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Hebert N, Rakotoson MG, Bodivit G, Audureau E, Bencheikh L, Kiger L, Oubaya N, Pakdaman S, Sakka M, Di Liberto G, Chadebech P, Vingert B, Pirenne F, Galactéros F, Cambot M, Bartolucci P. Individual red blood cell fetal hemoglobin quantification allows to determine protective thresholds in sickle cell disease. Am J Hematol 2020; 95:1235-1245. [PMID: 32681733 DOI: 10.1002/ajh.25937] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 02/04/2023]
Abstract
Polymerization of the sickle hemoglobin (HbS) is a key determinant of sickle cell disease (SCD), an inherited blood disorder. Fetal hemoglobin (HbF) is a major modulator of the disease severity by both decreasing HbS intracellular concentration and inhibiting its polymerization. However, heterocellular distribution of HbF is common in SCD. For HbS polymerization inhibition, the hypothesis of an "HbF per red blood cell (HbF/RBC) threshold" requires accurate measurement of HbF in individual RBC. To date, HbF detection methods are limited to a qualitative measurement of RBC populations containing HbF - the F cells, which are variable. We developed an accurate method for HbF quantification in individual RBC. A linear association between mean HbF content and mean RBC fluorescence by flow cytometry, using an anti-Human-HbF antibody, was obtained from non-SCD subjects presenting homogeneous HbF distribution. This correlation was then used to measure HbF/RBC. Hydroxyurea (HU) improves SCD clinical manifestations, mainly through its ability to induce HbF synthesis. The HbF distribution was analyzed in 14 SCD patients before and during HU treatment. A significant decrease in RBC population containing less than 2 pg of HbF/RBC was observed. Therefore, we tested associations for %RBC above different HbF/RBC thresholds and showed a decrease in the pathognomonic vaso-occlusive crisis incidence from the threshold of 4 pg. This quantity was also correlated with the level of sickle RBC after in vitro deoxygenation. This new method allows the comparison of HbF/RBC distributions and could be a useful tool to characterize baseline patients HbF distribution and therapeutic response to HbF inducers.
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Affiliation(s)
- Nicolas Hebert
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Etablissement Français du Sang, Île‐de‐France, Hôpital Henri Mondor Créteil France
- Sickle cell referral center, UMGGR Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC Hôpitaux Universitaires Henri Mondor, APHP Créteil France
| | - Marie Georgine Rakotoson
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
| | - Gwellaouen Bodivit
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Etablissement Français du Sang, Île‐de‐France, Hôpital Henri Mondor Créteil France
| | - Etienne Audureau
- Sickle cell referral center, UMGGR Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC Hôpitaux Universitaires Henri Mondor, APHP Créteil France
| | - Laura Bencheikh
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Sickle cell referral center, UMGGR Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC Hôpitaux Universitaires Henri Mondor, APHP Créteil France
| | - Laurent Kiger
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Sickle cell referral center, UMGGR Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC Hôpitaux Universitaires Henri Mondor, APHP Créteil France
| | - Nadia Oubaya
- Hôpital Henri Mondor Assistance Publique‐Hôpitaux De Paris (APHP), Université Paris‐Est Créteil Créteil France
| | - Sadaf Pakdaman
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Etablissement Français du Sang, Île‐de‐France, Hôpital Henri Mondor Créteil France
| | - Mehdi Sakka
- Hôpital Henri Mondor Assistance Publique‐Hôpitaux De Paris (APHP), Université Paris‐Est Créteil Créteil France
| | - Gaetana Di Liberto
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Etablissement Français du Sang, Île‐de‐France, Hôpital Henri Mondor Créteil France
| | - Philippe Chadebech
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Etablissement Français du Sang, Île‐de‐France, Hôpital Henri Mondor Créteil France
| | - Benoit Vingert
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Etablissement Français du Sang, Île‐de‐France, Hôpital Henri Mondor Créteil France
| | - France Pirenne
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Etablissement Français du Sang, Île‐de‐France, Hôpital Henri Mondor Créteil France
| | - Frédéric Galactéros
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Sickle cell referral center, UMGGR Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC Hôpitaux Universitaires Henri Mondor, APHP Créteil France
| | - Marie Cambot
- UMR_S1134, Université Sorbonne Paris Cité, Université Paris Diderot, Inserm, INTS, Unité Biologie Intégrée du Globule Rouge, Laboratory of excellence LABEX GRex Paris France
| | - Pablo Bartolucci
- Institut Mondor de Recherche Biomédicale, Unité 955, team Pirenne, INSERM, EFS, UPEC, Laboratory of excellence LABEX GRex Créteil France
- Sickle cell referral center, UMGGR Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC Hôpitaux Universitaires Henri Mondor, APHP Créteil France
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