L(-1) plasma; 10.7-19.9) compared with HU (22.2 mmol L(-1) plasma; 18.3-28.4; p<0.05), and HbSC (30.6 mmol L(-1) plasma; 20.8-39.5; p<0.05) and approach significance when compared with steady state (22.5mmol L(-1) plasma; 16.9-28.2; p=0.07). CONCLUSION Protein C and free PS are reduced in crisis with lower numbers of platelet MP and higher percentage of markers of endothelial damage and of red cell origin. During chest crisis, ADM and ET-1 were elevated suggesting a role for therapy inhibiting ET-1 in chest crisis.
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Affiliation(s)
- Andrea Piccin
- Irish Blood Transfusion Service, Dublin, Ireland.,Our Lady's Children Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland.,Haematology Department, San Maurizio Regional Hospital, Bolzano, Italy;
| | | | - Elva Eakins
- Irish Blood Transfusion Service, Dublin, Ireland
| | - Jan Kunde
- B.R.A.H.M.S. AG, Biotechnology Centre, Berlin, Germany
| | - Daisy Corvetta
- Haematology Department, San Maurizio Regional Hospital, Bolzano, Italy.,Pathology Department, San Maurizio Regional Hospital, Bolzano, Italy
| | - Angela Di Pierro
- Haematology Department, San Maurizio Regional Hospital, Bolzano, Italy
| | - Giovanni Negri
- Pathology Department, San Maurizio Regional Hospital, Bolzano, Italy
| | - Mazzoleni Guido
- Pathology Department, San Maurizio Regional Hospital, Bolzano, Italy
| | - Laura Sainati
- Clinica di Oncoematologia Pediatrica, Azienda Ospedaliera, University of Medicine of Padova, Padova, Italy
| | | | - Owen Patrick Smith
- Our Lady's Children Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - William Murphy
- Irish Blood Transfusion Service, Dublin, Ireland.,University College Dublin, Dublin, Ireland
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