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Özer Ö, Doğan L, Baysal Z, Basir H, Çıftçı AT, Eröz P, Güçlü ES. Evaluation of peripheral blood inflammatory biomarkers in sickle cell disease with and without retinopathy. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06569-9. [PMID: 38976013 DOI: 10.1007/s00417-024-06569-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the clinical significance of blood-cell associated inflammation markers in patients with sickle cell disease (SCD) and sickle cell retinopathy (SCR). METHODS Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), systemic immune inflammation index (SIII), systemic inflammation response index (SIRI), systemic inflammation modulation index (SIMI) and aggregate systemic inflammation index (AISI) were calculated. This study included 45 healthy controls (Group 1) and 100 SCD (Group 2). Patients in Group 2 were then divided into two groups: without SCR (Group 3) and with SCR (Group 4), and patients with SCR (Group 4) were further divided into two groups: non-proliferative sickle cell retinopathy (NPSCR) (Group 5) and proliferative sickle cell retinopathy (PSCR) (Group 6). RESULTS The mean values for NLR, PLR, SIII, SIRI, AISI, and SIMI were significantly higher in Group 2 compared to Group 1 (p = 0.011 for NLR, p = 0.004 for SIII, and p < 0.001 for others). Furthermore, AISI and SIMI parameters demonstrated statistically significant discriminatory power to distinguish Group 5 from Group 6 (p = 0.0016 and p = 0.0006, respectively). CONCLUSION Given the critical role of inflammatory mechanisms in the pathogenesis of SCD and its related complications, the assessment of blood-cell-associated inflammatory markers may present a pragmatic and advantageous approach to the clinical oversight and therapeutic intervention of SCD.
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Affiliation(s)
- Ömer Özer
- Department of Ophthalmology, Niğde Ömer Halisdemir University, Niğde, 51240, Turkey.
| | - Levent Doğan
- Department of Ophthalmology, Niğde Ömer Halisdemir University, Niğde, 51240, Turkey
| | - Zeki Baysal
- Department of Ophthalmology, Niğde Ömer Halisdemir University, Niğde, 51240, Turkey
| | - Hakan Basir
- Clinic of Internal Medicine, Gülnar State Hospital, Mersin, Turkey
| | - Ali Türker Çıftçı
- Department of Biostatistics and Medical Informatics, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Pınar Eröz
- Clinic of Ophthalmology, Tarsus State Hospital, Mersin, Turkey
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Mathavan A, Mathavan A, Mathavan M, Krekora U, Winer AJ, Altshuler E, Wnek R, Hones K, Thaper A, Artola R, Pucci L, Haley P, Carter D, Snead W, Manfrini D, Leach DF, DeLaune JD, Mandernach MW. Impact of genotype on clinical course in sickle cell disease and the utility of neutrophil-lymphocyte ratio: a ten-year single-institution experience. Expert Rev Hematol 2023; 16:701-710. [PMID: 37395002 DOI: 10.1080/17474086.2023.2231637] [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: 03/23/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a diverse group of blood disorders with significant global disease burden. Contemporary interest in the underlying inflammatory paradigm of SCD has emphasized the role of the neutrophil-lymphocyte ratio (NLR) as a prognostic inflammatory marker. METHODS We retrospectively reviewed 268 hospitalized patients with SCDs of different genotypes (HbSS, HbSβ0 thalassemia, HbSβ+ thalassemia, and HbSC), totaling 3329 hospital admissions over a 10-year period. Patients were stratified into SS/Sβ0 and Sβ+/SC groups for statistical analysis of parameters collected at steady state and at hospital admission. RESULTS At steady state, per unit increase of hemoglobin values was associated with reduced odds of ≥ 2 hospital admissions per year in SS/Sβ0 and Sβ+/SC groups; per unit increase in platelet count and white blood cell count was associated with increased odds only in the SS/Sβ0 group. The NLR had no association in either group. During admission, a cutoff of NLR = 3.5 discerned infection with a sensitivity of 60% and specificity of 57%. Performance improved when excluding patients on outpatient hydroxyurea therapy (cutoff of NLR = 3.5; sensitivity of 68% and specificity of 64%). CONCLUSION This study supports the utility of NLR as an accessible adjunctive clinical tool in SCD prognostication.
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Affiliation(s)
- Akash Mathavan
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Akshay Mathavan
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Mohit Mathavan
- Department of Internal Medicine, St George's University School of Medicine, New York, USA
| | - Urszula Krekora
- Department of Medicine, University of Central Florida College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Aaron J Winer
- Department of Medicine, University of Florida College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ellery Altshuler
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Russell Wnek
- Department of Medicine, University of Florida College of Medicine, University of Florida, Gainesville, FL, USA
| | - Keegan Hones
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Arushi Thaper
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Richard Artola
- Department of Medicine, University of Florida College of Medicine, University of Florida, Gainesville, FL, USA
| | - Logan Pucci
- Department of Medicine, University of Florida College of Medicine, University of Florida, Gainesville, FL, USA
| | - Patrick Haley
- Department of Medicine, University of Florida College of Medicine, University of Florida, Gainesville, FL, USA
| | - Del Carter
- Department of Medicine, University of Florida College of Medicine, University of Florida, Gainesville, FL, USA
| | - William Snead
- Department of Medicine, University of Florida College of Medicine, University of Florida, Gainesville, FL, USA
| | - Denise Manfrini
- Department of Medicine, University of Florida College of Medicine, University of Florida, Gainesville, FL, USA
| | - Daniel F Leach
- Department of Medicine, University of Florida College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jess D DeLaune
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
- Division of Hematology and Oncology, University of Florida, Gainesville, FL, USA
| | - Molly W Mandernach
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
- Division of Hematology and Oncology, University of Florida, Gainesville, FL, USA
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Ebermeyer T, Hequet O, Berard F, Prier A, Eyraud MA, Arthaud CA, Heestermans M, Duchez AC, Guironnet-Paquet A, Berthelot P, Cognasse F, Hamzeh-Cognasse H. The efficacy of therapeutic plasma exchange in COVID-19 patients on endothelial tightness in vitro is hindered by platelet activation. Front Cardiovasc Med 2023; 10:1094786. [PMID: 37215546 PMCID: PMC10192624 DOI: 10.3389/fcvm.2023.1094786] [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: 11/10/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Coronavirus disease (COVID)-19 is characterised in particular by vascular inflammation with platelet activation and endothelial dysfunction. During the pandemic, therapeutic plasma exchange (TPE) was used to reduce the cytokine storm in the circulation and delay or prevent ICU admissions. This procedure consists in replacing the inflammatory plasma by fresh frozen plasma from healthy donors and is often used to remove pathogenic molecules from plasma (autoantibodies, immune complexes, toxins, etc.). This study uses an in vitro model of platelet-endothelial cell interactions to assess changes in these interactions by plasma from COVID-19 patients and to determine the extent to which TPE reduces such changes. We noted that exposure of an endothelial monolayer to plasmas from COVID-19 patients post-TPE induced less endothelial permeability compared to COVID-19 control plasmas. Yet, when endothelial cells were co-cultured with healthy platelets and exposed to the plasma, the beneficial effect of TPE on endothelial permeability was somewhat reduced. This was linked to platelet and endothelial phenotypical activation but not with inflammatory molecule secretion. Our work shows that, in parallel to the beneficial removal of inflammatory factors from the circulation, TPE triggers cellular activation which may partly explain the reduction in efficacy in terms of endothelial dysfunction. These findings provide new insights for improving the efficacy of TPE using supporting treatments targeting platelet activation, for instance.
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Affiliation(s)
- Theo Ebermeyer
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
| | - Olivier Hequet
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Université Jean Monnet de Saint-Etienne, Lyon, France
| | - Frederic Berard
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Université Jean Monnet de Saint-Etienne, Lyon, France
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, Hospices Civils de Lyon, Lyon, France
| | - Amelie Prier
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Marie-Ange Eyraud
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Charles-Antoine Arthaud
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Marco Heestermans
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Anne-Claire Duchez
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Aurelie Guironnet-Paquet
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Université Jean Monnet de Saint-Etienne, Lyon, France
| | - Philippe Berthelot
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Université Jean Monnet de Saint-Etienne, Lyon, France
- University Hospital of Saint-Etienne, Infectious Diseases Department, F-42023, Saint-Etienne, France
| | - Fabrice Cognasse
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
- Etablissement Français du Sang Auvergne-Rhône-Alpes, Research Department, F-42023, Saint-Etienne, France
| | - Hind Hamzeh-Cognasse
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, F-42023, Saint-Etienne, France
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Kang YJ. Quantification of Blood Viscoelasticity under Microcapillary Blood Flow. MICROMACHINES 2023; 14:814. [PMID: 37421047 DOI: 10.3390/mi14040814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 07/09/2023]
Abstract
Blood elasticity is quantified using a single compliance model by analyzing pulsatile blood flow. However, one compliance coefficient is influenced substantially by the microfluidic system (i.e., soft microfluidic channels and flexible tubing). The novelty of the present method comes from the assessment of two distinct compliance coefficients, one for the sample and one for the microfluidic system. With two compliance coefficients, the viscoelasticity measurement can be disentangled from the influence of the measurement device. In this study, a coflowing microfluidic channel was used to estimate blood viscoelasticity. Two compliance coefficients were suggested to denote the effects of the polydimethylsiloxane (PDMS) channel and flexible tubing (C1), as well as those of the RBC (red blood cell) elasticity (C2), in a microfluidic system. On the basis of the fluidic circuit modeling technique, a governing equation for the interface in the coflowing was derived, and its analytical solution was obtained by solving the second-order differential equation. Using the analytic solution, two compliance coefficients were obtained via a nonlinear curve fitting technique. According to the experimental results, C2/C1 is estimated to be approximately 10.9-20.4 with respect to channel depth (h = 4, 10, and 20 µm). The PDMS channel depth contributed simultaneously to the increase in the two compliance coefficients, whereas the outlet tubing caused a decrease in C1. The two compliance coefficients and blood viscosity varied substantially with respect to homogeneous hardened RBCs or heterogeneous hardened RBCs. In conclusion, the proposed method can be used to effectively detect changes in blood or microfluidic systems. In future studies, the present method can contribute to the detection of subpopulations of RBCs in the patient's blood.
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Affiliation(s)
- Yang Jun Kang
- Department of Mechanical Engineering, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea
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Abstract
While neutrophils are the main effectors of protective innate immune responses, they are also key players in inflammatory pathologies. Sickle cell disease (SCD) is a genetic blood disorder in which red blood cells (RBCs) are constantly destroyed in the circulation which generates a highly inflammatory environment that culminates in vascular occlusions. Vaso-occlusion is the hallmark of SCD and a predictor of disease severity. Neutrophils initiate and propagate SCD-related vaso-occlusion through adhesive interactions with the activated and dysfunctional endothelium, sickle RBCs, and platelets, leading to acute and chronic complications that progress to irreversible organ damage and ultimately death. The use of SCD humanized mouse models, in combination with in vivo imaging techniques, has emerged as a fundamental tool to understand the dynamics of neutrophils under complex inflammatory contexts and their contribution to vascular injury in SCD. In this review, we discuss the various mechanisms by which circulating neutrophils sense and respond to the wide range of stimuli present in the blood of SCD patients and mice. We argue that the central role of neutrophils in SCD can be rationalized to develop targets for the management of clinical complications in SCD patients.
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Affiliation(s)
- Lidiane S Torres
- Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrés Hidalgo
- Area of Cell and Developmental Biology, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
- Vascular Biology and Therapeutics Program and Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
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6
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Alagbe AE, Domingos IF, Adekile AD, Blotta MHSL, Santos MNN. Anti-inflammatory cytokines in sickle cell disease. Mol Biol Rep 2022; 49:2433-2442. [PMID: 35000064 DOI: 10.1007/s11033-021-07009-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022]
Abstract
Sickle cell disease (SCD) is a well-studied monogenetic disease with an established chronic inflammatory component. The paradigm shift towards inflammation has made the pathophysiology of SCD even more complex. Studies have shown that an imbalance between the pro-inflammatory and anti-inflammatory cytokines in SCD exists; however, the reports are skewed toward the pro-inflammatory mediators. We enumerate recent in vitro and in vivo studies on anti-inflammatory cytokines in SCD patients, and discuss the biology of anti-inflammatory cytokines including the already reported IL-2, TGF-β, and IL-10 as well as the recently discovered IL-27, IL-35 and IL-37. This review will improve the understanding of the pathophysiology of SCD and aid in the search of new therapeutic options for patients with SCD.
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Affiliation(s)
- Adekunle E Alagbe
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Igor F Domingos
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Adekunle D Adekile
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Maria H S L Blotta
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil
| | - Magnun N N Santos
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.
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7
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Knisely MR, Tanabe PJ, Walker JKL, Yang Q, Shah NR. Severe Persistent Pain and Inflammatory Biomarkers in Sickle Cell Disease: An Exploratory Study. Biol Res Nurs 2022; 24:24-30. [PMID: 34189962 PMCID: PMC9248289 DOI: 10.1177/10998004211027220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Severe pain is among the most common and deleterious symptoms experienced by individuals with sickle cell disease (SCD), of whom more than 50% report chronic pain. Despite this, the understanding of the biological contributors to persistent severe SCD pain is limited. This exploratory study sought to describe pain phenotypes based on frequency of severe pain experienced over 6 months and identify inflammatory biomarkers associated with pain phenotypes among individuals with SCD. METHODS This study used self-report and electronic health record data collected from 74 individuals enrolled in the Duke Sickle Cell Disease Implementation Consortium Registry. Plasma from previously collected blood specimens was used to generate inflammatory biomarker data using the Inflammation 20-plex ProcartaPlexTM panel. Descriptive statistics were used to describe the occurrence of severe pain over the past 6 months, and bi-variate analyses were used to evaluate the relationship between inflammatory biomarkers and pain phenotypes. RESULTS Among the 74 participants included in this study, 33.8% reported severe pain occurring never or rarely, 40.5% reported severe pain occurring sometimes, and 25.7% reported severe pain occurring often or always. Soluble E-selectin (sE-selectin) was the only inflammatory biomarker significantly associated with the pain phenotype groups (p = 0.049). Post hoc comparisons identified that participants in the often/always severe pain group had significantly higher plasma concentrations of sE-selectin compared to those in the sometimes severe pain group (p = 0.040). CONCLUSIONS Our findings provide preliminary evidence of the frequent occurrence of severe pain and that sE-selectin may be an objective biomarker for the frequent occurrence of severe pain in this population.
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Affiliation(s)
| | | | | | - Qing Yang
- Duke University School of Nursing,
Durham, NC, USA
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8
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Conran N, Embury SH. Sickle cell vaso-occlusion: The dialectic between red cells and white cells. Exp Biol Med (Maywood) 2021; 246:1458-1472. [PMID: 33794696 DOI: 10.1177/15353702211005392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The pathophysiology of sickle cell anemia, a hereditary hemoglobinopathy, has fascinated clinicians and scientists alike since its description over 100 years ago. A single gene mutation in the HBB gene results in the production of abnormal hemoglobin (Hb) S, whose polymerization when deoxygenated alters the physiochemical properties of red blood cells, in turn triggering pan-cellular activation and pathological mechanisms that include hemolysis, vaso-occlusion, and ischemia-reperfusion to result in the varied and severe complications of the disease. Now widely regarded as an inflammatory disease, in recent years attention has included the role of leukocytes in vaso-occlusive processes in view of the part that these cells play in innate immune processes, their inherent ability to adhere to the endothelium when activated, and their sheer physical and potentially obstructive size. Here, we consider the role of sickle red blood cell populations in elucidating the importance of adhesion vis-a-vis polymerization in vaso-occlusion, review the direct adhesion of sickle red cells to the endothelium in vaso-occlusive processes, and discuss how red cell- and leukocyte-centered mechanisms are not mutually exclusive. Given the initial clinical success of crizanlizumab, a specific anti-P selectin therapy, we suggest that it is appropriate to take a holistic approach to understanding and exploring the complexity of vaso-occlusive mechanisms and the adhesive roles of the varied cell types, including endothelial cells, platelets, leukocytes, and red blood cells.
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Affiliation(s)
- Nicola Conran
- Hematology Center, University of Campinas-UNICAMP, Barão Geraldo 13083-8, Campinas, SP, Brazil
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Aich A, Lamarre Y, Sacomani DP, Kashima S, Covas DT, de la Torre LG. Microfluidics in Sickle Cell Disease Research: State of the Art and a Perspective Beyond the Flow Problem. Front Mol Biosci 2021; 7:558982. [PMID: 33763448 PMCID: PMC7982466 DOI: 10.3389/fmolb.2020.558982] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/24/2020] [Indexed: 01/21/2023] Open
Abstract
Sickle cell disease (SCD) is the monogenic hemoglobinopathy where mutated sickle hemoglobin molecules polymerize to form long fibers under deoxygenated state and deform red blood cells (RBCs) into predominantly sickle form. Sickled RBCs stick to the vascular bed and obstruct blood flow in extreme conditions, leading to acute painful vaso-occlusion crises (VOCs) – the leading cause of mortality in SCD. Being a blood disorder of deformed RBCs, SCD manifests a wide-range of organ-specific clinical complications of life (in addition to chronic pain) such as stroke, acute chest syndrome (ACS) and pulmonary hypertension in the lung, nephropathy, auto-splenectomy, and splenomegaly, hand-foot syndrome, leg ulcer, stress erythropoiesis, osteonecrosis and osteoporosis. The physiological inception for VOC was initially thought to be only a fluid flow problem in microvascular space originated from increased viscosity due to aggregates of sickled RBCs; however, over the last three decades, multiple molecular and cellular mechanisms have been identified that aid the VOC in vivo. Activation of adhesion molecules in vascular endothelium and on RBC membranes, activated neutrophils and platelets, increased viscosity of the blood, and fluid physics driving sickled and deformed RBCs to the vascular wall (known as margination of flow) – all of these come together to orchestrate VOC. Microfluidic technology in sickle research was primarily adopted to benefit from mimicking the microvascular network to observe RBC flow under low oxygen conditions as models of VOC. However, over the last decade, microfluidics has evolved as a valuable tool to extract biophysical characteristics of sickle red cells, measure deformability of sickle red cells under simulated oxygen gradient and shear, drug testing, in vitro models of intercellular interaction on endothelialized or adhesion molecule-functionalized channels to understand adhesion in sickle microenvironment, characterizing biomechanics and microrheology, biomarker identification, and last but not least, for developing point-of-care diagnostic technologies for low resource setting. Several of these platforms have already demonstrated true potential to be translated from bench to bedside. Emerging microfluidics-based technologies for studying heterotypic cell–cell interactions, organ-on-chip application and drug dosage screening can be employed to sickle research field due to their wide-ranging advantages.
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Affiliation(s)
- Anupam Aich
- Intel Corporation, Hillsboro, OR, United States
| | - Yann Lamarre
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Daniel Pereira Sacomani
- Department of Material and Bioprocess Engineering, School of Chemical Engineering, University of Campinas (UNICAMP), Campinas, Brazil
| | - Simone Kashima
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Dimas Tadeu Covas
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Lucimara Gaziola de la Torre
- Department of Material and Bioprocess Engineering, School of Chemical Engineering, University of Campinas (UNICAMP), Campinas, Brazil
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10
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Abstract
Sickle cell disease (SCD) is an inherited monogenic hemoglobinopathy characterized by formation of sickle erythrocytes under conditions of deoxygenation. Sickle erythrocytes can lead to thrombus formation and vaso-occlusive episodes that may result in hemolytic anemia, pain crisis and multiple organ damage. Moreover, SCD is characterized by endothelial damage, increased inflammatory response, platelet activation and aggravation, and activation of both the intrinsic and the extrinsic coagulation pathways. Cerebrovascular events constitute an important clinical complication of SCD. Children with SCD have a 300-fold higher risk of acute stroke and by the age of 45 about 25% of patients have suffered an overt stoke. Management and prevention of stroke in patients with SCD is not well defined. Moreover, the presence of patent foramen ovale (PFO) increases the risk of the occurrence of an embolic cerebrovascular event. The role of PFO closure and antiplatelet or anticoagulation therapy has not been well investigated. Moreover, during COVID-19 pandemic and taking into account the increased rates of thrombotic events and the difficulties in blood transfusion, management of SCD patients is even more challenging and difficult, since data are scarce regarding stroke occurrence and management in this specific population in the COVID-19 era. This review focuses on pathophysiology of stroke in patients with SCD and possible treatment strategies in the presence of PFO.
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11
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Abdulmalik O, Darwish NHE, Muralidharan-Chari V, Taleb MA, Mousa SA. Sulfated non-anticoagulant heparin derivative modifies intracellular hemoglobin, inhibits cell sickling in vitro, and prolongs survival of sickle cell mice under hypoxia. Haematologica 2021; 107:532-540. [PMID: 33567814 PMCID: PMC8804574 DOI: 10.3324/haematol.2020.272393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Indexed: 11/09/2022] Open
Abstract
Sickle cell disease (SCD) is an autosomal recessive genetic disease caused by a single point mutation, resulting in abnormal sickle hemoglobin (HbS). During hypoxia or dehydration, HbS polymerizes to form insoluble aggregates and induces sickling of red blood cells, which increases the adhesiveness of the cells, thereby altering the rheological properties of the blood, and triggers inflammatory responses, leading to hemolysis and vaso-occlusive crises. Unfractionated heparin and low-molecular weight heparins have been suggested as treatments to relieve coagulation complications in SCD. However, they are associated with bleeding complications after repeated dosing. An alternative sulfated non-anticoagulant heparin derivative (S-NACH) was previously reported to have no to low systemic anticoagulant activity and no bleeding side effects, and it interfered with P-selectin-dependent binding of sickle cells to endothelial cells, with concomitant decrease in the levels of adhesion biomarkers in SCD mice. S-NACH has been further engineered and structurally enhanced to bind with and modify HbS to inhibit sickling directly, thus employing a multimodal approach. Here, we show that S-NACH can: (i) directly engage in Schiff-base reactions with HbS to decrease red blood cell sickling under both normoxia and hypoxia in vitro, (ii) prolong the survival of SCD mice under hypoxia, and (iii) regulate the altered steady state levels of pro- and anti-inflammatory cytokines. Thus, our proof-of-concept, in vitro and in vivo preclinical studies demonstrate that the multimodal S-NACH is a highly promising candidate for development into an improved and optimized alternative to low-molecular weight heparins for the treatment of patients with SCD.
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Affiliation(s)
- Osheiza Abdulmalik
- Division of Hematology, the Children's Hospital of Philadelphia, Philadelphia, PA
| | - Noureldien H E Darwish
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA; Clinical Pathology (Hematology Section), Faculty of Medicine, Mansoura University, Mansoura
| | | | - Maii Abu Taleb
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY
| | - Shaker A Mousa
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA; Vascular Vison Pharmaceuticals Co., 7 University Place, Rensselaer, NY.
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12
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Hermand P, Azouzi S, Gautier EF, Guillonneau F, Bondet V, Duffy D, Dechavanne S, Tharaux PL, Mayeux P, Le Van Kim C, Koehl B. The proteome of neutrophils in sickle cell disease reveals an unexpected activation of interferon alpha signaling pathway. Haematologica 2020; 105:2851-2854. [PMID: 33256386 PMCID: PMC7716375 DOI: 10.3324/haematol.2019.238295] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Patricia Hermand
- Université de Paris, Institut National de la Transfusion Sanguine, Paris, France
| | - Slim Azouzi
- Institut national de la transfusion sanguine and Laboratoire Excellence GR-Ex, Paris, France
| | | | | | - Vincent Bondet
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France
| | - Darragh Duffy
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France
| | - Sebastien Dechavanne
- Université de Paris, Institut National de la Transfusion Sanguine, Paris, France
| | | | - Patrick Mayeux
- Université de Paris, INSERM U1016, Institut Cochin, Paris, France
| | - Caroline Le Van Kim
- Université de Paris, Institut National de la Transfusion Sanguine, Paris, France
| | - Berengere Koehl
- Sickle Cell Disease Center, Hematology Unit, Hôpital Robert Debré, Paris, France
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13
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Zhang C, Yu C, Li W, Zhu Y, Ye Y, Wang Z, Lin Z. Fibulin-3 affects vascular endothelial function and is regulated by angiotensin II. Microvasc Res 2020; 132:104043. [PMID: 32707048 DOI: 10.1016/j.mvr.2020.104043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the effect of fibulin-3 on vascular endothelial function, and to explore the relevant underlying mechanism with regard to the involvement of angiotensin II (AngII). METHODS One hundred and eight patients with essential hypertension (EH) and 31 controls were included to measure the flow-mediated dilatation (FMD). Serum fibulin-3 and AngII were examined using enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay. Stable transfection of fibulin-3 was conducted on human umbilical vein endothelial cells (HUVECs) and SV40T-transformed HUVECs (PUMC-HUVEC-T1 cells). Cell counting kit-8 assay, cell cycle assay, wound healing assay, Transwell assay, apoptosis assay, and tube formation assay were subsequently performed. The expression of angiogenesis-associated genes [endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor A (VEGFA)] were measured by western blot analysis. HUVECs and PUMC-HUVEC-T1 cells were treated with AngII, and with or without an inhibitor of nuclear factor κB (NF-κB), BAY 11-7082. Pro-inflammatory cytokines [interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)] were detected by ELISA. The expression levels of fibulin-3 and p65 were then measured by western blotting. RESULTS Lower levels of serum fibulin-3 were accompanied by poorer FMD and higher levels of serum AngII in patients with EH. Fibulin-3 overexpression promoted cell proliferation, migration, and angiogenesis, but led to an inhibition of apoptosis. By contrast, fibulin-3 downregulation inhibited cell proliferation, migration and angiogenesis, but promoted apoptosis. AngII induced inflammation and inhibited the expression of fibulin-3. BAY 11-7082 eliminated the inhibitory effect of AngII on fibulin-3. CONCLUSIONS Taken together, the results of the present study have shown that serum fibulin-3 may be a predictor of vascular endothelial function in patients with EH. Fibulin-3 gene may also have a beneficial role in repairing the vascular endothelium. Furthermore, the results also suggested that fibulin-3 gene was suppressed by AngII via the NF-κB signaling pathway.
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Affiliation(s)
- Chiming Zhang
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, PR China
| | - Chan Yu
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, PR China
| | - Wenlei Li
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, PR China
| | - Yaoyao Zhu
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, PR China
| | - Yuling Ye
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, PR China
| | - Zhuo Wang
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
| | - Zhongwei Lin
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, PR China.
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14
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Conran N, De Paula EV. Thromboinflammatory mechanisms in sickle cell disease - challenging the hemostatic balance. Haematologica 2020; 105:2380-2390. [PMID: 33054078 PMCID: PMC7556678 DOI: 10.3324/haematol.2019.239343] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/19/2020] [Indexed: 11/11/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy that is caused by the presence of abnormal hemoglobin S (HbS) in red blood cells, leading to alterations in red cell properties and shape, as the result of HbS dexoygenation and subsequent polymerization. SCD pathophysiology is characterized by chronic inflammatory processes, triggered by hemolytic and vaso-occlusive events, which lead to the varied complications, organ damage and elevated mortality seen in individuals with the disease. In association with activation of the endothelium and leukocytes, hemostatic alterations and thrombotic events are well-documented in SCD. Here we discuss the role for inflammatory pathways in modulating coagulation and inducing platelet activation in SCD, due to tissue factor activation, adhesion molecule expression, inflammatory mediator production and the induction of innate immune responses, amongst other mechanisms. Thromboinflammatory pathways may play a significant role in some of the major complications of SCD, such as stroke, venous thromboembolism and possibly acute chest syndrome, besides exacerbating the chronic inflammation and cellular interactions that trigger vaso-occlusion, ischemia-reperfusion processes, and eventually organ damage.
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Affiliation(s)
- Nicola Conran
- Hematology Center, University of Campinas, UNICAMP, Cidade Universitária, Campinas-SP, Brazil
| | - Erich V. De Paula
- Hematology Center, University of Campinas, UNICAMP, Cidade Universitária, Campinas-SP, Brazil
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15
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Ribeiro-Filho J, Yahouédéhou SCMA, Pitanga TN, Santana SS, Adorno EV, Barbosa CG, Ferreira JRD, Pina ETG, Neres JSDS, Leite IPR, Lyra IM, Goncalves MS. An evaluation of ticagrelor for the treatment of sickle cell anemia. Expert Rev Hematol 2020; 13:1047-1055. [PMID: 32972255 DOI: 10.1080/17474086.2020.1817736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Ticagrelor is an antiplatelet agent approved for the treatment of patients with an acute coronary syndrome or a history of myocardial infarction. Considering the evidence demonstrating that ticagrelor-mediated inhibition of platelet activation and aggregation have beneficial effects in the treatment of thrombotic conditions, clinical studies have been conducted to evaluate the use of this drug for the treatment of sickle cell disease (SCD), demonstrating satisfactory tolerability and safety. AREAS COVERED Clinical investigation has characterized the pharmacokinetic and pharmacodynamical profile, as well as the efficacy and safety of ticagrelor to prevent painful vaso-occlusive crisis (painful episodes and acute chest syndrome) in SCD patients. EXPERT OPINION While phase 1 and 2 clinical trials demonstrated satisfactory tolerability and safety, the conclusion of phase 3 clinical trials is crucial to prove the efficacy of ticagrelor as a therapeutic option for the treatment of SCD. Thus, it is expected that ticagrelor, especially in combination with other drugs, will improve the clinical profile and quality of life of patients with SCD.
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Affiliation(s)
- Jaime Ribeiro-Filho
- Laboratóriode Investigaçãoem Genéticae Hematologia Translacional, Instituto Gonçalo Moniz , Salvador, Bahia, Brasil
| | - Sètondji Cocou Modeste Alexandre Yahouédéhou
- Laboratóriode Investigaçãoem Genéticae Hematologia Translacional, Instituto Gonçalo Moniz , Salvador, Bahia, Brasil.,Laboratório de Pesquisa em Anemia, Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal da Bahia , Salvador, Bahia, Brasil
| | - Thassila Nogueira Pitanga
- Laboratóriode Investigaçãoem Genéticae Hematologia Translacional, Instituto Gonçalo Moniz , Salvador, Bahia, Brasil.,Faculdade de Biomedicina, Universidade Católica de Salvador , Salvador, Bahia, Brasil
| | - Sânzio Silva Santana
- Laboratóriode Investigaçãoem Genéticae Hematologia Translacional, Instituto Gonçalo Moniz , Salvador, Bahia, Brasil.,Faculdade de Biomedicina, Universidade Católica de Salvador , Salvador, Bahia, Brasil
| | - Elisângela Vitória Adorno
- Laboratório de Pesquisa em Anemia, Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal da Bahia , Salvador, Bahia, Brasil
| | - Cynara Gomes Barbosa
- Laboratório de Pesquisa em Anemia, Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal da Bahia , Salvador, Bahia, Brasil
| | - Júnia Raquel Dutra Ferreira
- Laboratório de Pesquisa em Anemia, Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal da Bahia , Salvador, Bahia, Brasil
| | - Eugênia Terra Granado Pina
- Laboratóriode Investigaçãoem Genéticae Hematologia Translacional, Instituto Gonçalo Moniz , Salvador, Bahia, Brasil
| | | | - Ivana Paula Ribeiro Leite
- Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia , Salvador, Bahia, Brasil
| | - Isa Menezes Lyra
- Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia , Salvador, Bahia, Brasil.,Ambulatório, Fundação de Hematologia e Hemoterapia da Bahia , Salvador, Bahia, Brasil.,Curso de Medicina, Escola de Ciências da Saúde e Bem-Estar, Universidade Salvador , Salvador, Bahia, Brasil
| | - Marilda Souza Goncalves
- Laboratóriode Investigaçãoem Genéticae Hematologia Translacional, Instituto Gonçalo Moniz , Salvador, Bahia, Brasil.,Laboratório de Pesquisa em Anemia, Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal da Bahia , Salvador, Bahia, Brasil
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16
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Blakely IP, Horton RE. A microfluidic computational fluid dynamics model for cellular interaction studies of sickle cell disease vaso-occlusions. Microvasc Res 2020; 132:104052. [PMID: 32768462 DOI: 10.1016/j.mvr.2020.104052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/02/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Abstract
Individuals with sickle cell disease are plagued with vaso-occlusions, chronic blockages within the vasculature. Several factors including stiffer sickle red blood cells and increased cell aggregation contribute to vaso-occlusion formation; however much remains to be understood. We present a computational fluid dynamics blood flow simulation within a microfluidic platform using the Carreau model and Murray's law. Vaso-occlusions form preferentially near bifurcations within 60 s in the sickle cell disease simulation. Velocity profiles and shear rates align with clinical and experimental reports. We assert that results from this study can be utilized to inform experimental investigations and microfluidic system design decisions.
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Affiliation(s)
- Ian P Blakely
- Agricultural and Biological Engineering, College of Arts and Life Sciences, James Worth Bagley College of Engineering, Mississippi State University, United States of America
| | - Renita E Horton
- Biomedical Engineering Department, Cullen College of Engineering, University of Houston, United States of America.
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17
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Dos-Santos JCK, Silva-Filho JL, Judice CC, Kayano ACAV, Aliberti J, Khouri R, de Lima DS, Nakaya H, Lacerda MVG, De Paula EV, Lopes SCP, Costa FTM. Platelet disturbances correlate with endothelial cell activation in uncomplicated Plasmodium vivax malaria. PLoS Negl Trop Dis 2020; 14:e0007656. [PMID: 32687542 PMCID: PMC7392343 DOI: 10.1371/journal.pntd.0007656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 07/30/2020] [Accepted: 05/30/2020] [Indexed: 12/14/2022] Open
Abstract
Platelets drive endothelial cell activation in many diseases. However, if this occurs in Plasmodium vivax malaria is unclear. As platelets have been reported to be activated and to play a role in inflammatory response during malaria, we hypothesized that this would correlate with endothelial alterations during acute illness. We performed platelet flow cytometry of PAC-1 and P-selectin. We measured platelet markers (CXCL4, CD40L, P-selectin, Thrombopoietin, IL-11) and endothelial activation markers (ICAM-1, von Willebrand Factor and E-selectin) in plasma with a multiplex-based assay. The values of each mediator were used to generate heatmaps, K-means clustering and Principal Component analysis. In addition, we determined pair-wise Pearson’s correlation coefficients to generate correlation networks. Platelet counts were reduced, and mean platelet volume increased in malaria patients. The activation of circulating platelets in flow cytometry did not differ between patients and controls. CD40L levels (Median [IQ]: 517 [406–651] vs. 1029 [732–1267] pg/mL, P = 0.0001) were significantly higher in patients, while P-selectin and CXCL4 showed a nonsignificant trend towards higher levels in patients. The network correlation approach demonstrated the correlation between markers of platelet and endothelial activation, and the heatmaps revealed a distinct pattern of activation in two subsets of P. vivax patients when compared to controls. Although absolute platelet activation was not strong in uncomplicated vivax malaria, markers of platelet activity and production were correlated with higher endothelial cell activation, especially in a specific subset of patients. Endothelial cell activation is a key process in the pathogenesis of Plasmodium vivax malaria. Platelets are classically involved in endothelial cell activation in several diseases, but their role in the context of vivax malaria remains unclear. Thrombocytopenia is the most common hematological disturbance in P. vivax-infected patients, and platelets have been implicated in parasitemia control. In this work, we studied the activation of platelets in association with endothelial cell activation in vivax malaria. Platelets retrieved from infected peripheral blood were non-activated when analyzed by flow cytometry; however, they displayed higher mean volume and significantly reduced counts. We also found higher levels of circulating factors associated with platelet activation (especially soluble CD40L), thrombopoiesis and endothelial cell activation in infected patients. Further, through pair-wise correlation and clustering analysis, we found a subgroup of patients showing significant associations between markers of platelet and endothelial activation in a pattern different from that of endemic controls. Collectively, our findings indicate a role of platelets in endothelial cell activation in vivax malaria and indicate a heterogeneous host response in the setting of uncomplicated disease, a finding to be further explored in future studies.
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Affiliation(s)
- João Conrado Khouri Dos-Santos
- Laboratório de Doenças Tropicais–Prof. Luiz Jacintho da Silva. Instituto de Biologia, Universidade Estadual de Campinas, Campinas, Brazil
- Pós-graduação em Fisiopatologia Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brazil
| | - João Luiz Silva-Filho
- Laboratório de Doenças Tropicais–Prof. Luiz Jacintho da Silva. Instituto de Biologia, Universidade Estadual de Campinas, Campinas, Brazil
| | - Carla C. Judice
- Laboratório de Doenças Tropicais–Prof. Luiz Jacintho da Silva. Instituto de Biologia, Universidade Estadual de Campinas, Campinas, Brazil
| | - Ana Carolina Andrade Vitor Kayano
- Laboratório de Doenças Tropicais–Prof. Luiz Jacintho da Silva. Instituto de Biologia, Universidade Estadual de Campinas, Campinas, Brazil
| | - Júlio Aliberti
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Ricardo Khouri
- Instituto Gonçalo Moniz, Fiocruz Bahia, Salvador, Brazil
| | - Diógenes S. de Lima
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, São Paulo, Brazil
| | - Helder Nakaya
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, São Paulo, Brazil
| | - Marcus Vinicius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fiocruz Amazônia, Manaus, Brazil
| | - Erich Vinicius De Paula
- Centro de Hematologia e Hemoterapia–Hemocentro, Universidade Estadual de Campinas, Campinas, Brazil
| | | | - Fabio Trindade Maranhão Costa
- Laboratório de Doenças Tropicais–Prof. Luiz Jacintho da Silva. Instituto de Biologia, Universidade Estadual de Campinas, Campinas, Brazil
- * E-mail:
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18
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Ansari J, Gavins FNE. Ischemia-Reperfusion Injury in Sickle Cell Disease: From Basics to Therapeutics. THE AMERICAN JOURNAL OF PATHOLOGY 2019; 189:706-718. [PMID: 30904156 DOI: 10.1016/j.ajpath.2018.12.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/17/2018] [Accepted: 12/07/2018] [Indexed: 12/17/2022]
Abstract
Sickle cell disease (SCD) is one of the most common hereditary hemoglobinopathies worldwide, affecting almost 400,000 newborns globally each year. It is characterized by chronic hemolytic anemia and endothelial dysfunction, resulting in a constant state of disruption of the vascular system and leading to recurrent episodes of ischemia-reperfusion injury (I/RI) to multiple organ systems. I/RI is a fundamental vascular pathobiological paradigm and contributes to morbidity and mortality in a wide range of conditions, including myocardial infarction, stroke, acute kidney injury, and transplantation. I/RI is characterized by an initial restriction of blood supply to an organ, which can lead to ischemia, followed by the subsequent restoration of perfusion and concomitant reoxygenation. Recent advances in the pathophysiology of SCD have led to an understanding that many of the consequences of this disease can be explained by mechanisms associated with I/RI. The following review focuses on the evolving pathobiology of SCD, how various complications of SCD can be attributed to I/RI, and the role of timely therapeutic intervention(s) based on targeting mediators or pathways that influence I/R insult.
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Affiliation(s)
- Junaid Ansari
- Department of Molecular & Cellular Physiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana
| | - Felicity N E Gavins
- Department of Molecular & Cellular Physiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana.
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19
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Stotesbury H, Kawadler JM, Hales PW, Saunders DE, Clark CA, Kirkham FJ. Vascular Instability and Neurological Morbidity in Sickle Cell Disease: An Integrative Framework. Front Neurol 2019; 10:871. [PMID: 31474929 PMCID: PMC6705232 DOI: 10.3389/fneur.2019.00871] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/26/2019] [Indexed: 12/20/2022] Open
Abstract
It is well-established that patients with sickle cell disease (SCD) are at substantial risk of neurological complications, including overt and silent stroke, microstructural injury, and cognitive difficulties. Yet the underlying mechanisms remain poorly understood, partly because findings have largely been considered in isolation. Here, we review mechanistic pathways for which there is accumulating evidence and propose an integrative systems-biology framework for understanding neurological risk. Drawing upon work from other vascular beds in SCD, as well as the wider stroke literature, we propose that macro-circulatory hyper-perfusion, regions of relative micro-circulatory hypo-perfusion, and an exhaustion of cerebral reserve mechanisms, together lead to a state of cerebral vascular instability. We suggest that in this state, tissue oxygen supply is fragile and easily perturbed by changes in clinical condition, with the potential for stroke and/or microstructural injury if metabolic demand exceeds tissue oxygenation. This framework brings together recent developments in the field, highlights outstanding questions, and offers a first step toward a linking pathophysiological explanation of neurological risk that may help inform future screening and treatment strategies.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Patrick W Hales
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Department of Radiology, Great Ormond Hospital, London, United Kingdom
| | - Christopher A Clark
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.,Department of Child Health, University Hospital Southampton, Southampton, United Kingdom.,Department of Paediatric Neurology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
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20
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Ogunsile FJ, Naik R, Lanzkron S. Overcoming challenges of venous thromboembolism in sickle cell disease treatment. Expert Rev Hematol 2019; 12:173-182. [PMID: 30773073 DOI: 10.1080/17474086.2019.1583554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a common comorbid condition found in sickle cell disease (SCD) and is associated with increased mortality for adults with SCD. The pathophysiology that leads to the thrombophilic state in SCD has been previously reviewed; however, evidence-based guidelines to aid in diagnosis, prevention, and management of VTE are lacking. Areas covered: This review article will cover the pathophysiology underlying the hypercoagulable state, the epidemiology of VTE, and management strategies of VTE in SCD. Expert opinion: Providers should have a high suspicion for diagnosing VTE to help reduce morbidity and mortality in the SCD population. Unlike other thrombophilias, the risk of life-threatening anemia while being treated with anticoagulation is compounded with the potential complications surrounding red blood cell transfusions in this population (i.e. alloimmunization, hyperhemolysis) and this provides another complexity to managing VTE in this population. Clinical trials evaluating the risk and benefit of treatment and treatment duration are needed.
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Affiliation(s)
- Foluso Joy Ogunsile
- a Department of Hematology , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Rakhi Naik
- a Department of Hematology , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Sophie Lanzkron
- a Department of Hematology , Johns Hopkins School of Medicine , Baltimore , MD , USA
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21
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Akrimi S, Simiyu V. Anaesthetic management of children with sickle cell disease. BJA Educ 2018; 18:331-336. [PMID: 33456798 DOI: 10.1016/j.bjae.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- S Akrimi
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - V Simiyu
- Kenyatta National Hospital, Nairobi, Kenya
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22
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Abstract
In the 100 years since sickle cell anemia (SCA) was first described in the medical literature, studies of its molecular and pathophysiological basis have been at the vanguard of scientific discovery. By contrast, the translation of such knowledge into treatments that improve the lives of those affected has been much too slow. Recent years, however, have seen major advances on several fronts. A more detailed understanding of the switch from fetal to adult hemoglobin and the identification of regulators such as BCL11A provide hope that these findings will be translated into genomic-based approaches to the therapeutic reactivation of hemoglobin F production in patients with SCA. Meanwhile, an unprecedented number of new drugs aimed at both the treatment and prevention of end-organ damage are now in the pipeline, outcomes from potentially curative treatments such as allogeneic hematopoietic stem cell transplantation are improving, and great strides are being made in gene therapy, where methods employing both antisickling β-globin lentiviral vectors and gene editing are now entering clinical trials. Encouragingly, after a century of neglect, the profile of the vast majority of those with SCA in Africa and India is also finally improving.
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Affiliation(s)
- Thomas N Williams
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Medicine, Imperial College London, London W2 1NY, United Kingdom;
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1589, USA;
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23
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Abstract
The primary β-globin gene mutation that causes sickle cell disease (SCD) has significant pathophysiological consequences that result in hemolytic events and the induction of the inflammatory processes that ultimately lead to vaso-occlusion. In addition to their role in the initiation of the acute painful vaso-occlusive episodes that are characteristic of SCD, inflammatory processes are also key components of many of the complications of the disease including autosplenectomy, acute chest syndrome, pulmonary hypertension, leg ulcers, nephropathy and stroke. We, herein, discuss the events that trigger inflammation in the disease, as well as the mechanisms, inflammatory molecules and cells that propagate these inflammatory processes. Given the central role that inflammation plays in SCD pathophysiology, many of the therapeutic approaches currently under pre-clinical and clinical development for the treatment of SCD endeavor to counter aspects or specific molecules of these inflammatory processes and it is possible that, in the future, we will see anti-inflammatory drugs being used either together with, or in place of, hydroxyurea in those SCD patients for whom hematopoietic stem cell transplants and evolving gene therapies are not a viable option.
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Affiliation(s)
- Nicola Conran
- Hematology Center, University of Campinas - UNICAMP, Cidade Universitária, Campinas-SP, Brazil
| | - John D Belcher
- Department of Medicine, Division of Hematology, Oncology and Transplantation, Vascular Biology Center, University of Minnesota, Minneapolis, MN, USA
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24
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Study of platelet activation markers and plasma cytokines in sickle cell disease patients during vaso-occlusive pain crises. J Hematop 2018. [DOI: 10.1007/s12308-018-0322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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25
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Horton RE. Microfluidics for investigating vaso-occlusions in sickle cell disease. Microcirculation 2018; 24. [PMID: 28376286 DOI: 10.1111/micc.12373] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/30/2017] [Indexed: 12/17/2022]
Abstract
SCD stems from amutation in the beta globin gene. Upon deoxygenation, hemoglobin polymerizes and triggers RBC remodeling. This phenomenon is central to SCD pathogenesis as individuals suffering from the disease are plagued by painful vaso-occlusive crises episodes. These episodes are the result of a combination of processes including inflammation, thrombosis, and blood cell adhesion to the vascular wall which leads to blockages within the vasculature termed vaso-occlusions. Vaso-occlusive episodes deprive tissues of oxygen and are a major contributor to SCD-related complications; unfortunately, the complex mechanisms that contribute to vaso-occlusions are not well understood. Vaso-occlusions can occur in post-capillary venules; hence, the microvasculature is a prime target for SCD therapies. Traditional in vitro systems poorly recapitulate architectural and dynamic flow properties of in vivo systems. However, microfluidic devices can capture features of the native vasculature such as cellular composition, flow, geometry, and ECM presentation. This review, although not comprehensive, highlights microfluidic approaches that aim to improve our current understanding of the pathophysiological mechanisms surrounding SCD. Microfluidic platforms can aid in identifying factors that may contribute to disease severity and can serve as suitable test beds for novel treatment strategies which may improve patient outcomes.
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Affiliation(s)
- Renita E Horton
- Agricultural and Biological Engineering Department, College of Agriculture and Life Sciences, James Worth Bagley College of Engineering, Mississippi State University, Starkville, MS, USA
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26
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Gu R, Sun X, Chi Y, Zhou Q, Xiang H, Bosco DB, Lai X, Qin C, So KF, Ren Y, Chen XM. Integrin β3/Akt signaling contributes to platelet-induced hemangioendothelioma growth. Sci Rep 2017; 7:6455. [PMID: 28744026 PMCID: PMC5527091 DOI: 10.1038/s41598-017-06927-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/22/2017] [Indexed: 01/16/2023] Open
Abstract
Hemangioendothelioma (HE) is a type of angiomatous lesions that features endothelial cell proliferation. Understanding the mechanisms orchestrating HE angiogenesis can provide therapeutic insights. It has been shown that platelets can support normal and malignant endothelial cells during angiogenesis. Using the mouse endothelial-derived EOMA cell line as a model of HE, we explored the regulatory effect of platelets. We found that platelets stimulated EOMA proliferation but did not mitigate apoptosis. Furthermore, direct platelet-EOMA cell contact was required and the proliferation was mediated via integrin β3/Akt signaling in EOMA cells. SiRNA knockdown of integrin β3 and inhibition of Akt activity significantly abolished platelet-induced EOMA cell proliferation in vitro and tumor development in vivo. These results provide a new mechanism by which platelets support HE progression and suggest integrin β3 as a potential target to treat HE.
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Affiliation(s)
- Rui Gu
- Institute of Inflammation and Diseases, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xin Sun
- Guangdong-Hong Kong-Macau Institute of CNS Regeneration (GHMICR), Joint International Research Laboratory of CNS Regeneration Ministry of Education, Guangdong Medical Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou, China.,Co-innovation Center of Neuroregeneration, Nantong, China
| | - Yijie Chi
- Institute of Inflammation and Diseases, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qishuang Zhou
- Institute of Inflammation and Diseases, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongkai Xiang
- Institute of Inflammation and Diseases, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dale B Bosco
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Xinhe Lai
- Institute of Inflammation and Diseases, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Caixia Qin
- Guangdong-Hong Kong-Macau Institute of CNS Regeneration (GHMICR), Joint International Research Laboratory of CNS Regeneration Ministry of Education, Guangdong Medical Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou, China
| | - Kwok-Fai So
- Guangdong-Hong Kong-Macau Institute of CNS Regeneration (GHMICR), Joint International Research Laboratory of CNS Regeneration Ministry of Education, Guangdong Medical Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou, China.,Co-innovation Center of Neuroregeneration, Nantong, China
| | - Yi Ren
- Institute of Inflammation and Diseases, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. .,Guangdong-Hong Kong-Macau Institute of CNS Regeneration (GHMICR), Joint International Research Laboratory of CNS Regeneration Ministry of Education, Guangdong Medical Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou, China. .,Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, USA.
| | - Xiao-Ming Chen
- Institute of Inflammation and Diseases, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Conran N, Rees DC. Prasugrel hydrochloride for the treatment of sickle cell disease. Expert Opin Investig Drugs 2017; 26:865-872. [PMID: 28562105 DOI: 10.1080/13543784.2017.1335710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Therapeutic options for sickle cell disease (SCD) are limited and, currently, only one drug (hydroxyurea) has FDA approval for the treatment of adult SCD. While this genetic disease is caused by hemoglobin polymerization, subsequent downstream events trigger platelet activation, vaso-occlusion and the disease's complex pathophysiology. Areas covered: The oral thienopyridine, prasugrel hydrochloride, irreversibly inhibits the P2Y12 receptors, inhibiting ADP-dependent platelet activation. We discuss recent clinical trials evaluating the pharmokinetics of prasugrel and its potential for use in SCD. Expert opinion: Prasugrel administration in SCD appears to be well tolerated and safe. However, although this drug modestly inhibits platelet activity in these patients, administration of prasugrel to a large group of children and adolescents for up to 24 months failed to convincingly reduce vaso-occlusive complications. Speculatively, prasugrel may be of occasional use for off-license purposes in patients unable or unwilling to take hydroxyurea (particularly in 12-17-year olds). Although there is currently no prospect of prasugrel being licensed for use in SCD, the success of on-going trials of other antiplatelet agents in SCD might lead to further trials of prasugrel in SCD.
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Affiliation(s)
- Nicola Conran
- a Hematology Center , University of Campinas - UNICAMP, Cidade Universitaria , Campinas-SP , Brazil
| | - David C Rees
- b Department of Paediatric Haematology , King's College Hospital , London , UK
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Nhek S, Clancy R, Lee KA, Allen NM, Barrett TJ, Marcantoni E, Nwaukoni J, Rasmussen S, Rubin M, Newman JD, Buyon JP, Berger JS. Activated Platelets Induce Endothelial Cell Activation via an Interleukin-1β Pathway in Systemic Lupus Erythematosus. Arterioscler Thromb Vasc Biol 2017; 37:707-716. [PMID: 28153882 DOI: 10.1161/atvbaha.116.308126] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/20/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is associated with the premature development of cardiovascular disease. The platelet-endothelium interaction is important in the pathogenesis of cardiovascular disease. In this study, we investigated the platelet phenotype from patients with SLE and matched controls, and their effect on endothelial cells. APPROACH AND RESULTS Platelet aggregability was measured in 54 SLE subjects off antiplatelet therapy (mean age 40.1±12.8 years; 82% female; 37% white) with age- and sex-matched controls. Platelets were coincubated with human umbilical vein endothelial cells (HUVECs) and changes to gene expression assessed by an RNA array and quantitative reverse transcription polymerase chain reaction. SLE disease activity index ranged from 0 to 22 (mean 5.1±3.9). Compared with controls, patients with SLE had significantly increased monocyte and leukocyte-platelet aggregation and platelet aggregation in response to submaximal agonist stimulation. An agnostic microarray of HUVECs cocultured with SLE platelets found a platelet-mediated effect on endothelial gene pathways involved in cell activation. Sera from SLE versus control subjects significantly increased (1) activation of control platelets; (2) platelet adhesion to HUVECs; (3) platelet-induced HUVEC gene expression of interleukin-8, and intercellular adhesion molecule 1; and (4) proinflammatory gene expression in HUVECs, mediated by interleukin-1β-dependent pathway. Incubation of SLE-activated platelets with an interleukin-1β-neutralizing antibody or HUVECs pretreated with interleukin-1 receptor antibodies attenuated the platelet-mediated activation of endothelial cells. CONCLUSIONS Platelet activity measurements and subsequent interleukin-1β-dependent activation of the endothelium are increased in subjects with SLE. Platelet-endothelial interactions may play a role in the pathogenesis of cardiovascular disease in patients with SLE.
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Affiliation(s)
- Sokha Nhek
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Robert Clancy
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Kristen A Lee
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Nicole M Allen
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Tessa J Barrett
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Emanuela Marcantoni
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Janet Nwaukoni
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Sara Rasmussen
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Maya Rubin
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Jonathan D Newman
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Jill P Buyon
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York
| | - Jeffrey S Berger
- From the Department of Medicine, Divisions of Cardiology (S.N., K.A.L., N.M.A., T.J.B., E.M., M.R., J.D.N., J.S.B.), Hematology (J.S.B.), and Rheumatology (R.C., J.N., S.R., J.P.B.), New York University School of Medicine, New York.
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29
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Alapan Y, Fraiwan A, Kucukal E, Hasan MN, Ung R, Kim M, Odame I, Little JA, Gurkan UA. Emerging point-of-care technologies for sickle cell disease screening and monitoring. Expert Rev Med Devices 2016; 13:1073-1093. [PMID: 27785945 PMCID: PMC5166583 DOI: 10.1080/17434440.2016.1254038] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Sickle Cell Disease (SCD) affects 100,000 Americans and more than 14 million people globally, mostly in economically disadvantaged populations, and requires early diagnosis after birth and constant monitoring throughout the life-span of the patient. Areas covered: Early diagnosis of SCD still remains a challenge in preventing childhood mortality in the developing world due to requirements of skilled personnel and high-cost of currently available modalities. On the other hand, SCD monitoring presents insurmountable challenges due to heterogeneities among patient populations, as well as in the same individual longitudinally. Here, we describe emerging point-of-care micro/nano platform technologies for SCD screening and monitoring, and critically discuss current state of the art, potential challenges associated with these technologies, and future directions. Expert commentary: Recently developed microtechnologies offer simple, rapid, and affordable screening of SCD and have the potential to facilitate universal screening in resource-limited settings and developing countries. On the other hand, monitoring of SCD is more complicated compared to diagnosis and requires comprehensive validation of efficacy. Early use of novel microdevices for patient monitoring might come in especially handy in new clinical trial designs of emerging therapies.
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Affiliation(s)
- Yunus Alapan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Arwa Fraiwan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Erdem Kucukal
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - M. Noman Hasan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Ryan Ung
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Myeongseop Kim
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Isaac Odame
- Division of Haematology/Oncology, The Hospital for Sick Children; Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jane A. Little
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Seidman Cancer Center at University Hospitals, Case Medical Center, Cleveland, OH, USA
| | - Umut A. Gurkan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
- Department of Orthopedics, Case Western Reserve University, Cleveland, OH, USA
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30
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Castilhos LG, Doleski PH, Adefegha SA, Becker LV, Ruchel JB, Leal DBR. Altered E-NTPDase/E-ADA activities and CD39 expression in platelets of sickle cell anemia patients. Biomed Pharmacother 2016; 79:241-6. [PMID: 27044834 DOI: 10.1016/j.biopha.2016.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/10/2016] [Indexed: 11/15/2022] Open
Abstract
Sickle cell anemia (SCA) is a hemoglobinopathy characterized by hemolysis and vaso-occlusions caused by rigidly distorted red blood cells. Sickle cell crisis is associated with extracellular release of nucleotides and platelets, which are critical mediators of hemostasis participating actively in purinergic thromboregulatory enzymes system.This study aimed to investigate the activities of purinergic system ecto-enzymes present on the platelet surface as well as CD39 and CD73 expressions on platelets of SCA treated patients. Fifteen SCA treated patients and 30 health subjects (control group) were selected. Ecto-nucleoside triphosphate diphosphohydrolase (E-NTPDase), ecto-5'-nucleotidase (E-5'-NT) and ecto-adenosine deaminase (E-ADA) activities were measured in platelets isolated from these individuals. Results demonstrated an increase of 41 % in the E-NTPDase for ATP hydrolysis, 52% for ADP hydrolysis and 60 % in the E-ADA activity in SCA patients (P<0.05); however, a two folds decrease in the CD39 expression in platelets was observed in the same group (P<0.01). The increased E-NTPDase activity could be a compensatory mechanism associated with the low expression of CD39 in platelets. Besides, alteration of these enzymes activities suggests that the purinergic system could be involved in the thromboregulatory process in SCA patients.
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Affiliation(s)
- Lívia G Castilhos
- Departamento de Microbiologia e Parasitologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria-RS, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria-RS, Brazil.
| | - Pedro H Doleski
- Programa de Pós-Graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria-RS, Brazil
| | - Stephen A Adefegha
- Programa de Pós-Graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria-RS, Brazil; Department of Biochemistry, Federal University of Technology, P. M. B. 704, Akure, Nigeria
| | - Lara V Becker
- Programa de Pós-Graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria-RS, Brazil
| | - Jader B Ruchel
- Programa de Pós-Graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria-RS, Brazil
| | - Daniela B R Leal
- Departamento de Microbiologia e Parasitologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria-RS, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria-RS, Brazil; Programa de Pós-Graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Av. Roraima, 97105-900, Santa Maria-RS, Brazil.
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31
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Torres LDS, Okumura JV, da Silva DGH, Belini Júnior É, de Oliveira RG, Mimura KKO, Lobo CLDC, Oliani SM, Bonini Domingos CR. Plasma levels of TGF-β1 in homeostasis of the inflammation in sickle cell disease. Cytokine 2016; 80:18-25. [PMID: 26928604 DOI: 10.1016/j.cyto.2016.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/20/2016] [Accepted: 02/23/2016] [Indexed: 01/02/2023]
Abstract
Sickle cell disease (SCD) represents a chronic inflammatory condition with complications triggered by the polymerization of hemoglobin S (Hb S), resulting in a series of cellular interactions mediated by inflammatory cytokines, as the transforming growth factor beta (TGF-β), which plays an important role in inflammation resolution. This study assessed the relation between SCD inflammation and the plasma concentration of TGF-β1, and also checked the influence of the presence of -509C/T polymorphism in TGFB1 gene on TGF-β1 plasma values. The plasma levels of TGF-β1 were quantified by ELISA in 115 patients with SCD (genotypes SS, SD-Los Angeles, Sβ-thalassemia and SC) and in 58 individuals with no hemoglobinopathies (Hb AA), as the control group. The -509C/T polymorphism in TGFB1 gene was screened by PCR-RFLP. The correlation between TGF-β1 plasma levels and the inflammation was based on its association with the count of platelets, total white blood cells (WBC) and neutrophils in the peripheral blood. Patients with SCD showed plasma levels of TGF-β1 higher than the control group, especially the Hb SS genotype, followed by the group with Hb SD. Polymorphism investigation showed no interference in the values obtained for the cytokine in the groups evaluated. All SCD groups showed TGF-β1 levels positively correlated to the platelets and WBC counts. The original data obtained in this study for SCD support the involvement of TGF-β1 in regulating of the inflammatory response and suggest that this marker possibly may become a potential therapeutic target in the treatment of the disease.
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Affiliation(s)
- Lidiane de Souza Torres
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil.
| | - Jéssika Viviani Okumura
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Danilo Grünig Humberto da Silva
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Édis Belini Júnior
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Renan Garcia de Oliveira
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Kallyne Kioko Oliveira Mimura
- Laboratory of Imunomorphology, Department of Biology, Sao Paulo State University (Unesp), Rua Cristovão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Clarisse Lopes de Castro Lobo
- Institute of Hematology Arthur de Siqueira Cavalcanti (Hemorio), Rua Frei Caneca, 08, Rio de Janeiro, RJ 20211-030, Brazil
| | - Sonia Maria Oliani
- Laboratory of Imunomorphology, Department of Biology, Sao Paulo State University (Unesp), Rua Cristovão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
| | - Claudia Regina Bonini Domingos
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, Sao Paulo State University (Unesp), Rua Cristóvão Colombo, 2265, São Jose do Rio Preto, SP 15054-000, Brazil
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Kataoka H, Ariyama Y, Deushi M, Osaka M, Nitta K, Yoshida M. Inhibitory Effect of Serotonin Antagonist on Leukocyte-Endothelial Interactions In Vivo and In Vitro. PLoS One 2016; 11:e0147929. [PMID: 26824242 PMCID: PMC4732655 DOI: 10.1371/journal.pone.0147929] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 01/11/2016] [Indexed: 11/25/2022] Open
Abstract
Background Although 5-HT2A serotonergic antagonists have been used to treat vascular disease in patients with diabetes mellitus or obesity, their effects on leukocyte-endothelial interactions have not been fully investigated. In this study, we assessed the effects of sarpogrelate hydrochloride (SRPO), a 5-HT2A receptor inverse agonist, on leukocyte-endothelial cell interactions in obesity both in vivo and in vitro. Methods and Findings In the in vivo experiment, C57BL/6 mice were fed a high-fat high-fructose diet (HFFD), comprising 20% fat and 30% fructose, with or without intraperitoneal injection of 5 mg/kg/day SRPO for 4 weeks. The body weight, visceral fat weight, and serum monocyte chemoattractant protein-1 levels in the mice increased significantly with the HFFD, but these effects were prevented by chronic injections of SRPO. Intravital microscopy of the femoral artery detected significant leukocyte-endothelial interactions after treatment with HFFD, but these leukocyte-endothelial interactions were reduced in the mice injected with SRPO. In the in vitro experiment, pre-incubation of activated human umbilical vein endothelial cells (HUVECs) with platelet-rich plasma (PRP) induced THP-1 cell adhesion under physiological flow conditions, but the adhesion was reduced by pretreatment of PRP with SRPO. A fluorescent immunobinding assay showed that PRP induced significant upregulation of E-selectin in HUVECs, but this upregulation was reduced by pretreatment of PRP with SRPO. In other in vitro conditions, pre-incubation of THP-1 cells with phorbol 12-myristate 13-acetate increased the adhesion of THP-1 cells to activated HUVECs under rotational conditions, but this adhesion was reduced by pretreatment with SRPO. Western blotting analysis showed that protein kinase C α activation in THP-1 cells was inhibited by SRPO. Conclusion Our findings indicated that SRPO inhibits vascular inflammation in obesity via inactivation of platelets and leukocytes, and improvement of obese.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yuno Ariyama
- Department of Life Sciences and Bioethics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Michiyo Deushi
- Department of Life Sciences and Bioethics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mizuko Osaka
- Department of Life Sciences and Bioethics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kosaku Nitta
- Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Life Sciences and Bioethics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- * E-mail:
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33
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Neutrophils, platelets, and inflammatory pathways at the nexus of sickle cell disease pathophysiology. Blood 2016; 127:801-9. [PMID: 26758915 DOI: 10.1182/blood-2015-09-618538] [Citation(s) in RCA: 269] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/28/2015] [Indexed: 02/07/2023] Open
Abstract
Sickle cell disease (SCD) is a severe genetic blood disorder characterized by hemolytic anemia, episodic vaso-occlusion, and progressive organ damage. Current management of the disease remains symptomatic or preventative. Specific treatment targeting major complications such as vaso-occlusion is still lacking. Recent studies have identified various cellular and molecular factors that contribute to the pathophysiology of SCD. Here, we review the role of these elements and discuss the opportunities for therapeutic intervention.
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34
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Dominical VM, Samsel L, Nichols JS, Costa FF, McCoy JP, Conran N, Kato GJ. Prominent role of platelets in the formation of circulating neutrophil-red cell heterocellular aggregates in sickle cell anemia. Haematologica 2015; 99:e214-7. [PMID: 25420284 DOI: 10.3324/haematol.2014.108555] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Venina M Dominical
- INCT de Sangue, Hematology and Hemotherapy Center, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Leigh Samsel
- Flow Cytometry Core, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - James S Nichols
- Sickle Cell Vascular Disease Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Fernando F Costa
- INCT de Sangue, Hematology and Hemotherapy Center, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - J Phillip McCoy
- Flow Cytometry Core, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicola Conran
- INCT de Sangue, Hematology and Hemotherapy Center, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Gregory J Kato
- Sickle Cell Vascular Disease Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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