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Chang MM, Natoli ME, Wilkinson AF, Tubman VN, Airewele GE, Richards-Kortum RR. A multiplexed, allele-specific recombinase polymerase amplification assay with lateral flow readout for sickle cell disease detection. LAB ON A CHIP 2024; 24:4115-4127. [PMID: 39051493 DOI: 10.1039/d4lc00281d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Isothermal nucleic acid amplification tests have the potential to improve disease diagnosis at the point of care, but it remains challenging to develop multiplexed tests that can detect ≥3 targets or to detect point mutations that may cause disease. These capabilities are critical to enabling informed clinical decision-making for many applications, such as sickle cell disease (SCD). To address this, we describe the development of a multiplexed allele-specific recombinase polymerase amplification (RPA) assay with lateral flow readout. We first characterize the specificity of RPA using primer design strategies employed in PCR to achieve point mutation detection, and demonstrate the utility of these strategies in achieving selective isothermal amplification and detection of genomic DNA encoding for the healthy βA globin allele, or genomic DNA containing point mutations encoding for pathologic βS and βC globin alleles, which are responsible for most sickle cell disorders. We then optimize reaction conditions to achieve multiplexed amplification and identification of the three alleles in a single reaction. Finally, we perform a small pilot study with 20 extracted genomic DNA samples from SCD patients and healthy volunteers - of the 13 samples with valid results, the assay demonstrated 100% sensitivity and 100% specificity for detecting pathologic alleles, and an overall accuracy of 92.3% for genotype prediction. This multiplexed assay is rapid, minimally instrumented, and when combined with point-of-care sample preparation, could enable DNA-based diagnosis of SCD in low-resource settings. The strategies reported here could be applied to other challenges, such as detection of mutations that confer drug resistance.
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Affiliation(s)
- Megan M Chang
- Department of Bioengineering, Rice University, Houston, TX, USA.
| | - Mary E Natoli
- Department of Bioengineering, Rice University, Houston, TX, USA.
| | | | - Venée N Tubman
- Texas Children's Cancer and Hematology Centers, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Gladstone E Airewele
- Texas Children's Cancer and Hematology Centers, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
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Purohit P, Parida C, Martha TK, Bholo S, Naik A, Behera SK. Evaluation of a point-of-care rapid diagnostic test kit (SICKLECHECK) for screening of sickle cell diseases. PLoS One 2024; 19:e0309045. [PMID: 39150948 PMCID: PMC11329129 DOI: 10.1371/journal.pone.0309045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 08/05/2024] [Indexed: 08/18/2024] Open
Abstract
Sickle cell diseases (SCD) are the most common genetic disorders with significant morbidity and mortality worldwide, including in India. The high prevalence of this disorder in many geographical regions calls for the use of a point-of-care rapid diagnostic test (RDT) for early screening and management of the diagnosed cases to reduce the allied clinical severity. In view of this, the present study was undertaken for the validation of a point-of-care RDT kit (SICKLECHECKTM) for the screening of SCD. This validation and diagnostic accuracy study was conducted among the cases advised for screening of SCD. For validation, all the recruited cases were investigated for both the SICKLECHECKTM RDT kit and HPLC (Variant-II) considering HPLC as a gold standard. A total of 400 cases were screened for both tests. For the presence and absence of sickle cell hemoglobin in the samples, SICKLECHECKTM RDT kit results showed a sensitivity and specificity of 99.39% and 98.73% respectively with references to HPLC findings. For the detection of the 'AS' pattern, the SICKLECHECKTM RDT kit has shown a sensitivity and specificity of 99.07% and 98.81% respectively. For the detection of the 'SS' pattern, the SICKLECHECKTM RDT kit has shown a sensitivity and specificity of 97.92% and 100.0% respectively. Cases with β thalassemia trait, hemoglobin E trait, hemoglobin Lepore trait and trait for hereditary-persistence-of-fetal-hemoglobin (high HbF %) diagnosed in HPLC were resulted with 'AA' pattern in SICKLECHECKTM RDT kit. The high sensitivity and specificity of the SICKLECHECKTM RDT kit insist on its use as a point-of-care screening tool for SCD especially where there is a lack of laboratory facilities as well as in hospital-based set-up requiring immediate diagnosis and management of SCD. However, for further confirmation, the samples should be analyzed with other gold standard techniques like HPLC.
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Affiliation(s)
- Prasanta Purohit
- Multi-Disciplinary Research Unit, Maharaja Krishna Chandra Gajapati (M.K.C.G) Medical College, Berhampur, Odisha, India
| | - Chinmayee Parida
- Multi-Disciplinary Research Unit, Maharaja Krishna Chandra Gajapati (M.K.C.G) Medical College, Berhampur, Odisha, India
| | - Tapan Kumar Martha
- Multi-Disciplinary Research Unit, Maharaja Krishna Chandra Gajapati (M.K.C.G) Medical College, Berhampur, Odisha, India
| | - Snehal Bholo
- Multi-Disciplinary Research Unit, Maharaja Krishna Chandra Gajapati (M.K.C.G) Medical College, Berhampur, Odisha, India
| | - Aparupa Naik
- Multi-Disciplinary Research Unit, Maharaja Krishna Chandra Gajapati (M.K.C.G) Medical College, Berhampur, Odisha, India
| | - Samira Kumar Behera
- Multi-Disciplinary Research Unit, Maharaja Krishna Chandra Gajapati (M.K.C.G) Medical College, Berhampur, Odisha, India
- Department of Pathology, Maharaja Krishna Chandra Gajapati (M.K.C.G) Medical College, Berhampur, Odisha, India
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Aol PM, Fahdil G, Bongomin F, Okello B, Batte C, Kirenga BJ, Nantanda R, Aanyu HT. Prevalence, patterns, and factors associated with abnormal lung function among children with sickle cell disease in Uganda: a cross-sectional study. BMC Pediatr 2024; 24:516. [PMID: 39127673 DOI: 10.1186/s12887-024-04988-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Pulmonary complications are common among children with sickle cell disease (SCD). However, there is little literature on associated lung function abnormalities in Uganda. We aimed to determine the prevalence, patterns, and factors associated with abnormal lung function among children with SCD in a tertiary care hospital in Uganda. METHOD A cross-sectional study was conducted among children aged 6 to 18 years at the SCD clinic (SCC) of Mulago National Super-Specialized Hospital between January 2020 and April 2021. Data on sociodemographic and clinical characteristics was collected using a standardized questionnaire. Laboratory investigations, including a complete blood count and serum lactate dehydrogenase (LDH), were done. Spirometry was performed following the ATS/ERS standards. Multivariable modified Poisson regression analysis was performed to determine factors associated with abnormal lung function. RESULTS A total of 332 participants were enrolled. The mean age was 11.7 ± 3.4 years, and 184 (55.4%) were female. Overall, 126 (37.9%) participants had abnormal lung function: 67/126 (53.2%) restrictive, 57/126 (45.2%) obstructive, and 2/126 (1.6%) mixed-ventilatory patterns. Factors associated with abnormal lung function were; serum LDH level > 600UL (aIRR: 1.89 95% CI: 1.2 - 7.4, p = 0.049), a history of acute chest syndrome (aIRR: 1.55, 95% CI: 1.06-2.25, p = 0.024), wasting (aIRR: 1.33, 95%CI: 1.02 - 1.72, p = 0.032), and use of charcoal for household cooking (aIRR: 1.49, 95% CI: 1.03-2.15, p = 0.035). CONCLUSION More than one-third of children with SCD in Uganda have lung function abnormalities. Strategies to improve nutrition, reduce exposure to charcoal smoke, and monitoring serum LDH levels may be important in preventing or managing abnormal lung function in this population. The identification of reversible and irreversible airway obstruction in children with sickle cell disease also highlights the need for targeted interventions to address these specific patterns of abnormal lung function.
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Affiliation(s)
- Pamella Mwa Aol
- Department of Paediatrics and Child Health, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Geriga Fahdil
- Uganda Cancer Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Bonny Okello
- Department of Planning, Kwania District Local Government, Kwania, Uganda
| | - Charles Batte
- College of Health Sciences, Makerere University Lung Institute, Makerere University Kampala, Kampala, Uganda
| | - Bruce J Kirenga
- College of Health Sciences, Makerere University Lung Institute, Makerere University Kampala, Kampala, Uganda
| | - Rebecca Nantanda
- College of Health Sciences, Makerere University Lung Institute, Makerere University Kampala, Kampala, Uganda.
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Sasi P, Makubi A, Sangeda RZ, Ngaeje MY, Mmbando BP, Soka J, Rosano C, Magesa AS, Cox SE, Makani J, Novelli EM. Hydroxyurea mobile directly observed therapy versus standard monitoring in patients with sickle cell anemia: a phase 2 randomized trial. COMMUNICATIONS MEDICINE 2024; 4:160. [PMID: 39122788 PMCID: PMC11315961 DOI: 10.1038/s43856-024-00552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/18/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Sickle cell anemia (SCA) prevalence remains high in sub-Saharan Africa. Long-term treatment with hydroxyurea (HU) increases survival, however, poor adherence to treatment could limit effectiveness. Whilst HU treatment adherence is currently high, this might decrease over time. METHODS We conducted a single-center, randomized, open-label, parallel group phase 2 controlled clinical trial to determine whether mobile Directly Observed Therapy (m-DOT) increases HU treatment adherence (NCT02844673). Eligible participants were adults with homozygous SCA. People on a chronic blood transfusion program, with hemoglobin (Hb) A levels greater than 20% of the total Hb, total Hb less than 4 g/dL, pregnant or HIV positive were excluded. After a 3-month pre-treatment period participants were randomized to either m-DOT or standard monitoring arm. All participants received smart mobile phones and were treated with HU (15 mg/kg) daily for three months. In the m-DOT arm, drug intake was video recorded on cell phone by the participant and the video sent to the study team. The primary objective was to evaluate the effect of m-DOT on adherence to HU treatment by medication possession ratio (MPR). RESULTS Of the 86 participants randomized, 76 completed the trial (26.13 ± 6.97 years, 63.5 % female). Adherence was high (MPR > 95 %) in both groups, 29 (80.6 %) in m-DOT versus 37 (94.9 %) in the standard monitoring arm (P = 0.079). No HU treatment was withheld from participants due to safety concerns. CONCLUSIONS m-DOT did not increase adherence to HU treatment. We recommend that further testing in larger trials with a longer follow up period be undertaken.
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Affiliation(s)
- Philip Sasi
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
- Department of Clinical Pharmacology, School of Biomedical Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Abel Makubi
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Raphael Z Sangeda
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mariam Y Ngaeje
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno P Mmbando
- National Institute for Medical Research, Tanga Cente, Tanga, Tanzania
| | - Joseph Soka
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Caterina Rosano
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, USA
| | - Alex S Magesa
- Muhimbili National Hospital, Central Pathology Laboratory, Dar es Salaam, Tanzania
- Department of Curative Services, Ministry of Health, Dodoma, Tanzania
| | - Sharon E Cox
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- London School of Hygiene & Tropical Medicine, London, UK
| | - Julie Makani
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- SickleInAfrica Clinical Coordinating Center (CCC), Dar es Salaam, Tanzania
- Imperial College London, London, UK
| | - Enrico M Novelli
- School of Medicine, Department of Medicine, Division of Classical Hematology, University of Pittsburgh, Pittsburgh, USA
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Marco Sánchez JM, Bardón Cancho EJ, Benéitez D, Payán-Pernía S, Collado Gimbert A, Ruiz-Llobet A, Salinas JA, Sebastián E, Argilés B, Bermúdez M, Vázquez MÁ, Ortega MJ, López Rubio M, Gondra A, Uriz JJ, Morado M, Coll MT, López Duarte M, Baro M, Cervera Á, Recasens V, García Blanes C, Del Carcavilla MP, Tallon M, González Espín A, Olteanu Olteanu FC, González P, Del Mañú Pereira MM, Cela E. Haemoglobinopathies and other rare anemias in Spain: ten years of a nationwide registry (REHem-AR). Ann Hematol 2024; 103:2743-2755. [PMID: 38763941 PMCID: PMC11283438 DOI: 10.1007/s00277-024-05788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/02/2024] [Indexed: 05/21/2024]
Abstract
REHem-AR was created in 2013. The progressive implementation of neonatal screening for haemoglobinopathies in Spanish autonomous communities where the registry had not been implemented, as well as the addition of new centres during this period, has considerably increased the sample of patients covered. In this study, we update our previous publication in this area, after a follow-up of more than 5 years. An observational, descriptive, multicentre and ambispective study of adult and paediatric patients with haemoglobinopathies and rare anaemias registered in REHem was performed. The data are from a cross-sectional analysis performed on 1 June, 2023. The study population comprised 1,756 patients, of whom 1,317 had SCD, 214 had thalassaemia and 224 were diagnosed with another condition. Slightly more than one third of SCD patients (37%) were diagnosed based on neonatal bloodspot screening, and the mean age at diagnosis was 2.5 years; 71% of thalassaemia patients were diagnosed based on the presence of anaemia. Vaso-occlusive crisis and acute chest syndrome continue to be the most frequent complications in SCD. HSCT was performed in 83 patients with SCD and in 50 patients with thalassaemia. Since the previous publication, REHem-AR has grown in size by more than 500 cases. SCD and TM are less frequent in Spain than in other European countries, although the data show that rare anaemias are frequent within rare diseases. REHem-AR constitutes an important structure for following the natural history of rare anaemias and enables us to calculate investment needs for current and future treatments.
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Affiliation(s)
- José Manuel Marco Sánchez
- Data Manager of the Spanish Registry of Rare Haemoglobinopathies and Rare Anaemias (REHem-AR), Gregorio Marañón Health Research Institute. Section of Pediatric Hemato-Oncology.Pediatrics Service, Hospital General Universitario Gregorio Marañón, O'Donnell, 48, Madrid, Spain
- CSUR Erithropathology. ERN-EuroBloodNet. CIBERER, Universidad Complutense de Madrid, Madrid, Spain
| | - Eduardo Jesús Bardón Cancho
- CSUR Erithropathology. ERN-EuroBloodNet. CIBERER, Universidad Complutense de Madrid, Madrid, Spain.
- Section of Pediatric Hemato-Oncology. Pediatrics Service. Hospital General, Universitario Gregorio Marañón, O'Donnell, 48, Madrid, Spain.
| | - David Benéitez
- Hematology Service. Hospital Universitario Vall d'Hebron. Barcelona. ERN-Eurobloodnet, Universitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, Barcelona, Spain
| | - Salvador Payán-Pernía
- Hematology Service. Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Av. Manuel Siurot, S/N, 41013, Seville, Spain
| | - Anna Collado Gimbert
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Universitario Vall d'Hebron. Barcelona, Passeig de La Vall d'Hebron, 119-129, Barcelona, Spain
| | - Anna Ruiz-Llobet
- Hematology Service. Hospital Sant Joan de DéuUniversitat de Barcelona. Institut de Recerca Hospital Sant Joan de Déu. CSUR Eritropatología. ERN-EuroBloodNet, Passeig de Sant Joan de Déu, 2Esplugues de Llobregat, Barcelona, Spain
| | - José Antonio Salinas
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120, Palma, Illes Balears, Spain
| | - Elena Sebastián
- Section of Pediatric Hemato-Oncology. Hospital Infantil Universitario Niño Jesús. Foundation for Biomedical Research of the Niño Jesús University Childrens Hospital, Av. de Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Bienvenida Argilés
- Section of Pediatric Hemato-Oncology. Pediatrics Service. Hospital, Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, Valencia, Spain
| | - Mar Bermúdez
- Section of Pediatric Hemato-Oncology. Pediatrics Service. Hospital Clínico, Universitario Virgen de La Arrixaca, Ctra. Madrid-Cartagena, S/N, 30120El Palmar, Murcia, Spain
| | - María Ángeles Vázquez
- Section of Pediatric Hematology. Hospital Materno-Infantil Torrecárdenas, Calle Hermandad de Donantes Sangre S/N, 04009, Almería, Spain
| | - María José Ortega
- Section of Pediatric Hematology. Hospital, Universitario Virgen de Las Nieves, Av. de Las Fuerzas Armadas, 2, 18014, Granada, Spain
| | - Montserrat López Rubio
- Hematology Service. Hospital Universitario Príncipe de Asturias, Carretera de Alcalá Meco S/N, 28805, Alcalá de Henares, Madrid, Spain
| | - Ainhoa Gondra
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Universitario de Basurto, Universidad del País Vasco UPV/EHU, Montevideo Etorb, 18, 48013, Bilbao, Bizkaia, Spain
| | - José Javier Uriz
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Universitario Donostia, , Begiristain Doktorea Pasealekua, S/N, 20014, Donostia, Gipuzkoa, Spain
| | - Marta Morado
- Hematology Service. Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 , Madrid, Spain
| | - María Teresa Coll
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital General de Granollers. , Carrer de Francesc Ribas, S/N, 08402, Barcelona, Granollers, Spain
| | - Mónica López Duarte
- Hematology Service, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Cantabria, Spain
| | - María Baro
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Doce de Octubre, Avenida Córdoba S/n2, 28041, Madrid, Spain
| | - Áurea Cervera
- Pediatric Service, Hospital Universitario Móstoles, C. Dr. Luis Montes, S/N, 28935, Madrid, Móstoles, Spain
| | - Valle Recasens
- Hematology Service. Hospital Miguel Servet, P.º de Isabel La Católica, 1-3, 50009, Zaragoza, Spain
| | - Carmen García Blanes
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Clínico Valencia, Av Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - María Pozo Del Carcavilla
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Complejo Hospitalario Albacete, C. Hermano Falco, 37, 02006, Albacete, Spain
| | - María Tallon
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, 36312, Vigo, Spain
| | - Ana González Espín
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Complejo Hospitalario Jaén, Av Ejército Español, 10, 23007, Jaén, Spain
| | - Filip Camil Olteanu Olteanu
- Section of Pediatric Hemato-Oncology. Pediatrics Service. Hospital, Universitario de Guadalajara, C Donante de Sangre, S/N, 19002, Guadalajara, Spain
| | - Pablo González
- Hospital General Universitario Gregorio Marañón, Calle O'Donnell, 48, Madrid, Spain
| | - María Mar Del Mañú Pereira
- Hospital Universitario Vall d'Hebron. BarcelonaERN-EurobloodnetUniversitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, Barcelona, Spain
| | - Elena Cela
- CSUR Erithropathology. ERN-EuroBloodNet. CIBERER, Universidad Complutense de Madrid, Madrid, Spain
- Section of Pediatric Hemato-Oncology. Pediatrics Service. Hospital General, Universitario Gregorio Marañón, O'Donnell, 48, Madrid, Spain
- Coordinator of REHem-AR. Erythropathology Working Group of the Spanish Society of Pediatric Hematology and Oncology (SEHOP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Sharma Y, Bhat D, Sridevi P, Surti SB, Ranjit M, Sarmah J, Sudhakar G, Babu BV. Sickle cell disease in Indian tribal population: Findings of a multi-centre Indian SCD registry. Blood Cells Mol Dis 2024; 109:102873. [PMID: 39024737 DOI: 10.1016/j.bcmd.2024.102873] [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: 03/08/2024] [Revised: 06/30/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Sickle cell disease (SCD) registries provide crucial real-world data on demographics, epidemiology, healthcare, patient outcomes, and treatment efficacy. This paper presents findings from the Indian SCD Registry (ISCDR) on clinical manifestations, crisis episodes, disease management, and healthcare utilization in patients with SCD from 12 primary health centres (PHCs) in six tribal districts of India. METHODS The ISCDR was introduced along with a three-tier screening process. Its Android-based application incorporates two electronic case report forms for patient data collection over one year. This paper presents a year's data from the ISCDR's 324 patients with SCD. RESULTS Patients with SCD, aged one to 65 years, exhibited varied clinical manifestations. Most patients (85.2 %) were unaware of their SCD status before enrolling in ISCDR. Moderate to severe anaemia was prevalent (66.05 % and 30.56 %, respectively). Pain was a common complaint (80.86 %; CI: 76.17-85.00), while symptoms of stroke included sudden severe headaches (34.57 %; CI: 29.40-40.02). Common splenic sequestration symptoms included stomach pain (42.90 %; CI: 37.44-48.49) and abdominal tenderness (13.27 %; CI: 9.77-17.46), as a sign. Healthcare utilization was high, with 96.30 % receiving treatment and 83.64 % consuming hydroxyurea. Hospitalization occurred for 38.27 % (CI: 32.95-43.81), and 12.04 % (CI: 8.70-16.09) had blood transfusion during last year. CONCLUSIONS ISCDR serves as a dynamic digital database on SCD epidemiology, clinical aspects, treatment and healthcare utilization. Notably, many patients lacked prior awareness of their SCD status, underscoring the need for improved awareness and care management. Integrating the registry into the national programme can streamline treatment implementation, prioritize management approaches, and optimize individual benefits.
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Affiliation(s)
- Yogita Sharma
- Division of Socio-Behavioural, Health Systems & Implementation Research, Indian Council of Medical Research, New Delhi, India
| | - Deepa Bhat
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Parikipandla Sridevi
- Department of Biotechnology, Central Tribal University of Andhra Pradesh, Vizianagaram, India
| | - Shaily B Surti
- Department of Community Medicine, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, India
| | - Manoranjan Ranjit
- Division of Molecular Epidemiology, Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Jatin Sarmah
- Department of Biotechnology, Bodoland University, Kokrajhar, India
| | - Godi Sudhakar
- Department of Human Genetics, Andhra University, Visakhapatnam, India
| | - Bontha V Babu
- Division of Socio-Behavioural, Health Systems & Implementation Research, Indian Council of Medical Research, New Delhi, India.
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Caria CA, Faà V, Porcu S, Marongiu MF, Poddie D, Perseu L, Meloni A, Vaccargiu S, Ristaldi MS. Post-GWAS Validation of Target Genes Associated with HbF and HbA 2 Levels. Cells 2024; 13:1185. [PMID: 39056767 PMCID: PMC11274989 DOI: 10.3390/cells13141185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Genome-Wide Association Studies (GWASs) have identified a huge number of variants associated with different traits. However, their validation through in vitro and in vivo studies often lags well behind their identification. For variants associated with traits or diseases of biomedical interest, this gap delays the development of possible therapies. This issue also impacts beta-hemoglobinopathies, such as beta-thalassemia and sickle cell disease (SCD). The definitive cures for these diseases are currently bone marrow transplantation and gene therapy. However, limitations regarding their effective use restrict their worldwide application. Great efforts have been made to identify whether modulators of fetal hemoglobin (HbF) and, to a lesser extent, hemoglobin A2 (HbA2) are possible therapeutic targets. Herein, we performed the post-GWAS in vivo validation of two genes, cyclin D3 (CCND3) and nuclear factor I X (NFIX), previously associated with HbF and HbA2 levels. The absence of Ccnd3 expression in vivo significantly increased g (HbF) and d (HbA2) globin gene expression. Our data suggest that CCND3 is a possible therapeutic target in sickle cell disease. We also confirmed the association of Nfix with γ-globin gene expression and present data suggesting a possible role for Nfix in regulating Kruppel-like transcription factor 1 (Klf1), a master regulator of hemoglobin switching. This study contributes to filling the gap between GWAS variant identification and target validation for beta-hemoglobinopathies.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maria Serafina Ristaldi
- Istituto di Ricerca Genetica e Biomedica, Cittadella Universitaria di Monserrato, SS 554, Bivio Sestu Km 4,500, 09042 Cagliari, Italy; (C.A.C.); (V.F.); (S.P.); (M.F.M.); (D.P.); (L.P.); (A.M.); (S.V.)
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8
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Adegoke SA, Makalo L, Sallah A, Saine H, Joof S, Conteh A, Bah R, Camara Jammeh AF, Bass M, Jallow M, Nnodu OE. Point-of-Care Newborn Screening for Sickle Cell Disease at Selected Health Facilities in the Gambia. Hemoglobin 2024:1-6. [PMID: 38980121 DOI: 10.1080/03630269.2024.2369523] [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: 03/04/2024] [Accepted: 06/09/2024] [Indexed: 07/10/2024]
Abstract
Sickle cell disease (SCD) contributes significantly to childhood morbidity and mortality in sub-Saharan Africa. Early diagnosis through newborn screening (NBS) and subsequent comprehensive follow-up care will reduce the burden. Up till now, the prevalence of SCD among newborns remains unknown in The Gambia and there is no national NBS programme to address this significant public health issue. We assessed the real-time frequency of SCD in the country and determined differences in the pattern of SCD phenotypes among different ethnic groups. A preliminary prospective feasibility study was done in eight purposively selected hospitals in the seven Health Administrative Regions and Banjul. Consecutive newborn babies delivered or managed in these facilities were screened using HemoTypeSC, a sensitive and specific ELISA-based point-of-care test (POCT). Babies identified as SCD with HemoTypeSC were retested at age ≥6 months using alkaline cellulose acetate hemoglobin electrophoresis (ACAE). Head-to-head comparison between HemoType screening and gold standard HPLC could not be done. 1,168 newborn babies were screened from April 14 to August 12, 2023. Fifteen (1.3%) had homozygous HbS (HbSS), two (0.2%) heterozygous for HbS and HbC (HbSC), 204 (17.5%) had sickle cell trait (HbAS), four (0.3%) heterozygous for HbA and HbC (HbAC), and 943 (80.7%) had normal hemoglobin (HbAA). The 17 with SCD (HbSS and HbSC) comprised of 7 (2.2%) of 324 Fula; 6 (1.4%) of 426 Mandinka; 2 (1.6%) of 125 Jola and 2 (1.3%) of 150 Wolof. Fourteen (82.4%) of the 17 accepted the diagnosis and were enrolled into the SCD program. For these 14, HemoTypeSC had 100% sensitivity with ACAE when repeated at age ≥6 months. In addition to determining the real-time newborn prevalence of SCD and trait in The Gambia for the first time, this pilot study showed that SCD-POCT is feasible in Gambian health facilities.
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Affiliation(s)
- Samuel Ademola Adegoke
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Lamin Makalo
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Adama Sallah
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Horeja Saine
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Sheikh Joof
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Amie Conteh
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Ramatoulie Bah
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | | | - Matthew Bass
- Nursing Unit, Bwian General Hospital, Banjul, The Gambia
| | - Mamadou Jallow
- American International University West Africa, Serrekunda, The Gambia
| | - Obiageli Eunice Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
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9
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Darlington WS, Syed S, Wroblewski K, Lapping-Carr G, Lindau ST, Peddinti R. Food insecurity and quality of life in patients with sickle cell disease. Pediatr Blood Cancer 2024; 71:e31045. [PMID: 38687256 DOI: 10.1002/pbc.31045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/21/2024] [Accepted: 04/13/2024] [Indexed: 05/02/2024]
Abstract
Little is known about the relationship between quality of life (QOL) and food insecurity (FI) among patients with sickle cell disease (SCD). We hypothesized FI is associated with lower QOL in children and young adults with SCD. Overall (N = 99), 22% screened positive for FI. Supplemental Nutrition Assistance Program (SNAP) enrollment was 50 and 71% among people from food secure and FI households, respectively. A higher FI score was correlated with lower overall QOL (r = -0.22, p = .03), specifically lower QOL in worry and communication domains. Interventions for FI beyond SNAP may be important for QOL among people living with SCD.
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Affiliation(s)
- Wendy S Darlington
- Department of Pediatrics, Section of Hematology/Oncology and Stem Cell Transplantation, University of Chicago, Chicago, USA
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, USA
| | - Sharjeel Syed
- Department of Medicine, University of Chicago, Chicago, USA
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, USA
| | - Gabrielle Lapping-Carr
- Department of Pediatrics, Section of Hematology/Oncology and Stem Cell Transplantation, University of Chicago, Chicago, USA
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology-Gynecologic Oncology, University of Chicago, Chicago, USA
- Department of Medicine-Geriatrics and Palliative Medicine, University of Chicago, Chicago, USA
- University of Chicago Comprehensive Cancer Center, Chicago, USA
| | - Radhika Peddinti
- Department of Pediatrics, Section of Hematology/Oncology and Stem Cell Transplantation, University of Chicago, Chicago, USA
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, USA
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10
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Prieto-Torres AE, Rojas-Torres AF, Salguedo GI, Martinez-Cordero H. Early Diagnosis of Hemophagocytic Lymphohistiocytosis in an Adult Presenting With Sickle Cell Disease: A Case Report. Cureus 2024; 16:e64411. [PMID: 39130868 PMCID: PMC11317069 DOI: 10.7759/cureus.64411] [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: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening syndrome characterized by excessive immune activation and tissue inflammation. This case report describes the early diagnosis of HLH in an adult patient who initially presented with a febrile syndrome associated with low back pain. The patient, a 33-year-old male, exhibited bicytopenia, hepatosplenomegaly, and hyperferritinemia without a previous diagnosis of sickle cell disease (SCD). Diagnostic challenges arose due to the overlapping clinical manifestations of SCD and HLH and their uncommon association. However, timely recognition and intervention were achieved through comprehensive diagnostic evaluations, including a bone marrow biopsy. The patient was promptly started on an appropriate therapeutic regimen, which led to significant clinical improvement. This case underscores the importance of considering HLH in the differential diagnosis of adults presenting with hematologic abnormalities and systemic inflammation. Early diagnosis and treatment are critical to improving outcomes for patients with this complex and severe disorder.
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Raghuraman A, Lawrence R, Shetty R, Avanthika C, Jhaveri S, Pichardo BV, Mujakari A. Role of gene therapy in sickle cell disease. Dis Mon 2024; 70:101689. [PMID: 38326171 DOI: 10.1016/j.disamonth.2024.101689] [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] [Indexed: 02/09/2024]
Abstract
BACKGROUND Gene therapy is an emerging treatment for sickle cell disease that works by replacing a defective gene with a healthy gene, allowing the body to produce normal red blood cells. This form of treatment has shown promising results in clinical trials, and is a promising alternative to traditional treatments. Gene therapy involves introducing a healthy gene into the body to replace a defective gene. The new gene can be delivered using a viral vector, which is a modified virus that carries the gene. The vector, carrying the healthy gene, is injected into the bloodstream. The healthy gene then enters the patient's cells and begins to produce normal hemoglobin, the protein in red blood cells that carries oxygen throughout the body. METHODOLOGY We conducted an all-language literature search on Medline, Cochrane, Embase, and Google Scholar until December 2022. The following search strings and Medical Subject Heading (MeSH) terms were used: "Sickle Cell," "Gene Therapy" and "Stem Cell Transplantation". We explored the literature on Sickle Cell Disease for its epidemiology, etiopathogenesis, the role of various treatment modalities and the risk-benefit ratio of gene therapy over conventional stem cell transplant. RESULTS Gene therapy can reduce or eliminate painful episodes, prevent organ damage, and raise the quality of life for those living with the disease. Additionally, gene therapy may reduce the need for blood transfusions and other traditional treatments. Gene therapy has the potential to improve the lives of those living with sickle cell disease, as well as reduce the burden of the disease on society.
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Affiliation(s)
| | - Rebecca Lawrence
- Richmond Gabriel University, College of Medicine, Saint Vincent and the Grenadines, United States
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Boma PM, Ngoy SKK, Panda JM, Bonnechère B. Empowering sickle cell disease care: the rise of TechnoRehabLab in Sub-Saharan Africa for enhanced patient's perspectives. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1388855. [PMID: 38994332 PMCID: PMC11236801 DOI: 10.3389/fresc.2024.1388855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/11/2024] [Indexed: 07/13/2024]
Abstract
Sickle-cell Disease (SCD) is a major public health problem in Africa, and there are significant obstacles to its comprehensive management, particularly in terms of access to appropriate healthcare. This calls for inventive approaches to improve patients' prospects. Among the major challenges to be met are the primary and secondary prevention of certain serious complications associated with the disease, such as neurocognitive, motor and respiratory functional disorders. This perspective argues for the rapid creation of specific, cost-effective, technology-supported rehabilitation centres to advance SCD care, identify patients at high risk of stroke and implement tailored rehabilitation strategies. The TechnoRehabLab in Lubumbashi illustrates this shift in thinking by using cutting-edge technologies such as virtual reality (VR), serious games and mobile health to create a comprehensive and easily accessible rehabilitation framework. Diagnostic tools used to perform functional assessment can be used to identify cognitive, balance and walking deficits respectively. Transcranial Doppler enables early detection of sickle cell cerebral vasculopathy, making it possible to provide early and appropriate treatment. VR technology and serious games enable effective rehabilitation and cognitive stimulation, which is particularly advantageous for remote or community-based rehabilitation. In the context of African countries where there is a glaring disparity in access to digital resources, the TechnoRehabLab serves as a tangible example, demonstrating the flexibility and accessibility of technology-assisted rehabilitation. This perspective is an urgent call to governments, non-governmental organisations and the international community to allocate resources to the replication and expansion of similar facilities across Africa.
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Affiliation(s)
- Paul Muteb Boma
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi, Democratic Republic of the Congo
| | - Suzanne Kamin Kisula Ngoy
- Nursing Department, Higher Institute of Medical Technology, Lubumbashi, Democratic Republic of the Congo
| | - Jules Mulefu Panda
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi, Democratic Republic of the Congo
- Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Hasselt, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, University of Hasselt, Hasselt, Belgium
- Department of PXL—Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
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Power-Hays A, Namazzi R, Kato C, McElhinney KE, Conroy AL, Hume H, John C, O'Hara SM, Stuber SE, Lane A, Latham TS, Opoka RO, Ware RE. Pharmacokinetic-Guided Hydroxyurea to Reduce Transfusions in Ugandan Children with Sickle Cell Anemia: Study Design of the Alternative Dosing And Prevention of Transfusions Trial. Acta Haematol 2024:1-12. [PMID: 38824918 DOI: 10.1159/000539541] [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: 02/08/2024] [Accepted: 05/22/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION People with sickle cell anemia (SCA) may require frequent blood transfusions to treat acute and chronic complications. Hydroxyurea is a life-saving treatment for SCA that could also decrease the need for blood transfusions. Inadequate medication access and challenges in dose optimization limit the widespread use of hydroxyurea in Africa. If feasible, pharmacokinetic (PK) dosing might improve dose determination to minimize toxicities and maximize clinical benefits. The Alternative Dosing And Prevention of Transfusions (ADAPT, NCT05662098) trial will analyze the impact of hydroxyurea on transfusion rate and serve as a pilot study to evaluate the feasibility of PK-guided hydroxyurea dosing in Uganda. METHODS Herein we describe the rationale and design of ADAPT, a prospective cohort study of ∼100 children with SCA in Jinja, Uganda. The primary hypothesis is that hydroxyurea will decrease blood transfusion use by ≥ 50%, comparing the transfusion incidence rate ratio between a 3-month pretreatment and a 12-month treatment period. A key secondary hypothesis is that our PK-dosing approach will generate a suitable hydroxyurea dose for ≥80% of participants. Every ADAPT participant will undergo hydroxyurea PK testing, and if a dose is generated within 15-35 mg/kg/day, participants will start on their individualized dose. If not, they will start on a default dose of 20 mg/kg/day. Hydroxyurea dose optimization will occur with periodic dose adjustments. CONCLUSION Overall, demonstrating the reduction in blood transfusion utilization with hydroxyurea treatment would provide leverage to increase hydroxyurea access, and PK-guided hydroxyurea dosing should optimize the safe and effective treatment of SCA across sub-Saharan Africa.
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Affiliation(s)
- Alexandra Power-Hays
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ruth Namazzi
- Global Health Uganda, Kampala, Uganda
- Makerere University, Kampala, Uganda
| | | | | | - Andrea L Conroy
- Global Health Uganda, Kampala, Uganda
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Heather Hume
- Division of Hematology/Oncology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Chandy John
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Sara M O'Hara
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Susan E Stuber
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adam Lane
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Teresa S Latham
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Russell E Ware
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Kazadi C, Ducruet T, Forté S, Robitaille N, Pastore Y. Positive impacts of universal newborn screening on the outcome of children with sickle cell disease in the province of Quebec: A retrospective cohort study. EJHAEM 2024; 5:447-454. [PMID: 38895082 PMCID: PMC11182396 DOI: 10.1002/jha2.926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/28/2024] [Accepted: 05/01/2024] [Indexed: 06/21/2024]
Abstract
A universal newborn screening program for sickle cell disease (uNS-SCD) was implemented in the province of Québec (Qc) in November 2013, close in time to the recommendation of early initiation of hydroxyurea (HU) therapy for children. This retrospective cohort study evaluated the impact of such a program on children first seen between January 2000 and December 2019. Cohorts pre-SCD-uNS in Qc (pre-QcNS) (n = 253) and post-QcNS (n = 157) for patients seen prior to or after Nov 2013 were compared. Kaplan-Meier curves, Poisson regression, and logistic regressions were used for statistical analysis, using Software R version 4.2.1. Median age at first visit decreased significantly from 14.4 [interquartile range: 2.4-72.0] to 1.2 months [1.2-57.6] (p < 0.001). The percentage of children born in Qc undiagnosed at birth and referred after a first SCD-related complication dropped from 42.6% to 0.0% (p < 0.0001). The median age of HU introduction for patients with SS/Sβ°-thalassemia decreased from 56.4 [31.2-96.0] to 9.0 months post-QcNS [8.0-12.1] (p < 0.001). Event-free survival improved significantly for any type of hospitalization as well as for vaso-occlusive crisis (VOC) (140-257 days (p < 0.001) and 1320 vs. 573 days (p < 0.002), respectively), resulting in a reduction from 2 [interquartile range: 1.0-3.0] to 1.0 hospitalizations/patient-year [0.6-1.4] (p < 0.001). Children with SS/Sβ°-thalassemia referred post-QcNS also had fewer emergency department visits for VOC (RR: 0.69, 95% confidence interval: 0.54-0.88). The Universal NS program allows early detection and referral of children with SCD to comprehensive care centers. Earlier access ensures that children benefit from essential preventive interventions, reducing disease burden. This cohort study highlights that uNS-SCD is an essential public health measure.
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Affiliation(s)
- Costa Kazadi
- Department of PediatricsDivision of Hematology‐OncologyCentre Hospitalier Universitaire Sainte‐JustineMontrealCanada
- Department of MedicineDivision of Hematology‐OncologyCHUMMontrealCanada
| | - Thierry Ducruet
- Unité de Recherche Clinique Appliquée (URCA)Centre Hospitalier Universitaire Sainte‐Justine Research CenterMontrealCanada
| | - Stéphanie Forté
- Department of PediatricsDivision of Hematology‐OncologyCentre Hospitalier Universitaire Sainte‐JustineMontrealCanada
- Department of MedicineDivision of Hematology‐OncologyCHUMMontrealCanada
- Carrefour de l'InnovationCHUMMontrealCanada
| | - Nancy Robitaille
- Department of PediatricsDivision of Hematology‐OncologyCentre Hospitalier Universitaire Sainte‐JustineMontrealCanada
- University of MontréalMontrealCanada
- Hema‐QuebecTransfusion MedicineMontrealCanada
| | - Yves Pastore
- Department of PediatricsDivision of Hematology‐OncologyCentre Hospitalier Universitaire Sainte‐JustineMontrealCanada
- University of MontréalMontrealCanada
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15
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Zhou G, Mohammad A, Shan Y. Unexpected Death of a Sickle Cell Disease Patient: A Case Report and Literature Review. Cureus 2024; 16:e62645. [PMID: 39036104 PMCID: PMC11258939 DOI: 10.7759/cureus.62645] [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] [Received: 03/07/2024] [Accepted: 06/16/2024] [Indexed: 07/23/2024] Open
Abstract
Sickle cell disease (SCD) is an autosomal recessive genetic disorder characterized by the abnormal formation of sickle hemoglobin (HbS). Under conditions of deoxygenation, HbS undergoes polymerization, resulting in microvascular occlusion, tissue hypoxia, and infarction. The elevated mortality rate associated with SCD is primarily attributed to complications such as sepsis, acute chest syndrome, stroke, acute multiorgan failure, and pulmonary hypertension. Despite advancements in awareness and treatments, preventing mortality in young individuals with SCD remains a formidable challenge. In an effort to shed light on these challenges, we present a case of unexpected death associated with SCD to emphasize the pressing need for continued research and intervention strategies to improve patient outcomes.
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Affiliation(s)
- Gang Zhou
- Pathology, Baylor Scott & White Medical Center-Temple, Temple, USA
| | - Amin Mohammad
- Pathology, Baylor Scott & White Medical Center-Temple, Temple, USA
| | - Yuan Shan
- Pathology, Baylor Scott & White Medical Center-Temple, Temple, USA
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Bolarinwa AB, Oduwole O, Okebe J, Ogbenna AA, Otokiti OE, Olatinwo AT. Antioxidant supplementation for sickle cell disease. Cochrane Database Syst Rev 2024; 5:CD013590. [PMID: 38775255 PMCID: PMC11110109 DOI: 10.1002/14651858.cd013590.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Sickle cell disease (SCD) refers to a group of genetic disorders characterized by the presence of an abnormal haemoglobin molecule called haemoglobin S (HbS). When subjected to oxidative stress from low oxygen concentrations, HbS molecules form rigid polymers, giving the red cell the typical sickle shape. Antioxidants have been shown to reduce oxidative stress and improve outcomes in other diseases associated with oxidative stress. Therefore, it is important to review and synthesize the available evidence on the effect of antioxidants on the clinical outcomes of people with SCD. OBJECTIVES To assess the effectiveness and safety of antioxidant supplementation for improving health outcomes in people with SCD. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 15 August 2023. SELECTION CRITERIA We included randomized and quasi-randomized controlled trials comparing antioxidant supplementation to placebo, other antioxidants, or different doses of antioxidants, in people with SCD. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed the risk of bias and certainty of the evidence, and reported according to Cochrane methodological procedures. MAIN RESULTS The review included 1609 participants in 26 studies, with 17 comparisons. We rated 13 studies as having a high risk of bias overall, and 13 studies as having an unclear risk of bias overall due to study limitations. We used GRADE to rate the certainty of evidence. Only eight studies reported on our important outcomes at six months. Vitamin C (1400 mg) plus vitamin E (800 mg) versus placebo Based on evidence from one study in 83 participants, vitamin C (1400 mg) plus vitamin E (800 mg) may not be better than placebo at reducing the frequency of crisis (risk ratio (RR) 1.18, 95% confidence interval (CI) 0.64 to 2.18), the severity of pain (RR 1.33, 95% CI 0.40 to 4.37), or adverse effects (AE), of which the most common were headache, nausea, fatigue, diarrhoea, and epigastric pain (RR 0.56, 95% CI 0.31 to 1.00). Vitamin C plus vitamin E may increase the risk of SCD-related complications (acute chest syndrome: RR 2.66, 95% CI 0.77 to 9.13; 1 study, 83 participants), and increase haemoglobin level (median (interquartile range) 90 (81 to 96) g/L versus 93.5 (84 to 105) g/L) (1 study, 83 participants) compared to placebo. However, the evidence for all the above effects is very uncertain. The study did not report on quality of life (QoL) of participants and their caregivers, nor on frequency of hospitalization. Zinc versus placebo Zinc may not be better than placebo at reducing the frequency of crisis at six months (rate ratio 0.62, 95% CI 0.17 to 2.29; 1 study, 36 participants; low-certainty evidence). We are uncertain whether zinc is better than placebo at improving sickle cell-related complications (complete healing of leg ulcers at six months: RR 2.00, 95% CI 0.60 to 6.72; 1 study, 34 participants; very low-certainty evidence). Zinc may be better than placebo at increasing haemoglobin level (g/dL) (MD 1.26, 95% CI 0.44 to 1.26; 1 study, 36 participants; low-certainty evidence). The study did not report on severity of pain, QoL, AE, and frequency of hospitalization. N-acetylcysteine versus placebo N-acetylcysteine (NAC) 1200 mg may not be better than placebo at reducing the frequency of crisis in SCD, reported as pain days (rate ratio 0.99 days, 95% CI 0.53 to 1.84; 1 study, 96 participants; low-certainty evidence). Low-certainty evidence from one study (96 participants) suggests NAC (1200 mg) may not be better than placebo at reducing the severity of pain (MD 0.17, 95% CI -0.53 to 0.87). Compared to placebo, NAC (1200 mg) may not be better at improving physical QoL (MD -1.80, 95% CI -5.01 to 1.41) and mental QoL (MD 2.00, 95% CI -1.45 to 5.45; very low-certainty evidence), reducing the risk of adverse effects (gastrointestinal complaints, pruritus, or rash) (RR 0.92, 95% CI 0.75 to 1.14; low-certainty evidence), reducing the frequency of hospitalizations (rate ratio 0.98, 95% CI 0.41 to 2.38; low-certainty evidence), and sickle cell-related complications (RR 5.00, 95% CI 0.25 to 101.48; very low-certainty evidence), or increasing haemoglobin level (MD -0.18 g/dL, 95% CI -0.40 to 0.04; low-certainty evidence). L-arginine versus placebo L-arginine may not be better than placebo at reducing the frequency of crisis (monthly pain) (RR 0.71, 95% CI 0.26 to 1.95; 1 study, 50 participants; low-certainty evidence). However, L-arginine may be better than placebo at reducing the severity of pain (MD -1.41, 95% CI -1.65 to -1.18; 2 studies, 125 participants; low-certainty evidence). One participant allocated to L-arginine developed hives during infusion of L-arginine, another experienced acute clinical deterioration, and a participant in the placebo group had clinically relevant increases in liver function enzymes. The evidence is very uncertain whether L-arginine is better at reducing the mean number of days in hospital compared to placebo (MD -0.85 days, 95% CI -1.87 to 0.17; 2 studies, 125 participants; very low-certainty evidence). Also, L-arginine may not be better than placebo at increasing haemoglobin level (MD 0.4 g/dL, 95% CI -0.50 to 1.3; 2 studies, 106 participants; low-certainty evidence). No study in this comparison reported on QoL and sickle cell-related complications. Omega-3 versus placebo Very low-certainty evidence shows no evidence of a difference in the risk of adverse effects of omega-3 compared to placebo (RR 1.05, 95% CI 0.74 to 1.48; 1 study, 67 participants). Very low-certainty evidence suggests that omega-3 may not be better than placebo at increasing haemoglobin level (MD 0.36 g/L, 95% CI -0.21 to 0.93; 1 study, 67 participants). The study did not report on frequency of crisis, severity of pain, QoL, frequency of hospitalization, and sickle cell-related complications. AUTHORS' CONCLUSIONS There was inconsistent evidence on all outcomes to draw conclusions on the beneficial and harmful effects of antioxidants. However, L-arginine may be better than placebo at reducing the severity of pain at six months, and zinc may be better than placebo at increasing haemoglobin level. We are uncertain whether other antioxidants are beneficial for SCD. Larger studies conducted on each comparison would reduce the current uncertainties.
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Affiliation(s)
- Abiola B Bolarinwa
- Department of Haematology & Blood Transfusion Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olabisi Oduwole
- Department of Medical Laboratory Science, Achievers University, Owo, Nigeria
| | - Joseph Okebe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ann A Ogbenna
- Department of Haematology & Blood Transfusion Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Oluwakemi E Otokiti
- Department of Haematology & Blood Transfusion Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adejoke T Olatinwo
- Department of Haematology & Blood Transfusion Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
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Chatio ST, Duah E, Ababio LO, Lister N, Egbujo O, Marfo K, Aborigo R, Ansah P, Odame I. Barriers and facilitators to community acceptability of integrating point-of-care testing to screen for sickle cell disease in children in primary healthcare settings in rural Upper East Region of Northern Ghana. PLoS One 2024; 19:e0303520. [PMID: 38768171 PMCID: PMC11104616 DOI: 10.1371/journal.pone.0303520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 04/25/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) remains a public health problem especially in sub-Saharan Africa including Ghana. While pilot initiatives in Africa have demonstrated that neonatal screening coupled with early intervention reduces SCD-related morbidity and mortality, only 50-70% of screen-positive babies have been successfully retrieved to benefit from these interventions. Point-of-care testing (POCT) with high specificity and sensitivity for SCD screening can be integrated into existing immunization programs in Africa to improve retrieval rates. This study explored community acceptability of integrating POCT to screen for SCD in children under 5 years of age in primary healthcare facilities in Northern Ghana. METHOD This was an exploratory study using qualitative research approach where 10 focus group discussions and 20 in-depth interviews were conducted with community members and health workers between April and June 2022. The recorded interviews were transcribed verbatim after repeatedly listening to the recordings. Data was coded into themes using QSR Nvivo 12 software before thematic analysis. RESULTS Most participants (70.9%) described SCD as serious and potentially life-threatening condition affecting children in the area. Of 148 community members and health workers, 141 (95.2%) said the screening exercise could facilitate diagnosis of SCD in children for early management. However, discrimination, fear of being tested positive, stigmatization, negative health worker attitude linked with issues of maintaining confidentiality were reported by participants as key factors that could affect uptake of the SCD screening exercise. Most participants suggested that intensive health education (78.3%), positive attitude of health workers (69.5%), and screening health workers not being biased (58.8%) could promote community acceptability. CONCLUSION A large majority of participants viewed screening of SCD in children as very important. However, opinions expressed by most participants suggest that health education and professionalism of health workers in keeping patients' information confidential could improve the uptake of the exercise.
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Affiliation(s)
| | - Enyonam Duah
- Navrongo Health Research Center, Navrongo, Ghana
| | | | - Nicola Lister
- Global Health & Sustainability, Novartis Pharma AG, Basel, Switzerland
| | - Olufolake Egbujo
- Global Health & Sustainability, Novartis Pharma AG, Basel, Switzerland
| | - Kwaku Marfo
- Global Health & Sustainability, Novartis Pharma AG, Basel, Switzerland
| | | | | | - Isaac Odame
- Hemoglobinopathy Program, The Hospital For Sick Children, University of Toronto, Toronto, ON, Canada
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18
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Mano RM, Kuona P, Misihairabgwi JM. Determination of birth prevalence of sickle cell disease using point of care test HemotypeSC™ at Rundu Hospital, Namibia. BMC Pediatr 2024; 24:323. [PMID: 38730340 PMCID: PMC11084002 DOI: 10.1186/s12887-024-04805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD), a noncommunicable disease, has the greatest burden in sub-Saharan Africa. The majority of children (50-90%) with SCD die before their 5th birthday, with approximately 150,000-300,000 annual SCD child deaths in Africa. In developed countries, newborn screening (NBS) has been shown to improve the survival of children with sickle cell disease, with under5 childhood mortality reduced tenfold due to interventions performed before the development of complications. Point -of-care tests have been developed for resource limited settings to expand NBS. The aim of this study was to determine the birth prevalence of sickle cell disease in Namibia using the HemoTypeSC™ point-of-care test. METHODS A cross-sectional descriptive study was carried out at Rundu Intermediate Hospital in the Kavango East Region. Two hundred and two (202) well newborns within 72 h of birth were recruited for the study from 22 February to the 23th March 2023. Descriptive statistics were used to compute the haemoglobin types of the study participants. RESULTS The majority of the participants (n = 105, 52%) were females, and (n = 97,48%) were males. The median age of the participants was 23 h (Q1, Q3; 11; 33),) with an age range of 2-98 h. Sickle cell trait was present in 9.4% of the screened newborns, no homozygous disease was detected, and 90.6% had Hb AA. CONCLUSIONS This study is the first to measure HbS gene carriage at birth using HemotypeSC point-of-care testing in Namibia. There was a moderate prevalence of sickle cell traits but no SCD. This baseline study may provide the foundation for larger epidemiological surveys to map HbS gene carriage in Namibia to provide evidence for policy makers to fashion appropriate SCD newborn screening services.
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Affiliation(s)
- Runyararo Mashingaidze Mano
- Department of Maternal & Child Health, Division of Paediatrics, School of Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia Hage Geingob Campus, Bach Street, Windhoek, Namibia.
| | - Patience Kuona
- Department of Child, Adolescent and Women's Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jane Masiiwa Misihairabgwi
- Department of Human, Biological and Translational Medical Sciences, School of Medicine, University of Namibia Faculty of Health Sciences & Veterinary Medicine, Windhoek, Namibia
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19
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Munung NS, Nnodu OE, Moru PO, Kalu AA, Impouma B, Treadwell MJ, Wonkam A. Looking ahead: ethical and social challenges of somatic gene therapy for sickle cell disease in Africa. Gene Ther 2024; 31:202-208. [PMID: 38012299 PMCID: PMC11090833 DOI: 10.1038/s41434-023-00429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
Somatic gene therapy will be one of the most exciting practices of genetic medicine in Africa and is primed to offer a "new life" for persons living with sickle cell disease (SCD). Recently, successful gene therapy trials for SCD in the USA have sparked a ray of hope within the SCD community in Africa. However, the high cost, estimated to exceed 1.5 million USD, continues to be a major concern for many stakeholders. While affordability is a key global health equity consideration, it is equally important to reflect on other ethical, legal and social issues (ELSIs) that may impact the responsible implementation of gene therapy for SCD in Africa. These include informed consent comprehension, risk of therapeutic misestimation and optimistic bias; priorities for SCD therapy trials; dearth of ethical and regulatory oversight for gene therapy in many African countries; identifying a favourable risk-benefit ratio; criteria for the selection of trial participants; decisional conflict in consent; standards of care; bounded justice; and genetic tourism. Given these ELSIs, we suggest that researchers, pharma, funders, global health agencies, ethics committees, science councils and SCD patient support/advocacy groups should work together to co-develop: (1) patient-centric governance for gene therapy in Africa, (2) public engagement and education materials, and (3) decision making toolkits for trial participants. It is also critical to establish harmonised ethical and regulatory frameworks for gene therapy in Africa, and for global health agencies to accelerate access to basic care for SCD in Africa, while simultaneously strengthening capacity for gene therapy.
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Affiliation(s)
- Nchangwi Syntia Munung
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Obiageli E Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training (CESRTA), University of Abuja, Abuja, Nigeria
| | - Patrick Ohiani Moru
- Centre of Excellence for Sickle Cell Disease Research and Training (CESRTA), University of Abuja, Abuja, Nigeria
| | - Akpaka A Kalu
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Benido Impouma
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Marsha J Treadwell
- Department of Pediatrics, Division of Hematology, University of California San Francisco, Oakland, CA, USA
| | - Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- McKusick-Nathans Institute & Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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20
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Alshahrani NZ, Algethami MR. The effectiveness of hematopoietic stem cell transplantation in treating pediatric sickle cell disease: Systematic review and meta-analysis. Saudi Pharm J 2024; 32:102049. [PMID: 38571765 PMCID: PMC10988128 DOI: 10.1016/j.jsps.2024.102049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Background Patients with sickle cell disease (SCD) have just one recognized curative therapy option: hematopoietic stem cell transplantation (HSCT), which results in a long-lasting improvement in the clinical phenotype. Here, we assessed the effectiveness of HSCT in treating children with SCD by a systematic review and meta-analysis. Methods Up until January 2024, a comprehensive search was done using Web of Science, CINAHL, Embase, Google Scholar, Cochrane Library, PubMed/Medline, and Embase. Two reviewers worked separately to extract the data, and Newcastle-Ottawa Quality Assessment tool was used to assess the research's quality. The outcomes analyzed were Overall survival (OS), event-free survival (EFS), graft failure (GF) and mortality. Results Nineteen papers satisfied our inclusion requirements and were assessed to be of fair quality. The pooled rate of OS was high (92%; 95% CI: 90.3%-93.5%). Similar finding was detected for EFS (85.8%; 95% CI: 83.7%-87.7%). In the other hand, pooled rates of GF and mortality were 6.9% (95% CI: 5.3%-8.9%) and 7.4% (95% CI: 5%-10.7%), respectively. A significant publication bias was detected for OS, EFS and GF outcomes. Subgroups analysis showed that study design was the major source of heterogeneity. Conclusion Our results show that HSCT is effective and safe, with pooled survival rates above 90%. It is important to assess innovative tactics in light of the alarming GF and mortality rates.
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Affiliation(s)
- Najim Z. Alshahrani
- Department of Family and Community Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Mohammed R. Algethami
- Department of Family and Community Medicine, University of Jeddah, Jeddah, Saudi Arabia
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21
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Abdu Y, Rahhal A, Ahmed K, Adli N, Abdou M, Ali EAH, Al-Kindi S, Al Rasheed M, Altooq J, Bougmiza I, Yassin MA. The role of preoperative transfusion in sickle cell disease, a systematic review and meta-analysis. Blood Rev 2024; 65:101183. [PMID: 38388223 DOI: 10.1016/j.blre.2024.101183] [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: 09/30/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024]
Abstract
This systematic review and meta-analysis aimed to provide guidance on preoperative blood transfusion strategies for patients with sickle cell disease (SCD). We included all randomized controlled and observational studies exploring the clinical outcomes of preoperative blood transfusion among patients with SCD compared to the conservative transfusion strategy until 14/09/2022. Sixteen studies involving 3486 participants were analysed. The findings revealed a significantly higher bleeding rate in patients who received preoperative transfusion than those who followed a conservative strategy (RR = 4.32, 95% CI 1.75-10.68, P = 0.002, I2 = 0%). However, the two strategies had no significant differences in other clinical outcomes, such as acute chest syndrome, painful crisis, fever, neurological complications, thrombosis, ICU admission, and mortality. It is important to note that all the included studies had a moderate risk of bias. Preoperative transfusion in SCD was associated with a higher bleeding risk but a similar risk in other outcomes compared to conservative strategies. Notably, the increased bleeding risk observed seldom had clinical significance. We recommend individualizing management strategies, considering the overall positive impact of transfusions in reducing complications. Further high-quality studies are needed to refine recommendations.
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Affiliation(s)
- Yasamin Abdu
- Department of Community Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Alaa Rahhal
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Ahmed
- Department of Haematology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation trust, Sheffield, UK
| | - Nada Adli
- Department of Community Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mariam Abdou
- Department of Community Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Salam Al-Kindi
- Department of Haematology, Sultan Qaboos University, Muscat, Oman.
| | | | - Jaffer Altooq
- Department of Internal Medicine, Bahrain Salmania Hospital, Manama, Bahrain
| | - Iheb Bougmiza
- Department of Community Medicine, Primary Health Care Corporation, Doha, Qatar; Faculty of Medicine, Sousse University, Sousse, Tunisia.
| | - Mohamed A Yassin
- Department of Haematology, NCCCR, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar
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Kaponda A, Muya K, Panda J, Koto KK, Bonnechère B. Unraveling the Complexity of Vaso-Occlusive Crises in Sickle Cell Disease: Insights from a Resource-Limited Setting. J Clin Med 2024; 13:2528. [PMID: 38731057 PMCID: PMC11084179 DOI: 10.3390/jcm13092528] [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: 04/05/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: This study investigated vaso-occlusive crises (VOCs) in sickle cell disease in Lubumbashi, Democratic Republic of Congo, aiming to understand the disease complexities amidst limited resources. With sickle cell hemoglobinopathies on the rise in sub-Saharan Africa, this nine-year study explored factors associated with VOCs and hematological components. Methods: This study comprised 838 patients, analyzing VOCs and hematological changes over time. Demographic characteristics and blood composition changes were carefully categorized. A total of 2910 crises were observed and managed, with analyses conducted on severity, localization, and age groups using statistical methods. Results: The majority of crises were mild or moderate, primarily affecting osteoarticular regions. Statistical analysis revealed significant disparities in crisis intensity based on location and age. The association between blood samples and the number of comorbidities was investigated. Significant positive associations were found for all parameters, except monocytes, indicating a potential link between blood variables and complication burden. Survival analysis using Cox regression was performed to predict the probability of experiencing a second crisis. No significant effects of medication or localization were observed. However, intensity (p < 0.001), age (p < 0.001), and gender (p < 0.001) showed significant effects. Adjusted Hazard Ratios indicated increased risk with age and male gender and reduced risk with mild or severe crisis intensity compared to light. Conclusions: This research sheds light on the complexities of VOCs in resource-limited settings where sickle cell disease is prevalent. The intricate interplay between clinical, laboratory, and treatment factors is highlighted, offering insights for improved patient care. It aims to raise awareness of patient challenges and provide valuable information for targeted interventions to alleviate their burden.
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Affiliation(s)
- Ali Kaponda
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi 1825, Democratic Republic of the Congo; (A.K.); (J.P.)
- Department of Clinical Biology, Faculty of Pharmaceutical Sciences, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo
| | - Kalunga Muya
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo;
| | - Jules Panda
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi 1825, Democratic Republic of the Congo; (A.K.); (J.P.)
- Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo
| | - Kodondi Kule Koto
- Department of Clinical Biology, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa 2212, Democratic Republic of the Congo;
| | - Bruno Bonnechère
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, 3590 Hasselt, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, University of Hasselt, 3590 Hasselt, Belgium
- Department of PXL—Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium
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23
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Ginete C, Delgadinho M, Santos B, Miranda A, Silva C, Guerreiro P, Chimusa ER, Brito M. Genetic Modifiers of Sickle Cell Anemia Phenotype in a Cohort of Angolan Children. Genes (Basel) 2024; 15:469. [PMID: 38674403 PMCID: PMC11049512 DOI: 10.3390/genes15040469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
The aim of this study was to identify genetic markers in the HBB Cluster; HBS1L-MYB intergenic region; and BCL11A, KLF1, FOX3, and ZBTB7A genes associated with the heterogeneous phenotypes of Sickle Cell Anemia (SCA) using next-generation sequencing, as well as to assess their influence and prevalence in an Angolan population. Hematological, biochemical, and clinical data were considered to determine patients' severity phenotypes. Samples from 192 patients were sequenced, and 5,019,378 variants of high quality were registered. A catalog of candidate modifier genes that clustered in pathophysiological pathways important for SCA was generated, and candidate genes associated with increasing vaso-occlusive crises (VOC) and with lower fetal hemoglobin (HbF) were identified. These data support the polygenic view of the genetic architecture of SCA phenotypic variability. Two single nucleotide polymorphisms in the intronic region of 2q16.1, harboring the BCL11A gene, are genome-wide and significantly associated with decreasing HbF. A set of variants was identified to nominally be associated with increasing VOC and are potential genetic modifiers harboring phenotypic variation among patients. To the best of our knowledge, this is the first investigation of clinical variation in SCA in Angola using a well-customized and targeted sequencing approach.
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Affiliation(s)
- Catarina Ginete
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal; (C.G.); (M.D.); (C.S.); (P.G.)
| | - Mariana Delgadinho
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal; (C.G.); (M.D.); (C.S.); (P.G.)
| | - Brígida Santos
- Centro de Investigação em Saúde de Angola (CISA), Bengo 9999, Angola;
- Hospital Pediátrico David Bernardino (HPDB), Luanda 3067, Angola
| | - Armandina Miranda
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), 1649-016 Lisbon, Portugal;
| | - Carina Silva
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal; (C.G.); (M.D.); (C.S.); (P.G.)
- Centro de Estatística e Aplicações, Universidade de Lisboa, 1649-013 Lisbon, Portugal
| | - Paulo Guerreiro
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal; (C.G.); (M.D.); (C.S.); (P.G.)
| | - Emile R. Chimusa
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Miguel Brito
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal; (C.G.); (M.D.); (C.S.); (P.G.)
- Centro de Investigação em Saúde de Angola (CISA), Bengo 9999, Angola;
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24
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Condé M, Lespessailles E, Wanneveich M, Allemandou D, Boulain T, Dimitrov G. Effect of nutritional supplementation on bone mineral density in children with sickle cell disease: protocol for an open-label, randomised controlled clinical trial. BMJ Open 2024; 14:e080235. [PMID: 38580373 PMCID: PMC11002356 DOI: 10.1136/bmjopen-2023-080235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/16/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Children with sickle cell disease show a significant decrease in bone mineral density, an increase in resting energy expenditure of more than 15%, a decrease in fat and lean mass as well as a significant increase in protein turnover, particularly in bone tissue. This study aims to evaluate the effectiveness of an increase in food intake on bone mineral density and the clinical and biological complications of paediatric sickle cell disease. METHODS AND ANALYSIS The study is designed as an open-label randomised controlled clinical trial conducted in the Paediatrics Unit of the Orléans University Hospital Centre. Participants aged 3-16 years will be randomly divided into two groups: the intervention group will receive oral nutritional supplements (pharmacological nutritional hypercaloric products) while the control group will receive age-appropriate and gender-appropriate nutritional intake during 12 months. Total body less head bone mineral density will be measured at the beginning and the end of the trial. A rigorous nutritional follow-up by weekly 24 hours recall dietary assessment and planned contacts every 6 weeks will be carried out throughout the study. A school absenteeism questionnaire, intended to reflect the patient's school productivity, will be completed by participants and parents every 3 months. Blood samples of each patient of both groups will be stocked at the beginning and at the end of the trial, for future biological trial. Clinical and biological complications will be regularly monitored. ETHICS AND DISSEMINATION The protocol has been approved by the French ethics committee (Comité de Protection des Personnes Sud-Ouest et Outre-Mer 2, Toulouse; approval no: 2-20-092 id9534). Children and their parents will give informed consent to participate in the study before taking part. Results will be disseminated through peer-reviewed journals or international academic conferences. TRIAL REGISTRATION NUMBER NCT04754711.
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Affiliation(s)
- Mohamed Condé
- Paediatrics, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Mathilde Wanneveich
- Statistics Department, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Delphine Allemandou
- Nutrition Department, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Thierry Boulain
- Medical Intensive Care Unit, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Georges Dimitrov
- Paediatrics, Centre Hospitalier Régional d'Orléans, Orleans, France
- Paediatric Surgery, Centre Hospitalier Régional d'Orléans, Orléans, France
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25
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Gordeuk VR. Glad tidings and joy for children with SCA. Blood 2024; 143:1326-1327. [PMID: 38573609 DOI: 10.1182/blood.2023023688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
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26
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Namazzi R, Bond C, Conroy AL, Datta D, Tagoola A, Goings MJ, Jang JH, Ware RE, Opoka R, John CC. Hydroxyurea reduces infections in children with sickle cell anemia in Uganda. Blood 2024; 143:1425-1428. [PMID: 38169476 PMCID: PMC11033589 DOI: 10.1182/blood.2023021575] [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: 06/21/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
ABSTRACT After starting hydroxyurea treatment, Ugandan children with sickle cell anemia had 60% fewer severe or invasive infections, including malaria, bacteremia, respiratory tract infections, and gastroenteritis, than before starting hydroxyurea treatment (incidence rate ratio, 0.40 [95% confidence interval, 0.29-0.54]; P < .001).
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Affiliation(s)
- Ruth Namazzi
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
| | - Caitlin Bond
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Andrea L. Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Dibyadyuti Datta
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Abner Tagoola
- Department of Pediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Michael J. Goings
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Jeong Hoon Jang
- Underwood International College and Department of Applied Statistics, Yonsei University, Seoul, Korea
| | - Russell E. Ware
- Division of Hematology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Chandy C. John
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
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Junqueira Fleury Silva P, Martins Silva C, Machado de Campos B, de Melo Campos P, de Souza Medina S, Lamonica A, Coimbra Trindade JV, Cendes F, Costa FF, Olalla Saad ST, Deltreggia Benites B. Montreal cognitive assessment in Brazilian adults with sickle cell disease: The burdens of poor sociocultural background. EJHAEM 2024; 5:308-315. [PMID: 38633117 PMCID: PMC11020111 DOI: 10.1002/jha2.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 04/19/2024]
Abstract
Sickle cell disease (SCD) patients are at higher risk of developing silent cerebral infarcts and overt stroke, which may reflect cognitive impairment, functional limitations, and worse quality of life. The cognitive function of Brazilian adult SCD patients (n = 124; 19-70 years; 56 men; 79 SS, 28 SC, 10 S/β0, 7 S/β+) was screened through Montreal Cognitive Assessment (MoCA) and correlated the results with possible predictive factors for test performance, including sociocultural, clinical, laboratory data and brain imaging. The Median MoCA score was 23 (8-30); 70% had a 25-or-less score, suggesting some level of cognitive impairment. There were no significant associations between MoCA results and any clinical or laboratory data in SS and SC patients; however, a significant correlation (P = 0.03) with stroke was found in HbS/β-thalassemic patients. Correlations were further detected according to sociodemographic conditions, such as age (r = -0.316; P < 0.001), age at first job (r = 0.221; P = 0.018), personal (r = 0.23; P = 0.012) and per capita familiar incomes (r = 0.303; P = 0.001), personal (r = 0.61; P = 0), maternal (r = 0.536; P = 0), and paternal educational status (r = 0.441; P = 0). We further sought independent predictors of performance using multivariable regressions and increased education was an independent predictor of better scores in MoCA (0.8099, 95% confidence interval [CI]: 0.509-1.111). Brain imaging analysis showed significant and progressive atrophy in important cerebral areas related to memory, learning, and executive function. These data point to the high prevalence and impact of cognitive decline in adult SCD patients, mirrored in brain atrophic areas. It is also possible to observe the influence of sociodemographic conditions on patients' cognitive performances and the need for creating focused therapeutic plans that address these deficiencies. Moreover, the absence of a significant correlation of MoCA values with stroke in the SS and SC groups may be related to the worst sociocultural and economic conditions of the Brazilian African descent population, in which the impact of low educational stimulation on cognitive function can outweigh even the anatomical damage caused by the disease.
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Affiliation(s)
| | - Caroline Martins Silva
- Hematology and Transfusion Medicine CenterUniversity of Campinas (UNICAMP)CampinasBrazil
| | | | - Paula de Melo Campos
- Hematology and Transfusion Medicine CenterUniversity of Campinas (UNICAMP)CampinasBrazil
| | - Samuel de Souza Medina
- Hematology and Transfusion Medicine CenterUniversity of Campinas (UNICAMP)CampinasBrazil
| | - Andreza Lamonica
- Hematology and Transfusion Medicine CenterUniversity of Campinas (UNICAMP)CampinasBrazil
| | | | - Fernando Cendes
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas (UNICAMP)CampinasBrazil
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Heitzer AM, MacArthur E, Tamboli M, Wilson A, Hankins JS, Hoyt CR. Awareness, access, and communication: provider perspectives on early intervention services for children with sickle cell disease. Front Pediatr 2024; 12:1366522. [PMID: 38590772 PMCID: PMC11000123 DOI: 10.3389/fped.2024.1366522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose This study aimed to identify determinants influencing the utilization of early intervention services among young children with sickle cell disease (SCD) based on perspectives from medical and early intervention providers. Design and methods Early intervention and medical providers from the catchment area surrounding St. Jude Children's Research Hospital and Washington University were recruited (20 total providers). Interviews were completed over the phone and audio recorded. All interviews were transcribed verbatim, coded, and analyzed using inductive thematic analysis. Results Three overarching themes were identified from both groups: Awareness (e.g., lack of awareness about the EI system and SCD), Access (e.g., difficulties accessing services), and Communication (e.g., limited communication between medical and early intervention providers, and between providers and families). Although these three themes were shared by medical and early intervention providers, the differing perspectives of each produced subthemes unique to the two professional fields. Conclusions Early intervention services can limit the neurodevelopmental deficits experienced by young children with SCD; however, most children with SCD do not receive these services. The perspectives of early intervention and medical providers highlight several potential solutions to increase early intervention utilization among young children with SCD.
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Affiliation(s)
- Andrew M. Heitzer
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Erin MacArthur
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Mollie Tamboli
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Ashley Wilson
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, United States
| | - Jane S. Hankins
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Catherine R. Hoyt
- Program in Occupational Therapy, Departments of Neurology and Pediatrics, Washington University in St. Louis, St. Louis, MO, United States
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Laurent-Lacroix C, Vincenti M, Matecki S, Mahé P, Moulis L, De La Villeon G, Guillaumont S, Requirand A, Moreau J, Lalande M, Picot MC, Amedro P, Gavotto A. Aerobic physical capacity and health-related quality of life in children with sickle cell disease. Pediatr Res 2024:10.1038/s41390-024-03143-1. [PMID: 38491141 DOI: 10.1038/s41390-024-03143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Aerobic fitness is a predictor of cardiovascular health which correlates with health-related quality of life in the general population. The aim is to evaluate the aerobic capacity by cardiopulmonary exercise test (CPET) in children with sickle cell disease in comparison with healthy matched controls. METHODS Controlled cross-sectional study. RESULTS A total of 72 children (24 with sickle cell disease and 48 healthy controls), aged 6-17 years old were enrolled. Children with sickle cell disease had a poor aerobic capacity, with median VO2max Z-score values significantly lower than matched controls (-3.55[-4.68; -2.02] vs. 0.25[-0.22; 0.66], P < 0.01, respectively), and a high proportion of 92% children affected by an impaired aerobic capacity (VO2max Z-score < -1.64). The VO2max decrease was associated with the level of anemia, the existence of a homozygote HbS/S mutation, restrictive lung disease and health-related quality of life. CONCLUSION Aerobic capacity is poor in children with sickle cell disease. VO2max decrease is associated with the level of anemia, the existence of a homozygote HbS/S mutation, lung function, and health-related quality of life. These results represent a signal in favor of early initiation of cardiac rehabilitation in patients with sickle cell disease. CLINICAL TRIALS NCT05995743. IMPACT Aerobic fitness is a predictor of cardiovascular health which correlates with health-related quality of life in the general population. Aerobic capacity (VO2max) is poor in children with sickle cell disease, despite the absence of any pattern of heart failure. VO2max decrease was associated with the level of anemia, the existence of a homozygote HbS/S mutation, restrictive lung disease, and health-related quality of life. These results are in favor of early initiation of cardiac rehabilitation in children with sickle cell disease.
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Affiliation(s)
- Corentin Laurent-Lacroix
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Marie Vincenti
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Stefan Matecki
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Pediatric Functional Exploration Laboratory, Physiology Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Perrine Mahé
- Pediatric Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Reference Center on Rare Red Cell Disorders, Montpellier University Hospital, 34000, Montpellier, France
| | - Lionel Moulis
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, 34000, Montpellier, France
| | - Gregoire De La Villeon
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, 371 Avenue de l'Évêché de Maguelone, 34250, Palavas-Les-Flots, France
| | - Sophie Guillaumont
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, 371 Avenue de l'Évêché de Maguelone, 34250, Palavas-Les-Flots, France
| | - Anne Requirand
- Pediatric Functional Exploration Laboratory, Physiology Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Johan Moreau
- Pediatric Functional Exploration Laboratory, Physiology Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Department of Pediatric Pneumology, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Muriel Lalande
- Pediatric Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Reference Center on Rare Red Cell Disorders, Montpellier University Hospital, 34000, Montpellier, France
| | - Marie-Christine Picot
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, 34000, Montpellier, France
- Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, 34000, Montpellier, France
| | - Pascal Amedro
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 1 Avenue Magellan, 33604, Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Avenue du Haut Lévêque, 33600, Pessac, France
| | - Arthur Gavotto
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.
- Pediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.
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Kaçmaz M, İlhan G. A comparison of the mixed and sequential use of acetaminophen and dexketoprofen in painful vaso-occlusive crises. Eur J Clin Pharmacol 2024; 80:475-480. [PMID: 38245872 DOI: 10.1007/s00228-024-03630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/17/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE Opioids are widely used to treat painful vaso-occlusive crises (VOC) in sickle cell disease (SCD). However, due to opioids' significant adverse effect profiles, the search for alternative therapies continues from the past to the present. The study aimed to investigate the efficacy of acetaminophen and dexketoprofen in the treatment of painful VOC. METHODS This study is a single-center, prospective, non-randomized, single-blinded, controlled study. The study comprised two groups: the first administered acetaminophen and dexketoprofen mixed group, while the second received them sequential group. Opioids were used in patients with persistent pain despite these analgesics. Demographic and laboratory information, pain scores, opioid requirement, dose amount, side effects, and length of hospital stay of the patients were recorded. RESULTS The study comprised 56 (100%) patients with painful VOC, 29 (51.8%) from the mixed group, and 27 (48.2%) from the sequential group. Opioid use was seen in 16 (55.2%) patients in the mixed group and 21 (77.8%) patients in the sequential group (p = 0.074). The median amount of opioid used was significantly lower in the mixed group than in the sequential group (p < 0.001). Also, the median length of hospital stay was significantly lower in the mixed group than in the sequential group (p < 0.001). CONCLUSION Our study suggests that administering acetaminophen and dexketoprofen in the mix for the treatment of painful VOC in patients with SCD may be a more efficient approach compared to sequential administration. This approach appears to reduce opioid usage and shorten hospital stays.
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Affiliation(s)
- Murat Kaçmaz
- Department of Hematology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
| | - Gül İlhan
- Department of Hematology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
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Kumari A, Chauhan G, Chaudhuri PK, Kumari S, Prasad A. Genetic Variants Associated with the Risk of Stroke in Sickle Cell Anemia: Systematic Review and Meta-Analysis. Hemoglobin 2024; 48:101-112. [PMID: 38637280 DOI: 10.1080/03630269.2024.2340685] [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: 09/22/2023] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
Sickle cell anemia (SCA) is the most common cause of stroke in children. As it is a rare disease, studies investigating the association with complications like stroke in SCD have small sample sizes. Here, we performed a systematic review and meta-analysis of the studies exploring an association of genetic variants with stroke to get a better indication of their association with stroke. PubMed and Google Scholar were searched to identify studies that had performed an association analysis of genetic variants for the risk of stroke in SCA patients. After screening of eligible studies, summary statistics of association analysis with stroke and other general information were extracted. Meta-analysis was performed using the fixed effect method on the tool METAL and forest plots were plotted using the R program. The random effect model was performed as a sensitivity analysis for loci where significant heterogeneity was observed. 407 studies were identified using the search term and after screening 37 studies that cumulatively analyzed 11,373 SCA patients were included. These 37 studies included a total of 2,222 SCA patients with stroke, predominantly included individuals of African ancestry (N = 16). Three of these studies performed whole exome sequencing while 35 performed single nucleotide-based genotyping. Though the studies reported association with 132 loci, meta-analyses could be performed only for 12 loci that had data from two or more studies. After meta-analysis we observed that four loci were significantly associated with risk for stroke: -α3.7 kb Alpha-thalassemia deletion (P = 0.00000027), rs489347-TEK (P = 0.00081), rs2238432-ADCY9 (P = 0.00085), rs11853426-ANXA2 (P = 0.0034), and rs1800629-TNF (P = 0.0003396). Ethnic representation of regions with a high prevalence of SCD like the Mediterranean basin and India needs to be improved for genetic studies on associated complications like stroke. Larger genome-wide collaborative studies on SCD and associated complications including stroke need to be performed.
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Affiliation(s)
- Aradhana Kumari
- Department of Genetics and Genomics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Ganesh Chauhan
- Department of Genetics and Genomics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- Central Research Facility, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Partha Kumar Chaudhuri
- Department of Paediatrics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sushma Kumari
- Department of Transfusion Medicine and Blood Centre, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Anupa Prasad
- Department of Genetics and Genomics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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Sadaf A, Dong M, Pfeiffer A, Latham T, Kalfa T, Vinks AA, Ware RE, Quinn CT. A Population Pharmacokinetic Analysis of L-Glutamine Exposure in Patients with Sickle Cell Disease: Evaluation of Dose and Food Effects. Clin Pharmacokinet 2024; 63:357-365. [PMID: 38401036 PMCID: PMC10954986 DOI: 10.1007/s40262-024-01349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND AND OBJECTIVE L-Glutamine is a treatment for children and adults with sickle cell disease. A comprehensive evaluation of the pharmacokinetics of L-glutamine in sickle cell disease has not been conducted. We aimed to assess the effects of long-term dosing, multiple dose levels, and food intake on L-glutamine exposure in patients with sickle cell disease compared to normal participants. METHODS We conducted an open-label dose-ascending trial of L-glutamine in pediatric and adult participants with sickle cell disease (N = 8) and adult healthy volunteers (N = 4), providing a total of 400 plasma L-glutamine concentrations. Each participant received three ascending oral doses (0.1 and 0.3 g/kg twice daily and 0.6 g/kg once daily) over 3 weeks. Plasma L-glutamine concentrations were quantified using ion exchange chromatography. Both a non-compartmental pharmacokinetic analysis and a population pharmacokinetic analysis were performed. RESULTS L-glutamine had rapid absorption and elimination, and there was no significant change in the baseline (pre-dose) L-glutamine concentration throughout the study, indicating no drug accumulation. Pharmacokinetics was best described by a one-compartment model with first-order kinetics. The dose-normalized peak concentration decreased with dose escalation, indicating the capacity-limited non-linear pharmacokinetics of oral L-glutamine. A covariate analysis showed that baseline L-glutamine concentrations correlated negatively with glutamine clearance, whereas dose positively correlated with volume of distribution. Food intake did not significantly affect glutamine clearance, indicating that L-glutamine can be taken with or without food. CONCLUSIONS We report the first pharmacokinetic study of multiple-dose, long-term oral L-glutamine therapy and the first population pharmacokinetic analysis of L-glutamine for sickle cell disease. These findings may permit optimized dosing of L-glutamine for patients with sickle cell disease to maximize treatment benefits. CLINICAL TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov (NCT04684381).
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Affiliation(s)
- Alina Sadaf
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA
| | - Min Dong
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amanda Pfeiffer
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA
| | - Teresa Latham
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA
| | - Theodosia Kalfa
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alexander A Vinks
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Charles T Quinn
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Ogu UO, Mukhopadhyay A, Patel K, Nelson MN, Strahan KS, Wu L, Smeltzer MP, Ataga KI. Hydroxyurea at escalated dose versus fixed low-dose hydroxyurea in adults with sickle cell disease. Eur J Haematol 2024; 112:466-474. [PMID: 38019026 PMCID: PMC10922392 DOI: 10.1111/ejh.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023]
Abstract
Hydroxyurea reduces the frequency of vaso-occlusive complications, increases hemoglobin, and decreases mortality in sickle cell disease (SCD). Although current guidelines recommend escalation to maximum tolerated dose (MTD), the use of fixed low-dose hydroxyurea is common in low-resource countries. We conducted a systematic review and meta-analysis to evaluate the efficacy of escalated doses versus fixed low-dose of hydroxyurea in adults with SCD. Nine studies were included in the quantitative synthesis, four evaluating fixed low-dose and five evaluating escalated doses of hydroxyurea. Average daily doses of hydroxyurea in the fixed low-dose and escalated dose studies were ~10 and 22 mg/kg, respectively. There was no difference in the estimate of vaso-occlusive crisis rate between escalated and fixed low-dose studies (p = .73). The mean difference in hemoglobin from baseline to follow-up was greater for fixed low-dose than escalated dose studies (1.07 g/dL vs. 0.54 g/dL, p = .01). No difference was seen in the mean estimate of fetal hemoglobin. Despite limited eligible studies and substantial heterogeneity of effect between the studies for several outcomes, there appears to be clinical equipoise regarding the most appropriate hydroxyurea dosing regimen in adults with SCD. Controlled studies of hydroxyurea at MTD versus fixed low-dose in adults with SCD are required.
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Affiliation(s)
- Ugochi O. Ogu
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
| | - Ayesha Mukhopadhyay
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - Kruti Patel
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
| | - Marquita N. Nelson
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
| | - KayLee S. Strahan
- Northwest Campus Library, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Lin Wu
- Research and Learning Services, Health Science Library, University of Tennessee Health Science Center, Memphis, TN
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - Kenneth I. Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
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Locatelli F, Corbacioglu S, Hobbs W, Frangoul H, Walters MC. Defining curative endpoints for sickle cell disease in the era of gene therapy and gene editing. Am J Hematol 2024; 99:430-438. [PMID: 38010293 DOI: 10.1002/ajh.27164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
A growing number of gene therapy- and gene editing-based treatments for patients with sickle cell disease (SCD) are entering clinical trials. These treatments, designed to target the underlying cause of SCD, have the potential to provide functional cures, which until now were possible only through allogeneic hematopoietic stem cell transplant. However, as these novel approaches advance from early- to late-stage clinical trials, it is essential to identify physiologically and clinically relevant endpoints that can demonstrate the achievement of a functional cure for SCD. Here, we present an overview of the pathophysiology of SCD and current treatment options, review ongoing SCD clinical trials using gene therapy or gene editing approaches, and identify the most relevant endpoints for demonstrating the attainment of a functional cure for SCD.
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Affiliation(s)
- Franco Locatelli
- Catholic University of the Sacred Heart, Rome, Italy
- IRCCS, Ospedale Pediatrico Bambino, Gesù, Rome, Italy
| | | | - William Hobbs
- Vertex Pharmaceuticals Incorporated, Boston, Massachusetts, USA
| | - Haydar Frangoul
- Sarah Cannon Research Institute and The Children's Hospital at TriStar Centennial, Nashville, Tennessee, USA
| | - Mark C Walters
- Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
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Rarick KR, Li K, Teng RJ, Jing X, Martin DP, Xu H, Jones DW, Hogg N, Hillery CA, Garcia G, Day BW, Naylor S, Pritchard KA. Sterile inflammation induces vasculopathy and chronic lung injury in murine sickle cell disease. Free Radic Biol Med 2024; 215:112-126. [PMID: 38336101 PMCID: PMC11290318 DOI: 10.1016/j.freeradbiomed.2024.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/11/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Murine sickle cell disease (SCD) results in damage to multiple organs, likely mediated first by vasculopathy. While the mechanisms inducing vascular damage remain to be determined, nitric oxide bioavailability and sterile inflammation are both considered to play major roles in vasculopathy. Here, we investigate the effects of high mobility group box-1 (HMGB1), a pro-inflammatory damage-associated molecular pattern (DAMP) molecule on endothelial-dependent vasodilation and lung morphometrics, a structural index of damage in sickle (SS) mice. SS mice were treated with either phosphate-buffered saline (PBS), hE-HMGB1-BP, an hE dual-domain peptide that binds and removes HMGB1 from the circulation via the liver, 1-[4-(aminocarbonyl)-2-methylphenyl]-5-[4-(1H-imidazol-1-yl)phenyl]-1H-pyrrole-2-propanoic acid (N6022) or N-acetyl-lysyltyrosylcysteine amide (KYC) for three weeks. Human umbilical vein endothelial cells (HUVEC) were treated with recombinant HMGB1 (r-HMGB1), which increases S-nitrosoglutathione reductase (GSNOR) expression by ∼80%, demonstrating a direct effect of HMGB1 to increase GSNOR. Treatment of SS mice with hE-HMGB1-BP reduced plasma HMGB1 in SS mice to control levels and reduced GSNOR expression in facialis arteries isolated from SS mice by ∼20%. These changes were associated with improved endothelial-dependent vasodilation. Treatment of SS mice with N6022 also improved vasodilation in SS mice suggesting that targeting GSNOR also improves vasodilation. SCD decreased protein nitrosothiols (SNOs) and radial alveolar counts (RAC) and increased GSNOR expression and mean linear intercepts (MLI) in lungs from SS mice. The marked changes in pulmonary morphometrics and GSNOR expression throughout the lung parenchyma in SS mice were improved by treating with either hE-HMGB1-BP or KYC. These data demonstrate that murine SCD induces vasculopathy and chronic lung disease by an HMGB1- and GSNOR-dependent mechanism and suggest that HMGB1 and GSNOR might be effective therapeutic targets for reducing vasculopathy and chronic lung disease in humans with SCD.
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Affiliation(s)
- Kevin R Rarick
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, 53226, USA; Childrens' Research Institute, Children's Wisconsin, Milwaukee, WI, 53226, USA
| | - Keguo Li
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Ru-Jeng Teng
- Department of Pediatrics, Division of Neonatology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA; Childrens' Research Institute, Children's Wisconsin, Milwaukee, WI, 53226, USA
| | - Xigang Jing
- Department of Pediatrics, Division of Neonatology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Dustin P Martin
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Hao Xu
- Department of Medicine, Division of Endocrinology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Deron W Jones
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Neil Hogg
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Cheryl A Hillery
- Department of Pediatrics, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA; Department of Pediatrics, Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
| | - Guilherme Garcia
- Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | | | | | - Kirkwood A Pritchard
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA; ReNeuroGen LLC, Milwaukee, WI, 53122, USA; Childrens' Research Institute, Children's Wisconsin, Milwaukee, WI, 53226, USA.
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Kisali EP, Iversen PO, Makani J. Low vitamin B 12 blood levels in sickle cell disease: Data from a large cohort study in Tanzania. Br J Haematol 2024; 204:1047-1053. [PMID: 38087805 DOI: 10.1111/bjh.19265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 03/14/2024]
Abstract
Sickle cell disease (SCD) is associated with high rates of undernutrition and stunting. Undernutrition in combination with chronic haemolysis may lead to deficiencies in micronutrients necessary for erythropoiesis. Here we examined selected levels of ferritin, vitamins B2 , B6 , B9 and B12 , and vitamin C that were measured in blood samples from 820 SCD patients from Tanzania with no history of hospital admission, infections or painful episodes in the previous 30 days. We studied children (0-8 years), early adolescents (9-14 years), late adolescents (15-17 years) and adults (≥18 years). Severely low levels of vitamin B12 were observed across the four age groups. Despite the lowered vitamin B12 concentrations, total homocysteine concentrations were normal across both genders in all age groups. We found no significant gender-related differences between the other measured micronutrients. In this large SCD population, spanning the whole life cycle, a low level of vitamin B12 was consistently found across both genders and all age groups. Given the pivotal role of vitamin B12 in cellular metabolism, particularly in erythropoiesis, more studies are required to unravel how to better detect clinically relevant vitamin B12 deficiency among SCD patients, and thus to identify more precisely those who need supplementation of vitamin B12 .
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Affiliation(s)
- Eka Patricia Kisali
- Muhimbili Sickle Cell Programme, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Julie Makani
- Muhimbili Sickle Cell Programme, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
- Department of Immunology and Inflammation, Center for Haematology, Imperial College of London, London, UK
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Tang H, Zhang N, Liu X, Xiao H, Zhang H, Zhou K, Deng J. Incidence Trends of Inherited Anemias at the Global, Regional, and National Levels Over Three Decades. J Epidemiol Glob Health 2024; 14:72-85. [PMID: 38079097 PMCID: PMC11043255 DOI: 10.1007/s44197-023-00170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 04/25/2024] Open
Abstract
Inherited anemia continues to pose a significant public health concern on a global scale, owing to its extensive geographical prevalence, substantial patient population, and profound ramifications. Here, we investigated detailed information on inherited anemias (including thalassemias, thalassemias trait, sickle cell disease, sickle cell trait, G6PD deficiency, and G6PD trait) for the period 1990-2019 from the Global Burden of Disease study. Over the course of three decades, there has been a persistent rise in the incidence of inherited anemias worldwide, culminating in a total of 44,896,026 incident cases in 2019. However, the prevalence of inherited anemias has exhibited a consistent downward trend over successive years. Significantly, these inherited anemias primarily impact females, exhibiting a male-to-female ratio of 1:1.88. Among males, the most prevalent inherited anemia is G6PD deficiency, whereas G6PD trait prevails among females. The incidence rates of inherited anemias and their temporal trend exhibited significant variations across different regions, with Central Sub-Saharan Africa displaying the highest incidence rates and Central Latin America experiencing the most substantial decline. The findings of this study suggest a significant correlation between the Socio-Demographic index (SDI) and incidence rates of inherited anemias, particularly in regions with lower SDI levels such as Africa and South Asia. These results contribute valuable insights for the analysis of global trends in the burden of inherited anemias.
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Affiliation(s)
- Hongwei Tang
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China
| | - Nan Zhang
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Xinlei Liu
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China
| | - Hongbo Xiao
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China
| | - Hanyue Zhang
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China
| | - Kang Zhou
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China.
| | - Jianchuan Deng
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China.
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Obeagu EI, Obeagu GU. Implications of climatic change on sickle cell anemia: A review. Medicine (Baltimore) 2024; 103:e37127. [PMID: 38335412 PMCID: PMC10860944 DOI: 10.1097/md.0000000000037127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
Sickle cell anemia (SCA) is a hereditary blood disorder characterized by abnormal hemoglobin, causing red blood cells to assume a sickle shape, leading to various complications. Climate change has emerged as a significant global challenge, influencing environmental conditions worldwide. This paper explores the implications of climatic variations on the prevalence, management, and outcomes of SCA. Climate change affects weather patterns, leading to altered temperatures, increased frequency of extreme weather events, and variations in humidity levels. These changes can have a profound impact on individuals living with SCA. High temperatures exacerbate the symptoms of SCA, potentially triggering painful vaso-occlusive crises due to dehydration and increased blood viscosity. Conversely, cold temperatures may induce vaso-occlusion by causing blood vessels to constrict. Changes in rainfall patterns might also affect water accessibility, which is crucial for maintaining adequate hydration, particularly in regions prone to droughts. The management of SCA is multifaceted, involving regular medical care, hydration, and avoiding triggers that could precipitate a crisis. Adverse weather events and natural disasters can disrupt healthcare infrastructure and access to essential medications and resources for SCA patients, especially in vulnerable communities. To mitigate the implications of climatic change on SCA, interdisciplinary strategies are essential. These strategies may include enhancing healthcare systems' resilience to climate-related disruptions, implementing adaptive measures to address changing environmental conditions, and promoting public awareness and education on managing SCA amidst climate variability. In conclusion, climatic variations pose significant challenges for individuals with SCA, affecting the prevalence, management, and outcomes of the disease.
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Ali A. Neurologic Findings in Patients With Sickle Cell Disease: Carving a Path Between the Old and the New. Neurol Clin Pract 2024; 14:e200236. [PMID: 38144898 PMCID: PMC10741377 DOI: 10.1212/cpj.0000000000200236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/20/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Amza Ali
- Department of Medicine, Kingston Public Hospital and Faculty of Medical Sciences Department of Medicine, University of the West Indies, Kingston, Jamaica
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Baynam G, Julkowska D, Bowdin S, Hermes A, McMaster CR, Prichep E, Richer É, van der Westhuizen FH, Repetto GM, Malherbe H, Reichardt JKV, Arbour L, Hudson M, du Plessis K, Haendel M, Wilcox P, Lynch SA, Rind S, Easteal S, Estivill X, Caron N, Chongo M, Thomas Y, Letinturier MCV, Vorster BC. Advancing diagnosis and research for rare genetic diseases in Indigenous peoples. Nat Genet 2024; 56:189-193. [PMID: 38332370 PMCID: PMC11229440 DOI: 10.1038/s41588-023-01642-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Gareth Baynam
- Rare Care Centre and Genetic Services of Western Australia, Department of Health, Government of Western Australia, Perth, Western Australia, Australia.
- Faculty of Health and Medicine, Division of Pediatrics, University of Western Australia, Perth, Western Australia, Australia.
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
- Faculty of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.
- Faculty of Science and Engineering, Spatial Sciences, Curtin University, Perth, Western Australia, Australia.
- Faculty of Medicine, Notre Dame University, Perth, Western Australia, Australia.
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Daria Julkowska
- IRDiRC Scientific Secretariat, French National Institute of Health and Medical Research (Inserm), Paris, France
| | - Sarah Bowdin
- Department of Clinical Genetics, Addenbrooke's Hospital, Cambridge, UK
| | - Azure Hermes
- National Centre for Indigenous Genomics, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher R McMaster
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
- Institute of Genetics, Canadian Institutes of Health Research, Halifax, Nova Scotia, Canada
| | - Elissa Prichep
- Platform on Shaping the Future of Health and Healthcare, World Economic Forum, New York, NY, USA
| | - Étienne Richer
- Institute of Genetics, Canadian Institutes of Health Research, Halifax, Nova Scotia, Canada
| | | | - Gabriela M Repetto
- Facultad de Medicina, Center for Genetics and Genomics, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Helen Malherbe
- Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Pretoria, South Africa
- Rare Diseases South Africa, Johannesburg, South Africa
| | - Juergen K V Reichardt
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, Queensland, Australia
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Victoria, British Columbia, Canada
| | - Maui Hudson
- Faculty of Maori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
| | | | - Melissa Haendel
- Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, OR, USA
| | - Phillip Wilcox
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Sally Ann Lynch
- National Rare Disease Office, Mater Misericordiae University Hospital, Dublin, Ireland
- Academic Centre on Rare Diseases, University College Dublin, Dublin, Ireland
| | - Shamir Rind
- Western Australian Register of Developmental Anomalies, Perth, Western Australia, Australia
| | - Simon Easteal
- National Centre for Indigenous Genomics, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Xavier Estivill
- Quantitative Genomics Medicine Laboratories (qgenomics), Esplugues de Llobregat, Barcelona, Spain
| | - Nadine Caron
- UBC Centre for Excellence in Indigenous Health, Vancouver, British Columbia, Canada
- UBC Northern Medical Program and Department of Surgery, Prince George, British Columbia, Canada
| | - Meck Chongo
- UBC Centre for Excellence in Indigenous Health, Vancouver, British Columbia, Canada
| | - Yarlalu Thomas
- Western Australian Register of Developmental Anomalies, Perth, Western Australia, Australia
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Namukasa S, Maina R, Nakaziba S, Among G, Asasira L, Mayambala P, Atukwatse J, Namuguzi M, Sarki AM. Prevalence of sickle cell trait and needs assessment for uptake of sickle cell screening among secondary school students in Kampala City, Uganda. PLoS One 2024; 19:e0296119. [PMID: 38241244 PMCID: PMC10798531 DOI: 10.1371/journal.pone.0296119] [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: 01/07/2023] [Accepted: 12/06/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is one of the most frequent and traumatizing genetic disease in Uganda, with the prevalence of the sickle cell trait (SCT) estimated at 13.3% leading to serious psycho-social and economic impact on the patients and their families. AIM This study aimed to determine the burden of SCT and factors influencing the uptake of screening services among secondary school students in Uganda. METHODS We used an analytical cross-sectional design with a multi-stage sampling approach. A total of 399 students from four secondary schools in Kampala City were enrolled in this study. Data were gathered using semi-structured questionnaires and blood screening. We used the sickling test to determine the presence of sickle cell alleles among the participants and hemoglobin electrophoresis as a confirmatory test. Data gathered using the questionnaire were analyzed using descriptive and inferential statistics. RESULTS In total, 5.8% of participants who were tested during this study had SCT. Most (80.2%) participants were not in an intimate relationship at the time of data collection. The majority (60.4%) had moderate knowledge about SCT screening and obtained information about screening from the school. Only 29 (7.3%) participants knew of a family member with sickle cell. Overall, participants had a negative attitude toward SCT screening (67%), although 41.6% believed that most people who were sickle cell carriers did not live long and were often sick. Statistically significant associations were found between testing for SCT and knowing a partner's sickle cell status (odds ratio [OR] 2.112, p = 0.043) and Anglican religion (OR 2.075, p = 0.047). CONCLUSION Despite the moderate level of knowledge and negative attitudes, a relatively large number of participants had SCT. This highlights the need for a comprehensive health education package targeting adolescents to promote SCD/SCT screening.
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Affiliation(s)
- Shamim Namukasa
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Rose Maina
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
| | - Sarah Nakaziba
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Grace Among
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Lydia Asasira
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | | | - Joseph Atukwatse
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Mary Namuguzi
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Ahmed M. Sarki
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
- Family and Youth Health Initiative (FAYOHI), Duste, Jigawa State, Nigeria
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Bell V, Varzakas T, Psaltopoulou T, Fernandes T. Sickle Cell Disease Update: New Treatments and Challenging Nutritional Interventions. Nutrients 2024; 16:258. [PMID: 38257151 PMCID: PMC10820494 DOI: 10.3390/nu16020258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Sickle cell disease (SCD), a distinctive and often overlooked illness in the 21st century, is a congenital blood disorder characterized by considerable phenotypic diversity. It comprises a group of disorders, with sickle cell anemia (SCA) being the most prevalent and serious genotype. Although there have been some systematic reviews of global data, worldwide statistics regarding SCD prevalence, morbidity, and mortality remain scarce. In developed countries with a lower number of sickle cell patients, cutting-edge technologies have led to the development of new treatments. However, in developing settings where sickle cell disease (SCD) is more prevalent, medical management, rather than a cure, still relies on the use of hydroxyurea, blood transfusions, and analgesics. This is a disease that affects red blood cells, consequently affecting most organs in diverse manners. We discuss its etiology and the advent of new technologies, but the aim of this study is to understand the various types of nutrition-related studies involving individuals suffering from SCD, particularly in Africa. The interplay of the environment, food, gut microbiota, along with their respective genomes collectively known as the gut microbiome, and host metabolism is responsible for mediating host metabolic phenotypes and modulating gut microbiota. In addition, it serves the purpose of providing essential nutrients. Moreover, it engages in direct interactions with host homeostasis and the immune system, as well as indirect interactions via metabolites. Nutrition interventions and nutritional care are mechanisms for addressing increased nutrient expenditures and are important aspects of supportive management for patients with SCD. Underprivileged areas in Sub-Saharan Africa should be accompanied by efforts to define and promote of the nutritional aspects of SCD. Their importance is key to maintaining well-being and quality of life, especially because new technologies and products remain limited, while the use of native medicinal plant resources is acknowledged.
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Affiliation(s)
- Victoria Bell
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
| | - Theodoros Varzakas
- Department of Food Science and Technology, University of the Peloponnese, 24100 Kalamata, Greece
| | - Theodora Psaltopoulou
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Tito Fernandes
- CIISA, Faculty of Veterinary Medicine, University of Lisbon, 1649-004 Lisbon, Portugal
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Gollamudi J, Karkoska KA, Gbotosho OT, Zou W, Hyacinth HI, Teitelbaum SL. A bone to pick-cellular and molecular mechanisms of bone pain in sickle cell disease. FRONTIERS IN PAIN RESEARCH 2024; 4:1302014. [PMID: 38239327 PMCID: PMC10794347 DOI: 10.3389/fpain.2023.1302014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/04/2023] [Indexed: 01/22/2024] Open
Abstract
The bone is one of the most commonly affected organs in sickle cell disease (SCD). Repeated ischemia, oxidative stress and inflammation within the bone is largely responsible for promoting bone pain. As more individuals with SCD survive into adulthood, they are likely to experience a synergistic impact of both aging and SCD on their bone health. As bone health deteriorates, bone pain will likely exacerbate. Recent mechanistic and observational studies emphasize an intricate relationship between bone remodeling and the peripheral nervous system. Under pathological conditions, abnormal bone remodeling plays a key role in the propagation of bone pain. In this review, we first summarize mechanisms and burden of select bone complications in SCD. We then discuss processes that contribute to pathological bone pain that have been described in both SCD as well as non-sickle cell animal models. We emphasize the role of bone-nervous system interactions and pitfalls when designing new therapies especially for the sickle cell population. Lastly, we also discuss future basic and translational research in addressing questions about the complex role of stress erythropoiesis and inflammation in the development of SCD bone complications, which may lead to promising therapies and reduce morbidity in this vulnerable population.
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Affiliation(s)
- Jahnavi Gollamudi
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kristine A. Karkoska
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Oluwabukola T. Gbotosho
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Wei Zou
- Department of Medicine, Division of Bone and Mineral Diseases, and Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St. Louis, MO, United States
| | - Hyacinth I. Hyacinth
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Steven L. Teitelbaum
- Department of Medicine, Division of Bone and Mineral Diseases, and Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St. Louis, MO, United States
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Kuczynski CE, Porada CD, Atala A, Cho SS, Almeida-Porada G. Evaluating sheep hemoglobins with MD simulations as an animal model for sickle cell disease. Sci Rep 2024; 14:276. [PMID: 38168584 PMCID: PMC10761887 DOI: 10.1038/s41598-023-50707-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
Sickle cell disease (SCD) affects millions worldwide, yet there are few therapeutic options. To develop effective treatments, preclinical models that recapitulate human physiology and SCD pathophysiology are needed. SCD arises from a single Glu-to-Val substitution at position 6 in the β subunit of hemoglobin (Hb), promoting Hb polymerization and subsequent disease. Sheep share important physiological and developmental characteristics with humans, including the same developmental pattern of fetal to adult Hb switching. Herein, we investigated whether introducing the SCD mutation into the sheep β-globin locus would recapitulate SCD's complex pathophysiology by generating high quality SWISS-MODEL sheep Hb structures and performing MD simulations of normal/sickle human (huHbA/huHbS) and sheep (shHbB/shHbS) Hb, establishing how accurately shHbS mimics huHbS behavior. shHbS, like huHbS, remained stable with low RMSD, while huHbA and shHbB had higher and fluctuating RMSD. shHbB and shHbS also behaved identically to huHbA and huHbS with respect to β2-Glu6 and β1-Asp73 (β1-Asn72 in sheep) solvent interactions. These data demonstrate that introducing the single SCD-causing Glu-to-Val substitution into sheep β-globin causes alterations consistent with the Hb polymerization that drives RBC sickling, supporting the development of a SCD sheep model to pave the way for alternative cures for this debilitating, globally impactful disease.
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Affiliation(s)
| | | | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, 27101, USA
| | - Samuel S Cho
- Department of Physics, Wake Forest University, Winston-Salem, NC, 27109, USA.
- Department of Computer Science, Wake Forest University, Winston-Salem, NC, 27109, USA.
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Lopes CMI, Marques KMG, Miranda ML, de Menezes VA. Assessment of the developmental defects of the enamel in children and adolescents with sickle cell disease: A comparative study. Int J Paediatr Dent 2024; 34:26-34. [PMID: 37163292 DOI: 10.1111/ipd.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is the most important hemoglobinopathy in terms of frequency and social impact and can affect the stomatognathic system. AIM To assess and compare the developmental defects of the enamel (DDE) in children and adolescents with and without SCD. DESIGN This was a cross-sectional, analytical, and comparative study of 210 children and adolescents aged 5-18 years, who visited the Hematology and Hemotherapy Hospital of Pernambuco. RESULTS Developmental defects of the enamel were observed in 55.2% of the SCD patients and 35.2% of the non-SCD patients (healthy group; p < .05). In the SCD group, DDE were more common in females than in males (69.1% vs. 40.0%; p < .05). The incidence of DDE in the permanent teeth was higher in the upper arch than in the lower arch (SCD group, 13.1% vs. 4.6%; healthy group, 8.9% vs. 3.6%; p < .05). CONCLUSION Compared with the healthy group, the SCD patients were almost twice as likely to develop DDE, mostly affecting females and the permanent teeth. These findings suggest that individuals with SCD need early dental care to avoid future oral problems.
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Charlotte EE, Edgar MML, Yolande PD, Daniele-Christiane KMK, Betoko MR, Patricia E, Iyawa H, Ngenge MB, Abigaelle M, Diomède NN, Dominique E, Gaelle NK, Juliana J, Karen E, Georgette MEJ, Margaret EM, Doriane E, Penda CI. Comparison of in-hospital mortality in children and adolescents with sickle cell disease in a resource-limited setting before and during the COVID-19 pandemic. Arch Pediatr 2024; 31:38-43. [PMID: 37989661 DOI: 10.1016/j.arcped.2023.10.001] [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: 09/29/2022] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND COVID-19 in children and adolescents with sickle cell disease (SCD) has variable presentations (from mild to severe disease), and the main symptoms are vaso-occlusive crises (VOC) and acute chest syndrome (ACS). We hypothesized that the desertion of hospitals due to the pandemic would lead to late arrival at the emergency room and an increased mortality. In this study, we sought to measure and compare the mortality of children with sickle cell disease before and during the COVID-19 pandemic. MATERIAL AND METHODS We conducted a retrospective cohort study at the sickle cell disease management center of Laquintinie Hospital in Douala (Cameroon). The study period was divided into two, i.e., from March 2019 to February 2020 (Pre-COVID-19) and from March 2020 to February 2021 (COVID-19). All administrative and ethical considerations were fully respected. Data were analyzed using SPSS 20.0. RESULTS Overall, 823 patients were admitted during the study period. Males represented 52.4% of the overall population, giving a sex ratio of 1.1:1. We admitted 479 patients during the pre-COVID-19 period versus 344 patients during the COVID-19 period, which is a 28.2% drop in admissions during the COVID-19 period. The mortality rate was 3.5% during the pre-COVID-19 period and 3.2% during the COVID-19 period (p>0.05). The most common causes of death were ACS (39.3%, n = 11), severe anemia (25.0%, n = 7), and VOC (17.9%, n = 5). ACS (adjusted odds ratio [aOR]=3.628, 95% confidence interval [CI], [1.645-7.005], p<0.001) was significantly associated with mortality. CONCLUSION During the COVID-19 pandemic, although the consultation frequency decreased, the mortality rate of sickle cell disease patients remained unchanged.
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Affiliation(s)
- Eposse Ekoube Charlotte
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; Laquintinie Hospital of Douala, Douala, Cameroon
| | - Mandeng Ma Linwa Edgar
- Laquintinie Hospital of Douala, Douala, Cameroon; Faculty of Health Sciences, University of Buea, Buea, Cameroon.
| | | | | | - Mbono Ritha Betoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; Laquintinie Hospital of Douala, Douala, Cameroon
| | - Epee Patricia
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Hassanatou Iyawa
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; Laquintinie Hospital of Douala, Douala, Cameroon
| | | | - Megoze Abigaelle
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Noukeu Njinkui Diomède
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Enyama Dominique
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | | | | | - Ekotto Karen
- Laquintinie Hospital of Douala, Douala, Cameroon
| | | | | | - Ekoe Doriane
- Laquintinie Hospital of Douala, Douala, Cameroon
| | - Calixte Ida Penda
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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McClish D, Okhomina V, Pascale A, Valrie C, Sisler I, Villella A, Smith W. Vaso-occlusive crisis pain intensity, frequency, and duration: which best correlates with health-related quality of life in adolescents and adults with sickle cell disease? Pain 2024; 165:135-143. [PMID: 37578485 PMCID: PMC10840919 DOI: 10.1097/j.pain.0000000000003011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 06/15/2023] [Indexed: 08/15/2023]
Abstract
ABSTRACT In a cross-sectional analysis of baseline data from a randomized clinical trial, we studied 198 adolescents and adults aged 15+ with sickle cell disease. Interest was in assessing the relative strengths of the relationship of vaso-occlusive crisis (VOC) pain domains of intensity, frequency, and duration, with health-related quality of life (HRQOL). Variation in psychosocial, physical function, and pain expression domains of HRQOL was partially explained by frequency, intensity, and duration of VOC pain, separately and together, over and above differences in age, sex, genotype, and organ system damage. However, no single domain measure accounted for more than an additional partial R2 of 12.5% alone. Vaso-occlusive crisis pain frequency explained the most variation, when simultaneously considering VOC intensity and duration, except for stiffness , where duration was most predictive. Yet VOC pain intensity, and even VOC duration, also contributed to variability in HRQOL. We recommend that for most purposes, because all 3 VOC pain domains contribute to variability in HRQOL, all 3 domains should be assessed and interventions should be targeted to improve all 3 domains to maximize HRQOL outcomes (Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02197845 ).
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Affiliation(s)
| | | | - Angela Pascale
- Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Cecelia Valrie
- Psychology, Virginia Commonwealth University, Richmond, VA, United States
- VCU Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, United States
| | - India Sisler
- Division of Pediatric Haematology and Oncology, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, United States
| | - Anthony Villella
- Children's Hospital of King's Daughter, Norfolk, VA, United States
| | - Wally Smith
- Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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Assad Z, Valtuille Z, Rybak A, Kaguelidou F, Lazzati A, Varon E, Pham LL, Lenglart L, Faye A, Caseris M, Cohen R, Levy C, Vabret A, Gravey F, Angoulvant F, Koehl B, Ouldali N. Unique Changes in the Incidence of Acute Chest Syndrome in Children With Sickle Cell Disease Unravel the Role of Respiratory Pathogens: A Time Series Analysis. Chest 2024; 165:150-160. [PMID: 37544426 DOI: 10.1016/j.chest.2023.07.4219] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD). Although respiratory pathogens are frequently detected in children with ACS, their respective role in triggering the disease is still unclear. We hypothesized that the incidence of ACS followed the unprecedented population-level changes in respiratory pathogen dynamics after COVID-19-related nonpharmaceutical interventions (NPIs). RESEARCH QUESTION What is the respective role of respiratory pathogens in ACS epidemiology? STUDY DESIGN AND METHODS This study was an interrupted time series analysis of patient records from a national hospital-based surveillance system. All children aged < 18 years with SCD hospitalized for ACS in France between January 2015 and May 2022 were included. The monthly incidence of ACS per 1,000 children with SCD over time was analyzed by using a quasi-Poisson regression model. The circulation of 12 respiratory pathogens in the general pediatric population over the same period was included in the model to assess the fraction of ACS potentially attributable to each respiratory pathogen. RESULTS Among the 55,941 hospitalizations of children with SCD, 2,306 episodes of ACS were included (median [interquartile range] age, 9 [5-13] years). A significant decrease was observed in ACS incidence after NPI implementation in March 2020 (-29.5%; 95% CI, -46.8 to -12.2; P = .001) and a significant increase after lifting of the NPIs in April 2021 (24.4%; 95% CI, 7.2 to 41.6; P = .007). Using population-level incidence of several respiratory pathogens, Streptococcus pneumoniae accounted for 30.9% (95% CI, 4.9 to 56.9; P = .02) of ACS incidence over the study period and influenza 6.8% (95% CI, 2.3 to 11.3; P = .004); other respiratory pathogens had only a minor role. INTERPRETATION NPIs were associated with significant changes in ACS incidence concomitantly with major changes in the circulation of several respiratory pathogens in the general population. This unique epidemiologic situation allowed determination of the contribution of these respiratory pathogens, in particular S pneumoniae and influenza, to the burden of childhood ACS, highlighting the potential benefit of vaccine prevention in this vulnerable population.
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Affiliation(s)
- Zein Assad
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France.
| | - Zaba Valtuille
- Centre d'Investigation Clinique, INSERM CIC1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris Cité University, Paris, France
| | - Alexis Rybak
- INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France; Urgences Pédiatriques, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France; Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France
| | - Florentia Kaguelidou
- Centre d'Investigation Clinique, INSERM CIC1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris Cité University, Paris, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre de Recherche Clinique et Biologique, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luu-Ly Pham
- INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; Department of General Pediatrics, Jean Verdier University Hospital, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Léa Lenglart
- INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; Service d'Accueil des Urgences Pédiatriques, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France; Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France; Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Astrid Vabret
- Department of Virology, Caen University Hospital, Caen, France; Univ Caen Normandie, Univ Rouen Normandie, INSERM UMR 1311, DYNAMICURE, Caen, France
| | - François Gravey
- Univ Caen Normandie, Univ Rouen Normandie, INSERM UMR 1311, DYNAMICURE, Caen, France
| | - François Angoulvant
- Paris Sorbonne University, Centre de Recherche des Cordeliers, INSERM UMRS 1138, Paris, France
| | - Bérengère Koehl
- Department of Child Hematology, Reference Center for Sickle-Cell Disease, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR S1134, Integrated Biology of Red Blood Cells, Paris Cité University, Paris, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France
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49
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Omar AM, Abdulmalik O, El-Say KM, Ghatge MS, Cyril-Olutayo M, Paredes S, Al-Awadh M, El-Araby ME, Safo MK. Targeted modification of furan-2-carboxaldehydes into Michael acceptor analogs yielded long-acting hemoglobin modulators with dual antisickling activities. Chem Biol Drug Des 2024; 103:e14371. [PMID: 37798397 DOI: 10.1111/cbdd.14371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Sickle cell disease (SCD) is the most common genetic disorder, affecting millions of people worldwide. Aromatic aldehydes, which increase the oxygen affinity of human hemoglobin to prevent polymerization of sickle hemoglobin and inhibit red blood cell (RBC) sickling, have been the subject of keen interest for the development of effective treatment against SCD. However, the aldehyde functional group metabolic instability has severly hampered their development, except for voxelotor, which was approved in 2019 for SCD treatment. To improve the metabolic stability of aromatic aldehydes, we designed and synthesized novel molecules by incorporating Michael acceptor reactive centers into the previously clinically studied aromatic aldehyde, 5-hydroxymethylfurfural (5-HMF). Eight such derivatives, referred to as MMA compounds were synthesized and studied for their functional and biological activities. Unlike 5-HMF, which forms Schiff-base interaction with αVal1 nitrogen of hemoglobin, the MMA compounds covalently interacted with βCys93, as evidenced by reverse-phase HPLC and disulfide exchange reaction, explaining their RBC sickling inhibitory activities, which at 2 mM and 5 mM, range from 0% to 21% and 9% to 64%, respectively. Additionally, the MMA compounds showed a second mechanism of sickling inhibition (12%-41% and 13%-62% at 2 mM and 5 mM, respectively) by directly destabilizing the sickle hemoglobin polymer. In vitro studies demonstrated sustained pharmacologic activities of the compounds compared to 5-HMF. These findings hold promise for advancing SCD therapeutics.
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Affiliation(s)
- Abdelsattar M Omar
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
- Center for Artificial Intelligence in Precision Medicines, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osheiza Abdulmalik
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Khalid M El-Say
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohini S Ghatge
- Department of Medicinal Chemistry, School of Pharmacy and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mojisola Cyril-Olutayo
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven Paredes
- Department of Medicinal Chemistry, School of Pharmacy and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mohammed Al-Awadh
- Department of Medicinal Chemistry, School of Pharmacy and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Moustafa E El-Araby
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
- Center for Artificial Intelligence in Precision Medicines, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Martin K Safo
- Department of Medicinal Chemistry, School of Pharmacy and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia, USA
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50
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Peters C. Haematopoietic stem cell transplantation in children with sickle cell disease: Still to do? Br J Haematol 2024; 204:22-23. [PMID: 37957026 DOI: 10.1111/bjh.19175] [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: 10/04/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/21/2023]
Abstract
Sickle cell disease affects the whole body through acute and chronic organ damage and results in significant physical and neurological constraints. The report by Cseh et al. demonstrates in a retrospective multinational study that allogeneic haematopoietic stem cell transplantation from HLA-identical siblings using a contemporary conditioning regimen is safe and effective in more than 96% of patients. Commentary on: Cseh et al. Busulfan-fludarabine- or treosulfan-fludarabine-based conditioning before allogeneic HSCT from matched sibling donors in paediatric patients with sickle cell disease: A study on behalf of the EBMT Paediatric Diseases and Inborn Errors Working Parties. Br J Haematol 2024;204:e1-e5. [Correction added on 23 November 2023, after first online publication: In the preceding sentence, the article title and doi have been updated in this version.].
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Affiliation(s)
- Christina Peters
- St. Anna Children's Hospital, St. Anna Children's Cancer Research Institute, Vienna, Austria
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