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Mahesri M, Lee SB, Levin R, Imren S, Zhang L, Beukelman T, Titievsky L, Desai RJ. Infrequent Resolution of Vaso-Occlusive Crises in Routine Clinical Care Among Patients Mimicking the Exa-Cel Trial Population: A Cohort Study of Medicaid Enrollees. Clin Pharmacol Ther 2024. [PMID: 39328080 DOI: 10.1002/cpt.3449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 09/04/2024] [Indexed: 09/28/2024]
Abstract
The CRISPR-based gene editing therapy exagamglogene autotemcel (exa-cel) recently received FDA approval for patients with severe sickle cell disease (SCD). The approval was based on a phase III trial (CLIMB SCD 121), which showed 97% efficacy of this treatment in eliminating vaso occlusive crises (VOCs) for 12 consecutive months. To help contextualize results from this trial, we aimed to investigate the proportion of patients with severe SCD who remain VOC-free for a 1-year period in routine clinical care. Using Medicaid claims data (2000-2018), we identified a cohort of patients, 12-35 years old with severe SCD, defined by ≥ 2 VOCs per year for 2 consecutive years, who met other exa-cel trial inclusion criteria to mimic a trial-like population. A VOC was identified using ICD diagnosis codes during hospitalization and ER visits. The primary outcome was the proportion of patients with no VOCs during a 1-year follow-up. A total of 7,425 patients with severe SCD [mean (SD) age: 20.5 (6.0) years, 54.6% females, 84% African Americans], had a mean of 5.2 VOCs, 5.1 ER visits and 3.5 hospitalizations per year during the baseline period. The proportion of patients with no VOCs during the 1-year follow-up was 7.7% (95% confidence interval: 7.1%-8.3%). In conclusion, less than one in 12 patients with severe SCD achieved VOC-free status within 1 year in routine clinical care. These findings suggest that the high efficacy observed for exa-cel in the trial, if replicated in routine clinical care, could translate into a significant public health impact.
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Affiliation(s)
- Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Suzan Imren
- Vertex Pharmaceuticals Inc., Boston, Massachusetts, USA
| | - Lanju Zhang
- Vertex Pharmaceuticals Inc., Boston, Massachusetts, USA
| | - Timothy Beukelman
- Vertex Pharmaceuticals Inc., Boston, Massachusetts, USA
- Epi Excellence LLC, Garnet Valley, Pennsylvania, USA
| | | | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts, USA
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Sadeghi A, Taherifard E, Movahed H, Ahmadkhani A, Dehdari Ebrahimi N, Taherifard E. Electrocardiographic findings in patients with sickle cell disease: A protocol for systematic review and meta-analysis. Health Sci Rep 2024; 7:e2212. [PMID: 38915361 PMCID: PMC11194293 DOI: 10.1002/hsr2.2212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/06/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024] Open
Abstract
Background Despite advancements in the management of patients with sickle cell disease (SCD), the involvement of the cardiovascular system in these patients remains a significant concern. Cardiovascular manifestations of SCD are well-documented, with electrocardiography (ECG) serving as a valuable diagnostic tool. Studies have reported a high rate of critical ECG findings in patients with SCD that warrants consideration when managing these patients, indicating the need for proactive cardiac screening and management strategies in this patient population. This study aims to systematically review the literature to identify sociodemographic, clinical, and paraclinical factors associated with ECG abnormalities in patients with SCD. Methods A comprehensive search strategy will be employed across multiple online databases, including PubMed, Embase, Scopus, Web of Science, and Google Scholar, for published and gray literature. Eligible studies will include original articles reporting associations between sociodemographic, clinical, and paraclinical variables and a spectrum of ECG findings in patients with SCD. Independent reviewers will conduct the screening, quality assessment, and data extraction. Quantitative analyses will be performed under a random-effect model using Comprehensive Meta-Analysis software, with subgroup analyses based on SCD status, sickle hemoglobinopathy form, and age group.
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Affiliation(s)
- Alireza Sadeghi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Ehsan Taherifard
- Hematology Research CenterShiraz University of Medical SciencesShirazIran
| | - Hamed Movahed
- Hematology Research CenterShiraz University of Medical SciencesShirazIran
| | - Alireza Ahmadkhani
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- Department of PathologyShiraz University of Medical SciencesShirazIran
| | - Niloofar Dehdari Ebrahimi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- Transplant Research CenterShiraz University of Medical SciencesShirazIran
| | - Erfan Taherifard
- Hematology Research CenterShiraz University of Medical SciencesShirazIran
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Nwosu CS, Nri-Ezedi CA, Okechukwu C, Ulasi TO, Umeh EO, Ebubedike UR, Aronu ME, Obi-Nwosu AL, Odita AO, Agu NV, Ngonadi SC, Emedike NC, Uke KM, Emegoakor AC. Two-Dimensional Ultrasound Assessment of Long-Term Intra-Abdominal Organ Changes in Children with Sickle Cell Anemia during Steady State: A Comparative Study. Niger J Clin Pract 2023; 26:1861-1867. [PMID: 38158354 DOI: 10.4103/njcp.njcp_411_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Sickle cell anemia (SCA) is a hereditary blood disorder with global prevalence, including in Nigeria. Despite advancements in SCA care management, understanding the long-term impact on organs during steady state has remained inconclusive. AIM This study aimed to investigate the long-term changes in intra-abdominal organs of SCA children compared with non-SCA children during steady state using two-dimensional ultrasound assessment. MATERIALS AND METHODS A total of 116 children (58 SCA and 58 controls) were enrolled between June 2021 and July 2022. Clinico-demographic data were collected through an interviewer-administered questionnaire. Two-dimensional ultrasound was used to measure the liver, spleen, kidneys, and inferior vena cava in all subjects. Age-matched controls had AA or AS genotypes. RESULTS Of the 58 patients with SCA, 65.5% were males with an overall mean age of 8.1 ± 3.4 years, while among the non-SCA cohort (n = 58), 48.3% were males with an overall mean age of 8.7 ± 3.9 years. There was no statistically significant difference in the age and gender distribution between the SCA and non-SCA cohorts (P = 0.390 and P = 0.091, respectively). SCA subjects had a larger mean hepatic size than non-SCA subjects (12.09 cm ± 2.23 vs. 11.67 cm ± 1.96; P = 0.276) but smaller mean splenic size (8.01 cm ± 1.89 vs. 8.19 cm ± 1.61; P = 0.577) and inferior vena cava diameter (1.16 cm ± 0.29 vs. 1.25 cm ± 0.33; P = 0.100). Left kidney length and breadth were significantly greater in SCA patients (8.91 ± 1.16 vs. 8.27 ± 1.30; P = 0.006 and 4.15 ± 0.92 vs. 3.79 ± 0.48; P = 0.008, respectively). CONCLUSION This study highlights the utility of two-dimensional ultrasound assessment in monitoring intra-abdominal organ changes in SCA children, suggesting its cost-effective benefits in monitoring health outcomes in SCA patients.
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Affiliation(s)
- C S Nwosu
- Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - C A Nri-Ezedi
- Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - C Okechukwu
- Department of Paediatrics and Child Health, Rivers State University Teaching Hospital, Port-Harcourt, Rivers State, Nigeria
| | - T O Ulasi
- Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - E O Umeh
- Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - U R Ebubedike
- Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - M E Aronu
- Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - A L Obi-Nwosu
- Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - A O Odita
- Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - N V Agu
- Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - S C Ngonadi
- Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - N C Emedike
- Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - K M Uke
- Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - A C Emegoakor
- Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Osueni A, Alasadi L, Jean-Louis F, Sergiy S, Spitalewitz S. The Resolution of a Cerebrovascular Accident With Phlebotomy in a Hemodialysis Patient With Sickle Cell Disease. Cureus 2023; 15:e48897. [PMID: 38106733 PMCID: PMC10725196 DOI: 10.7759/cureus.48897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Anemia is commonly observed in patients with end-stage renal disease (ESRD) on maintenance hemodialysis (HD) and can be quite severe, particularly when there is an additional comorbidity. With the use of erythropoietin-stimulating agents (ESAs), anemia is effectively treated, but the complete normalization of hemoglobin is not recommended since these agents increase the risk of thrombosis. With improvements in the therapy of sickle cell disease (SCD), patients now survive longer and may more frequently reach end-stage renal disease and require renal replacement therapy. Their anemia can be severe but does respond to ESAs. The goal hemoglobin in these patients is not established and likely should be lower than others on maintenance hemodialysis (HD) since SCD patients already have an increased risk of thrombosis, and the use of ESAs may exacerbate this risk. We present a 57-year-old African-American female with SCD on maintenance HD admitted with an acute cerebrovascular accident (CVA) that occurred in spite of the fact that her hemoglobin was within the accepted range for the general population on maintenance HD. Her neurologic status did not improve with blood pressure control and exchange transfusions, the suggested initial therapy for an acute CVA in a patient with sickle cell disease (SCD). However, with phlebotomy, the patient's symptoms rapidly improved when her hemoglobin was lowered and subsequently maintained with a lower dose of ESAs. Our experience suggests that the hemoglobin goal in SCD patients on maintenance HD should be lower than in other HD patients. The role of phlebotomy during an acute thrombotic event needs to be explored further.
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Affiliation(s)
- Azeberoje Osueni
- Nephrology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Lutfi Alasadi
- Medicine/Nephrology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Farla Jean-Louis
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Shurin Sergiy
- Nephrology, Brookdale University Hospital Medical Center, Brooklyn, USA
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Alshabeeb MA, Alwadaani D, Al Qahtani FH, Abohelaika S, Alzahrani M, Al Zayed A, Al Saeed HH, Al Ajmi H, Alsomaie B, Rashid M, Daly AK. Impact of Genetic Variations on Thromboembolic Risk in Saudis with Sickle Cell Disease. Genes (Basel) 2023; 14:1919. [PMID: 37895268 PMCID: PMC10606407 DOI: 10.3390/genes14101919] [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: 07/16/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a Mendelian disease characterized by multigenic phenotypes. Previous reports indicated a higher rate of thromboembolic events (TEEs) in SCD patients. A number of candidate polymorphisms in certain genes (e.g., FVL, PRT, and MTHFR) were previously reported as risk factors for TEEs in different clinical conditions. This study aimed to genotype these genes and other loci predicted to underlie TEEs in SCD patients. METHODOLOGY A multi-center genome-wide association study (GWAS) involving Saudi SCD adult patients with a history of TEEs (n = 65) and control patients without TEE history (n = 285) was performed. Genotyping used the 10× Affymetrix Axiom array, which includes 683,030 markers. Fisher's exact test was used to generate p-values of TEE associations with each single-nucleotide polymorphism (SNP). The haplotype analysis software tool version 1.05, designed by the University of Göttingen, Germany, was used to identify the common inherited haplotypes. RESULTS No association was identified between the targeted single-nucleotide polymorphism rs1801133 in MTHFR and TEEs in SCD (p = 0.79). The allele frequency of rs6025 in FVL and rs1799963 in PRT in our cohort was extremely low (<0.01); thus, both variants were excluded from the analysis as no meaningful comparison was possible. In contrast, the GWAS analysis showed novel genome-wide associations (p < 5 × 10-8) with seven signals; five of them were located on Chr 11 (rs35390334, rs331532, rs317777, rs147062602, and rs372091), one SNP on Chr 20 (rs139341092), and another on Chr 9 (rs76076035). The other 34 SNPs located on known genes were also detected at a signal threshold of p < 5 × 10-6. Seven of the identified variants are located in olfactory receptor family 51 genes (OR51B5, OR51V1, OR51A1P, and OR51E2), and five variants were related to family 52 genes (OR52A5, OR52K1, OR52K2, and OR52T1P). The previously reported association between rs5006884-A in OR51B5 and fetal hemoglobin (HbF) levels was confirmed in our study, which showed significantly lower levels of HbF (p = 0.002) and less allele frequency (p = 0.003) in the TEE cases than in the controls. The assessment of the haplotype inheritance pattern involved the top ten significant markers with no LD (rs353988334, rs317777, rs14788626882, rs49188823, rs139349992, rs76076035, rs73395847, rs1368823, rs8888834548, and rs1455957). A haplotype analysis revealed significant associations between two haplotypes (a risk, TT-AA-del-AA-ins-CT-TT-CC-CC-AA, and a reverse protective, CC-GG-ins-GG-del-TT-CC-TT-GG-GG) and TEEs in SCD (p = 0.024, OR = 6.16, CI = 1.34-28.24, and p = 0.019, OR = 0.33, CI = 0.13-0.85, respectively). CONCLUSIONS Seven markers showed novel genome-wide associations; two of them were exonic variants (rs317777 in OLFM5P and rs147062602 in OR51B5), and less significant associations (p < 5 × 10-6) were identified for 34 other variants in known genes with TEEs in SCD. Moreover, two 10-SNP common haplotypes were determined with contradictory effects. Further replication of these findings is needed.
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Affiliation(s)
- Mohammad A. Alshabeeb
- King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard Health Affairs (MNGHA), Riyadh 11426, Saudi Arabia (M.A.)
| | - Deemah Alwadaani
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard Health Affairs (MNGHA), Riyadh 11426, Saudi Arabia (M.A.)
- Medical Genomics Research Department, King Abdullah International Medical Research Center (KAIMRC), Riyadh 11481, Saudi Arabia
| | - Farjah H. Al Qahtani
- Hematology/Oncology Center, King Saud University Medical City (KSUMC), Riyadh 11411, Saudi Arabia;
| | - Salah Abohelaika
- Research Department, Qatif Central Hospital (QCH), Qatif 32654, Saudi Arabia;
- Pharmacy Department, Qatif Central Hospital (QCH), Qatif 32654, Saudi Arabia
| | - Mohsen Alzahrani
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard Health Affairs (MNGHA), Riyadh 11426, Saudi Arabia (M.A.)
- King Fahad Hospital, Ministry of National Guard Health Affairs (MNGHA), Riyadh 11426, Saudi Arabia
| | - Abdullah Al Zayed
- Hematology Department, Qatif Central Hospital (QCH), Qatif 32654, Saudi Arabia; (A.A.Z.); (H.H.A.S.)
| | - Hussain H. Al Saeed
- Hematology Department, Qatif Central Hospital (QCH), Qatif 32654, Saudi Arabia; (A.A.Z.); (H.H.A.S.)
| | - Hala Al Ajmi
- King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard Health Affairs (MNGHA), Riyadh 11426, Saudi Arabia (M.A.)
| | - Barrak Alsomaie
- King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard Health Affairs (MNGHA), Riyadh 11426, Saudi Arabia (M.A.)
| | - Mamoon Rashid
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard Health Affairs (MNGHA), Riyadh 11426, Saudi Arabia (M.A.)
- Department of AI and Bioinformatics, King Abdullah International Medical Research Center (KAIMRC), Riyadh 11481, Saudi Arabia
| | - Ann K. Daly
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
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Orssaud C, Flamarion E, Michon A, Ranque B, Arlet JB. Relationship between paramacular thinning, cerebral vasculopathy, and hematological risk factors in sickle cell disease. Front Med (Lausanne) 2023; 10:1226210. [PMID: 37700770 PMCID: PMC10493280 DOI: 10.3389/fmed.2023.1226210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/27/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose To identify risk factors for sickle cell maculopathy due to hematological parameters (especially anemia and hemolysis) or cerebral vasculopathy. Methods This retrospective study was conducted at a Referral Center. The follow-up included optical coherent tomography/optical coherent tomography angiography, neuro-radiological imaging, and a hematological assessment (hemoglobin, hemoglobin S level, reticulocytes, mean corpuscular volume, bilirubin, and lactate dehydrogenase). Results Hundred and thirty-two sickle cell patients were included. Maculopathy was observed in 127 eyes of SS patients and 10 eyes of SC patients (p < 0.001), unrelated to peripheral retinopathy. Cerebral vasculopathy was more frequent in SS patients (p < 0.001) and was also associated with the presence of maculopathy (p = 0.049), and it was related to peripheral retinopathy (p < 0.001). All biological parameters significantly differed according to the genotype (p < 0.001) but not according to the presence of cerebral vasculopathy or maculopathy. In the multivariate analysis, reticulocytes and bilirubin were associated with the presence of cerebral vasculopathy and maculopathy. Conclusion The data obtained were consistent with the role of anemia or hemolysis markers in cerebral vasculopathy and macular involvement. As a trend of hemolysis appears to be a risk factor for these complications, this validates the use of preventive plasmapheresis in these patients.
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Affiliation(s)
- Christophe Orssaud
- Functional Unity of Ophthalmology, ERN EYE, Ophthalmological Rare Diseases Center, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Edouard Flamarion
- Internal Medicine Department, French National Sickle Cell Referral Center, European Hospital Georges Pompidou, Paris, France
| | - Adrien Michon
- Internal Medicine Department, French National Sickle Cell Referral Center, European Hospital Georges Pompidou, Paris, France
| | - Brigitte Ranque
- Internal Medicine Department, French National Sickle Cell Referral Center, European Hospital Georges Pompidou, Paris, France
- Faculty of Medicine Université Paris Cité, Paris, France
| | - Jean Benoit Arlet
- Internal Medicine Department, French National Sickle Cell Referral Center, European Hospital Georges Pompidou, Paris, France
- Université Paris Cité, INSERM UMR-S970, Paris, France
- Laboratoire d'Excellence sur le globule rouge GR-ex, Paris, France
- INSERM U, CNRS 8254, Institut IMAGINE, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
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Giriraja KV, Bhatnagar SK, Tomlinson L, Sancilio F. An open-label, multicenter, phase 2 study of a food enriched with docosahexaenoic acid in adults with sickle cell disease. Prostaglandins Leukot Essent Fatty Acids 2023; 193:102574. [PMID: 37121179 DOI: 10.1016/j.plefa.2023.102574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023]
Abstract
Sickle cell disease (SCD) induces red blood cell sickling, which causes debilitating symptoms including vaso-occlusion and inflammation. We investigated a food enriched with omega-3 fatty acids to determine its effect on certain factors: blood cell membrane fatty acid composition (including anti-inflammatory elements-docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)-and the pro-inflammatory, arachidonic acid (AA)); the inflammation biomarker, C-reactive protein (CRP); and vaso-occlusive crisis (VOC) pain. Ten adults with SCD ingested the food, daily, for 28 days. Evaluated measures included blood cell membrane fatty acid ratios (AA vs omega-3 (DHA+EPA)), CRP (mg/L) levels, and Visual Analogue Scale (VAS) scores (a VOC assessment). The food was well tolerated and led to a statistically significant CRP reduction (39%). However, changes in omega-3 fatty acid ratios and VAS scores were not significant. Overall, while the omega-3-enriched food reduced inflammation, larger, blinded studies are needed to assess its effectiveness on other measures.
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Affiliation(s)
- K V Giriraja
- Rajalakshmi Hospital & Research Centre, Bangalore, Karnataka, 560097, India
| | - S K Bhatnagar
- Abhinav Multi-specialty Hospital, Nagpur, Maharashtra, 440017, India
| | - L Tomlinson
- Sancilio & Company, Inc. Stuart, Florida, 34997, United States of America
| | - F Sancilio
- Sancilio & Company, Inc. Stuart, Florida, 34997, United States of America; Florida Atlantic University, Boca Raton, Florida, 33431, United States of America.
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Quelal K, Torres A, Shahi A, Almani MU, Yadav N. Prevalence and predictors of non-rheumatic valvular heart disease in patients with sickle cell disease: insights from the National In-Patient Database in 2016 and 2017. J Investig Med 2023; 71:489-494. [PMID: 36945196 DOI: 10.1177/10815589231162525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Sickle cell disease (SCD) life expectancy has increased in high-income countries, approaching the fifth decade in the United States. Aging in SCD has raised concerns about chronic organ damage due to adaptative and maladaptive cardiac remodeling. This study aims to assess the prevalence and predictors of non-rheumatic valvular heart disease (NRVHD) in SCD patients using the United States National Inpatient Sample database from 2016 and 2017. We conducted a weighted analysis on SCD patients during their index hospitalization. We obtained the prevalence of NRVHD and calculated adjusted odds ratios to identify the associated demographic, social, and clinical characteristics using multivariable logistic regression. We identified 192,460 SCD admissions during 2016 and 2017. Of them, 2450 (1.3%) had NRVHD. Mitral insufficiency (MI) was the most common NRVHD present in 52% of the cases. Mitral valve prolapse represented 12.4%, while aortic stenosis and aortic insufficiency in 10.8% and 12.7%, respectively. Right-sided NRVHD had a lower prevalence, with 17.1% of patients having tricuspid insufficiency (TI) and 6.3% pulmonary insufficiency. There were no cases of mitral, tricuspid, or pulmonary stenosis. Characteristics associated with the presence of NRVHD in SCD were secondary pulmonary hypertension, congestive heart failure, chronic kidney disease, and female sex. NRVHDs, especially MI and TI, are comorbidities in SCD. Literature is scarce on this topic. The predictors found for its occurrence could help address modifiable factors that can positively affect patients with SCD who, due to the natural history of the disease, are at risk of developing NRVHD.
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Affiliation(s)
- Karol Quelal
- Department of Internal Medicine, Cook County Health, Chicago, IL, USA
| | - Andrea Torres
- Department of Internal Medicine, Cook County Health, Chicago, IL, USA
| | - Anoj Shahi
- Department of Internal Medicine, Cook County Health, Chicago, IL, USA
| | | | - Neha Yadav
- Division of Cardiology, Cook County Health, Chicago, IL, USA
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9
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Ershler WB, De Castro LM, Pakbaz Z, Moynahan A, Weycker D, Delea TE, Agodoa I, Cong Z. Hemoglobin and End-Organ Damage in Individuals with Sickle Cell Disease. CURRENT THERAPEUTIC RESEARCH 2023; 98:100696. [PMID: 36950457 PMCID: PMC10025127 DOI: 10.1016/j.curtheres.2023.100696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/12/2023] [Indexed: 02/25/2023]
Abstract
Background Sickle cell disease (SCD) is an inherited, chronic, multifaceted blood disorder. Patients with SCD develop anemia, which has been associated with end-organ damage (EOD). Objectives This retrospective, observational, repeated-measures study systematically characterizes the relationship between hemoglobin (Hb) level and EOD in adolescent and adult patients with SCD. Methods The study population comprised patients with SCD aged ≥12 years with available Hb data from a US provider-centric health care database. For each patient, each Hb value over time was included as a separate observation. Study outcomes-the onset of any new EOD, including chronic kidney disease, pulmonary hypertension, stroke, and leg ulcer-were ascertained during the 1-year period after each Hb assessment. The association between Hb levels and risk of new EOD was estimated using multivariable generalized estimating equations. Results A total of 16,043 unique patients with SCD contributed 44,913 observations. Adjusted odds of any EOD during the 1-year follow-up were significantly lower with higher Hb level. Risk reductions with higher Hb levels for chronic kidney disease, pulmonary hypertension, and leg ulcer were comparable. The risk of new EOD was significantly lower among adolescent and adult patients with higher Hb levels. Conclusions In patients with SCD, higher Hb levels are associated with a reduced risk of developing EOD. Therapeutic strategies that result in higher Hb levels may offer clinical and economic value for patients with SCD. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX).
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Affiliation(s)
- William B. Ershler
- Department of Hematology, Inova Schar Cancer Institute, Fairfax, Virginia
- Address correspondence to: William B. Ershler, MD, Inova Schar Cancer Institute, 8081 Innovation Park Dr, Suite 4408, Fairfax, VA 22031 (W. Ershler).
| | - Laura M. De Castro
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Zahra Pakbaz
- Division of Hematology/Oncology, UC Irvine Chao Family Cancer Center, Orange, California
| | | | | | | | - Irene Agodoa
- Global Blood Therapeutics, Inc., South San Francisco, California
| | - Ze Cong
- Global Blood Therapeutics, Inc., South San Francisco, California
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Snyder AB, Lakshmanan S, Hulihan MM, Paulukonis ST, Zhou M, Horiuchi SS, Abe K, Pope SN, Schieve LA. Surveillance for Sickle Cell Disease - Sickle Cell Data Collection Program, Two States, 2004-2018. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2022; 71:1-18. [PMID: 36201430 PMCID: PMC9552568 DOI: 10.15585/mmwr.ss7109a1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PROBLEM/CONDITION Sickle cell disease (SCD), an inherited blood disorder affecting an estimated 100,000 persons in the United States, is associated with multiple complications and reduced life expectancy. Complications of SCD can include anemia, debilitating acute and chronic pain, infection, acute chest syndrome, stroke, and progressive organ damage, including decreased cognitive function and renal failure. Early diagnosis, screenings and preventive interventions, and access to specialist health care can decrease illness and death. Population-based public health surveillance is critical to understanding the course and outcomes of SCD as well as the health care use, unmet health care needs, and gaps in essential services of the population affected by SCD. PERIOD COVERED 2004-2018. DESCRIPTION OF THE PROGRAM In 2015, CDC established the Sickle Cell Data Collection (SCDC) program to characterize the epidemiology of SCD in two states (California and Georgia). Previously, surveillance for SCD was conducted by two short-term projects: Registry and Surveillance System for Hemoglobinopathies (RuSH), which was conducted during 2010-2012 and included 2004-2008 data, and Public Health Research, Epidemiology, and Surveillance for Hemoglobinopathies (PHRESH), which was conducted during 2012-2014 and included 2004-2008 data. Both California and Georgia participated in RuSH and PHRESH, which guided the development of the SCDC methods and case definitions. SCDC is a population-based tracking system that uses comprehensive data linkages in state health systems. These linkages serve to synthesize and disseminate population-based, longitudinal data for persons identified with SCD from multiple sources using selected International Classification of Diseases, Ninth Revision, Clinical Modification, and Tenth Revision codes and laboratory results confirmed through state newborn screening (NBS) programs or clinic case reporting. Administrative and clinical data sources include state Medicaid and Children's Health Insurance Program databases, death certificates, NBS programs, hospital discharge and emergency department records, and clinical records or case reports. Data from multiple sources and years are linked and deduplicated so that states can analyze and report on SCD population prevalence, demographic characteristics, health care access and use, and health outcomes. The SCD case definition is based on an algorithm that classifies cases with laboratory confirmation as confirmed cases and those with a reported clinical diagnosis or three or more diagnostic codes over a 5-year period from an administrative data source as probable cases. In 2019, nine states (Alabama, California, Georgia, Indiana, Michigan, Minnesota, North Carolina, Tennessee, and Virginia) were funded as part of an SCDC capacity-building initiative. The newly funded states developed strategies for SCD case identification and data linkage similar to those used by California and Georgia. As of 2021, the SCDC program had expanded to 11 states with the addition of Colorado and Wisconsin. RESULTS During 2004-2018, the cumulative prevalence of confirmed and probable SCD cases identified in California and Georgia was 9,875 and 14,777 cases, respectively. The 2018 annual prevalence count was 6,027 cases for California and 9,141 for Georgia. Examination of prevalence counts by contributing data source during 2014-2018 revealed that each data source captured 16%-71% of cases in California and 17%-87% in Georgia; therefore, no individual source is sufficient to estimate statewide population prevalence. The proportion of pediatric SCD patients (children aged 0-18 years) was 27% in California and 40% in Georgia. The percentage of females with SCD in California and Georgia was 58% and 57%, respectively. Of the cases with SCD genotyping data available (n = 5,856), 63% of patients had sickle cell anemia. SCDC data have been used to directly apprise health care providers and policymakers about health care needs and gaps for patients with SCD. For example, an SCDC Georgia assessment indicated that 10% of babies born during 2004-2016 with SCD lived more than a 1-hour drive from any SCD specialty care option, and another 14% lived within a 1-hour drive of a periodic SCD specialty clinic only. Likewise, an SCDC California assessment indicated that during 2016-2018, most patients with SCD in Los Angeles County lived approximately 15-60 miles from hematologists experienced in SCD care. A surveillance capacity and performance assessment of all 11 SCDC states during 2020-2021 indicated that states differed in the availability of data sources used for SCD surveillance and the time frames for accessing each state data source. Nonetheless, methods for standardizing reporting were developed across all participating states. INTERPRETATION This report is the first comprehensive description of CDC's efforts in collaboration with participating states to establish, maintain, and expand SCD surveillance through the SCDC program to improve health outcomes for persons living with SCD. Findings from California and Georgia analyses highlighted a need for additional SCD specialty clinics. Despite different approaches, expansion of SCDC to multiple states was possible using standardized, rigorous methods developed across all participating states for reporting on disease prevalence, health care needs and use, and deaths. PUBLIC HEALTH ACTION Findings from surveillance can be used to improve and monitor care and outcomes for persons with SCD. These and other SCDC analyses have had a role in opening new SCD clinics, educating health care providers, developing state health care policies, and guiding new research initiatives. Public health officials can use this report as a guiding framework to plan or implement surveillance programs for persons with SCD. Both data-related activities (data sources; patient identifiers; and obtaining, transferring, and linking data) and the administrative considerations (stakeholder engagement, costs and resources, and long-term sustainability) are crucial to the success of these programs.
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Early ML, Linton E, Bosch A, Campbell T, Hill‐Briggs F, Pecker LH, Lance EI, Lanzkron S. The Montreal cognitive assessment as a cognitive screening tool in sickle cell disease: Associations with clinically significant cognitive domains. Br J Haematol 2022; 198:382-390. [PMID: 35385886 PMCID: PMC9541858 DOI: 10.1111/bjh.18188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/24/2022]
Abstract
Adults with sickle cell disease (SCD) are at risk for cognitive impairment, which causes significant morbidity. Guidelines support routine cognitive screening, but no screening test is validated in this population. We explored the Montreal Cognitive Assessment (MoCA) as a possible screening test in SCD. We administered the MoCA; a literacy test, the Wide Range Achievement Test, fourth edition (WRAT-4); and a health literacy test, the Shortened Test of Functional Health Literacy in Adults (S-TOFHLA) to adults with SCD and gathered clinical variables through chart review. Spearman's rho, Mann-Whitney, and Kruskal-Wallis tests and quantile regression models were used. Among our sample of 49 adults with SCD, the median MoCA score was 25.0 [interquartile range (IQR) 22.0-28.0]. Higher educational attainment was associated with MoCA scores (p = 0.001). In multivariable models, MoCA scores were associated with S-TOFHLA (p = 0.001) and WRAT-4 Reading (p = 0.002) scores, and overt stroke (p = 0.03) at the median. This pilot study adds to the limited literature of cognitive screening tests in adults with SCD and demonstrates a relationship between MoCA scores and measures of literacy and health literacy. The MoCA is a promising option for briefly screening for cognitive impairment in adults with SCD, though further study is needed to confirm its validity.
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Affiliation(s)
- Macy L. Early
- Division of Hematology, Department of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Elizabeth Linton
- Center on Aging and Health, Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMarylandUSA
| | - Allison Bosch
- Department of Gynecology and ObstetricsEmory University School of MedicineAtlantaGeorgiaUSA
| | | | - Felicia Hill‐Briggs
- Feinstein Institutes for Medical ResearchZucker School of Medicine, Northwell HealthNew YorkNew YorkUSA
| | - Lydia H. Pecker
- Division of Hematology, Department of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Eboni I. Lance
- Neurology and Developmental MedicineKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Sophie Lanzkron
- Division of Hematology, Department of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
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12
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Brown C, Tonda M, Abboud MR. Voxelotor for the treatment of sickle cell disease in pediatric patients. Expert Rev Hematol 2022; 15:485-492. [DOI: 10.1080/17474086.2022.2082408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Clark Brown
- Department of Pediatrics, Emory School of Medicine, Aflac Cancer and Blood Disorder Center of Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Miguel R. Abboud
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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13
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Adebayo OC, Van den Heuvel LP, Olowu WA, Levtchenko EN, Labarque V. Sickle cell nephropathy: insights into the pediatric population. Pediatr Nephrol 2022; 37:1231-1243. [PMID: 34050806 DOI: 10.1007/s00467-021-05126-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/10/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
The life expectancy of individuals with sickle cell disease has increased over the years, majorly due to an overall improvement in diagnosis and medical care. Nevertheless, this improved longevity has resulted in an increased prevalence of chronic complications such as sickle cell nephropathy (SCN), which poses a challenge to the medical care of the patient, shortening the lifespan of patients by 20-30 years. Clinical presentation of SCN is age-dependent, with kidney dysfunction slowly beginning to develop from childhood, progressing to chronic kidney disease and kidney failure during the third and fourth decades of life. This review explores the epidemiology, pathology, pathophysiology, clinical presentation, and management of SCN by focusing on the pediatric population. It also discusses the factors that can modify SCN susceptibility.
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Affiliation(s)
- Oyindamola C Adebayo
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.,Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lambertus P Van den Heuvel
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Pediatric Nephrology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Wasiu A Olowu
- Pediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Elena N Levtchenko
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium. .,Department of Pediatric Nephrology, University Hospital Leuven, Herestraat 49, Bus 817, 3000, Leuven, Belgium.
| | - Veerle Labarque
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Pediatric Hematology, University Hospital Leuven, Leuven, Belgium
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14
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Dela-Pena JC, King MA, Brown J, Nachar VR. Incorporation of novel therapies for the management of sickle cell disease: A pharmacist's perspective. J Oncol Pharm Pract 2022; 28:646-663. [DOI: 10.1177/10781552211072468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with sickle cell disease (SCD) experience significant disease-related morbidity including multiorgan damage, chronic anemia, and debilitating pain crises. While hydroxyurea has been the primary disease modifying modality in SCD, novel therapies with unique mechanism of action have recently been approved. This review article examines the evidence surrounding the available SCD therapies to guide pharmacists on potential treatment selection and management strategies for patients with SCD. A systematic search of online databases was performed to identify literature on the management of SCD. While the newly approved novel agents have demonstrated clinical benefit it remains unclear how these agents fit into the treatment paradigm. Pharmacists should be aware of the data supporting the use of these novel agents to optimize use on a patient-specific basis.
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Affiliation(s)
| | | | - Julia Brown
- C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
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15
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Forsyth S, Schroeder P, Geib J, Vrishabhendra L, Konstantinidis DG, LaSalvia K, Ribadeneira MD, Wu E, Kelly P, Kalfa TA. Safety, Pharmacokinetics, and Pharmacodynamics of Etavopivat (FT-4202), an Allosteric Activator of Pyruvate Kinase-R, in Healthy Adults: A Randomized, Placebo-Controlled, Double-Blind, First-in-Human Phase 1 Trial. Clin Pharmacol Drug Dev 2022; 11:654-665. [PMID: 35019238 PMCID: PMC9306898 DOI: 10.1002/cpdd.1058] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/21/2021] [Indexed: 11/14/2022]
Abstract
Etavopivat (FT‐4202) is an orally administered, small‐molecule allosteric activator of erythrocyte pyruvate kinase‐R (PKR) in clinical development for the treatment of sickle cell disease and other hemoglobin disorders. This randomized, placebo‐controlled, double‐blind, first‐in‐human combination single‐ascending dose and multiple‐ascending dose phase 1 trial (NCT03815695) evaluated the safety and pharmacokinetics/pharmacodynamics of etavopivat in 90 healthy adult subjects. In 4 single‐ascending dose cohorts, 8 participants were randomized 3:1 to a single oral dose of either etavopivat (n = 6) or placebo (n = 2). In four 14‐day multiple‐ascending dose cohorts, 12 participants were randomized 3:1 to 14 days of etavopivat (n = 9) or placebo (n = 3). In these studies, most treatment‐emergent adverse events were of mild severity (grade 1) and none led to study discontinuation. Etavopivat exhibited a linear and time‐independent pharmacokinetic profile (at doses ≤400 mg) and elicited the expected pharmacodynamic effects of PKR activation (decreased 2,3‐diphosphoglycerate and increased adenosine triphosphate) and evidence of improved hemoglobin‐oxygen affinity. In addition, pharmacodynamic responses were durable with effects continuing for 48 to 72 hours after the last dose, thereby supporting once‐daily dosing. Food appeared to have no clinically meaningful effects on etavopivat exposure, thus facilitating administration with or without food. In conclusion, the evaluation of etavopivat in healthy subjects demonstrated proof of mechanism (PKR activation) without significant adverse events. This study also allowed for the selection of dose levels, projected to have an acceptable safety profile and provide therapeutic benefit, for evaluation in future trials in patients with sickle cell disease.
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Affiliation(s)
| | | | - James Geib
- Forma Therapeutics, Inc., Watertown, Massachusetts, USA
| | | | | | - Kari LaSalvia
- Medpace Clinical Pharmacology Unit, Cincinnati, Ohio, USA
| | | | - Eric Wu
- Forma Therapeutics, Inc., Watertown, Massachusetts, USA
| | - Patrick Kelly
- Forma Therapeutics, Inc., Watertown, Massachusetts, USA
| | - Theodosia A Kalfa
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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16
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Holdford D, Vendetti N, Sop DM, Johnson S, Smith WR. Indirect Economic Burden of Sickle Cell Disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1095-1101. [PMID: 34372974 DOI: 10.1016/j.jval.2021.02.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/13/2021] [Accepted: 02/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to quantify the indirect costs of sickle cell disease in the United States. METHODS Adult patients from a sickle cell disease clinic at an urban academic healthcare system completed an adapted Institute for Medical Technology Assessment Productivity Cost Questionnaire related to the impact of their disorder on absenteeism, presenteeism, ability to contribute through unpaid work outside of employment, and other aspects of life. Additional data were collected from patient records about each participant's genotype, total hemoglobin level, and pain level. RESULTS Of the 192 individuals, 187 who completed the survey reported experiencing vaso-occlusive crisis pain events during the last year that negatively affected their productivity at work and in daily roles. Three-fourths of respondents reported impairment in their ability to complete everyday tasks, such as caring for children, running errands, doing housework, shopping for groceries, and volunteer (unpaid) work. Only 30% of respondents reported being employed or self-employed. Of those employed, estimated costs of absenteeism and presenteeism attributable to pain events averaged $15 103 per person annually. Estimated total annual losses in unpaid work productivity averaged $3 145 862 for the study respondents and another $2 870 652 for their caregivers. CONCLUSIONS Sickle cell disease affected the work productivity, nonwork productivity, and the daily lives of adults seen with the disorder in an academic medical center.
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Affiliation(s)
| | | | - Daniel M Sop
- Virginia Commonwealth University, Richmond, VA, USA
| | | | - Wally R Smith
- Virginia Commonwealth University, Richmond, VA, USA.
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17
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Gbotosho OT, Taylor M, Malik P. Cardiac pathophysiology in sickle cell disease. J Thromb Thrombolysis 2021; 52:248-259. [PMID: 33677791 DOI: 10.1007/s11239-021-02414-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Oluwabukola Temitope Gbotosho
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA
| | - Michael Taylor
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA
| | - Punam Malik
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA. .,Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
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18
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Zhou J, Calip GS, Nutescu EA, Han J, Walton SM, Srisuwananukorn A, Galanter WL. Type 2 diabetes mellitus burdens among adults with sickle cell disease: A 12-year single health system-based cohort analysis. EJHAEM 2021; 2:94-98. [PMID: 35846078 PMCID: PMC9175929 DOI: 10.1002/jha2.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Jifang Zhou
- School of International Pharmaceutical BusinessChina Pharmaceutical UniversityNanjingChina
- Center for Pharmacoepidemiology and Pharmacoeconomic ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Department of Pharmacy Systems, Outcomes and Policy, College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Gregory S. Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Department of Pharmacy Systems, Outcomes and Policy, College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Flatiron HealthNew YorkNew YorkUSA
| | - Edith A. Nutescu
- Center for Pharmacoepidemiology and Pharmacoeconomic ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Department of Pharmacy Systems, Outcomes and Policy, College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Department of Pharmacy Practice, College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Jin Han
- Center for Pharmacoepidemiology and Pharmacoeconomic ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Department of Pharmacy Practice, College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Division of Hematology & Oncology, Department of Medicine, Comprehensive Sickle Cell CenterUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Surrey M. Walton
- Center for Pharmacoepidemiology and Pharmacoeconomic ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Department of Pharmacy Systems, Outcomes and Policy, College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Andrew Srisuwananukorn
- Division of Hematology & Oncology, Department of Medicine, Comprehensive Sickle Cell CenterUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - William L. Galanter
- Department of Pharmacy Systems, Outcomes and Policy, College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Section of Academic Internal Medicine & GeriatricsDepartment of MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
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19
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Okoroiwu HU, López-Muñoz F, Povedano-Montero FJ. Bibliometric analysis of global sickle cell disease research from 1997 to 2017. Hematol Transfus Cell Ther 2020; 44:186-196. [PMID: 33423980 PMCID: PMC9123586 DOI: 10.1016/j.htct.2020.09.156] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/13/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023] Open
Abstract
Introduction Sickle cell disease is an autosomal recessive genetic disease caused by a single point mutation in the β-globin chain of the hemoglobin. It has been recognized by the World Health Organization as a public health priority since 2006. Methods The Scopus database was used in this study with the search descriptors: “sickle cell” and “sickle cell disease”. We applied common bibliometric indicators to evaluate the trend in scientific literature in sickle cell disease research. Results We retrieved a total of 19,921 pieces of scientific literature in the repertoire from 1997 to 2017. The Price law was fulfilled in the trend of production of scientific literature on SCD as the growth of scientific literature was more exponential (r = 0.9751; r2 = 0.9509) than linear (r = 0.9721; r2 = 0.9449). We observed a duplication time of 4.52 years. The Bradford core was made up of 69 journals with Blood at the top, publishing the greatest number of articles. The most productive institutions were mostly United States agencies and hospitals. The United States was the most productive country. The National Institute of Health was the most productive institution and also had the highest number of citations. Vichinsky E was the most productive author, while the most cited article was published by Circulation. Conclusion The growth of scientific literature in Sickle cell disease was found to be high. However, the exponential growth trend shows a “yet-to-be-explored” area of research. This study will be useful for physicians, researchers, research funders and policy-cum-decision makers.
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Affiliation(s)
| | - Francisco López-Muñoz
- Faculty of Health Sciences, University Camilo José Cela, Madrid, Spain; Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain; Portucalense Institute of Neuropsychology and Cognitive and Behavioral Neurosciences (INPP), Portucalense University, Porto, Portugal; Thematic Network for Cooperative Health Research (RETICS), Addictive Disorders Network, Health Institute Carlos III, MICINN and FEDER, Madrid, Spain
| | - F Javier Povedano-Montero
- Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain; School of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain; Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
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20
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Hyponatremia in Patients with Hematologic Diseases. J Clin Med 2020; 9:jcm9113721. [PMID: 33228240 PMCID: PMC7699475 DOI: 10.3390/jcm9113721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Hyponatremia is the most common electrolyte disorder in clinical practice and is associated with increased morbidity and mortality. It is frequently encountered in hematologic patients with either benign or malignant diseases. Several underlying mechanisms, such as hypovolemia, infections, toxins, renal, endocrine, cardiac, and liver disorders, as well as the use of certain drugs appear to be involved in the development or the persistence of hyponatremia. This review describes the pathophysiology of hyponatremia and discusses thoroughly the contributing factors and mechanisms that may be encountered specifically in patients with hematologic disorders. The involvement of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion and renal salt wasting syndrome (RSWS) in the development of hyponatremia in such patients, as well as their differential diagnosis and management, are also presented. Furthermore, the distinction between true hyponatremia and pseudohyponatremia is explained. Finally, a practical algorithm for the evaluation of hyponatremia in hematologic patients, as well as the principles of hyponatremia management, are included in this review.
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21
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Cintron-Garcia J, Ajebo G, Kota V, Guddati AK. Mortality trends in sickle cell patients. AMERICAN JOURNAL OF BLOOD RESEARCH 2020; 10:190-197. [PMID: 33224563 PMCID: PMC7675124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Sickle cell disease affects a significant portion of US patients with African descent. It continues to be one of the leading causes of frequent hospitalizations and high in-hospital morality risk. Until the approval of disease-modifying therapies in last two years, medical therapy has relied mostly on management of pain episodes and the use of hydroxyurea. We discuss the nationwide analysis of trends in in-hospital mortality in patients with Sickle Cell Disease from 2000 to 2014. METHODS Trends of in-hospital mortality in sickle cell patients were analyzed from a database provided by the Agency of Healthcare Research and Quality. From the data hospitalization rates and in-hospital mortality in categories by region in the US, hospital size, health insurance status, comorbidities and gender were examined. Patterns of in-hospital mortality were analyzed by logistic regression. RESULTS Ratio for hospitalization and mortality among the four regions described Northeast, Midwest, South, West with respective values of 0.63%, 0.65%, 0.76% and 0.89% with P = 0.008 and OR = 1.07. Odds ratio for sickle cell patients that died during hospitalization and health insurance status was OR = 0.08. Comorbidities considered in sickle cell patients; diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), chronic kidney disease (CKD), smoking status. The odds ratio for comorbidities show A-fib with a value of OR = 4.47, followed by hypertension OR = 1.92, diabetes mellitus OR = 1.44 and chronic kidney disease OR = 1.29, smoking status OR = 0.60. Mortality-hospitalization ratio by gender was: males 0.77% and females 0.69% with OR = 0.87. CONCLUSIONS In-hospital mortality by US regions, as well as health insurance status are important measurable elements that show the impact of the disease from a public health perspective. Further and more specific data of regions by states, comorbidities by states and sex, as well as health insurance status by states will provide further insight in local mortality trends.
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Affiliation(s)
- Juan Cintron-Garcia
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University Augusta, GA 30909, USA
| | - Germame Ajebo
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University Augusta, GA 30909, USA
| | - Vamsi Kota
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University Augusta, GA 30909, USA
| | - Achuta K Guddati
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University Augusta, GA 30909, USA
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22
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Accelerated approval of Oxbryta® (voxelotor): A case study on novel endpoint selection in sickle cell disease. Contemp Clin Trials 2020; 98:106161. [PMID: 33010428 DOI: 10.1016/j.cct.2020.106161] [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: 06/26/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022]
Abstract
Sickle cell disease (SCD) is an inherited disease characterized by hemolysis, anemia, and vaso-occlusion leading to substantial morbidity and mortality. Development of prior pharmacologic therapies exclusively utilized vaso-occlusive crisis (VOC) as a clinical efficacy endpoint; however, this focus on VOC did not capture the full extent of disease symptomatology and complications and slowed the development of new therapies. Voxelotor, a hemoglobin S polymerization inhibitor, was recently approved in the United States for the treatment of SCD in adults and adolescents 12 years of age and older through an accelerated approval pathway. The rapid approval and availability of voxelotor was facilitated in a collaborative effort with the US Food and Drug Administration (FDA), using hemoglobin, a biologic surrogate endpoint, as reasonably likely to predict clinical benefit. Use of this new endpoint was supported by FDA-led multistakeholder discussions with physician and patient communities to identify unmet needs and potential clinical trial endpoints, as well as by a company-sponsored analysis of external patient-level data to demonstrate a correlation between hemoglobin change and stroke risk. A two-part phase 3 study was used to allow for rank ordering of key secondary endpoints based on a planned interim analysis. Continued open communication with the FDA was essential to gain agreement on hemoglobin as a novel endpoint and to address the unmet and urgent need of new therapies for SCD.
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Gbotosho OT, Kapetanaki MG, Ghosh S, Villanueva FS, Ofori-Acquah SF, Kato GJ. Heme Induces IL-6 and Cardiac Hypertrophy Genes Transcripts in Sickle Cell Mice. Front Immunol 2020; 11:1910. [PMID: 32973791 PMCID: PMC7473032 DOI: 10.3389/fimmu.2020.01910] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022] Open
Abstract
Emerging data indicate that free heme promotes inflammation in many different disease settings, including in sickle cell disease (SCD). Although free heme, proinflammatory cytokines, and cardiac hypertrophy are co-existing features of SCD, no mechanistic links between these features have been demonstrated. We now report significantly higher levels of IL-6 mRNA and protein in hearts of the Townes sickle cell disease (SS) mice (2.9-fold, p ≤ 0.05) than control mice expressing normal human hemoglobin (AA). We find that experimental administration of heme 50 μmoles/kg body weight induces IL-6 expression directly in vivo and induces gene expression markers of cardiac hypertrophy in SS mice. We administered heme intravenously and found that within three hours plasma IL-6 protein significantly increased in SS mice compared to AA mice (3248 ± 275 vs. 2384 ± 255 pg/ml, p ≤ 0.05). In the heart, heme induced a 15-fold increase in IL-6 transcript in SS mice heart compared to controls. Heme simultaneously induced other markers of cardiac stress and hypertrophy, including atrial natriuretic factor (Nppa; 14-fold, p ≤ 0.05) and beta myosin heavy chain (Myh7; 8-fold, p ≤ 0.05) in SS mice. Our experiments in Nrf2-deficient mice indicate that the cardiac IL-6 response to heme does not require Nrf2, the usual mediator of transcriptional response to heme for heme detoxification by heme oxygenase-1. These data are the first to show heme-induced IL-6 expression in vivo, suggesting that hemolysis may play a role in the elevated IL-6 and cardiac hypertrophy seen in patients and mice with SCD. Our results align with published evidence from rodents and humans without SCD that suggest a causal relationship between IL-6 and cardiac hypertrophy.
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Affiliation(s)
- Oluwabukola T Gbotosho
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Maria G Kapetanaki
- Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Samit Ghosh
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Department of Medicine, Center for Translational and International Hematology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Flordeliza S Villanueva
- Center for Ultrasound Molecular Imaging and Therapeutics, Heart and Vascular Institute, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Solomon F Ofori-Acquah
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Department of Medicine, Center for Translational and International Hematology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Gregory J Kato
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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24
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Outcomes following kidney transplantation in patients with sickle cell disease: The impact of automated exchange blood transfusion. PLoS One 2020; 15:e0236998. [PMID: 32790687 PMCID: PMC7425908 DOI: 10.1371/journal.pone.0236998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/18/2020] [Indexed: 11/19/2022] Open
Abstract
There are over 12,000 people with sickle cell disease (SCD) in the UK, and 4-12% of patients who develop Sickle Cell Nephropathy (SCN) progress to End Stage Renal Disease (ESRD). Renal transplantation offers the best outcomes for these patients with but their access to transplantation is often limited. Regular automated exchange blood transfusions (EBT) reduce the complications of SCD and may improve outcomes. However, concerns over alloimmunisation limit its widespread implementation. In this retrospective multicenter study, data were collected on 34 SCD patients who received a kidney transplant across 6 London Hospitals between 1997 and 2017. 20/34 patients were on an EBT program, pre or post renal transplantation. Overall patient and graft survival were inferior to contemporaneous UK data in the ESRD population as a whole, a finding which is well-recognised. However, patient survival (CI 95%, p = 0.0032), graft survival and graft function were superior at all time-points in those who received EBT versus those who did not. 4/20 patients (20%) on EBT developed de novo donor specific antibodies (DSAs). 3/14 patients (21%) not on EBT developed de novo DSAs. The incidence of rejection in those on EBT was 5/18 (28%), as compared with 7/13 (54%) not on EBT. In conclusion, our data, while limited by an inevitably small sample size and differences in the date of transplantation, do suggest that long-term automated EBT post renal transplant is effective and safe, with improvement in graft and patient outcomes and no increase in antibody formation or graft rejection.
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25
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Nouraie M, Ashley-Koch AE, Garrett ME, Sritharan N, Zhang Y, Little J, Gordeuk VR, Gladwin MT, Telen MJ, Kato GJ. Serum albumin is independently associated with higher mortality in adult sickle cell patients: Results of three independent cohorts. PLoS One 2020; 15:e0237543. [PMID: 32776978 PMCID: PMC7416942 DOI: 10.1371/journal.pone.0237543] [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: 05/12/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022] Open
Abstract
Sickle cell disease (SCD) impacts liver and kidney function as well as skin integrity. These complications, as well as the hyperinflammatory state of SCD, could affect serum albumin. Serum albumin has key roles in antioxidant, anti-inflammatory and antithrombotic pathways and maintains vascular integrity. In SCD, these pathways modulate disease severity and clinical outcomes. We used three independent SCD adult cohorts to assess clinical predictors of serum albumin as well its association with mortality. In 2553 SCD adult participants, the frequency of low (<35 g/L) serum albumin was 5%. Older age and lower hemoglobin (P <0.001) were associated with lower serum albumin in all three cohorts. In age and hemoglobin adjusted analysis, higher liver enzymes (P <0.05) were associated with lower serum albumin. In two of the three cohorts, lower kidney function as measured by Glomerular Filtration Rate (P<0.001) was associated with lower serum albumin. Lower serum albumin predicted higher risk of tricuspid regurgitation velocity ≥ 2.5 m/s (OR = 1.1 per g/L, P ≤0.01). In all three cohorts, patients with low serum albumin had higher mortality (adjusted HR ≥2.9, P ≤0.003). This study confirms the role of serum albumin as a biomarker of disease severity and prognosis in patients with SCD. Albumin as a biomarker and possible mediator of SCD severity should be studied further.
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Affiliation(s)
- Mehdi Nouraie
- Department of Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Allison E Ashley-Koch
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Melanie E Garrett
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Nithya Sritharan
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Yingze Zhang
- Department of Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jane Little
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Victor R Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Mark T Gladwin
- Department of Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Marilyn J Telen
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Gregory J Kato
- Department of Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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26
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Biochemical and therapeutic effects of Omega-3 fatty acids in sickle cell disease. Complement Ther Med 2020; 52:102482. [PMID: 32951732 DOI: 10.1016/j.ctim.2020.102482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 01/29/2023] Open
Abstract
Sickle cell disease (SCD) is a hematologic disorder with complex pathophysiology that includes chronic hemolysis, vaso-occlusion and inflammation. Increased leukocyte-erythrocyte-endothelial interactions, due to upregulated expression of adhesion molecules and activated endothelium, are thought to play a primary role in initiation and progression of SCD vaso-occlusive crisis and end-organ damage. Several new pathophysiology-based therapeutic options for SCD are being developed, chiefly targeting the inflammatory pathways. Omega-3 fatty acids are polyunsaturated fatty acids that are known to have effects on diverse physiological processes. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the principal biologically active omega-3 fatty acids. The therapeutic effects of DHA and EPA on chronic inflammatory disorders and cardiovascular diseases are well recognized. The therapeutic effects of omega-3 fatty acids are attributed to their anti-inflammatory and anti-thrombotic eicosanoids, and the novel class of EPA and DHA derived lipid mediators: resolvins, protectins and maresins. Blood cell membranes of patients with SCD have abnormal fatty acids composition characterized by high ratio of pro-inflammatory arachidonic acid (AA) to anti-inflammatory DHA and EPA (high omega-6/omega-3 ratio). In addition, experimental and clinical studies provide evidence that treatment with DHA does confer improvement in rheological properties of sickle RBC, inflammation and hemolysis. The clinical studies have shown improvements in VOC rate, markers of inflammation, adhesion, and hemolysis. In toto, the results of studies on the therapeutic effects of omega-3 fatty acids in SCD provide good body of evidence that omega-3 fatty acids could be a safe and effective treatment for SCD.
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Buehler PW, Humar R, Schaer DJ. Haptoglobin Therapeutics and Compartmentalization of Cell-Free Hemoglobin Toxicity. Trends Mol Med 2020; 26:683-697. [PMID: 32589936 DOI: 10.1016/j.molmed.2020.02.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
Hemolysis and accumulation of cell-free hemoglobin (Hb) in the circulation or in confined tissue compartments such as the subarachnoid space is an important driver of disease. Haptoglobin is the Hb binding and clearance protein in human plasma and an efficient antagonist of Hb toxicity resulting from physiological red blood cell turnover. However, endogenous concentrations of haptoglobin are insufficient to provide protection against Hb-driven disease processes in conditions such as sickle cell anemia, sepsis, transfusion reactions, medical-device associated hemolysis, or after a subarachnoid hemorrhage. As a result, there is increasing interest in developing haptoglobin therapeutics to target 'toxic' cell-free Hb exposures. Here, we discuss key concepts of Hb toxicity and provide a perspective on the use of haptoglobin as a therapeutic protein.
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Affiliation(s)
- Paul W Buehler
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA; Center for Blood Oxygen Transport and Hemostasis, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Rok Humar
- Division of Internal Medicine, University Hospital, Zurich, Switzerland
| | - Dominik J Schaer
- Division of Internal Medicine, University Hospital, Zurich, Switzerland.
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28
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Fiocchi J, Urits I, Orhurhu V, Orhurhu MS, Giacomazzi S, Hoyt B, Kaye AD, Kaye RJ, Viswanath O. A Comprehensive Review of the Treatment and Management of Pain in Sickle Cell Disease. Curr Pain Headache Rep 2020; 24:17. [PMID: 32200490 DOI: 10.1007/s11916-020-00854-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Sickle cell disease (SCD) is a hematological disorder which leads to serious complications in multiple organ systems. While significant research has addressed many of the effects of acute pain episodes and end-organ damage connected to this disease, little has approached the chronic pain state associated with this condition. RECENT FINDINGS Associated chronic pain represents a significant detractor from the quality of life experienced by these patients, affecting over half of those with SCD on more days than not. Current treatment typically is centered upon preventing and responding to acute vasoocclusive crises, presumably because this is the most common reason for hospitalization in these patients. The lack of management of chronic pain symptoms leaves many with SCD in a state of suffering. In this review, the treatment methodologies of SCD patients are examined including alternative treatments, both pharmaceutical and non-pharmaceutical, as well as procedural approaches specifically aimed at reducing chronic pain in these patients.
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Affiliation(s)
- Jacob Fiocchi
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Vwaire Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Mariam Salisu Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stephen Giacomazzi
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Briggs Hoyt
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Rachel J Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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29
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Howard J, Thein SL. Optimal disease management and health monitoring in adults with sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:505-512. [PMID: 31808832 PMCID: PMC6913450 DOI: 10.1182/hematology.2019000055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In countries with access to organized health care, survival of children with sickle cell disease (SCD) has greatly improved, resulting in a growing population of adults with SCD. Transition from pediatric to adult care presents many challenges for the patient, who now faces the reality of emerging complications in many organs that are cumulative, adding to other age-related nonsickle conditions that interact and add to the disease morbidity. We recommend regular comprehensive annual assessments, monitoring for early signs of organ damage and joint clinics with relevant specialists, if applicable. While maintaining a low threshold for intervention with disease-modifying therapies, we should always keep in mind that there is no single complication that is pathognomonic of SCD, and nonsickle comorbidities should always be excluded and treated if present. We need to reevaluate our approach to managing adults with SCD by putting a greater emphasis on multidisciplinary care while proactively considering curative options (hematopoietic stem cell transplant and gene therapy) and experimental pharmacological agents for adults with SCD of all ages before complications render the patients ineligible for these treatments.
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Affiliation(s)
- Jo Howard
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom; and
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung, and Blood Institute/National Institutes of Health, Bethesda, MD
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30
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Vichinsky E, Hoppe CC, Ataga KI, Ware RE, Nduba V, El-Beshlawy A, Hassab H, Achebe MM, Alkindi S, Brown RC, Diuguid DL, Telfer P, Tsitsikas DA, Elghandour A, Gordeuk VR, Kanter J, Abboud MR, Lehrer-Graiwer J, Tonda M, Intondi A, Tong B, Howard J. A Phase 3 Randomized Trial of Voxelotor in Sickle Cell Disease. N Engl J Med 2019; 381:509-519. [PMID: 31199090 DOI: 10.1056/nejmoa1903212] [Citation(s) in RCA: 375] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deoxygenated sickle hemoglobin (HbS) polymerization drives the pathophysiology of sickle cell disease. Therefore, direct inhibition of HbS polymerization has potential to favorably modify disease outcomes. Voxelotor is an HbS polymerization inhibitor. METHODS In a multicenter, phase 3, double-blind, randomized, placebo-controlled trial, we compared the efficacy and safety of two dose levels of voxelotor (1500 mg and 900 mg, administered orally once daily) with placebo in persons with sickle cell disease. The primary end point was the percentage of participants who had a hemoglobin response, which was defined as an increase of more than 1.0 g per deciliter from baseline at week 24 in the intention-to-treat analysis. RESULTS A total of 274 participants were randomly assigned in a 1:1:1 ratio to receive a once-daily oral dose of 1500 mg of voxelotor, 900 mg of voxelotor, or placebo. Most participants had sickle cell anemia (homozygous hemoglobin S or hemoglobin Sβ0-thalassemia), and approximately two thirds were receiving hydroxyurea at baseline. In the intention-to-treat analysis, a significantly higher percentage of participants had a hemoglobin response in the 1500-mg voxelotor group (51%; 95% confidence interval [CI], 41 to 61) than in the placebo group (7%; 95% CI, 1 to 12). Anemia worsened between baseline and week 24 in fewer participants in each voxelotor dose group than in those receiving placebo. At week 24, the 1500-mg voxelotor group had significantly greater reductions from baseline in the indirect bilirubin level and percentage of reticulocytes than the placebo group. The percentage of participants with an adverse event that occurred or worsened during the treatment period was similar across the trial groups. Adverse events of at least grade 3 occurred in 26% of the participants in the 1500-mg voxelotor group, 23% in the 900-mg voxelotor group, and 26% in the placebo group. Most adverse events were not related to the trial drug or placebo, as determined by the investigators. CONCLUSIONS In this phase 3 randomized, placebo-controlled trial involving participants with sickle cell disease, voxelotor significantly increased hemoglobin levels and reduced markers of hemolysis. These findings are consistent with inhibition of HbS polymerization and indicate a disease-modifying potential. (Funded by Global Blood Therapeutics; HOPE ClinicalTrials.gov number, NCT03036813.).
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Affiliation(s)
- Elliott Vichinsky
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Carolyn C Hoppe
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Kenneth I Ataga
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Russell E Ware
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Videlis Nduba
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Amal El-Beshlawy
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Hoda Hassab
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Maureen M Achebe
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Salam Alkindi
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - R Clark Brown
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - David L Diuguid
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Paul Telfer
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Dimitris A Tsitsikas
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Ashraf Elghandour
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Victor R Gordeuk
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Julie Kanter
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Miguel R Abboud
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Joshua Lehrer-Graiwer
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Margaret Tonda
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Allison Intondi
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Barbara Tong
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Jo Howard
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
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Gbotosho OT, Ghosh S, Kapetanaki MG, Lin Y, Weidert F, Bullock GC, Ofori-Acquah SF, Kato GJ. Cardiac expression of HMOX1 and PGF in sickle cell mice and haem-treated wild type mice dominates organ expression profiles via Nrf2 (Nfe2l2). Br J Haematol 2019; 187:666-675. [PMID: 31389006 DOI: 10.1111/bjh.16129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/27/2019] [Indexed: 12/13/2022]
Abstract
Haemolysis is a major feature of sickle cell disease (SCD) that contributes to organ damage. It is well established that haem, a product of haemolysis, induces expression of the enzyme that degrades it, haem oxygenase-1 (HMOX1). We have also shown that haem induces expression of placental growth factor (PGF), but the organ specificity of these responses has not been well-defined. As expected, we found high level expression of Hmox1 and Pgf transcripts in the reticuloendothelial system organs of transgenic sickle cell mice, but surprisingly strong expression in the heart (P < 0·0001). This pattern was largely replicated in wild type mice by intravenous injection of exogenous haem. In the heart, haem induced unexpectedly strong mRNA responses for Hmox1 (18-fold), Pgf (4-fold), and the haem transporter Slc48a1 (also termed Hrg1; 2·4-fold). This was comparable to the liver, the principal known haem-detoxifying organ. The NFE2L2 (also termed NRF2) transcription factor mediated much of the haem induction of Hmox1 and Hrg1 in all organs, but less so for Pgf. Our results indicate that the heart expresses haem response pathway genes at surprisingly high basal levels and shares with the liver a similar transcriptional response to circulating haem. The role of the heart in haem response should be investigated further.
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Affiliation(s)
- Oluwabukola T Gbotosho
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Samit Ghosh
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Medicine, Center for Translational and International Hematology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria G Kapetanaki
- Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yu Lin
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frances Weidert
- Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Grant C Bullock
- Division of Hematopathology, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Solomon F Ofori-Acquah
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Medicine, Center for Translational and International Hematology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Gregory J Kato
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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How I treat the older adult with sickle cell disease. Blood 2018; 132:1750-1760. [PMID: 30206116 DOI: 10.1182/blood-2018-03-818161] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/21/2018] [Indexed: 12/31/2022] Open
Abstract
With increasing survival, cumulative complications of sickle cell disease (SCD), which develop insidiously over time, are becoming more apparent and common in older patients, particularly those in their fifth decade and beyond. The older patient is also more likely to develop other age-related nonsickle conditions that interact and add to the disease morbidity. A common misconception is that any symptom in a SCD patient is attributable to their SCD and this may lead to delays in diagnosis and appropriate intervention. We recommend regular comprehensive reviews and monitoring for early signs of organ damage and a low threshold for the use of hydroxyurea and blood transfusions as preventative measures for end-organ disease. Treatable comorbidities and acute deterioration should be managed aggressively. Although the primary goal in management of the older adult with SCD is improving anemia and minimizing organ damage, the time has come for us to be more proactive in considering curative therapies previously offered to the younger patient. Curative or experimental interventions should be discussed early, before complications render the patients ineligible for these treatments.
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Guilcher GMT, Truong TH, Saraf SL, Joseph JJ, Rondelli D, Hsieh MM. Curative therapies: Allogeneic hematopoietic cell transplantation from matched related donors using myeloablative, reduced intensity, and nonmyeloablative conditioning in sickle cell disease. Semin Hematol 2018; 55:87-93. [PMID: 29958564 DOI: 10.1053/j.seminhematol.2018.04.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/19/2018] [Indexed: 01/08/2023]
Abstract
Sickle cell disease (SCD) chronically damages multiple organs over the lifetime of affected individuals. Allogeneic hematopoietic cell transplantation (allo-HCT) is the most studied curative intervention. Fully matched related marrow, peripheral blood derived, or cord blood HCT have the best transplant outcome for symptomatic patients with SCD. For patients with asymptomatic or milder disease who have this donor option available, risks and benefits of HCT should be discussed among the patient, family, treating hematologist, and transplant physician, and decision to proceed to HCT should be individualized. Myeloablative conditioning with busulfan, cyclophosphamide, and ATG has been a commonly employed regimen for children and young adults. Recently, low intensity conditioning with low dose total body irradiation and alemtuzumab is emerging as an efficacious and safe regimen for adults, young adults, and possibly children. Mixed donor chimerism (minimum ≥20% myeloid cells), from myeloablative or nonmyeloablative conditioning regimen, produces robust normal donor erythropoiesis and is sufficient to provide a clinical cure. The proportion of patients remaining on immunosuppression beyond 2 years post-HCT is likely <10% with either myeloablative or low intensity regimens. Late effects from myeloablative or reduced intensity conditioning, or from several more months of immunosuppression in low intensity conditioning may be less common than those observed in HCT for malignant indications. Nonmyeloablative approaches with low toxicities should be the focus of future research efforts. Prevention of GVHD is a shared goal in all approaches of allo-HCT in SCD.
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Affiliation(s)
- Gregory M T Guilcher
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Tony H Truong
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Santosh L Saraf
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
| | - Jacinth J Joseph
- Department of Hematology, Washington Hospital Center/Georgetown University, Washington, DC; Sickle Cell Branch, NHLBI, NIH, Bethesda, MD
| | - Damiano Rondelli
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
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