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Jones RS, Ford AL, Donahue MJ, Fellah S, Davis LT, Pruthi S, Balamurugan C, Cohen R, Davis S, Debaun MR, Kassim AA, Rodeghier M, Jordan LC. Distribution of Silent Cerebral Infarcts in Adults With Sickle Cell Disease. Neurology 2024; 102:e209247. [PMID: 38684044 PMCID: PMC11177592 DOI: 10.1212/wnl.0000000000209247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/05/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Previously we demonstrated that 90% of infarcts in children with sickle cell anemia occur in the border zone regions of cerebral blood flow (CBF). We tested the hypothesis that adults with sickle cell disease (SCD) have silent cerebral infarcts (SCIs) in the border zone regions, with a secondary hypothesis that older age and traditional stroke risk factors would be associated with infarct occurrence in regions outside the border zones. METHODS Adults with SCD 18-50 years of age were enrolled in a cross-sectional study at 2 centers and completed a 3T brain MRI. Participants with a history of overt stroke were excluded. Infarct masks were manually delineated on T2-fluid-attenuated inversion-recovery MRI and registered to the Montreal Neurological Institute 152 brain atlas to generate an infarct heatmap. Border zone regions between anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA) were quantified using the Digital 3D Brain MRI Arterial Territories Atlas, and logistic regression was applied to identify relationships between infarct distribution, demographics, and stroke risk factors. RESULTS Of 113 participants with SCD (median age 26.1 years, interquartile range [IQR] 21.6-31.4 years, 51% male), 56 (49.6%) had SCIs. Participants had a median of 5.5 infarcts (IQR 3.2-13.8). Analysis of infarct distribution showed that 350 of 644 infarcts (54.3%) were in 4 border zones of CBF and 294 (45.6%) were in non-border zone territories. More than 90% of infarcts were in 3 regions: the non-border zone ACA and MCA territories and the ACA-MCA border zone. Logistic regression showed that older participants have an increased chance of infarcts in the MCA territory (odds ratio [OR] 1.08; 95% CI 1.03-1.13; p = 0.001) and a decreased chance of infarcts in the ACA-MCA border zone (OR 0.94; 95% CI 0.90-0.97; p < 0.001). The presence of at least 1 stroke risk factor did not predict SCI location in any model. DISCUSSION When compared with children with SCD, in adults with SCD, older age is associated with expanded zones of tissue infarction that stretch beyond the traditional border zones of CBF, with more than 45% of infarcts in non-border zone regions.
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Affiliation(s)
- R Sky Jones
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Andria L Ford
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Manus J Donahue
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Slim Fellah
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - L Taylor Davis
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Sumit Pruthi
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Charu Balamurugan
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Rachel Cohen
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Samantha Davis
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Michael R Debaun
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Adetola A Kassim
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Mark Rodeghier
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Lori C Jordan
- From the Departments of Pediatrics (R.S.J., C.B., S.D.), Vanderbilt University Medical Center, Nashville, TN; Neurology (A.L.F., S.F., R.C.), Washington University, St. Louis, MO; Neurology (M.J.D.); Radiology (L.T.D., S.P.); Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease (M.R.D.); Medicine (A.A.K.), Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consulting (M.R.), Chicago, IL; Pediatrics, Neurology and Radiology (L.C.J.), Vanderbilt University Medical Center, Nashville, TN
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Bell V, Varzakas T, Psaltopoulou T, Fernandes T. Sickle Cell Disease Update: New Treatments and Challenging Nutritional Interventions. Nutrients 2024; 16:258. [PMID: 38257151 PMCID: PMC10820494 DOI: 10.3390/nu16020258] [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: 12/19/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Sickle cell disease (SCD), a distinctive and often overlooked illness in the 21st century, is a congenital blood disorder characterized by considerable phenotypic diversity. It comprises a group of disorders, with sickle cell anemia (SCA) being the most prevalent and serious genotype. Although there have been some systematic reviews of global data, worldwide statistics regarding SCD prevalence, morbidity, and mortality remain scarce. In developed countries with a lower number of sickle cell patients, cutting-edge technologies have led to the development of new treatments. However, in developing settings where sickle cell disease (SCD) is more prevalent, medical management, rather than a cure, still relies on the use of hydroxyurea, blood transfusions, and analgesics. This is a disease that affects red blood cells, consequently affecting most organs in diverse manners. We discuss its etiology and the advent of new technologies, but the aim of this study is to understand the various types of nutrition-related studies involving individuals suffering from SCD, particularly in Africa. The interplay of the environment, food, gut microbiota, along with their respective genomes collectively known as the gut microbiome, and host metabolism is responsible for mediating host metabolic phenotypes and modulating gut microbiota. In addition, it serves the purpose of providing essential nutrients. Moreover, it engages in direct interactions with host homeostasis and the immune system, as well as indirect interactions via metabolites. Nutrition interventions and nutritional care are mechanisms for addressing increased nutrient expenditures and are important aspects of supportive management for patients with SCD. Underprivileged areas in Sub-Saharan Africa should be accompanied by efforts to define and promote of the nutritional aspects of SCD. Their importance is key to maintaining well-being and quality of life, especially because new technologies and products remain limited, while the use of native medicinal plant resources is acknowledged.
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Affiliation(s)
- Victoria Bell
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
| | - Theodoros Varzakas
- Department of Food Science and Technology, University of the Peloponnese, 24100 Kalamata, Greece
| | - Theodora Psaltopoulou
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Tito Fernandes
- CIISA, Faculty of Veterinary Medicine, University of Lisbon, 1649-004 Lisbon, Portugal
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