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Bathla T, Lotfollahzadeh S, Quisel M, Mehta M, Malikova M, Chitalia VC. End Organ Affection in Sickle Cell Disease. Cells 2024; 13:934. [PMID: 38891066 PMCID: PMC11174153 DOI: 10.3390/cells13110934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024] Open
Abstract
Sickle cell disease is an orphan disease affecting ethnic minorities and characterized by profound systemic manifestations. Although around 100,000 individuals with SCD are living in the US, the exact number of individuals is unknown, and it is considered an orphan disease. This single-gene disorder leads to red blood cell sickling and the deoxygenation of hemoglobin, resulting in hemolysis. SCD is associated with acute complications such as vaso-occlusive crisis, infections, and chronic target organ complications such as pulmonary disease and renal failure. While genetic therapy holds promise to alter the fundamental disease process, the major challenge in the field remains the target end organ damage and ways to mitigate or reverse it. Here, we provide an overview of the clinical manifestations and pathogenesis with a focus on end-organ damage and current therapeutic options, including recent FDA-approved stem cell and gene editing therapies.
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Affiliation(s)
- Tanvi Bathla
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
| | - Saran Lotfollahzadeh
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
| | - Matthew Quisel
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
| | - Mansi Mehta
- Saint Vincent’s Medical Hospital, Worcester, MA 01608, USA;
| | - Marina Malikova
- Department of Surgery, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Vipul C. Chitalia
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
- Veterans Affairs Boston Healthcare System, Boston, MA 02118, USA
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Center of Cross-Organ Vascular Pathology, Department of Medicine, Boston University Medical Center, Evans Biomedical Research Center, X-530, Boston, MA 02118, USA
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2
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Ellison V, Berlin KS, Longoria J, Potter B, Raches D, Hankins JS, Takemoto C, Heitzer AM. Empirically derived profiles of neurocognitive functioning in youth and young adults with sickle cell disease. J Pediatr Psychol 2024:jsae029. [PMID: 38623054 DOI: 10.1093/jpepsy/jsae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE Sickle cell disease (SCD) is an inherited blood disorder associated with neurocognitive deficits. In contrast to variable-centered approaches, no known research has utilized person-centered strategies to identify multidimensional patterns of neurocognitive functioning of an individual with SCD. The purpose of the present study was to create empirically derived profiles and identify predictors of neurocognitive functioning subgroups among youth and young adults with SCD. METHODS Individuals with SCD (N = 393, mean age 14.05 years, age range 8-24, 50.4% female/49.6% male) completed neurocognitive assessments. Latent profile analysis derived subgroups/classes of neurocognitive functioning and determined relations with demographic and medical variables. RESULTS Three latent classes emerged: average functioning (n = 102, 27%), low average functioning (n = 225, 60%), and exceptionally low functioning (n = 46, 12%). Older age was associated with membership in the low average and exceptionally low functioning groups (relative to the average group). Being prescribed hydroxyurea was associated with membership in the average functioning group (relative to the low average group) and absence of hydroxyurea use was associated with membership in the exceptionally low group (relative to the low average group). Lower social vulnerability was associated with membership in the average functioning group compared to the low average and exceptionally low groups. CONCLUSIONS Clinicians can help reduce disparities in cognitive development for individuals with SCD by promoting early treatment with hydroxyurea and implementing methods to reduce social vulnerabilities that can interfere with access to evidence-based care.
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Affiliation(s)
- Vinkrya Ellison
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, United States
- The Department of Psychology, The University of Memphis, Memphis, TN, United States
- The Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Kristoffer S Berlin
- The Department of Psychology, The University of Memphis, Memphis, TN, United States
- The Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Jennifer Longoria
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Brian Potter
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Darcy Raches
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, United States
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Clifford Takemoto
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Andrew M Heitzer
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, United States
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3
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Hankins JS, Brambilla D, Potter MB, Kutlar A, Gibson R, King AA, Baumann AA, Melvin C, Gordeuk VR, Hsu LL, Nwosu C, Porter JS, Alberts NM, Badawy SM, Simon J, Glassberg JA, Lottenberg R, DiMartino L, Jacobs S, Fernandez ME, Bosworth HB, Klesges LM, Shah N. A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease. Blood Adv 2023; 7:7190-7201. [PMID: 37738155 PMCID: PMC10698253 DOI: 10.1182/bloodadvances.2023010670] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
Hydroxyurea reduces sickle cell disease (SCD) complications, but medication adherence is low. We tested 2 mobile health (mHealth) interventions targeting determinants of low adherence among patients (InCharge Health) and low prescribing among providers (HU Toolbox) in a multi-center, non-randomized trial of individuals with SCD ages 15-45. We compared the percentage of days covered (PDC), labs, healthcare utilization, and self-reported pain over 24 weeks of intervention and 12 weeks post-study with a 24-week preintervention interval. We enrolled 293 patients (51% male; median age 27.5 years, 86.8% HbSS/HbSβ0-thalassemia). The mean change in PDC among 235 evaluable subjects increased (39.7% to 56.0%; P < 0.001) and sustained (39.7% to 51.4%, P < 0.001). Mean HbF increased (10.95% to 12.78%; P = 0.03). Self-reported pain frequency reduced (3.54 to 3.35 events/year; P = 0.041). InCharge Health was used ≥1 day by 199 of 235 participants (84.7% implementation; median usage: 17% study days; IQR: 4.8-45.8%). For individuals with ≥1 baseline admission for pain, admissions per 24 weeks declined from baseline through 24 weeks (1.97 to 1.48 events/patient, P = 0.0045) and weeks 25-36 (1.25 events/patient, P = 0.0015). PDC increased with app use (P < 0.001), with the greatest effect in those with private insurance (P = 0.0078), older subjects (P = 0.033), and those with lower pain interference (P = 0.0012). Of the 89 providers (49 hematologists, 36 advanced care providers, 4 unreported), only 11.2% used HU Toolbox ≥1/month on average. This use did not affect change in PDC. Tailoring mHealth solutions to address barriers to hydroxyurea adherence can potentially improve adherence and provide clinical benefits. A definitive randomized study is warranted. This trial was registered at www.clinicaltrials.gov as #NCT04080167.
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Affiliation(s)
- Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Michael B Potter
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Abdullah Kutlar
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Robert Gibson
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Allison A King
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Victor R Gordeuk
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Lewis L Hsu
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Chinonyelum Nwosu
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jerlym S Porter
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Sherif M Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jena Simon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Sara Jacobs
- RTI International, Research Triangle Park, NC
| | - Maria E Fernandez
- Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hayden B Bosworth
- Department of Population Health Studies, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Medical Center, Durham, NC
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Nirmish Shah
- Department of Pediatric Hematology and Oncology, Duke University, Durham, NC
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4
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Wang WC, Brown RC, McNaull MA, Rogers ZR, Barton M, Dua MR, Hankins JS, Gossett J, Richardson J, Porter JS, Kang G, Estepp JH. Intensive hydroxyurea dosing in very young children with sickle cell anemia. Blood Adv 2023; 7:6931-6935. [PMID: 37695741 PMCID: PMC10685164 DOI: 10.1182/bloodadvances.2022009613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/13/2023] Open
Affiliation(s)
- Winfred C. Wang
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - R. Clark Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Melissa A. McNaull
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS
| | - Zora R. Rogers
- Department of Pediatric Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Martha Barton
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Meghna R. Dua
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jeffrey Gossett
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Julie Richardson
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jeremie H. Estepp
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN
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Cronin RM, Wuichet K, Ghafuri DL, Hodges B, Chopra M, He J, Niu X, Kassim AA, Wilkerson K, Rodeghier M, DeBaun MR. Creating an automated contemporaneous cohort in sickle cell anemia to predict survival after disease-modifying therapy. Blood Adv 2023; 7:3775-3782. [PMID: 36350716 PMCID: PMC10393740 DOI: 10.1182/bloodadvances.2022008692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 11/10/2022] Open
Abstract
The Food and Drug Administration requires contemporaneous controls to compare clinical outcomes for participants receiving experimental gene therapy or gene editing clinical trials. However, developing a contemporaneous cohort of rare diseases requires multiple person-hours. In a single referral center for sickle cell disease, we tested the hypothesis that we could create an automated contemporaneous cohort of children and adults with sickle cell anemia (SCA) to predict mortality. Data were obtained between 1 January 2004 and 30 April 2021. We identified 419 individuals with SCA with consistent medical care defined as followed continuously for >0.5 years with no visit gaps >3.0 years. The median age was 10.2 years (IQR, 1-24 years), with a median follow-up of 7.4 years (IQR, 3.6-13.5 years) and 47 deaths. A total of 98% (274 of 277) of the children remained alive at 18 years of age, and 34.3% (94 of 274) of those children were followed into adulthood. For adults, the median age of survival was 49.3 years. Treatment groups were mutually exclusive and in a hierarchical order: hematopoietic stem cell transplant (n = 22)>regular blood transfusion for at least 2 years (n = 56)>hydroxyurea for at least 1 year (n = 243)>no disease-modifying therapy (n = 98). Compared to those receiving no disease-modifying treatment, those treated with hydroxyurea therapy had a significantly lower hazard of mortality (hazard ratio = 0.38; P = 0.016), but no statistical difference for those receiving regular blood transfusions compared to no disease-modifying therapy (hazard ratio = 0.71; P = 0.440). An automated contemporaneous SCA cohort can be generated to estimate mortality in children and adults with SCA.
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Affiliation(s)
- Robert M. Cronin
- Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Kristin Wuichet
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Djamila L Ghafuri
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Brock Hodges
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Maya Chopra
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Jing He
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Xinnan Niu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Adetola A. Kassim
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Karina Wilkerson
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Michael R. DeBaun
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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6
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Piel FB, Rees DC, DeBaun MR, Nnodu O, Ranque B, Thompson AA, Ware RE, Abboud MR, Abraham A, Ambrose EE, Andemariam B, Colah R, Colombatti R, Conran N, Costa FF, Cronin RM, de Montalembert M, Elion J, Esrick E, Greenway AL, Idris IM, Issom DZ, Jain D, Jordan LC, Kaplan ZS, King AA, Lloyd-Puryear M, Oppong SA, Sharma A, Sung L, Tshilolo L, Wilkie DJ, Ohene-Frempong K. Defining global strategies to improve outcomes in sickle cell disease: a Lancet Haematology Commission. Lancet Haematol 2023; 10:e633-e686. [PMID: 37451304 DOI: 10.1016/s2352-3026(23)00096-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Frédéric B Piel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - David C Rees
- Department of Paediatric Haematology, King's College London, King's College Hospital, London, UK
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence for Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Obiageli Nnodu
- Department of Haematology and Blood Transfusion, College of Health Sciences and Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Brigitte Ranque
- Department of Internal Medicine, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris Centre, University of Paris Cité, Paris, France
| | - Alexis A Thompson
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Russell E Ware
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Miguel R Abboud
- Department of Pediatrics and Adolescent Medicine, and Sickle Cell Program, American University of Beirut, Beirut, Lebanon
| | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, DC, USA
| | - Emmanuela E Ambrose
- Department of Paediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania
| | - Biree Andemariam
- New England Sickle Cell Institute, University of Connecticut Health, Connecticut, USA
| | - Roshan Colah
- Department of Haematogenetics, Indian Council of Medical Research National Institute of Immunohaematology, Mumbai, India
| | - Raffaella Colombatti
- Pediatric Oncology Hematology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Nicola Conran
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Fernando F Costa
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Robert M Cronin
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Mariane de Montalembert
- Department of Pediatrics, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris Centre, Paris, France
| | - Jacques Elion
- Paris Cité University and University of the Antilles, Inserm, BIGR, Paris, France
| | - Erica Esrick
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Anthea L Greenway
- Department Clinical Haematology, Royal Children's Hospital, Parkville and Department Haematology, Monash Health, Clayton, VIC, Australia
| | - Ibrahim M Idris
- Department of Hematology, Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
| | - David-Zacharie Issom
- Department of Business Information Systems, School of Management, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland
| | - Dipty Jain
- Department of Paediatrics, Government Medical College, Nagpur, India
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zane S Kaplan
- Department of Clinical Haematology, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Allison A King
- Departments of Pediatrics and Internal Medicine, Divisions of Pediatric Hematology and Oncology and Hematology, Washington University School of Medicine, St Louis, MO, USA
| | - Michele Lloyd-Puryear
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leon Tshilolo
- Institute of Biomedical Research/CEFA Monkole Hospital Centre and Official University of Mbuji-Mayi, Mbuji-Mayi, Democratic Republic of the Congo
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Kwaku Ohene-Frempong
- Division of Hematology, Children's Hospital of Philadelphia, Pennsylvania, USA; Sickle Cell Foundation of Ghana, Kumasi, Ghana
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7
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Venkatesan V, Christopher AC, Rhiel M, Azhagiri MKK, Babu P, Walavalkar K, Saravanan B, Andrieux G, Rangaraj S, Srinivasan S, Karuppusamy KV, Jacob A, Bagchi A, Pai AA, Nakamura Y, Kurita R, Balasubramanian P, Pai R, Marepally SK, Mohankumar KM, Velayudhan SR, Boerries M, Notani D, Cathomen T, Srivastava A, Thangavel S. Editing the core region in HPFH deletions alters fetal and adult globin expression for treatment of β-hemoglobinopathies. MOLECULAR THERAPY. NUCLEIC ACIDS 2023; 32:671-688. [PMID: 37215154 PMCID: PMC10197010 DOI: 10.1016/j.omtn.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
Reactivation of fetal hemoglobin (HbF) is a commonly adapted strategy to ameliorate β-hemoglobinopathies. However, the continued production of defective adult hemoglobin (HbA) limits HbF tetramer production affecting the therapeutic benefits. Here, we evaluated deletional hereditary persistence of fetal hemoglobin (HPFH) mutations and identified an 11-kb sequence, encompassing putative repressor region (PRR) to β-globin exon-1 (βE1), as the core deletion that ablates HbA and exhibits superior HbF production compared with HPFH or other well-established targets. PRR-βE1-edited hematopoietic stem and progenitor cells (HSPCs) retained their genome integrity and their engraftment potential to repopulate for long-term hematopoiesis in immunocompromised mice producing HbF positive cells in vivo. Furthermore, PRR-βE1 gene editing is feasible without ex vivo HSPC culture. Importantly, the editing induced therapeutically significant levels of HbF to reverse the phenotypes of both sickle cell disease and β-thalassemia major. These findings imply that PRR-βE1 gene editing of patient HSPCs could lead to improved therapeutic outcomes for β-hemoglobinopathy gene therapy.
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Affiliation(s)
- Vigneshwaran Venkatesan
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
- Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Abisha Crystal Christopher
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
| | - Manuel Rhiel
- Institute for Transfusion Medicine and Gene Therapy, Medical Center – University of Freiburg, 79106 Freiburg, Germany
- Center for Chronic Immunodeficiency, Medical Faculty, University of Freiburg, 79106 Freiburg, Germany
| | - Manoj Kumar K. Azhagiri
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
- Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Prathibha Babu
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
- Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Kaivalya Walavalkar
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka 560065, India
| | - Bharath Saravanan
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka 560065, India
| | - Geoffroy Andrieux
- Institute of Medical Bioinformatics and Systems Medicine, Faculty of Medicine & Medical Center - University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Sumathi Rangaraj
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
| | - Saranya Srinivasan
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
| | - Karthik V. Karuppusamy
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
- Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Annlin Jacob
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
| | - Abhirup Bagchi
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
| | - Aswin Anand Pai
- Department of Hematology, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Yukio Nakamura
- Cell Engineering Division, RIKEN BioResource Research Center, Ibaraki 3050074, Japan
| | - Ryo Kurita
- Cell Engineering Division, RIKEN BioResource Research Center, Ibaraki 3050074, Japan
| | | | - Rekha Pai
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Srujan Kumar Marepally
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
| | | | - Shaji R. Velayudhan
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
- Department of Hematology, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine, Faculty of Medicine & Medical Center - University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Dimple Notani
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka 560065, India
| | - Toni Cathomen
- Institute for Transfusion Medicine and Gene Therapy, Medical Center – University of Freiburg, 79106 Freiburg, Germany
- Center for Chronic Immunodeficiency, Medical Faculty, University of Freiburg, 79106 Freiburg, Germany
| | - Alok Srivastava
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
- Department of Hematology, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Saravanabhavan Thangavel
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu 632002, India
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8
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Sharpe CC, Suddle A, Stuart-Smith S. An Overview of Solid Organ Transplantation in Patients With Sickle Cell Disease. Transplantation 2023; 107:596-604. [PMID: 36210501 DOI: 10.1097/tp.0000000000004305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sickle cell disease is a common genetic disorder affecting >300 000 people across the world. The vast majority of patients cared for in high-resource settings live well into adulthood, but many develop a high burden of disease complications. Good standard of care including disease-modifying agents and transfusion programs limits the number of patients who develop end-stage organ disease, but for those that do, the prognosis can be very poor. Solid organ transplantation is a well-established mode of treatment for patients with sickle cell disease and kidney or liver failure, but appropriate patient selection and perioperative management are important for achieving good outcomes. Hematopoietic stem cell transplantation and gene therapy may offer novel treatment options for adult patients with chronic organ damage in the future, but these are not yet widely available. For now, good, holistic care and early intervention of end-organ complications can minimize the number of patients requiring solid organ transplantation later in life.
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Affiliation(s)
- Claire C Sharpe
- Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Abid Suddle
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sara Stuart-Smith
- Department of Haematology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
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9
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Dayer LE, Wagner R, King D, Lakkad M, Wilson LA, Montgomery C, Painter JT. Impact of Hydroxyurea Starting Dose on Pain Outcomes in Patients with Sickle Cell Disease. J Pain Palliat Care Pharmacother 2022; 36:223-227. [PMID: 36688614 DOI: 10.1080/15360288.2022.2128154] [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: 01/12/2023]
Abstract
In patients with sickle cell disease, hydroxyurea decreases the number of pain crises experienced. This study aimed to evaluate the difference in pain outcomes between patients started on a guideline concordant, weight-based starting dose of at least 15 mg/kg/day of hydroxyurea and those not. The first prescription of hydroxyurea was the baseline date, follow-up was a visit 60-120 days after baseline. The primary outcome was the change in opioid prescribing between baseline and follow-up. 138 patients met inclusion criteria; of these, 55 were started on a guideline concordant dose of hydroxyurea. Greater white blood cell count (9.5 vs 12.0; p < 0.01) was statistically associated with subtherapeutic dosing. Greater actual body weight (68.0 vs 72.1 kg; p = 0.16) also appeared higher in the non-guideline concordant group. No statistically significant difference in opioid prescribing was observed between those started on a guideline concordant dose of hydroxyurea and those who were not. In the guideline concordant starting dose group, 42% had a reduction in pain scores at first follow up, compared to 35% with a non-guideline recommended starting dose. (p = 0.41). While this difference is in the direction that would be expected based on the guidelines, the difference does not appear to be clinically meaningful.
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10
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Single Nucleotide Polymorphisms in XMN1-HBG2, HBS1L-MYB, and BCL11A and Their Relation to High Fetal Hemoglobin Levels That Alleviate Anemia. Diagnostics (Basel) 2022; 12:diagnostics12061374. [PMID: 35741184 PMCID: PMC9221560 DOI: 10.3390/diagnostics12061374] [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: 02/28/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
Anemia is a condition in which red blood cells and/or hemoglobin (Hb) concentrations are decreased below the normal range, resulting in a lack of oxygen being transported to tissues and organs. Those afflicted with this condition may feel lethargic and weak, which reduces their quality of life. The condition may be manifested in inherited blood disorders, such as thalassemia and sickle cell disease, whereas acquired disorders include aplastic anemia, chronic disease, drug toxicity, pregnancy, and nutritional deficiency. The augmentation of fetal hemoglobin (HbF) results in the reduction in clinical symptoms in beta-hemoglobinopathies. Several transcription factors as well as medications such as hydroxyurea may help red blood cells produce more HbF. HbF expression increases with the downregulation of three main quantitative trait loci, namely, the XMN1-HBG2, HBS1L-MYB, and BCL11A genes. These genes contain single nucleotide polymorphisms (SNPs) that modulate the expression of HbF differently in various populations. Allele discrimination is important in SNP genotyping and is widely applied in many assays. In conclusion, the expression of HbF with a genetic modifier is crucial in determining the severity of anemic diseases, and genetic modification of HbF expression may offer clinical benefits in diagnosis and disease management.
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11
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Long-Term Health Effects of Curative Therapies on Heart, Lungs, and Kidneys for Individuals with Sickle Cell Disease Compared to Those with Hematologic Malignancies. J Clin Med 2022; 11:jcm11113118. [PMID: 35683502 PMCID: PMC9181610 DOI: 10.3390/jcm11113118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 12/30/2022] Open
Abstract
The goal of curing children and adults with sickle cell disease (SCD) is to maximize benefits and minimize intermediate and long-term adverse outcomes so that individuals can live an average life span with a high quality of life. While greater than 2000 individuals with SCD have been treated with curative therapy, systematic studies have not been performed to evaluate the long-term health effects of hematopoietic stem cell transplant (HSCT) in this population. Individuals with SCD suffer progressive heart, lung, and kidney disease prior to curative therapy. In adults, these sequalae are associated with earlier death. In comparison, individuals who undergo HSCT for cancer are heavily pretreated with chemotherapy, resulting in potential acute and chronic heart, lung, and kidney disease. The long-term health effects on the heart, lung, and kidney for children and adults undergoing HSCT for cancer have been extensively investigated. These studies provide the best available data to extrapolate the possible late health effects after curative therapy for SCD. Future research is needed to evaluate whether HSCT abates, stabilizes, or exacerbates heart, lung, kidney, and other diseases in children and adults with SCD receiving myeloablative and non-myeloablative conditioning regimens for curative therapy.
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12
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Heitzer AM, Longoria J, Rampersaud E, Rashkin SR, Estepp JH, Okhomina VI, Wang WC, Raches D, Potter B, Steinberg MH, King AA, Kang G, Hankins JS. Fetal hemoglobin modulates neurocognitive performance in sickle cell anemia ✰,✰✰. Curr Res Transl Med 2022; 70:103335. [PMID: 35303690 PMCID: PMC9086114 DOI: 10.1016/j.retram.2022.103335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE OF THE STUDY Fetal hemoglobin (HbF) is a modifier of the clinical and hematologic phenotype of sickle cell anemia (SCA). Three quantitative trait loci (QTL) modulate HbF expression. The neurocognitive effects of variants in these QTL have yet to be explored. We evaluated the relation between 11 SNPs in the three HbF QTL: BCL11A, MYB, the HBB gene cluster, and full-scale intelligence (IQ) in SCA. PATIENTS AND METHODS The prospective longitudinal cohort study, Sickle Cell Clinical Research and Intervention Program, was used as a discovery cohort (n = 166). The genotypes for 11 SNPs were extracted through whole genome sequencing and were analyzed using an additive model. A polygenic score for HbF (PGSHbF) integrating the numbers of low HbF alleles from 11 SNPs was analyzed as a continuous variable. The Cooperative Study of Sickle Cell Disease (n = 156) and the Silent Cerebral Infarction Transfusion (n = 114) Trial were used as two independent replication cohorts. Benjamini and Hochberg approach was used to calculate false discovery rate adjusted p-value (pFDR). RESULTS HbF was positively associated with IQ (minimum raw p = 0·0018) at pFDR<0·05. HbF mediated the relationship between two BCL11A SNPs, rs1427407 and rs7606173, HBS1L-MYB: rs9494142, and PGSHbF with IQ (minimum raw p = 0·0035) at pFDR<0·05. CONCLUSION As the major modulator of the severity of SCA, HbF also influences neurocognition, which is done through mediation of its QTL. These findings have implications for early identification of neurocognitive risk and targeted intervention.
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Affiliation(s)
- Andrew M Heitzer
- Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN.
| | - Jennifer Longoria
- Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Evadnie Rampersaud
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN
| | - Sara R Rashkin
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN; Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Winfred C Wang
- Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Darcy Raches
- Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Brian Potter
- Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Martin H Steinberg
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Allison A King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO
| | - Guolian Kang
- Biostatistics, St. Jude Children's Research Hospital, Memphis, TN; Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jane S Hankins
- Hematology, St. Jude Children's Research Hospital, Memphis, TN
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13
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Shah N, Lipato T, Alvarez O, Delea T, Lonshteyn A, Weycker D, Nguyen A, Beaubrun A, Agodoa I. Real-world effectiveness of voxelotor for treating sickle cell disease in the US: a large claims data analysis. Expert Rev Hematol 2022; 15:167-173. [PMID: 35191358 DOI: 10.1080/17474086.2022.2031967] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a genetic disease that impacts patients' quality of life, healthcare costs, and life expectancy. Elevated sickle hemoglobin (HbS), which readily polymerizes, causes red blood cell sickling, leading to chronic hemolytic anemia and complications often requiring hospitalization and transfusions. In 2019, voxelotor, which inhibits HbS polymerization, was approved for SCD treatment. OBJECTIVES This study uses real-world evidence to assess voxelotor's effectiveness in SCD patients in typical clinical practice from 2019 to 2021 using a national medical claims database (N = 3128). RESULTS After initiating voxelotor, 60.8% of patients with available hemoglobin (Hb) laboratory data (n = 74) showed a Hb increase >1 g/dL. Mean transfusion rate per patient-year dropped 52% in patients with ≥1 transfusion before treatment (n = 190). In patients with ≥1 of the corresponding events (n = 1065), decreases were observed in mean vaso-occlusive crisis (VOC) frequency (-23%); mean VOC-related hospitalizations and length of stay (LOS) time (-34% and -30%, respectively); mean all-cause hospitalization and LOS time (-37% and -23%, respectively); outpatient visits (-10%); iron chelation use (-46%); and prescribed opioids (-13%). CONCLUSION These data align with randomized controlled trial results showing voxelotor improvements and support that voxelotor may lower transfusion and VOC rates in clinical practice.
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Affiliation(s)
- Nirmish Shah
- Division of Hematology, Division of Pediatric Hematology/Oncology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thokozeni Lipato
- Department of Internal Medicine, VCU Health, Richmond, Virginia, USA
| | - Ofelia Alvarez
- Division of Pediatric Hematology/Oncology, University of Miami, Miami, Florida, USA
| | - Thomas Delea
- Policy Analysis Inc. (PAI), Brookline, Massachusetts, USA
| | | | - Derek Weycker
- Policy Analysis Inc. (PAI), Brookline, Massachusetts, USA
| | - Andy Nguyen
- Global Blood Therapeutics, South San Francisco, California, USA
| | - Anne Beaubrun
- Global Blood Therapeutics, South San Francisco, California, USA
| | - Irene Agodoa
- Global Blood Therapeutics, South San Francisco, California, USA
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14
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Heitzer AM, Longoria J, Okhomina V, Wang WC, Raches D, Potter B, Jacola LM, Porter J, Schreiber JE, King AA, Kang G, Hankins JS. Hydroxyurea treatment and neurocognitive functioning in sickle cell disease from school age to young adulthood. Br J Haematol 2021; 195:256-266. [PMID: 34272726 DOI: 10.1111/bjh.17687] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 12/18/2022]
Abstract
Neurocognitive impairment is common in sickle cell disease (SCD) and is associated with significant functional limitations. In a cross-sectional analysis, we examined the association between hydroxyurea (HU) treatment and neurocognitive functioning from school-age to young adulthood in individuals with SCD. A total of 215 patients with HbSS/HbSβ0 -thalassaemia (71% HU treated) and 149 patients with HbSC/HbSβ+ -thalassaemia (20% HU treated) completed neurocognitive measures at one of four developmental stages: school-age (age 8-9 years), early adolescence (age 12-13 years), late adolescence (age 16-17 years) and young adulthood (ages 19-24 years). For participants with multiple assessments, only the most recent evaluation was included. In multivariable analysis adjusted for social vulnerability, HU treatment and sex, older age was associated with a reduction in overall intelligence quotient (IQ) of 0·55 points per year of life [standard error (SE) = 0·18, false discovery rate adjusted P value (PFDR) = 0.01] for patients with HbSS/HbSβ0 -thalassaemia. Earlier initiation of HU (n = 152) in HbSS/HbSβ0 -thalassaemia was associated with higher scores on neurocognitive measures across most domains, including IQ [estimate (SE) 0·77 (0·25)/year, PFDR = 0·01], after adjusting for social vulnerability, sex and treatment duration. These results support the early use of HU to limit the detrimental neurocognitive effects of SCD, while highlighting the need for additional measures to further mitigate neurocognitive deterioration.
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Affiliation(s)
- Andrew M Heitzer
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Victoria Okhomina
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Winfred C Wang
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Darcy Raches
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Brian Potter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa M Jacola
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jerlym Porter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane E Schreiber
- Department of Psychology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allison A King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
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15
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Abstract
Sickle cell disease is an umbrella term for a group of hemoglobinopathies characterized by the presence of 2 β-globin gene mutations or deletions, at least 1 of which is the point mutation that leads to the production of hemoglobin S. Sickle cell disease is associated with hemolytic anemia, significant chronic end-organ damage, and early death. In high-income countries, at least 95% of children with the disease survive into adulthood, resulting in a growing population of affected adults with significant comorbidities, complex medical issues, and not enough specialists to provide care. Hydroxyurea is the primary therapy, and recent advances in understanding disease pathophysiology have led to new therapies; progress in bone marrow transplant and gene editing has resulted in cure in some patients. The purpose of this review is to provide an overview of the diagnosis, common acute and chronic clinical manifestations, and best practices for management of sickle cell disease.
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Affiliation(s)
- Lydia H Pecker
- Johns Hopkins University School of Medicine, Baltimore, Maryland (L.H.P., S.L.)
| | - Sophie Lanzkron
- Johns Hopkins University School of Medicine, Baltimore, Maryland (L.H.P., S.L.)
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16
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Abstract
Fetal hemoglobin (HbF) can blunt the pathophysiology, temper the clinical course, and offer prospects for curative therapy of sickle cell disease. This review focuses on (1) HbF quantitative trait loci and the geography of β-globin gene haplotypes, especially those found in the Middle East; (2) how HbF might differentially impact the pathophysiology and many subphenotypes of sickle cell disease; (3) clinical implications of person-to-person variation in the distribution of HbF among HbF-containing erythrocytes; and (4) reactivation of HbF gene expression using both pharmacologic and cell-based therapeutic approaches. A confluence of detailed understanding of the molecular basis of HbF gene expression, coupled with the ability to precisely target by genomic editing most areas of the genome, is producing important preliminary therapeutic results that could provide new options for cell-based therapeutics with curative intent.
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Affiliation(s)
- Martin H Steinberg
- Division of Hematology/Oncology, Department of Medicine, Center of Excellence for Sickle Cell Disease, Center for Regenerative Medicine, Genome Science Institute, Boston University School of Medicine and Boston Medical Center, Boston, MA
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17
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Mohammadi Z, Mohammadi R, Haghpanah S, Moghadam M, Pazhoomand R, Karimi M. Association of Exon 14 of the SOX6 Gene Sequence Variations with Response to Hydroxyurea Therapy in Patients Carrying Non Transfusion-Dependent Thalassemia. Hemoglobin 2020; 44:406-410. [PMID: 33164584 DOI: 10.1080/03630269.2020.1845722] [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] [Indexed: 01/15/2023]
Abstract
Hydroxyurea (HU) activates the γ-globin gene, resulting in increased Hb F synthesis. The SOX6 gene is a member of the Sox (Sry-type HMG box) family of transcription factors, characterized by minor groove binding domain. The DNA binding domain of this gene is encoded by exon 14. We assessed the relationship between response to HU and exon 14 of the SOX6 gene sequence variations in patients with non transfusion-dependent thalassemia (NTDT). One hundred NTDT patients from southern Iran underwent HU therapy randomly participated in this cross-sectional study between February 2013 and October 2014. Based on response to HU therapy, the patients were divided into two groups: good and poor responder. Sequence variations of exon 14 of the SOX6 gene was assayed by the Sanger sequencing technique. From all evaluated single nucleotide polymorphisms (SNPs) as above, we found no significant association between sequence variations of exon 14 of the SOX6 gene and response to HU therapy (p > 0.05). It seems that no SNPs in exon 14 of the SOX6 gene is associated with response to HU in NTDT patients, but more studies are needed for further evaluation.
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Affiliation(s)
- Zahra Mohammadi
- Department of Pediatric Hematology/Oncology, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Mohammadi
- Department of Medical Genetics, Shiraz Infertility Treatment, Shiraz, Iran
| | - Sezaneh Haghpanah
- Department of Pediatric Hematology/Oncology, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad Moghadam
- Department of Pediatric Hematology/Oncology, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Pazhoomand
- Department of Medical Genetics, Shiraz Infertility Treatment, Shiraz, Iran
| | - Mehran Karimi
- Department of Pediatric Hematology/Oncology, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Oldham M, Conrey A, Pittman C, Fisher C, Hargrett S, West K, Jackson M, Martin S, Hsieh MM, Jeffries N, Kaplarevic M, Johnson D, Olkhanud P, Fitzhugh CD. Computer Algorithm-Based Hydroxyurea Dosing Facilitates Titration to Maximum Tolerated Dose in Sickle Cell Anemia. J Clin Pharmacol 2020; 61:41-51. [PMID: 32673439 DOI: 10.1002/jcph.1699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
Adults with sickle cell disease (SCD) experience acute and chronic complications and die prematurely. When taken at maximum tolerated dose (MTD), hydroxyurea prolongs survival; however, it has not consistently reversed organ dysfunction. Patients also frequently do not take hydroxyurea, at least in part because of physician discomfort with prescribing hydroxyurea. We sought to develop a computer program that could easily titrate hydroxyurea to MTD. This was a single-arm, open-label pilot study. Fifteen patients with homozygous SCD were enrolled in the protocol, and 10 patients were followed at baseline and then for 1 year after hydroxyurea initiation or dose titration. Fetal hemoglobin significantly increased in all 10 patients from 8.3% to 25.1% (P < .001). Nine patients were titrated to MTD in an average of 7.9 months, and the tenth patient's hydroxyurea dose was increased to 33 mg/kg/day. Computer program dosing recommendations were the same as manual dosing decisions made using the same algorithm for all patients and at all times. We also evaluated markers of cardiopulmonary, liver and renal damage. Although cardiopulmonary function did not significantly improve, direct bilirubin and alanine aminotransferase levels significantly decreased (P < .001 and P < .01, respectively). Last, although kidney function did not improve, degree of proteinuria was significantly reduced (P < .05). We have developed a computer program that reliably titrates hydroxyurea to MTD. A larger study is indicated to test the program either as a computer program or a downloadable application.
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Affiliation(s)
| | - Anna Conrey
- Sickle Cell Branch, NHLBI, NIH, Bethesda, Maryland, USA
| | | | | | | | - Kamille West
- Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Mary Jackson
- Sickle Cell Branch, NHLBI, NIH, Bethesda, Maryland, USA
| | - Staci Martin
- Pediatric Oncology Branch, NCI, NIH, Bethesda, Maryland, USA
| | | | - Neal Jeffries
- Office of Biostatistics Research, NHLBI, NIH, Bethesda, Maryland, USA
| | | | - Dachelle Johnson
- Pharmacy Department, Clinical Center, NIH, Bethesda, Maryland, USA
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19
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Shaw R, Kappa S, Nickel RS. Inpatient Ordering of Home Hydroxyurea by Residents for Hospitalized Patients With Sickle Cell Disease. J Pediatr Hematol Oncol 2020; 42:e38-e41. [PMID: 31688620 DOI: 10.1097/mph.0000000000001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hydroxyurea is a well-established disease-modifying medication for sickle cell disease (SCD). At some institutions, hydroxyurea can only be ordered by "chemotherapy-certified" providers which may not include pediatric resident physicians. METHODS We conducted a survey of 39 American pediatric hospitals regarding their policy on resident hydroxyurea ordering for SCD. Our institution changed its policy in June 2016 to allow residents to order hydroxyurea for hospitalized patients with SCD who were already on hydroxyurea at home. We conducted a retrospective review of the medical records of a random sample of patients with SCD on hydroxyurea admitted the year before and the year after this policy change. RESULTS In our national survey, 51% of surveyed hospitals allowed residents to order hydroxyurea, 19% required a second signature, and 30% did not allow residents to order hydroxyurea. In our institutional study, patients after the policy change were significantly more likely to have received their home hydroxyurea by hospital day 1: before 62/90 (69%) versus after 105/119 (88%), P=0.0005. The proportion of patients who inappropriately received hydroxyurea was very low in both groups: before 1/91 (1%) versus after 3/126 (2%), P=0.64, with no serious adverse clinical events due to inappropriate hydroxyurea administration. CONCLUSIONS Considerable national variation in practice currently exists in regards to resident hydroxyurea ordering hospital policies. A policy allowing residents to order hydroxyurea significantly increased the likelihood of a patient receiving hydroxyurea while hospitalized with no significant increase in inappropriate hydroxyurea administration. Resident hydroxyurea ordering seems safe and beneficial.
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Affiliation(s)
- Rebekah Shaw
- C. S. Mott Children's Hospital at the University of Michigan, Ann Arbor, MI
| | | | - Robert S Nickel
- Children's National Health System.,The George Washington University School of Medicine and Health Sciences, Washington, DC
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20
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Choice of Donor Source and Conditioning Regimen for Hematopoietic Stem Cell Transplantation in Sickle Cell Disease. J Clin Med 2019; 8:jcm8111997. [PMID: 31731790 PMCID: PMC6912427 DOI: 10.3390/jcm8111997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022] Open
Abstract
In the United States, one out of every 500 African American children have sickle cell disease (SCD), and SCD affects approximately 100,000 Americans. Significant advances in the treatment of this monogenetic disorder have failed to substantially extend the life expectancy of adults with SCD over the past two decades. Hematopoietic stem cell transplantation (HSCT) remains the only curative option for patients with SCD. While human leukocyte antigen (HLA) matched sibling HSCT has been successful, its availability is extremely limited. This review summarizes various conditioning regimens that are currently available. We explore recent efforts to expand the availability of allogeneic HSCT, including matched unrelated, umbilical cord blood, and haploidentical stem cell sources. We consider the use of nonmyeloablative conditioning and haploidentical donor sources as emerging strategies to expand transplant availability, particularly for SCD patients with complications and comorbidities who can undergo neither matched related transplant nor myeloablative conditioning. Finally, we show that improved conditioning agents have improved success rates not only in the HLA-matched sibling setting but also alternative donor settings.
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21
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Kanter J, Lanzkron S. Innovations in Targeted Anti-Adhesion Treatment for Sickle Cell Disease. Clin Pharmacol Ther 2019; 107:140-146. [PMID: 31617585 DOI: 10.1002/cpt.1682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/13/2019] [Indexed: 02/02/2023]
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy that leads to significant lifetime morbidity and early mortality. An enhanced understanding of the complex pathophysiology of the disease has elucidated novel therapeutic targets for which new therapies are in development. In order to increase the therapeutic landscape, it has been important to identify the blood vessel and more specifically the endothelium as the target organ in this complex disease. Through this lens, we present a review of new anti-adhesion therapies for SCD in development. The long-term promise of multimodal therapies for SCD is finally on the horizon.
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Affiliation(s)
- Julie Kanter
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sophie Lanzkron
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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22
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Allogeneic Hematopoietic Stem Cell Transplantation for Adults with Sickle Cell Disease. J Clin Med 2019; 8:jcm8101565. [PMID: 31581479 PMCID: PMC6832368 DOI: 10.3390/jcm8101565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 12/30/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited red blood cell disorder that leads to substantial morbidity and early mortality. Acute and chronic SCD-related complications increase with older age, and therapies are urgently needed to treat adults. Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative therapy, but has been used less frequently in adults compared to children. This is, in part, due to (1) greater chronic organ damage, limiting tolerability to myeloablative conditioning regimens, (2) a higher rate of HSCT-related complications in adults versus children with SCD, and (3) limited coverage by public and private health insurance. Newer approaches using nonmyeloablative and reduced-intensity conditioning HSCT regimens have demonstrated better safety and tolerability, with high rates of stable engraftment in SCD adults. This review will focus on the impacts of HSCT, using more contemporary approaches to SCD-related complications in adults.
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Bernaudin F. Why, Who, When, and How? Rationale for Considering Allogeneic Stem Cell Transplantation in Children with Sickle Cell Disease. J Clin Med 2019; 8:jcm8101523. [PMID: 31546720 PMCID: PMC6833062 DOI: 10.3390/jcm8101523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/14/2019] [Accepted: 09/19/2019] [Indexed: 02/07/2023] Open
Abstract
Considering the progress made in the management of sickle cell disease during the past 30 years, along with the excellent results obtained with hematopoietic stem cell transplantation (SCT), it is important to reexamine why, who, when and how to recommend allogeneic SCT in children with sickle cell disease. While sickle cell disease has a low risk of death in children and a high risk for morbidity during aging, SCT carries an early risk of death, graft-vs-host disease and infertility. Nevertheless, SCT offers at least 95% chance of cure with low risk of chronic graft-vs-host disease when a matched-sibling donor is available and the risks of infertility can be reduced by ovarian, sperm or testis cryopreservation. Thus, all available therapies such as hydroxyurea, transfusions and SCT should be presented to the parents, providers, and affected children and discussed with them from infancy. Furthermore, the use of these therapies should be adjusted to the severity of the disease and to local availabilities in order to choose the treatment offering the best benefit/risk ratio.
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Affiliation(s)
- Françoise Bernaudin
- French Referral Center for Sickle Cell Disease; SFGM-TC (Société Française de Greffe de Moelle et de Thérapie Cellulaire); DrepaGreffe Association 20 rue de Coulmiers, 94130 Nogent sur Marne, France.
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Patel DA, Akinsete AM, Connelly JA, Kassim AA. T-cell deplete versus T-cell replete haploidentical hematopoietic stem cell transplantation for sickle cell disease: where are we? Expert Rev Hematol 2019; 12:733-752. [DOI: 10.1080/17474086.2019.1642103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Dilan A. Patel
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adeseye M. Akinsete
- College of Medicine, Division of Pediatric Hematology & Oncology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - James A. Connelly
- Department of Pediatrics, Pediatric Hematopoietic Cell Transplant, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adetola A. Kassim
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
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Jose J, Elsadek RA, Jimmy B, George P. Hydroxyurea: Pattern of Use, Patient Adherence, and Safety Profile in Patients with Sickle Cell Disease in Oman. Oman Med J 2019; 34:327-335. [PMID: 31360322 PMCID: PMC6642718 DOI: 10.5001/omj.2019.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Many barriers contribute to the underutilization of hydroxyurea (HU) in the treatment of sickle cell disease (SCD), and adherence to its use is often reported to be suboptimal. It is important to have information on the safety of HU in patients with SCD. Our study assessed the pattern of use, patients' adherence to medication, discontinuation of use, and safety of HU in patients with SCD. METHODS This cross-sectional study was conducted in the department of medicine of a referral hospital in Oman over five months and included a review of patient files and patient interview. Approval was obtained from the Regional Research and Ethics Committee of the A'Dakhiliyah Governorate and the hospital administration. The parameters were compared between groups using the chi-square test. RESULTS Of 298 patients studied, 128 (43.0%) had used HU at some points. The difference in the prevalence of HU use was statistically significant based only on age (p = 0.014), with younger patients more likely to be currently using HU or used HU in the past. The majority of patients were adherent (82.5%) based on self-reported adherence. The prevalence of discontinuation (temporary or permanent) of HU use was high (57.0%), and suspected adverse drug reaction (ADR) was the most common reason. Among those who had never used HU, 33.7% of patients had an indication for the initiation of HU. A quarter of patients who used HU developed a suspected ADR, with blood abnormalities being the commonest. The duration of HU use influenced ADR prevalence (p = 0.015). CONCLUSIONS Among the current users of HU, the majority of the patients were adherent based on self-reported medication adherence. The prevalence of discontinuation of HU use and instances of non-initiation of HU among those indicated were high. A larger study, ideally of a prospective nature, in various governorates of Oman, would provide a wider picture at the national level.
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Affiliation(s)
- Jimmy Jose
- School of Pharmacy, University of Nizwa, Nizwa, Oman
| | | | - Beena Jimmy
- School of Pharmacy, University of Nizwa, Nizwa, Oman
| | - Prasad George
- Department of General Medicine, Nizwa Hospital, Nizwa, Oman
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Moser BA, LaBell ES, Chigutsa E, Jakubowski JA, Small DS. Population Pharmacokinetic and Exposure-Response Analyses of Prasugrel in Pediatric Patients with Sickle Cell Anemia. Clin Pharmacokinet 2019; 57:243-254. [PMID: 28578536 DOI: 10.1007/s40262-017-0556-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Prasugrel, a P2Y12 adenosine diphosphate (ADP) receptor antagonist, inhibits ADP-mediated platelet activation and aggregation in patients with sickle cell anemia (SCA). We developed a population pharmacokinetic (popPK) model in pediatric patients from 2 to <18 years of age with SCA, and performed exposure-response evaluations to characterize the effects of prasugrel in a subset of these patients who weighed 19 kg or more and experienced at least two episodes of vaso-occlusive crises (VOC) in the past year. METHODS A three-compartment popPK model adapted from that used in adults with acute coronary syndrome was used to describe the relationship between plasma concentrations of prasugrel's active metabolite (Pras-AM) and time using data from phase II and III clinical studies in children. A VOC event rate model was developed from the phase III study to explore the exposure-response relationship between Pras-AM exposure and VOC, and included evaluation of covariates. RESULTS The final popPK model for children with SCA provided a reasonable fit to Pras-AM plasma concentrations over time, with estimates of apparent clearance (CL/F) (172 L/h) and apparent volume of distribution (Vd/F) (51.7 L) that were comparable to previous studies in adults. The final model included weight as a covariate on both CL/F and Vd/F, and age as a covariate on CL/F. Analyses of safety (bleeding events requiring medical intervention) and efficacy (VOC event rate) variables showed no apparent relationship to model-predicted Pras-AM exposure quartiles, and no statistically significant effects of intrinsic or extrinsic factors on the VOC event rate were identified in the VOC event rate model. The effect of post hoc exposures on the VOC event rate did not reach statistical significance. CONCLUSIONS A popPK model was developed that provided reasonable parameter estimates, goodness-of-fit diagnostics, and visual predictive checks when applied to Pras-AM plasma concentrations in pediatric patients with SCA. Post hoc exposures obtained from this model did not correlate with measures of VOC or bleeding events in this population.
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Affiliation(s)
- Brian A Moser
- Eli Lilly and Company, Lilly Corporate Center, DC 0724, Indianapolis, IN, 46285, USA.
| | - Elizabeth S LaBell
- Eli Lilly and Company, Lilly Corporate Center, DC 0724, Indianapolis, IN, 46285, USA
| | - Emmanuel Chigutsa
- Eli Lilly and Company, Lilly Corporate Center, DC 0724, Indianapolis, IN, 46285, USA
| | - Joseph A Jakubowski
- Eli Lilly and Company, Lilly Corporate Center, DC 0724, Indianapolis, IN, 46285, USA
| | - David S Small
- Eli Lilly and Company, Lilly Corporate Center, DC 0724, Indianapolis, IN, 46285, USA
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Akingbola TS, Tayo BO, Ezekekwu CA, Sonubi O, Zhang X, Saraf SL, Molokie R, Hsu LL, Han J, Cooper RS, Gordeuk VR. "Maximum tolerated dose" vs "fixed low-dose" hydroxyurea for treatment of adults with sickle cell anemia. Am J Hematol 2019; 94:E112-E115. [PMID: 30663794 PMCID: PMC6440541 DOI: 10.1002/ajh.25412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Titilola S. Akingbola
- Department of Hematology, University of Ibadan College of Medicine, University College Hospital Ibadan Nigeria
| | - Bamidele O. Tayo
- Department of Public Health Sciences Loyola University Chicago Stritch School of Medicine Maywood Illinois
| | - Chinedu A. Ezekekwu
- Department of Hematology, University of Ibadan College of Medicine, University College Hospital Ibadan Nigeria
| | - Omowunmi Sonubi
- Department of Hematology, University of Ibadan College of Medicine, University College Hospital Ibadan Nigeria
| | - Xu Zhang
- Division of Hematology & Oncology, Department of Medicine University of Illinois at Chicago Chicago Illinois
| | - Santosh L. Saraf
- Division of Hematology & Oncology, Department of Medicine University of Illinois at Chicago Chicago Illinois
| | - Robert Molokie
- Division of Hematology & Oncology, Department of Medicine University of Illinois at Chicago Chicago Illinois
- Jesse Brown VA Chicago Illinois
| | - Lewis L. Hsu
- Division of Pediatric Hematology‐Oncology, Department of Pediatrics University of Illinois at Chicago Chicago Illinois
| | - Jin Han
- Department of Pharmacy Practice University of Illinois at Chicago Chicago Illinois
| | - Richard S. Cooper
- Department of Public Health Sciences Loyola University Chicago Stritch School of Medicine Maywood Illinois
| | - Victor R. Gordeuk
- Division of Hematology & Oncology, Department of Medicine University of Illinois at Chicago Chicago Illinois
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Pecker LH, Maher JY, Law JY, Beach MC, Lanzkron S, Christianson MS. Risks associated with fertility preservation for women with sickle cell anemia. Fertil Steril 2019; 110:720-731. [PMID: 30196969 DOI: 10.1016/j.fertnstert.2018.05.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To highlight the risk of complications among women with sickle cell anemia (SCA) receiving fertility preservation treatment (FPT) before hematopoietic stem cell transplant (HSCT). DESIGN Single-center case series. SETTING Academic fertility center. PATIENT(S) Women aged 15-32 years with SCA undergoing FPT before HSCT. INTERVENTION(S) Retrospective, systematic review. MAIN OUTCOME MEASURE(S) FPT modality, SCA complications during FPT. RESULT(S) Over an 8-year period (2009-2017), seven women with SCA ages 15-32 years (mean 28.5 years) underwent FPT with embryo cryopreservation (n = 1), oocyte cryopreservation (n = 4), and ovarian tissue cryopreservation (n = 2). The five women subjects who underwent oocyte or embryo cryopreservation were treated with an antagonist controlled ovarian hyperstimulation protocol and individualized gonadotropin dosing. The trigger medications included leuprolide acetate (n = 2), and human chorionic gonadotropin (n = 3). Most patients (n = 5) received a disease-modifying therapy for SCA (hydroxyurea or chronic transfusions) before FPT. Three patients experienced periprocedural SCA complications that included life-threatening respiratory failure, painful crisis requiring interruption of a stimulation cycle, and severe postharvest painful crisis. CONCLUSION(S) Women with SCA may choose to undergo diverse FPT strategies before HSCT and are at risk for serious SCA-related complications. Evidence-based strategies to mitigate SCA-related morbidity and to optimize fertility preservation outcomes are needed.
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Affiliation(s)
- Lydia H Pecker
- Division of Pediatric Hematology, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Jacqueline Y Maher
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jennie Y Law
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sophie Lanzkron
- Division of Adult Hematology, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mindy S Christianson
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Chambers TM, Kahan S, Camanda JF, Scheurer M, Airewele GE. Intermittent or uneven daily administration of low-dose hydroxyurea is effective in treating children with sickle cell anemia in Angola. Pediatr Blood Cancer 2018; 65:e27365. [PMID: 30051651 DOI: 10.1002/pbc.27365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/30/2018] [Accepted: 06/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although hydroxyurea is proven effective in treatment of sickle cell anemia (SCA) and is widely prescribed in high-income countries, due to questions about feasibility of treating large numbers of patients in resource-limited health systems, its use is limited in sub-Saharan Africa (SSA), where most children with SCA live. We assessed hematological response and toxicity of hydroxyurea treatment for SCA in Angola. METHODS Retrospective study of children with SCA (not selected for clinical severity) treated on a fixed dose of hydroxyurea for at least 6 months. Because only the 500 mg capsule was available, dose was averaged weekly. We evaluated toxicity events and magnitude of hydroxyurea-induced changes in blood counts and compared patients who received a uniform daily dose to those prescribed intermittent or uneven daily doses. RESULTS Only 13% of 303 patients received a uniform dose of hydroxyurea daily. Dose ranged from 16.5 to 22.8 mg/kg/day. Hydroxyurea increased HGB and mean cell volume values by 0.5 g/dL (P < 0.0001) and 8 fL (P < 0.0001), while ANC, PLT, and ARC decreased 1.1 × 109 /L (P < 0.0001), 34 × 109 /L (P = < 0.0001), and 19 × 109 /L (P = 0.0008), respectively. There were no differences in magnitude of hydroxyurea-induced changes between patients prescribed intermittent or uneven doses and uniform daily doses, or between those treated in the lower and higher dose quartiles. Hematological toxicity events were mild and reversible. CONCLUSION Intermittent or uneven daily dosing of hydroxyurea is as effective as fixed daily doses in treating SCA. This strategy may enable treatment of additional children with SCA in SSA.
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Affiliation(s)
- Tiffany M Chambers
- Department of Pediatrics-Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas
| | - Silvina Kahan
- Global Health Corps, Baylor College of Medicine, Houston, Texas
| | - Joao F Camanda
- Faculty of Medicine, Universidade 11 de Novembro, Cabinda, Angola
| | - Michael Scheurer
- Department of Pediatrics-Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas
| | - Gladstone E Airewele
- Department of Pediatrics-Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas
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Pecker LH, Kappa S, Greenfest A, Darbari DS, Nickel RS. Targeted Hydroxyurea Education after an Emergency Department Visit Increases Hydroxyurea Use in Children with Sickle Cell Anemia. J Pediatr 2018; 201:221-228.e16. [PMID: 30251637 PMCID: PMC6159227 DOI: 10.1016/j.jpeds.2018.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/17/2018] [Accepted: 05/11/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the impact of an initiative to increase hydroxyurea use among children with sickle cell anemia (SCA) who presented to the emergency department (ED). STUDY DESIGN This observational cohort study included children with SCA not taking hydroxyurea who presented to the ED with pain or acute chest syndrome and then attended a Quick-Start Hydroxyurea Initiation Project (Q-SHIP) session. A Q-SHIP session includes a hematologist-led discussion on hydroxyurea, a video of patients talking about hydroxyurea, and a direct offer to start hydroxyurea. RESULTS Over 64 weeks, 112 eligible patients presented to the ED and 59% (n = 66) participated in a Q-SHIP session a median of 6 days (IQR 2, 20 days) after ED or hospital discharge; 55% of participants (n = 36) started hydroxyurea. After a median follow-up of 49 weeks, 83% (n = 30) of these participants continued hydroxyurea. Laboratory markers of hydroxyurea adherence were significantly increased from baseline: median mean corpuscular volume +8.6 fL (IQR 5.0, 17.7, P < .0001) and median hemoglobin F +5.7% (IQR 2.5, 9.8, P = .0001). Comparing Q-SHIP participants to nonparticipants, 12 weeks after ED visit, participants were more likely to have started hydroxyurea than nonparticipants (53% vs 20%, P = .0004) and to be taking hydroxyurea at last follow-up (50% vs 20%, P = .001). Two years after the implementation of Q-SHIP the overall proportion of eligible patients on hydroxyurea presenting to our ED increased from 56% to 80%, P = .0069. CONCLUSIONS Participation in a clinic to specifically address starting hydroxyurea after a SCA complication increases hydroxyurea use.
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Affiliation(s)
- Lydia H. Pecker
- Division of Hematology, Department of Pediatrics, Johns Hopkins University, Baltimore MD
| | - Sarah Kappa
- Division of Hematology, Children’s National Health System, Washington D.C
| | - Adam Greenfest
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Deepika S. Darbari
- Division of Hematology, Children’s National Health System, Washington D.C,George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Robert Sheppard Nickel
- Division of Hematology, Children's National Health System, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC.
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van Straaten S, Verhoeven J, Hagens S, Schutgens R, van Solinge W, van Wijk R, van Beers EJ. Organ involvement occurs in all forms of hereditary haemolytic anaemia. Br J Haematol 2018; 185:602-605. [PMID: 30183081 DOI: 10.1111/bjh.15575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stephanie van Straaten
- Laboratory of Clinical Chemistry & Haematology, University Medical Centre Utrecht, Utrecht, Netherlands.,Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Jill Verhoeven
- Laboratory of Clinical Chemistry & Haematology, University Medical Centre Utrecht, Utrecht, Netherlands.,Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Sanne Hagens
- Laboratory of Clinical Chemistry & Haematology, University Medical Centre Utrecht, Utrecht, Netherlands.,Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Roger Schutgens
- Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Wouter van Solinge
- Laboratory of Clinical Chemistry & Haematology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Richard van Wijk
- Laboratory of Clinical Chemistry & Haematology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Eduard J van Beers
- Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, Netherlands
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Qureshi A, Kaya B, Pancham S, Keenan R, Anderson J, Akanni M, Howard J. Guidelines for the use of hydroxycarbamide in children and adults with sickle cell disease: A British Society for Haematology Guideline. Br J Haematol 2018; 181:460-475. [PMID: 29732531 DOI: 10.1111/bjh.15235] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Amrana Qureshi
- Department of Paediatric Haematology and Oncology, Oxford Children's Hospital, Oxford University Hospital NHS Trust, Oxford, UK
| | - Banu Kaya
- Department of Paediatric Haematology and Oncology, Royal London Hospitals, Barts Health NHS Trust, London, UK
| | - Shivan Pancham
- Department of Haematology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Russell Keenan
- Department of Paediatric Haematology, Alderhey Children's Hospital NHS Trust, Liverpool, UK
| | - Jeremy Anderson
- Department of Clinical Psychology, Imperial College Healthcare NHS Trust, London, UK
| | - Magbor Akanni
- Department of Haematology, Milton Keynes Hospital NHS Trust, Milton Keynes, UK
| | - Jo Howard
- Department of Haematology, Guys and St Thomas's NHS Foundation Trust, London, UK
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Guilcher GMT, Truong TH, Saraf SL, Joseph JJ, Rondelli D, Hsieh MM. Curative therapies: Allogeneic hematopoietic cell transplantation from matched related donors using myeloablative, reduced intensity, and nonmyeloablative conditioning in sickle cell disease. Semin Hematol 2018; 55:87-93. [PMID: 29958564 DOI: 10.1053/j.seminhematol.2018.04.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/19/2018] [Indexed: 01/08/2023]
Abstract
Sickle cell disease (SCD) chronically damages multiple organs over the lifetime of affected individuals. Allogeneic hematopoietic cell transplantation (allo-HCT) is the most studied curative intervention. Fully matched related marrow, peripheral blood derived, or cord blood HCT have the best transplant outcome for symptomatic patients with SCD. For patients with asymptomatic or milder disease who have this donor option available, risks and benefits of HCT should be discussed among the patient, family, treating hematologist, and transplant physician, and decision to proceed to HCT should be individualized. Myeloablative conditioning with busulfan, cyclophosphamide, and ATG has been a commonly employed regimen for children and young adults. Recently, low intensity conditioning with low dose total body irradiation and alemtuzumab is emerging as an efficacious and safe regimen for adults, young adults, and possibly children. Mixed donor chimerism (minimum ≥20% myeloid cells), from myeloablative or nonmyeloablative conditioning regimen, produces robust normal donor erythropoiesis and is sufficient to provide a clinical cure. The proportion of patients remaining on immunosuppression beyond 2 years post-HCT is likely <10% with either myeloablative or low intensity regimens. Late effects from myeloablative or reduced intensity conditioning, or from several more months of immunosuppression in low intensity conditioning may be less common than those observed in HCT for malignant indications. Nonmyeloablative approaches with low toxicities should be the focus of future research efforts. Prevention of GVHD is a shared goal in all approaches of allo-HCT in SCD.
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Affiliation(s)
- Gregory M T Guilcher
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Tony H Truong
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Santosh L Saraf
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
| | - Jacinth J Joseph
- Department of Hematology, Washington Hospital Center/Georgetown University, Washington, DC; Sickle Cell Branch, NHLBI, NIH, Bethesda, MD
| | - Damiano Rondelli
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
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The case for HLA-identical sibling hematopoietic stem cell transplantation in children with symptomatic sickle cell anemia. Blood Adv 2017; 1:2563-2567. [PMID: 29296908 DOI: 10.1182/bloodadvances.2017007708] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/02/2017] [Indexed: 12/11/2022] Open
Abstract
This article has a companion Counterpoint by DeBaun and Clayton.
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Figueiredo L, Morrone K, Wei C, Ireland K, Cohen HW, Driscoll C, Manwani D. An age dependent response to hydroxyurea in pediatric sickle cell anemia patients with alpha thalassemia trait. Blood Cells Mol Dis 2017; 66:19-23. [PMID: 28783617 DOI: 10.1016/j.bcmd.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/29/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Abstract
Hydroxyurea (HU) is a key drug therapy for individuals with sickle cell anemia (SCA), yet its clinical and hematologic responses can be variable. Various studies have reported the role of α-thalassemia as one of the most prevalent heritable traits that may modify HU response. We provide data from 62 pediatric and adolescent patients with SCA, 26 with co-inherited α-thalassemia trait. Our data suggest that altered hematologic and clinical responses to HU therapy are noted in adolescent SCA individuals with co-inherited α-thalassemia trait. Adolescent patients who co-inherited α-thalassemia trait had a greater reduction in vaso-occlusive episodes compared to those without α-thalassemia, despite a less robust fetal hemoglobin induction as well as a lower maximum HU dose. This clinical improvement was associated with a lower MCH and higher RBC count. Responses to HU in younger SCA children (ages 5-11years) with co-inherited α-thalassemia trait, compared to those without α-thalassemia trait, did not show any difference in number vaso-occlusive episodes, fetal hemoglobin induction and change in MCH and RBC count.
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Affiliation(s)
- Lisa Figueiredo
- Children's Hospital at Montefiore, Department of Pediatrics, Division of Hematology/Oncology, Bronx, NY, United States; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States.
| | - Kerry Morrone
- Children's Hospital at Montefiore, Department of Pediatrics, Division of Hematology/Oncology, Bronx, NY, United States; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Catherine Wei
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Karen Ireland
- Children's Hospital at Montefiore, Department of Pediatrics, Division of Hematology/Oncology, Bronx, NY, United States
| | - Hillel W Cohen
- Dept. of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Catherine Driscoll
- Children's Hospital at Montefiore, Department of Pediatrics, Division of Hematology/Oncology, Bronx, NY, United States; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Deepa Manwani
- Children's Hospital at Montefiore, Department of Pediatrics, Division of Hematology/Oncology, Bronx, NY, United States; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States
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Cyclophosphamide improves engraftment in patients with SCD and severe organ damage who undergo haploidentical PBSCT. Blood Adv 2017; 1:652-661. [PMID: 29296707 DOI: 10.1182/bloodadvances.2016002972] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/07/2017] [Indexed: 12/25/2022] Open
Abstract
Peripheral blood stem cell transplantation (PBSCT) offers a curative option for sickle cell disease (SCD). Although HLA-matched sibling transplantation is promising, the vast majority of patients lack such a donor. We sought to develop a novel nonmyeloablative HLA-haploidentical PBSCT approach that could safely be used for patients with severe organ damage. Based on findings in our preclinical model, we developed a phase 1/2 trial using alemtuzumab, 400 cGy total body irradiation, and escalating doses of posttransplant cyclophosphamide (PT-Cy): 0 mg/kg in cohort 1, 50 mg/kg in cohort 2, and 100 mg/kg in cohort 3. A total of 21 patients with SCD and 2 with β-thalassemia received a transplant. The mean hematopoietic cell transplant-specific comorbidity index of 6 reflected patients with cirrhosis, heart failure, and end-stage renal disease. The engraftment rate improved from 1 (33%) of 3 in cohort 1 to 5 (63%) of 8 in cohort 2 and 10 (83%) of 12 in cohort 3. Percentage of donor myeloid and CD3 chimerism also improved with subsequent cohorts. There was no transplant-related mortality, and overall survival was 87%. At present, 0% in cohort 1, 25% in cohort 2, and 50% in cohort 3 remain free of their disease. There was no grade 2 to 4 acute or extensive chronic graft-versus-host disease (GVHD). Therefore, PT-Cy improves engraftment and successfully prevents severe GVHD after nonmyeloablative conditioning in patients with SCD who are at high risk for early mortality. Additional strategies are necessary to decrease the graft rejection rate and achieve a widely available cure for all patients with SCD. This trial was registered at www.clinicaltrials.gov as #NCT00977691.
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37
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Parrow NL, Tu H, Nichols J, Violet PC, Pittman CA, Fitzhugh C, Fleming RE, Mohandas N, Tisdale JF, Levine M. Measurements of red cell deformability and hydration reflect HbF and HbA 2 in blood from patients with sickle cell anemia. Blood Cells Mol Dis 2017; 65:41-50. [PMID: 28472705 DOI: 10.1016/j.bcmd.2017.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
Decreased erythrocyte deformability, as measured by ektacytometry, may be associated with disease severity in sickle cell anemia (SCA). Heterogeneous populations of rigid and deformable cells in SCA blood result in distortions of diffraction pattern measurements that correlate with the concentration of hemoglobin S (HbS) and the percentage of irreversibly sickled cells. We hypothesize that red cell heterogeneity, as well as deformability, will also be influenced by the concentration of alternative hemoglobins such as fetal hemoglobin (HbF) and the adult variant, HbA2. To test this hypothesis, we investigate the relationship between diffraction pattern distortion, osmotic gradient ektacytometry parameters, and the hemoglobin composition of SCA blood. We observe a correlation between the extent of diffraction pattern distortions and percentage of HbF and HbA2. Osmotic gradient ektacytometry data indicate that minimum elongation in the hypotonic region is positively correlated with HbF, as is the osmolality at which it occurs. The osmolality at both minimum and maximum elongation is inversely correlated with HbS and HbA2. These data suggest that HbF may effectively improve surface-to-volume ratio and osmotic fragility in SCA erythrocytes. HbA2 may be relatively ineffective in improving these characteristics or cellular hydration at the levels found in this patient cohort.
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Affiliation(s)
- Nermi L Parrow
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Hongbin Tu
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - James Nichols
- Molecular and Clinical Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Pierre-Christian Violet
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Corinne A Pittman
- Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Courtney Fitzhugh
- Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert E Fleming
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO, USA; Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Narla Mohandas
- Red Cell Physiology Laboratory, New York Blood Center, New York, NY, USA
| | - John F Tisdale
- Molecular and Clinical Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Mark Levine
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA.
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38
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Uchida N, Fujita A, Hsieh MM, Bonifacino AC, Krouse AE, Metzger ME, Donahue RE, Tisdale JF. Bone Marrow as a Hematopoietic Stem Cell Source for Gene Therapy in Sickle Cell Disease: Evidence from Rhesus and SCD Patients. HUM GENE THER CL DEV 2017; 28:136-144. [PMID: 28447889 DOI: 10.1089/humc.2017.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Steady state bone marrow (BM) is the preferred hematopoietic stem cell (HSC) source for gene therapy in sickle cell disease (SCD) due to the recognized risk of vaso-occlusive crisis during granulocyte colony-stimulating factor mobilization. We previously established clinically relevant HSC gene transfer in the rhesus model following transplantation of mobilized peripheral blood (PB) CD34+ cells transduced with lentiviral vectors. In this study, we examined steady state bone marrow (BM) in the rhesus competitive repopulation model and demonstrate similar gene marking in vitro and in vivo, as compared with mobilized PB CD34+ cells. We then evaluated PB and steady state BM in subjects with SCD and observed a higher frequency of CD34+ cells when compared with controls, likely due to enhanced hematopoiesis. However, CD34+ cell counts were reduced in both the PB and BM in patients treated with hydroxyurea, and hydroxyurea treatment strongly inhibited iPS cell generation from SCD subjects. Our data support that steady state BM is a useful HSC source for SCD gene therapy with similar transduction. The lower CD34+ percentages observed with hydroxyurea treatment warrants withholding hydroxyurea temporarily prior to harvesting HSCs. Our results are important for the design of gene targeting strategies for SCD.
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Affiliation(s)
- Naoya Uchida
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes/National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland, MD
| | - Atsushi Fujita
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes/National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland, MD
| | - Matthew M Hsieh
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes/National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland, MD
| | - Aylin C Bonifacino
- 2 Hematology Branch, National Heart Lung and Blood Institutes/National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland, MD
| | - Allen E Krouse
- 2 Hematology Branch, National Heart Lung and Blood Institutes/National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland, MD
| | - Mark E Metzger
- 2 Hematology Branch, National Heart Lung and Blood Institutes/National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland, MD
| | - Robert E Donahue
- 2 Hematology Branch, National Heart Lung and Blood Institutes/National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland, MD
| | - John F Tisdale
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes/National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland, MD
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39
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Uchida N, Washington KN, Mozer B, Platner C, Ballantine J, Skala LP, Raines L, Shvygin A, Hsieh MM, Mitchell LG, Tisdale JF. RNA Trans-Splicing Targeting Endogenous β-Globin Pre-Messenger RNA in Human Erythroid Cells. Hum Gene Ther Methods 2017; 28:91-99. [PMID: 28267358 DOI: 10.1089/hgtb.2016.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sickle cell disease results from a point mutation in exon 1 of the β-globin gene (total 3 exons). Replacing sickle β-globin exon 1 (and exon 2) with a normal sequence by trans-splicing is a potential therapeutic strategy. Therefore, this study sought to develop trans-splicing targeting β-globin pre-messenger RNA among human erythroid cells. Binding domains from random β-globin sequences were comprehensively screened. Six candidates had optimal binding, and all targeted intron 2. Next, lentiviral vectors encoding RNA trans-splicing molecules were constructed incorporating a unique binding domain from these candidates, artificial 5' splice site, and γ-globin cDNA, and trans-splicing was evaluated in CD34+ cell-derived erythroid cells from healthy individuals. Lentiviral transduction was efficient, with vector copy numbers of 9.7 to 15.3. The intended trans-spliced RNA product, including exon 3 of endogenous β-globin and γ-globin, was detected at the molecular level. Trans-splicing efficiency was improved to 0.07-0.09% by longer binding domains, including the 5' splice site of intron 2. In summary, screening was performed to select efficient binding domains for trans-splicing. Detectable levels of trans-splicing were obtained for endogenous β-globin RNA in human erythroid cells. These methods provide the basis for future trans-splicing directed gene therapy.
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Affiliation(s)
- Naoya Uchida
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) , Bethesda, Maryland
| | | | - Brian Mozer
- 3 Office of Research Integrity , Office of the Assistant Secretary for Health, Rockville, Maryland
| | - Charlotte Platner
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) , Bethesda, Maryland
| | - Josiah Ballantine
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) , Bethesda, Maryland
| | - Luke P Skala
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) , Bethesda, Maryland
| | - Lydia Raines
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) , Bethesda, Maryland
| | - Anna Shvygin
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) , Bethesda, Maryland
| | - Matthew M Hsieh
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) , Bethesda, Maryland
| | | | - John F Tisdale
- 1 Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) , Bethesda, Maryland
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Kinetic assay shows that increasing red cell volume could be a treatment for sickle cell disease. Proc Natl Acad Sci U S A 2017; 114:E689-E696. [PMID: 28096387 DOI: 10.1073/pnas.1619054114] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Although it has been known for more than 60 years that the cause of sickle cell disease is polymerization of a hemoglobin mutant, hydroxyurea is the only drug approved for treatment by the US Food and Drug Administration. This drug, however, is only partially successful, and the discovery of additional drugs that inhibit fiber formation has been hampered by the lack of a sensitive and quantitative cellular assay. Here, we describe such a method in a 96-well plate format that is based on laser-induced polymerization in sickle trait cells and robust, automated image analysis to detect the precise time at which fibers distort ("sickle") the cells. With this kinetic method, we show that small increases in cell volume to reduce the hemoglobin concentration can result in therapeutic increases in the delay time prior to fiber formation. We also show that, of the two drugs (AES103 and GBT440) in clinical trials that inhibit polymerization by increasing oxygen affinity, one of them (GBT440) also inhibits sickling in the absence of oxygen by two additional mechanisms.
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Wang WC. Minireview: Prognostic factors and the response to hydroxurea treatment in sickle cell disease. Exp Biol Med (Maywood) 2016; 241:730-6. [PMID: 27026724 DOI: 10.1177/1535370216642048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This review describes current considerations in the use of hydroxyurea for the management of sickle cell disease in the context of clinical severity. Randomized trials of hydroxyurea have generally enrolled subjects with increased severity based on frequent vaso-occlusive events. An exception was the BABY HUG study in infants which documented substantial benefit even for asymptomatic subjects. Increasing data indicate that hydroxyurea has a substantial effect on reducing mortality in both adults and children-perhaps the most compelling reason for advocating the drug's widespread use. Although the efficacy of hydroxyurea is mediated primarily through increased erythrocyte fetal hemoglobin and much has been learned about the genomic influences on fetal hemoglobin levels in sickle cell disease, our ability to predict the fetal hemoglobin response to hydroxyurea remains limited; much more work in this area is indicated. The review is concluded with the recommendations of the 2014 NIH Evidence-Based Management of Sickle Cell Disease Expert Panel Report.
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Affiliation(s)
- Winfred C Wang
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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