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Bhat V, Sheehan VA. Can we use biomarkers to identify those at risk of acute pain from sickle cell disease? Expert Rev Hematol 2024; 17:411-418. [PMID: 38949576 DOI: 10.1080/17474086.2024.2372322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/21/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Acute pain episodes, also known as vaso-occlusive crises (VOC), are a major symptom of sickle cell disease (SCD) and lead to frequent hospitalizations. The diagnosis of VOC can be challenging, particularly in adults with SCD, 50% of whom have chronic pain. Several potential biomarkers have been proposed for identifying individuals with VOC, including elevation above the baseline of various vascular growth factors, cytokines, and other markers of inflammation. However, none have been validated to date. AREAS COVERED We summarize prospective biomarkers for the diagnosis of acute pain in SCD, and how they may be involved in the pathophysiology of a VOC. Previous and current strategies for biomarker discovery, including the use of omics techniques, are discussed. EXPERT OPINION Implementing a multi-omics-based approach will facilitate the discovery of objective and validated biomarkers for acute pain.
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Affiliation(s)
- Varsha Bhat
- Center for Integrative Genomics, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Vivien A Sheehan
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
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Njoku F, Pugh N, Brambilla D, Kroner B, Shah N, Treadwell M, Gibson R, Hsu LL, Gordeuk VR, Glassberg J, Hankins JS, Kutlar A, King AA, Kanter J. Mortality in adults with sickle cell disease: Results from the sickle cell disease implementation consortium (SCDIC) registry. Am J Hematol 2024; 99:900-909. [PMID: 38450756 PMCID: PMC11001513 DOI: 10.1002/ajh.27279] [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: 11/24/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Abstract
The cause of death in people affected by sickle cell disease (SCD) is often challenging to define as prior studies have used retrospective or administrative data for analysis. We used a prospective longitudinal registry to assess mortality and clinical co-morbidities among subjects enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. At enrollment, we collected the following data: patient-reported demographics, SCD phenotype, baseline laboratory values, comorbidities, and current medications. Subjects were followed for a median of 4.7 years before the present analysis. The relationship of clinical co-morbidities (at time of enrollment) to mortality was determined using survival analysis, adjusting for SCD phenotype and gender. There was a total of 2439 people with SCD enrolled in the SCDIC registry. One hundred and twenty-eight participants (5%) died during the observation period (2017-2022). Six people died from trauma and were excluded from further analysis. Proximate cause of death was unwitnessed in 17% of the deaths, but commonest causes of death include cardiac (18%), acute chest or respiratory failure (11%), sudden unexplained death (8%). Enrollment characteristics of the individuals who died (n = 122) were compared to those of survivors (n = 2317). Several co-morbidities at enrollment increased the odds of death on univariate analysis. All co-morbidities were included in a multivariable model. After backward elimination, iron overload, pulmonary hypertension, and depression, remained statistically significant predictors of the risk of death. SCD reduces life expectancy. Improved comprehensive and supportive care to prevent end-organ damage and address comorbidities is needed for this population.
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Affiliation(s)
- Franklin Njoku
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Norma Pugh
- Department of Clinical Research, SSES, RTI International, Research Triangle Park, North Carolina, USA
| | - Donald Brambilla
- Department of Clinical Research, SSES, RTI International, Research Triangle Park, North Carolina, USA
| | - Barbara Kroner
- Department of Clinical Research, SSES, RTI International, Research Triangle Park, North Carolina, USA
| | - Nirmish Shah
- Pediatric Hematology/Oncology, Duke University, Durham, North Carolina, USA
| | - Marsha Treadwell
- Department of Pediatrics/Division of Hematology, University of California San Francisco, Oakland, California, USA
| | - Robert Gibson
- Department of Emergency Medicine and Hospitalist Services, Augusta University, Augusta, Georgia
| | - Lewis L. Hsu
- Division of Pediatric Hematology-Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Victor R. Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jane S. Hankins
- Departments of Hematology and Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Abdullah Kutlar
- Sickle Cell Center, Augusta University, Augusta, Georgia, USA
| | - Allison A. King
- Division of Pediatric Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Julie Kanter
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
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Chatzidavid S, Flevari P, Tombrou I, Anastasiadis G, Dimopoulou M. Pulmonary Hypertension in Sickle Cell Disease: Novel Findings of Gene Polymorphisms Related to Pathophysiology. Int J Mol Sci 2024; 25:4792. [PMID: 38732015 PMCID: PMC11084253 DOI: 10.3390/ijms25094792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Pulmonary hypertension (PH) is a progressive and potentially fatal complication of sickle cell disease (SCD), affecting 6-10% of adult SCD patients. Various mechanisms and theories have been evaluated to explain the pathophysiology of this disease. However, questions remain, particularly regarding the clinical heterogeneity of the disease in terms of symptoms, complications, and survival. Beyond the classical mechanisms that have been thoroughly investigated and include hemolysis, nitric oxide availability, endothelial disorders, thrombosis, and left heart failure, attention is currently focused on the potential role of genes involved in such processes. Potential candidate genes are investigated through next-generation sequencing, with the transforming growth factor-beta (TGF-β) pathway being the initial target. This field of research may also provide novel targets for pharmacologic agents in the future, as is already the case with idiopathic PH. The collection and processing of data and samples from multiple centers can yield reliable results that will allow a better understanding of SCD-related PH as a part of the disease's clinical spectrum. This review attempts to capture the most recent findings of studies on gene polymorphisms that have been associated with PH in SCD patients.
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Affiliation(s)
| | | | | | | | - Maria Dimopoulou
- Thalassemia and Sickle Cell Disease Unit, Center of Expertise in Rare Hematological Diseases (Hemoglobinopathies), Laikon General Hospital Member of EuroBlood NET, 16 Sevastoupoleos Str., 11526 Athens, Greece; (S.C.); (P.F.); (I.T.); (G.A.)
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Abstract
Thalassemia syndromes are common monogenic disorders and represent a significant health issue worldwide. In this review, the authors elaborate on fundamental genetic knowledge about thalassemias, including the structure and location of globin genes, the production of hemoglobin during development, the molecular lesions causing α-, β-, and other thalassemia syndromes, the genotype-phenotype correlation, and the genetic modifiers of these conditions. In addition, they briefly discuss the molecular techniques applied for diagnosis and innovative cell and gene therapy strategies to cure these conditions.
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Affiliation(s)
- Nicolò Tesio
- Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Regione Gonzole, 10, 10043 Orbassano, Turin, Italy. https://twitter.com/nicolotesio
| | - Daniel E Bauer
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Pediatrics, Harvard Stem Cell Institute, Broad Institute, Harvard Medical School, Boston, MA, USA.
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Does TGFBR3 Polymorphism Increase the Risk of Silent Cerebral Infarction in Egyptian Children with Sickle Cell Disease? Indian J Pediatr 2023; 90:146-152. [PMID: 35781614 PMCID: PMC9842542 DOI: 10.1007/s12098-022-04181-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/27/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate the relationship between TGFBR3 rs284875 single nucleotide polymorphism (SNP) state and silent cerebral infarction (SCI) in asymptomatic patients with sickle cell disease (SCD). METHODS A cross-sectional study was conducted on 50 children with SCD above 2 y of age followed up at the hematology outpatient clinic of Alexandria University Children's Hospital in Egypt. Twenty-four healthy children were included as a control group. All patients included in the study were subjected to complete history and clinical examination. Real-time polymerase chain reaction was performed on patients and controls for identification of SNP rs284875 of the TGFBR3 gene. A magnetic resonance imaging (MRI) of the brain were performed only on patients for detection of SCI. RESULTS Fifty SCD patients were enrolled (26 males and 24 females), with a median age of 10.9 y (2.3-17.8 y), and 24 children as healthy control for the studied SNP. Thirty-five (70%) patients had homozygous SCD, while 30% had sickle β-thalassemia. The brain MRI was normal in all the patients except for 2 patients who had features of SCI. The TGFBR3 rs284875 SNP was detected in 15 (30%) patients in the homozygous state (GG) versus only 1 (4.2%) child from the control group (p = 0.003). The prevalence of SCI was low in the study population and there was no statistically significant relationship between the TGFBR3 rs284875 SNP status and the presence of SCI in the brain MRI (p = 0.621). CONCLUSIONS This study confirmed a low prevalence of SCI in the SCD patient included in the study. The TGFBR3 rs284875 SNP did not significantly increase SCI among those patients.
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Loh D, Reiter RJ. Melatonin: Regulation of Prion Protein Phase Separation in Cancer Multidrug Resistance. Molecules 2022; 27:705. [PMID: 35163973 PMCID: PMC8839844 DOI: 10.3390/molecules27030705] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 12/13/2022] Open
Abstract
The unique ability to adapt and thrive in inhospitable, stressful tumor microenvironments (TME) also renders cancer cells resistant to traditional chemotherapeutic treatments and/or novel pharmaceuticals. Cancer cells exhibit extensive metabolic alterations involving hypoxia, accelerated glycolysis, oxidative stress, and increased extracellular ATP that may activate ancient, conserved prion adaptive response strategies that exacerbate multidrug resistance (MDR) by exploiting cellular stress to increase cancer metastatic potential and stemness, balance proliferation and differentiation, and amplify resistance to apoptosis. The regulation of prions in MDR is further complicated by important, putative physiological functions of ligand-binding and signal transduction. Melatonin is capable of both enhancing physiological functions and inhibiting oncogenic properties of prion proteins. Through regulation of phase separation of the prion N-terminal domain which targets and interacts with lipid rafts, melatonin may prevent conformational changes that can result in aggregation and/or conversion to pathological, infectious isoforms. As a cancer therapy adjuvant, melatonin could modulate TME oxidative stress levels and hypoxia, reverse pH gradient changes, reduce lipid peroxidation, and protect lipid raft compositions to suppress prion-mediated, non-Mendelian, heritable, but often reversible epigenetic adaptations that facilitate cancer heterogeneity, stemness, metastasis, and drug resistance. This review examines some of the mechanisms that may balance physiological and pathological effects of prions and prion-like proteins achieved through the synergistic use of melatonin to ameliorate MDR, which remains a challenge in cancer treatment.
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Affiliation(s)
- Doris Loh
- Independent Researcher, Marble Falls, TX 78654, USA
| | - Russel J. Reiter
- Department of Cellular and Structural Biology, UT Health San Antonio, San Antonio, TX 78229, USA
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Leandro MP, Almeida ND, Hocevar LS, Sá CKCD, Souza AJD, Matos MA. Polimorfismos e necrose avascular em pacientes com doença falciforme – Uma revisão sistemática. REVISTA PAULISTA DE PEDIATRIA 2022. [DOI: 10.1590/1984-0462/2022/40/2021013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumo Objetivo: Estabelecer, de modo sistemático, se existe associação entre polimorfismos e a necrose avascular em pacientes com doença falciforme. Fontes de dados: A revisão, conduzida segundo as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) e registrada no International Prospective Register of Systematic Reviews (PROSPERO), foi baseada na busca de estudos nas bases de dados PubMed, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Virtual em Saúde (BVS) e na literatura cinza (Google Scholar e Open Gray) até junho de 2020. A análise da qualidade dos artigos foi baseada nos critérios do Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Síntese dos dados: Dez artigos foram selecionados nas bases de dados e dois incluídos por meio da busca manual, totalizando 12 estudos elencados. As amostras resultaram em 2.362 pacientes incluídos. Com base na iniciativa STROBE, sete estudos atenderam total e/ou parcialmente mais de 70% dos itens essenciais e dois atingiram menos que 60% deles, com variação geral de 86,4–54,5%. Os resultados mostram que os polimorfismos nos genes da proteína morfogenética óssea 6 (BMP6), da Klotho (KL) e da Anexina A2 (ANXA2) podem ter associação com osteonecrose no contexto da doença falciforme. Seis artigos estudaram o polimorfismo no gene da enzima MTHFR, mas apenas um obteve associação positiva. Os polimorfismos associados ao receptor DARC, ao gene ITGA4, ao CD36 e aos genes de proteínas trombofílicas não demonstraram associação em nenhum dos estudos. Conclusões: Os polimorfismos nos genes BMP6, KL e ANXA2 estão possivelmente associados com a necrose avascular em indivíduos com doença falciforme. Entretanto, para a confirmação dessas alterações genéticas como fatores de risco, é necessário que mais estudos com maior poder estatístico e com maior rigor metodológico sejam realizados.
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Leandro MP, Almeida ND, Hocevar LS, Sá CKCD, Souza AJD, Matos MA. Polymorphisms and avascular necrosis in patients with sickle cell disease – A systematic review. REVISTA PAULISTA DE PEDIATRIA 2022; 40:e2021013. [PMID: 35584416 PMCID: PMC9113627 DOI: 10.1590/1984-0462/2022/40/2021013in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
Objective: To systematically establish whether there is an association between polymorphisms and avascular necrosis in patients with sickle cell disease. Data source: The review, conducted according to PRISMA guidelines and registered with PROSPERO, was based on research of studies in PubMed, SciELO, LILACS, BVS databases and in the gray literature (Google Scholar and Open Gray) published until June 2020. The STROBE initiative was used to analyze the articles’ quality. Data synthesis: Ten articles were selected from the databases and two were included through manual search, totaling 12 studies. All samples gathered 2,362 patients. According to STROBE, seven studies fully and/or partially covered more than 70% of the essential items and two studies reached less than 60%, with an overall variation of 86.4–54.5%. The results indicate that polymorphisms in the genes of the bone morphogenetic protein 6 (BMP6), Klotho (KL) and Annexin A2 (ANXA2) may be associated with osteonecrosis in the context of sickle cell disease. Six articles addressed the polymorphism in the MTHFR enzyme gene, but only one found a positive association. Polymorphisms associated with the DARC receptor, the ITGA4 gene, CD36 and thrombophilia protein genes were not associated in any of the studies. Conclusions: The results indicate that the polymorphisms in BMP6, Klotho and ANXA2 genes may be associated with avascular necrosis in patients with sickle cell disease. However, in order to confirm these genetic changes as risk factors, further studies with greater statistical power and methodological rigor are needed.
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Lakkakula BVKS, Pattnaik S. The HBG2 rs7482144 (C > T) Polymorphism is Linked to HbF Levels but not to the Severity of Sickle Cell Anemia. J Pediatr Genet 2021; 12:129-134. [PMID: 37090825 PMCID: PMC10118708 DOI: 10.1055/s-0041-1733950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022]
Abstract
AbstractSickle cell anemia (SCA) is a severe disease characterized by anemia, acute clinical complications, and a relatively short life span. In this disease, abnormal hemoglobin makes the red blood cells deformed, rigid, and sticky. Fetal hemoglobin (HbF) is one of the key modulators of SCA morbidity and mortality. Interindividual HbF variation is a heritable trait that is controlled by polymorphism in genes linked and unlinked to the hemoglobin β gene (HBB). The genetic polymorphisms that determine HbF levels are known to ameliorate acute clinical events. About 190 well-characterized homozygous SCA patients were included in this study. Complete blood count (CBC), high-performance liquid chromatography (HPLC), and clinical investigations were obtained from patient's records. Severity scores were determined by using the combination of anemia, complications, total leucocyte count, and transfusion scores. HBG2 rs7482144 polymorphism was genotyped by using the polymerase chain reaction and restriction fragment length polymorphism. The association between HBG2 rs7482144 polymorphism and HbF levels as well as the disease severity of SCA were assessed. SCA patients carrying TT genotype were found to have higher HbF levels. In addition, SCA patients with increased severity showed significantly lower levels of hemoglobin, HbF, and hematocrit values. However, the genotypes of HBG2 rs7482144 polymorphism were not found to be associated with the risk of disease severity. In summary, this study demonstrated that HBG2 rs7482144 polymorphism is linked with HbF levels, but it does not affect disease severity. The sample sizes used and the pattern of association deduced from our small sample size prevents us from extrapolating our findings further.
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Affiliation(s)
| | - Smaranika Pattnaik
- Department of Biotechnology and Bioinformatics, Sambalpur University, Sambalpur, Odisha, India
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Batista JVGF, Pereira-Martins DA, Falcão DA, Domingos IF, Arcanjo GS, Hatzlhofer BL, Weinhäuser I, Batista THC, Cardoso PRG, Dos Anjos AC, Hazin MF, Pitta MGR, Costa FF, Araujo AS, Lucena-Araujo AR, Bezerra MA. Association of KLOTHO polymorphisms with clinical complications of sickle cell anemia. Ann Hematol 2021; 100:1921-1927. [PMID: 34125262 DOI: 10.1007/s00277-021-04532-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/12/2021] [Indexed: 11/24/2022]
Abstract
The clinical and phenotypic heterogeneity of patients with sickle cell anemia (SCA) is influenced by environmental and genetic factors. Several genetic modifiers, such as the KLOTHO (KL) gene, have been associated with SCA clinical outcomes. The KL gene and its encoded proteins are implicated in important biological pathways, which affect the disease's pathophysiology, such as expression of adhesion molecules VCAM-1 and ICAM-1, oxidative stress, and nitric oxide biology. Here, we evaluated the clinical relevance of two polymorphisms found on the KL gene (rs685417 and rs211239) in 588 unrelated patients with SCA. Genotyping analyses were performed using the TaqMan system. The KL rs211239 was associated with increased number of vaso-occlusive crisis (VOCs) per year (P = 0.001), while KL rs685417 was associated with increased frequency of stroke (P = 0.034), priapism (P = 0.011), number of complications (P = 0.019), and with a lower incidence of priapism (P = 0.036). Additionally, the associations with VOCs, stroke, and priapism remained consistent in multivariate analyses (P < 0.05). Our data highlight the clinical importance of KL in SCA.
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Affiliation(s)
| | - Diego A Pereira-Martins
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil.,Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Diego A Falcão
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil
| | - Igor F Domingos
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil.,Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Gabriela S Arcanjo
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil
| | - Betânia L Hatzlhofer
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil.,Department of Pharmaceutical Sciences, Health Sciences Center, Federal University of Pernambuco, Recife, Brazil
| | - Isabel Weinhäuser
- Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Thais H C Batista
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil
| | - Pablo R G Cardoso
- Laboratory of Immunomodulation and Novel Therapeutic Approaches (LINAT), Research Center for Therapeutic Innovation Suely Galdino (NUPIT-SG), Federal University of Pernambuco, Recife, Brazil
| | - Ana C Dos Anjos
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Brazil
| | - Manuela F Hazin
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Brazil
| | - Maira G R Pitta
- Laboratory of Immunomodulation and Novel Therapeutic Approaches (LINAT), Research Center for Therapeutic Innovation Suely Galdino (NUPIT-SG), Federal University of Pernambuco, Recife, Brazil
| | - Fernando F Costa
- Hematology and Hemotherapy Center, State University of Campinas, Campinas, Brazil
| | - Aderson S Araujo
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Brazil
| | | | - Marcos A Bezerra
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil.
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Boğa C, Asma S, Leblebisatan G, Şen N, Tombak A, Demiroğlu YZ, Yeral M, Akın Ş, Yeşilağaç H, Habeşoğlu MA, Arıboğan A, Kasar M, Korur A, Özdoğu H. Comparison of the clinical course of COVID-19 infection in sickle cell disease patients with healthcare professionals. Ann Hematol 2021; 100:2195-2202. [PMID: 34032899 PMCID: PMC8144274 DOI: 10.1007/s00277-021-04549-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/01/2021] [Indexed: 12/04/2022]
Abstract
It is highly expected that COVID-19 infection will have devastating consequences in sickle cell disease (SCD) patients due to endothelial activation and decreased tissue and organ reserve as a result of microvascular ischemia and continuous inflammation. In this study, we aimed to compare the clinical course of COVID-19 in adult SCD patients under the organ injury mitigation and clinical care improvement program (BASCARE) with healthcare professionals without significant comorbid conditions. The study was planned as a retrospective, multicenter and cross-sectional study. Thirty-nine SCD patients, ages 18 to 64 years, and 121 healthcare professionals, ages 21 to 53, were included in the study. The data were collected from the Electronic Health Recording System of PRANA, where SCD patients under the BASCARE program had been registered. The data of other patients were collected from the Electronic Hospital Data Recording System and patient files. In the SCD group, the crude incidence of COVID-19 was 9%, while in healthcare professionals at the same period was 23%. Among the symptoms, besides fever, loss of smell and taste were more prominent in the SCD group than in healthcare professionals. There was a significant difference between the two groups in terms of development of pneumonia, hospitalization, and need for intubation (43 vs 5%, P < 0.00001; 26 vs 7%, P = 0.002; and 10 vs 1%, P = 0.002, respectively). Prophylactic low molecular weight heparin and salicylate were used more in the SCD group than in healthcare professionals group (41 vs 9% and 28 vs 1%; P < 0.0001 for both). The 3-month mortality rate was demonstrated as 5% in the SCD group, while 0 in the healthcare professionals group. One patient in the SCD group became continously dependent on respiratory support. The cause of death was acute chest syndrome in the first case, hepatic necrosis and multi-organ failure in the second case. In conclusion, these observations supported the expectation that the course of COVID-19 in SCD patients will get worse. The BASCARE program applied in SCD patients could not change the poor outcome.
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Affiliation(s)
- Can Boğa
- Department of Hematology, Sickle Cell Unit and Adana Adult Bone Marrow Transplantation Center, Baskent University School of Medicine, Ankara, Turkey.
| | - Süheyl Asma
- Department of Family Medicine, Baskent University School of Medicine, Ankara, Turkey
| | - Göksel Leblebisatan
- Department of Pediatric Hematology, Cukurova University School of Medicine, Adana, Turkey
| | - Nazan Şen
- Department of Pulmonology, Baskent University School of Medicine, Ankara, Turkey
| | - Anıl Tombak
- Department of Hematology, Mersin University, Mersin, Turkey
| | - Yusuf Ziya Demiroğlu
- Department of Infectious Disease, Baskent University School of Medicine, Ankara, Turkey
| | - Mahmut Yeral
- Department of Hematology, Baskent University School of Medicine, Ankara, Turkey
| | - Şule Akın
- Department of Anesthesiology and Reanimation, Baskent University School of Medicine, Ankara, Turkey
| | - Hasan Yeşilağaç
- Department of Emergency Medicine and Traumatology, Baskent University School of Medicine, Ankara, Turkey
| | - Mehmet Ali Habeşoğlu
- Department of Pulmonology, Baskent University School of Medicine, Ankara, Turkey
| | - Anış Arıboğan
- Department of Anesthesiology and Reanimation, Baskent University School of Medicine, Ankara, Turkey
| | - Mutlu Kasar
- Department of Hematology, Sickle Cell Unit and Adana Adult Bone Marrow Transplantation Center, Baskent University School of Medicine, Ankara, Turkey
| | - Aslı Korur
- Department of Family Medicine, Baskent University School of Medicine, Ankara, Turkey
| | - Hakan Özdoğu
- Department of Hematology, Sickle Cell Unit and Adana Adult Bone Marrow Transplantation Center, Baskent University School of Medicine, Ankara, Turkey
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Adekile A, Akbulut-Jeradi N, Al Khaldi R, Fernandez MJ, Sukumaran J. Diagnosis of Sickle Cell Disease and HBB Haplotyping in the Era of Personalized Medicine: Role of Next Generation Sequencing. J Pers Med 2021; 11:jpm11060454. [PMID: 34071035 PMCID: PMC8224627 DOI: 10.3390/jpm11060454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022] Open
Abstract
Hemoglobin genotype and HBB haplotype are established genetic factors that modify the clinical phenotype in sickle cell disease (SCD). Current methods of establishing these two factors are cumbersome and/or prone to errors. The throughput capability of next generation sequencing (NGS) makes it ideal for simultaneous interrogation of the many genes of interest in SCD. This study was designed to confirm the diagnosis in patients with HbSS and Sβ-thalassemia, identify any ß-thal mutations and simultaneously determine the ßS HBB haplotype. Illumina Ampliseq custom DNA panel was used to genotype the DNA samples. Haplotyping was based on the alleles on five haplotype-specific SNPs. The patients studied included 159 HbSS patients and 68 Sβ-thal patients, previously diagnosed using high performance liquid chromatography (HPLC). There was considerable discordance between HPLC and NGS results, giving a false +ve rate of 20.5% with a sensitivity of 79% for the identification of Sβthal. Arab/India haplotype was found in 81.5% of βS chromosomes, while the two most common, of the 13 β-thal mutations detected, were IVS-1 del25 and IVS-II-1 (G>A). NGS is very versatile and can be deployed to simultaneously screen multiple gene loci for modifying polymorphisms, to afford personalized, evidence-based counselling and early intervention.
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Affiliation(s)
- Adekunle Adekile
- Department of Pediatrics, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait; jalajasukumaran@hotmail
- Correspondence: ; Tel.: +965-253-194-86
| | | | - Rasha Al Khaldi
- Advanced Technology Company, Hawali 32060, Kuwait; (N.A.-J.); (R.A.); (M.J.F.)
| | | | - Jalaja Sukumaran
- Department of Pediatrics, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait; jalajasukumaran@hotmail
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Techniques for the Detection of Sickle Cell Disease: A Review. MICROMACHINES 2021; 12:mi12050519. [PMID: 34063111 PMCID: PMC8148117 DOI: 10.3390/mi12050519] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/17/2021] [Accepted: 04/25/2021] [Indexed: 12/14/2022]
Abstract
Sickle cell disease (SCD) is a widespread disease caused by a mutation in the beta-globin gene that leads to the production of abnormal hemoglobin called hemoglobin S. The inheritance of the mutation could be homozygous or heterozygous combined with another hemoglobin mutation. SCD can be characterized by the presence of dense, sickled cells that causes hemolysis of blood cells, anemia, painful episodes, organ damage, and in some cases death. Early detection of SCD can help to reduce the mortality and manage the disease effectively. Therefore, different techniques have been developed to detect the sickle cell disease and the carrier states with high sensitivity and specificity. These techniques can be screening tests such as complete blood count, peripheral blood smears, and sickling test; confirmatory tests such as hemoglobin separation techniques; and genetic tests, which are more expensive and need to be done in centralized labs by highly skilled personnel. However, advanced portable point of care techniques have been developed to provide a low-cost, simple, and user-friendly device for detecting SCD, for instance coupling solubility tests with portable devices, using smartphone microscopic classifications, image processing techniques, rapid immunoassays, and sensor-based platforms. This review provides an overview of the current and emerging techniques for sickle cell disease detection and highlights the different potential methods that could be applied to help the early diagnosis of SCD.
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14
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Ngo LT, Wang WK, Tseng YT, Chang TC, Kuo PL, Chau LK, Huang TT. MutS protein-based fiber optic particle plasmon resonance biosensor for detecting single nucleotide polymorphisms. Anal Bioanal Chem 2021; 413:3329-3337. [PMID: 33712917 DOI: 10.1007/s00216-021-03271-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/08/2021] [Accepted: 03/04/2021] [Indexed: 01/29/2023]
Abstract
A new biosensing method is presented to detect gene mutation by integrating the MutS protein from bacteria with a fiber optic particle plasmon resonance (FOPPR) sensing system. In this method, the MutS protein is conjugated with gold nanoparticles (AuNPs) deposited on an optical fiber core surface. The target double-stranded DNA containing an A and C mismatched base pair in a sample can be captured by the MutS protein, causing increased absorption of green light launching into the fiber and hence a decrease in transmitted light intensity through the fiber. As the signal change is enhanced through consecutive total internal reflections along the fiber, the limit of detection for an AC mismatch heteroduplex DNA can be as low as 0.49 nM. Because a microfluidic chip is used to contain the optical fiber, the narrow channel width allows an analysis time as short as 15 min. Furthermore, the label-free and real-time nature of the FOPPR sensing system enables determination of binding affinity and kinetics between MutS and single-base mismatched DNA. The method has been validated using a heterozygous PCR sample from a patient to determine the allelic fraction. The obtained allelic fraction of 0.474 reasonably agrees with the expected allelic fraction of 0.5. Therefore, the MutS-functionalized FOPPR sensor may potentially provide a convenient quantitative tool to detect single nucleotide polymorphisms in biological samples with a short analysis time at the point-of-care sites.
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Affiliation(s)
- Loan Thi Ngo
- Department of Chemistry and Biochemistry and Center for Nano Bio-Detection, National Chung Cheng University, Chiayi, 62102, Taiwan
| | - Wei-Kai Wang
- Department of Dentistry, Institute of Oral Medicine, Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Yen-Ta Tseng
- Department of Chemistry and Biochemistry and Center for Nano Bio-Detection, National Chung Cheng University, Chiayi, 62102, Taiwan
| | - Ting-Chou Chang
- Department of Chemistry and Biochemistry and Center for Nano Bio-Detection, National Chung Cheng University, Chiayi, 62102, Taiwan
| | - Pao-Lin Kuo
- Department of Obstetrics Gynecology, National Cheng Kung University Hospital, College of Medicine and Hospital, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Lai-Kwan Chau
- Department of Chemistry and Biochemistry and Center for Nano Bio-Detection, National Chung Cheng University, Chiayi, 62102, Taiwan.
| | - Tze-Ta Huang
- Department of Dentistry, Institute of Oral Medicine, Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan.
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15
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Alpha thalassemia, but not β S-globin haplotypes, influence sickle cell anemia clinical outcome in a large, single-center Brazilian cohort. Ann Hematol 2021; 100:921-931. [PMID: 33586016 DOI: 10.1007/s00277-021-04450-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Alpha thalassemia and beta-globin haplotype are considered classical genetic disease modifiers in sickle cell anemia (SCA) causing clinical heterogeneity. Nevertheless, their functional impact on SCA disease emergence and progression remains elusive. To better understand the role of alpha thalassemia and beta-globin haplotype in SCA, we performed a retrospective study evaluating the clinical manifestations of 614 patients. The univariate analysis showed that the presence of alpha-thalassemia -3.7-kb mutation (αα/-α and -α/-α) decreased the risk of stroke development (p = 0.046), priapism (p = 0.033), and cholelithiasis (p = 0.021). Furthermore, the cumulative incidence of stroke (p = 0.023) and cholelithiasis (p = 0.006) was also significantly lower for patients carrying the alpha thalassemia -3.7-kb mutation. No clinical effects were associated with the beta-globin haplotype analysis, which could be explained by the relatively homogeneous haplotype composition in our cohort. Our results reinforce that alpha thalassemia can provide protective functions against hemolysis-related symptoms in SCA. Although, several genetic modifiers can impact the inflammatory state of SCA patients, the alpha thalassemia mutation remains one of the most recurrent genetic aberration and should therefore always be considered first.
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16
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Transforming Growth Factor Beta Receptor 3 Haplotypes in Sickle Cell Disease Are Associated with Lipid Profile and Clinical Manifestations. Mediators Inflamm 2020; 2020:3185015. [PMID: 33149723 PMCID: PMC7603616 DOI: 10.1155/2020/3185015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/24/2020] [Accepted: 09/25/2020] [Indexed: 01/10/2023] Open
Abstract
Individuals with sickle cell disease (SCD) present both chronic and acute inflammatory events. The TGF-β pathway is known to play a role in immune response, angiogenesis, inflammation, hematopoiesis, vascular inflammation, and cell proliferation. Polymorphisms in the transforming growth factor-beta receptor 3 (TGFBR3) gene have been linked to several inflammatory diseases. This study investigated associations between two TGFBR3 haplotypes and classical laboratory parameters, as well as clinical manifestations, in SCD. We found that individuals with the GG haplotype presented higher levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides, non-HDL cholesterol, total proteins, and globulin than individuals with non-GG haplotypes. In addition, the GG haplotype was associated with a previous history of pneumonia. Individuals with the CGG haplotype presented increased plateletcrit, TC, LDL-C levels, and non-HDL cholesterol. The CCG haplotype was also associated with a previous history of pneumonia. Our findings suggest that individuals with the GG and CGG haplotypes of TGFBR3 present important alterations in lipid profile.
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17
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TGFBR3 Polymorphisms (rs1805110 and rs7526590) Are Associated with Laboratory Biomarkers and Clinical Manifestations in Sickle Cell Anemia. DISEASE MARKERS 2020; 2020:8867986. [PMID: 33062074 PMCID: PMC7547350 DOI: 10.1155/2020/8867986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 01/11/2023]
Abstract
Individuals with sickle cell anemia (SCA) present chronic anemia, hemolysis, an exacerbated inflammatory response, and heterogeneous clinical complications, which may be modulated by the transforming growth factor beta (TGF-β) pathway. Thus, we aimed to investigate polymorphisms (rs1805110 and rs7526590) of the transforming growth factor beta receptor III gene (TGFBR3) with regard to laboratory biomarkers and clinical manifestations in individuals with SCA. Hematological, biochemical, immunological, and genetic analyses were carried out, as well as serum endothelin-1 measurements. The minor allele (A) of the TGFBR3 rs1805110 polymorphism was associated with increased hemoglobin, hematocrit, reticulocyte counts, total cholesterol, low-density lipoprotein, uric acid, and endothelin levels, as well as decreased platelet distribution width (PDW) and the occurrence of bone alterations. The minor allele (T) of TGFBR3 rs7526590 was associated with increased red cell distribution width, PDW, alkaline phosphatase, aspartate aminotransferase, total and indirect bilirubin, and lactate dehydrogenase levels, as well as lower ferritin levels and the occurrence of leg ulcers. Our data suggest that the minor allele (A) of TGFBR3 rs1805110 is associated with inflammation and bone alterations, while the minor allele (T) of TGFBR3 rs7526590 is related to hemolysis and the occurrence of leg ulcers.
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18
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Tozatto-Maio K, Girot R, Ly ID, Silva Pinto AC, Rocha V, Fernandes F, Diagne I, Benzerara Y, Dinardo CL, Soler JP, Kashima S, Araujo IL, Kenzey C, Fonseca GHH, Rodrigues ES, Volt F, Jarduli L, Ruggeri A, Mariaselvam C, Gualandro SFM, Rafii H, Cappelli B, Nogueira FM, Scigliuolo GM, Guerino-Cunha RL, Malmegrim KCR, Simões BP, Gluckman E, Tamouza R. Polymorphisms in Inflammatory Genes Modulate Clinical Complications in Patients With Sickle Cell Disease. Front Immunol 2020; 11:2041. [PMID: 33013863 PMCID: PMC7510050 DOI: 10.3389/fimmu.2020.02041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/27/2020] [Indexed: 01/27/2023] Open
Abstract
Sickle cell disease (SCD), the most common monogenic disease worldwide, is marked by a phenotypic variability that is, to date, only partially understood. Because inflammation plays a major role in SCD pathophysiology, we hypothesized that single nucleotide polymorphisms (SNP) in genes encoding functionally important inflammatory proteins might modulate the occurrence of SCD complications. We assessed the association between 20 SNPs in genes encoding Toll-like receptors (TLR), NK cell receptors (NKG), histocompatibility leukocyte antigens (HLA), major histocompatibility complex class I polypeptide-related sequence A (MICA) and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), and the occurrence of six SCD clinical complications (stroke, acute chest syndrome (ACS), leg ulcers, cholelithiasis, osteonecrosis, or retinopathy). This study was performed in a cohort of 500 patients. We found that the TLR2 rs4696480 TA, TLR2 rs3804099 CC, and HLA-G, rs9380142 AA genotypes were more frequent in patients who had fewer complications. Also, in logistic regression, the HLA-G rs9380142 G allele increased the risk of cholelithiasis (AG vs. AA, OR 1.57, 95%CI 1.16-2.15; GG vs. AA, OR 2.47, 95%CI 1.34-4.64; P = 0.02). For SNPs located in the NKG2D loci, in logistic regression, the A allele in three SNPs was associated with a lower frequency of retinopathy, namely, rs2246809 (AA vs. GG: OR 0.22, 95%CI 0.09-0.50; AG vs. GG: OR 0.47, 95%CI 0.31-0.71; P = 0.004, for patients of same origin), rs2617160 (AT vs. TT: OR 0.67, 95%CI 0.48-0.92; AA vs. TT: OR 0.45, 95%CI 0.23-0.84; P = 0.04), and rs2617169 (AA vs. TT: OR 0.33, 95%CI 0.13-0.82; AT vs. TT: OR 0.58, 95%CI 0.36-0.91, P = 0.049, in patients of same SCD genotype). These results, by uncovering susceptibility to, or protection against SCD complications, might contribute to a better understanding of the inflammatory pathways involved in SCD manifestations and to pave the way for the discovery of biomarkers that predict disease severity, which would improve SCD management.
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Affiliation(s)
- Karina Tozatto-Maio
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco.,Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Indou Deme Ly
- National Children Hospital Center Albert Royer, Cheikh Anta Diop University, Dakar, Senegal
| | - Ana Cristina Silva Pinto
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Vanderson Rocha
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Fernandes
- Instituto de Matematica e Estatistica da Universidade de São Paulo, São Paulo, Brazil
| | - Ibrahima Diagne
- National Children Hospital Center Albert Royer, Cheikh Anta Diop University, Dakar, Senegal
| | - Yahia Benzerara
- Département de Bactériologie, Hôpital Saint-Antoine, Hôpitaux de l'Est parisien, Paris, France
| | - Carla L Dinardo
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Julia Pavan Soler
- Instituto de Matematica e Estatistica da Universidade de São Paulo, São Paulo, Brazil
| | - Simone Kashima
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Chantal Kenzey
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Guilherme H H Fonseca
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Evandra S Rodrigues
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Fernanda Volt
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Luciana Jarduli
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.,School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Annalisa Ruggeri
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Cellular Therapy and Immunobiology Working Party, The European Society for Blood and Marrow Transplantation, Paris, France
| | | | - Sandra F M Gualandro
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hanadi Rafii
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Barbara Cappelli
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Felipe Melo Nogueira
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Graziana Maria Scigliuolo
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Renato Luiz Guerino-Cunha
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Belinda P Simões
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Eliane Gluckman
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
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19
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Sadhu N, Jhun EH, Posen A, Yao Y, He Y, Molokie RE, Wilkie DJ, Wang ZJ. Phenylethanolamine N-methyltransferase gene polymorphisms associate with crisis pain in sickle cell disease patients. Pharmacogenomics 2020; 21:269-278. [PMID: 32162598 DOI: 10.2217/pgs-2019-0096] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: Phenylethanolamine N-methyltransferase (PNMT) catalyzes the conversion of sympathetic neurotransmitter norepinephrine to epinephrine. We examined the association of PNMT polymorphisms with acute and chronic pain in sickle cell disease (SCD). Methods: Utilization of emergency care owing to painful crisis was used as a marker for acute pain in 131 patients with SCD. Results: rs876493 A allele, rs2934965 T allele and rs2941523 G allele were significantly associated with decreased utilization (p ≤ 0.05). rs876493 A allele showed association with utilization in females (p = 0.003), not males (p = 0.803). rs2934965 T allele and rs2941523 G allele were predicted to cause loss of putative transcription factor binding sites. This is the first report of the association of PNMT polymorphisms with acute crisis pain in SCD. Together with our previous findings in catechol-o-methyltransferase, polymorphisms in catecholamine metabolizing enzymes appear to primarily influence acute pain in SCD.
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Affiliation(s)
- Nilanjana Sadhu
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA
| | - Ellie H Jhun
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA
| | - Andrew Posen
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Ying He
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA.,Comprehensive Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert E Molokie
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA.,Comprehensive Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.,Jesse Brown Veteran's Administration Medical Center, Chicago, IL, USA.,Division of Hematology/Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Zaijie J Wang
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA.,Comprehensive Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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20
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Cesar P, Dhyani A, Augusto Schwade L, Acordi P, Xerez Albuquerque C, Nina R, De Paula EV, Fraiji N. Epidemiological, clinical, and severity characterization of sickle cell disease in a population from the Brazilian Amazon. Hematol Oncol Stem Cell Ther 2019; 12:204-210. [DOI: 10.1016/j.hemonc.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 03/21/2019] [Accepted: 04/28/2019] [Indexed: 11/25/2022] Open
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21
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Stephanou C, Tamana S, Minaidou A, Papasavva P, Kleanthous M, Kountouris P. Genetic Modifiers at the Crossroads of Personalised Medicine for Haemoglobinopathies. J Clin Med 2019; 8:E1927. [PMID: 31717530 PMCID: PMC6912721 DOI: 10.3390/jcm8111927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/25/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022] Open
Abstract
Haemoglobinopathies are common monogenic disorders with diverse clinical manifestations, partly attributed to the influence of modifier genes. Recent years have seen enormous growth in the amount of genetic data, instigating the need for ranking methods to identify candidate genes with strong modifying effects. Here, we present the first evidence-based gene ranking metric (IthaScore) for haemoglobinopathy-specific phenotypes by utilising curated data in the IthaGenes database. IthaScore successfully reflects current knowledge for well-established disease modifiers, while it can be dynamically updated with emerging evidence. Protein-protein interaction (PPI) network analysis and functional enrichment analysis were employed to identify new potential disease modifiers and to evaluate the biological profiles of selected phenotypes. The most relevant gene ontology (GO) and pathway gene annotations for (a) haemoglobin (Hb) F levels/Hb F response to hydroxyurea included urea cycle, arginine metabolism and vascular endothelial growth factor receptor (VEGFR) signalling, (b) response to iron chelators included xenobiotic metabolism and glucuronidation, and (c) stroke included cytokine signalling and inflammatory reactions. Our findings demonstrate the capacity of IthaGenes, together with dynamic gene ranking, to expand knowledge on the genetic and molecular basis of phenotypic variation in haemoglobinopathies and to identify additional candidate genes to potentially inform and improve diagnosis, prognosis and therapeutic management.
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Affiliation(s)
| | | | | | | | - Marina Kleanthous
- Correspondence: (M.K.); (P.K.); Tel.:+357-2239-2652 (M.K.); +357-2239-2623 (P.K.)
| | - Petros Kountouris
- Correspondence: (M.K.); (P.K.); Tel.:+357-2239-2652 (M.K.); +357-2239-2623 (P.K.)
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22
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Seamans BN, Pellechio SL, Capria AL, Agyingi SE, Morenikeji OB, Ojurongbe O, Thomas BN. Genetic diversity of CD14, CD28, CTLA-4 and ICOS gene promoter polymorphism in African and American sickle cell disease. Hum Immunol 2019; 80:930-936. [PMID: 31474499 DOI: 10.1016/j.humimm.2019.08.005] [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: 06/10/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
Variable immune response to external stimuli remains a major concern in sickle cell disease (SCD), with such responses predicted to be contributors to disease pathogenesis. Elucidating the diversity of host genes contributing to immune response would assist to clarify differing outcomes among and between disease groups. We hypothesize that there is a significant interethnic diversity in the CD14 (rs2569190), CD28 (rs35593994), CTLA-4 (rs5742909) and ICOS (rs4404254) gene polymorphisms among and between SCD groups. We genotyped single nucleotide polymorphisms of the 4 loci among African and African American SCD and control groups and between SCD groups. In all, 375 individuals from Mali (145 SCD and 230 controls) and 700 DNA samples from the United States (321 SCD and 379 controls) were subjected to a PCR-RFLP assay. We found no intraethnic difference in genotypic and allelic frequencies of the 4 loci among Africans and African Americans, potentially significant in disease association studies, including a similar observation for interethnic frequencies of CD28, CTLA-4 and ICOS genes, but not CD14. The CD14 (rs2569190) gene promoter demonstrated a significant difference (p < 0.02) between African and African American SCD groups, with the mutant variant (-159 T/T) more frequent (p < 0.0002) in African American SCD (38.9% versus 26.2%). The higher frequency of CD14 mutants among African Americans without an accompanying defect in CD28, CTLA-4 and ICOS diversity possibly indicates a defective innate response, driven by CD14, is untethered to downstream T cell differentiation or effector function. Additionally, we show that CD28 (rs35593994) mutant variants have no impact on T cell differentiation, as the ICOS gene provides an alternative pathway to override this impairment. We conclude that in spite of the defect in CD14, T cell selection and differentiation is unimpeded and a robust adaptive immune response initiated.
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Affiliation(s)
- Brooke N Seamans
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, USA.
| | - Summer L Pellechio
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, USA.
| | - Anna L Capria
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, USA.
| | - Smith E Agyingi
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, USA.
| | - Olanrewaju B Morenikeji
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, USA.
| | - Olusola Ojurongbe
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Osogbo, Nigeria.
| | - Bolaji N Thomas
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, USA.
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23
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Bakr S, Khorshied M, Talha N, Jaffer KY, Soliman N, Eid K, El-Ghamrawy M. Implication of HMOX1 and CCR5 genotypes on clinical phenotype of Egyptian patients with sickle cell anemia. Ann Hematol 2019; 98:1805-1812. [PMID: 31030250 DOI: 10.1007/s00277-019-03697-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
Abstract
Sickle cell disease (SCD) is a relatively common inherited hemolytic anemia among individuals of African descent. Genetic factors might clarify clinical diversity of the disease and variations in treatment response. Some researchers investigated heme oxygenase-1 (HMOX1) or chemokine receptor 5 (CCR5Δ32) genotypes among SCD patients and their correlation with fetal hemoglobin (HbF) and disease severity. However, there are no such records among Arab nations. We aimed to estimate the prevalence of the HMOX1-413 A>T (rs2071746) and CCR5Δ32 (rs333) polymorphisms, and to assess their effect on SCD phenotype and HbF level among Egyptian patients. Polymerase chain reaction assay was used to determine these polymorphisms among 100 SCD patients and 100 healthy controls. Though not statistically significant, the frequency of individual carrying HMOX-1 polymorphic AT and TT genotypes in both patient and control groups was 92% and 85% respectively. Regarding CCR5Δ32 polymorphisms, all SCD patients harbored the wild genotype (100%), while the heteromutant genotype was encountered in 2% of our controls. Patients harboring mutant HMOX-1 had a less frequent vaso-occlusive crisis (VOC)/lifetime, less VOC in the last year, less incidence of stroke, less frequency of hospitalization, and responded more frequently to hydroxyurea with statistically significant differences (p = 0.028, 0.007, 0.046, 0.007, and 0.011 respectively). No significant associations with HbF level or other hematologic parameters were encountered among our cohort. Our study results suggest a protective effect of mutant HMOX-1 genotypes in ameliorating the phenotypic severity of the disease. HMOX1-413 A>T (rs2071746) polymorphisms might prove to be a prognostic marker among Egyptian SCD, but not CCR5Δ32 (rs333) polymorphisms.
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Affiliation(s)
- Salwa Bakr
- Department of Clinical Pathology/Hematology, Faculty of Medicine, Fayoum University, P.O. Box 63514, Faiyum, Egypt.
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Mervat Khorshied
- Department of Clinical & Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha Talha
- Department of Pediatric, Pediatric Hematology and BMT Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Karim Yahia Jaffer
- Department of Pediatric, Pediatric Hematology and BMT Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nohair Soliman
- Department of Clinical & Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled Eid
- College of Medicine, Ain Shams University, Cairo, Egypt
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Tozatto-Maio K, Girot R, Ly ID, Rocha V, Silva Pinto AC, Diagne I, Benzerara Y, Dinardo CL, Kashima S, Leston-Araujo I, Kenzey C, Fonseca GHH, Rodrigues ES, Volt F, Jarduli LR, Ruggeri A, Mariaselvam CM, Gualandro SFM, Elayoubi H, Cunha R, Cappelli B, Malmegrim KCR, Simões BP, Gluckman E, Tamouza R. A Toll-like receptor 2 genetic variant modulates occurrence of bacterial infections in patients with sickle cell disease. Br J Haematol 2019; 185:918-924. [PMID: 30908604 DOI: 10.1111/bjh.15875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/28/2019] [Indexed: 12/11/2022]
Abstract
Despite adequate immunization and penicillin prophylaxis, bacterial infections remain a leading cause of morbidity and mortality in patients with sickle cell disease (SCD). Besides hyposplenism, inflammatory and genetic factors might modulate their susceptibility to bacterial infections. We performed a candidate gene association of single nucleotide polymorphisms (SNPs) located in Toll-like receptor (TLR) genes, encoding prominent molecules for innate immune responses, with the occurrence of bacterial infections in patients with SCD. A cohort followed in centres in Brazil, France and Senegal (n = 430) was divided in two groups: patients who presented at least one episode of bacterial infection (n = 235) and patients who never had bacterial infections (n = 195). There were no differences in gender or age distribution among the groups. The frequency of the TLR2 rs4696480 TA genotype was significantly lower in the infected group (50% vs. 67%, odds ratio [OR] = 0·50, 95% confidence interval [CI] 0·34-0·75, P < 0·001), and the TT genotype was significantly higher in the infected group (15% vs. 5%, OR = 3·18, 95% CI 1·53-6·61, P < 0·001). Previous reports demonstrated higher secretion of inflammatory factors in cells from AA individuals, lower occurrence and severity of immune diseases in T carriers. The rs4696480 TA genotype might stand between deleterious effects of over inflammatory response (AA genotype) and inefficient responses (TT genotype) to infectious agents in SCD settings.
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Affiliation(s)
- Karina Tozatto-Maio
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Haematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Robert Girot
- Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Indou D Ly
- Pediatrics Unit, Cheikh Anta Diop University, Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Vanderson Rocha
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Haematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.,Department of Haematology, Churchill Hospital, University of Oxford, Oxford, UK
| | - Ana C Silva Pinto
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Yahia Benzerara
- Département de Bactériologie, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Carla L Dinardo
- Department of Haematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Simone Kashima
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Itauá Leston-Araujo
- INSERM 1160, Alloimmunity-Autoimmunity-Transplantation, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Chantal Kenzey
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Guilherme H H Fonseca
- Department of Haematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Evandra S Rodrigues
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Fernanda Volt
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Luciana R Jarduli
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Annalisa Ruggeri
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Cellular Therapy & Immunobiology Working Party of EBMT, Rome, Italy.,Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Sandra F M Gualandro
- Department of Haematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Hanadi Elayoubi
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Renato Cunha
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Barbara Cappelli
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Kelen C R Malmegrim
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Clinical Analysis, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Belinda P Simões
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Eliane Gluckman
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Ryad Tamouza
- INSERM U955, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
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25
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Adekile AD, Gupta R, Al-Khayat A, Mohammed A, Atyani S, Thomas D. Risk of avascular necrosis of the femoral head in children with sickle cell disease on hydroxyurea: MRI evaluation. Pediatr Blood Cancer 2019; 66:e27503. [PMID: 30345708 DOI: 10.1002/pbc.27503] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/03/2018] [Accepted: 09/21/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND There are conflicting reports on the role of hydroxyurea (HU) in the pathogenesis of avascular necrosis of the femoral head (AVNFH) in patients with sickle cell disease (SCD). PROCEDURE The present study is a prospective cohort study of Kuwaiti children with SCD who were treated with HU. They had magnetic resonance imaging of the hips before starting HU and at regular intervals during a follow-up period, ranging from 1 to 15 years. RESULTS There were 40 patients (18 SS, 19 Sβ0-thalassemia, and three SD genotypes), aged 6-20 years. Pre-HU, 11 (27.5%) had varying grades of AVNFH, while post HU, the prevalence was 32.5%. Two patients developed new lesions during the study, while five (45.5%) that had lesions pre-HU remained static, another five (45.5%) progressed, and one (9%) improved radiologically. The older patients who had been on HU the longest were more likely to deteriorate. The only hematological parameter that was consistently associated with AVNFH was the reticulocyte count. CONCLUSIONS The frequency and rate of progression of AVNFH in this study is much less than that previously reported for our patients not treated with HU. There is no evidence that HU therapy is a risk factor for AVNFH. It may, in fact, prevent new lesions and deter the progression of existing AVNFH.
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Affiliation(s)
- Adekunle D Adekile
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait.,Pediatric Hematology Unit, Mubarak Al-Kabeer Hospital, Safat, Kuwait
| | - Renu Gupta
- Department of Radiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.,Department of Radiology, Mubarak Al-Kabeer Hospital, Safat, Kuwait
| | - Abdullah Al-Khayat
- Department of Radiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Ahmed Mohammed
- Center for Medical Education, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Said Atyani
- Department of Radiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Diana Thomas
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait
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26
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ElAlfy MS, Ebeid FSE, Kamal TM, Eissa DS, Ismail EAR, Mohamed SH. Angiotensinogen M235T Gene Polymorphism is a Genetic Determinant of Cerebrovascular and Cardiopulmonary Morbidity in Adolescents with Sickle Cell Disease. J Stroke Cerebrovasc Dis 2019; 28:441-449. [PMID: 30409744 DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/09/2018] [Accepted: 10/13/2018] [Indexed: 01/19/2023] Open
Affiliation(s)
- Mohsen Saleh ElAlfy
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Tarek Mostafa Kamal
- Medical Genetics Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Deena Samir Eissa
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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27
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Chang AK, Ginter Summarell CC, Birdie PT, Sheehan VA. Genetic modifiers of severity in sickle cell disease. Clin Hemorheol Microcirc 2018; 68:147-164. [PMID: 29614629 DOI: 10.3233/ch-189004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sickle cell disease (SCD) is one of the most common single disease disorders world-wide. It is remarkable for its clinical heterogeneity, even among individuals with identical genotypes. Some individuals experience morbidity and mortality in early childhood, while others have a relatively mild course, and normal or near normal life expectancy. Many clinical complications are associated with SCD; most notably frequent pain episodes, stroke, acute chest syndrome, avascular necrosis, nephropathy, retinopathy and pulmonary hypertension. While the effects of higher fetal hemoglobin (HbF) levels, UGTA1A polymorphisms, alpha-thalassemia and G6PD deficiency on SCD has been extensively studied, these variables do not explain all of the clinical heterogeneity of SCD. It is not known why some patients develop certain complications, and it is difficult to predict which complications a particular patient will experience. Much work has been done to identify genetic variants associated with these disease complications; many associations remain unvalidated. As the field continues to move beyond small sample collections and candidate gene approaches into whole genome sequencing and merging of samples from all over the world, we will identify more genetic variants associated with development of specific SCD related complications, and hopefully leverage this knowledge into targeted therapies.
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Affiliation(s)
- Alicia K Chang
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Carly C Ginter Summarell
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Parendi T Birdie
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Vivien A Sheehan
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
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28
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Abstract
Sickle cell disease (SCD) is a group of inherited disorders caused by mutations in HBB, which encodes haemoglobin subunit β. The incidence is estimated to be between 300,000 and 400,000 neonates globally each year, the majority in sub-Saharan Africa. Haemoglobin molecules that include mutant sickle β-globin subunits can polymerize; erythrocytes that contain mostly haemoglobin polymers assume a sickled form and are prone to haemolysis. Other pathophysiological mechanisms that contribute to the SCD phenotype are vaso-occlusion and activation of the immune system. SCD is characterized by a remarkable phenotypic complexity. Common acute complications are acute pain events, acute chest syndrome and stroke; chronic complications (including chronic kidney disease) can damage all organs. Hydroxycarbamide, blood transfusions and haematopoietic stem cell transplantation can reduce the severity of the disease. Early diagnosis is crucial to improve survival, and universal newborn screening programmes have been implemented in some countries but are challenging in low-income, high-burden settings.
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29
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30
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Jain S, Bakshi N, Krishnamurti L. Acute Chest Syndrome in Children with Sickle Cell Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2017; 30:191-201. [PMID: 29279787 PMCID: PMC5733742 DOI: 10.1089/ped.2017.0814] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/11/2017] [Indexed: 02/02/2023]
Abstract
Acute chest syndrome (ACS) is a frequent cause of acute lung disease in children with sickle cell disease (SCD). Patients may present with ACS or may develop this complication during the course of a hospitalization for acute vaso-occlusive crises (VOC). ACS is associated with prolonged hospitalization, increased risk of respiratory failure, and the potential for developing chronic lung disease. ACS in SCD is defined as the presence of fever and/or new respiratory symptoms accompanied by the presence of a new pulmonary infiltrate on chest X-ray. The spectrum of clinical manifestations can range from mild respiratory illness to acute respiratory distress syndrome. The presence of severe hypoxemia is a useful predictor of severity and outcome. The etiology of ACS is often multifactorial. One of the proposed mechanisms involves increased adhesion of sickle red cells to pulmonary microvasculature in the presence of hypoxia. Other commonly associated etiologies include infection, pulmonary fat embolism, and infarction. Infection is a common cause in children, whereas adults usually present with pain crises. Several risk factors have been identified in children to be associated with increased incidence of ACS. These include younger age, severe SCD genotypes (SS or Sβ0 thalassemia), lower fetal hemoglobin concentrations, higher steady-state hemoglobin levels, higher steady-state white blood cell counts, history of asthma, and tobacco smoke exposure. Opiate overdose and resulting hypoventilation can also trigger ACS. Prompt diagnosis and management with intravenous fluids, analgesics, aggressive incentive spirometry, supplemental oxygen or respiratory support, antibiotics, and transfusion therapy, are key to the prevention of clinical deterioration. Bronchodilators should be considered if there is history of asthma or in the presence of acute bronchospasm. Treatment with hydroxyurea should be considered for prevention of recurrent episodes. This review evaluates the etiology, pathophysiology, risk factors, clinical presentation of ACS, and preventive and treatment strategies for effective management of ACS.
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Affiliation(s)
- Shilpa Jain
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Women and Children's Hospital of Buffalo, Hemophilia Center of Western New York, Buffalo, New York
| | - Nitya Bakshi
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lakshmanan Krishnamurti
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
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31
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Association between diffuse myocardial fibrosis and diastolic dysfunction in sickle cell anemia. Blood 2017; 130:205-213. [PMID: 28507082 DOI: 10.1182/blood-2017-02-767624] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/11/2017] [Indexed: 12/11/2022] Open
Abstract
Sickle cell anemia (SCA)-related cardiomyopathy is characterized by diastolic dysfunction and hyperdynamic features. Diastolic dysfunction portends early mortality in SCA. Diastolic dysfunction is associated with microscopic myocardial fibrosis in SCA mice, but the cause of diastolic dysfunction in humans with SCA is unknown. We used cardiac magnetic resonance measurements of extracellular volume fraction (ECV) to discover and quantify diffuse myocardial fibrosis in 25 individuals with SCA (mean age, 23 ± 13 years) and determine the association between diffuse myocardial fibrosis and diastolic dysfunction. ECV was calculated from pre- and post-gadolinium T1 measurements of blood and myocardium, and diastolic function was assessed by echocardiography. ECV was markedly increased in all participants compared with controls (0.44 ± 0.08 vs 0.26 ± 0.02, P < .0001), indicating the presence of diffuse myocardial fibrosis. Seventeen patients (71%) had diastolic abnormalities, and 7 patients (29%) met the definition of diastolic dysfunction. Participants with diastolic dysfunction had higher ECV (0.49 ± 0.07 vs 0.37 ± 0.04, P = .01) and N-terminal pro-brain natriuretic peptide (NT-proBNP; 191 ± 261 vs 33 ± 33 pg/mL, P = .04) but lower hemoglobin (8.4 ± 0.3 vs 10.9 ± 1.4 g/dL, P = .004) compared with participants with normal diastolic function. Participants with the highest ECV values (≥0.40) were more likely to have diastolic dysfunction (P = .003) and increased left atrial volume (57 ± 11 vs 46 ± 12 mL/m2, P = .04) compared with those with ECV <0.4. ECV correlated with hemoglobin (r = -0.46, P = .03) and NT-proBNP (r = 0.62, P = .001). In conclusion, diffuse myocardial fibrosis, determined by ECV, is a common and previously underappreciated feature of SCA that is associated with diastolic dysfunction, anemia, and high NT-proBNP. Diffuse myocardial fibrosis is a novel mechanism that appears to underlie diastolic dysfunction in SCA.
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da Silva DGH, Belini Junior E, de Souza Torres L, Okumura JV, Marcel Barberino W, Garcia de Oliveira R, Urbinatti Teixeira V, Lopes de Castro Lobo C, Alves de Almeida E, Bonini-Domingos CR. Impact of genetic polymorphisms in key enzymes of homocysteine metabolism on the pathophysiology of sickle cell anemia. Free Radic Biol Med 2017; 106:53-61. [PMID: 28188925 DOI: 10.1016/j.freeradbiomed.2017.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/20/2017] [Accepted: 02/07/2017] [Indexed: 01/08/2023]
Abstract
This work aimed at studying a possible influence of methylenetetrahydrofolate reductase (MTHFR; c. 677C>T) and cystathionine β-synthase (CBS; 844ins68) polymorphisms on overall oxidative status of sickle cell anemia (SCA) patients and on routine markers, correlating them with hydroxycarbamide (HC) treatment. We evaluated 95 unrelated and diagnosed SCA patients. All patients received a prophylactic treatment with folic acid of 5mg/day, while 41 (43.2%) of them were under hydroxycarbamide (HC) treatment (average dose: 22mg/kg/day). MTHFR and CBS polymorphisms were identified by Polymerase Chain Reaction. Biochemical parameters were measured using spectrophotometric and chromatographic methods. Routine markers were developed by specialized laboratory. We did not find any effect of 677T and "I" allele combination on the biomarkers evaluated. On the other hand, MTHFR 677T mutation was related to a depletion of antioxidant capacity, according to the decreased catalase activity and a reduction about 30% of glutathione levels. Moreover, the presence of the insertion was related to about 23% less biomolecule oxidation levels and lower monocytes count, but about 14% higher lactate dehydrogenase activity. These findings may contribute to highlight that the MTHFR and CBS polymorphisms involvement in SCA pathophysiology is likely to be far more complex than it was explored to date.
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Affiliation(s)
- Danilo Grünig Humberto da Silva
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Genetic Diseases Laboratory, Sao Paulo, Brazil; UNESP - Sao Paulo State University, Department of Chemistry and Environmental Sciences, Sao Paulo, Brazil.
| | - Edis Belini Junior
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Genetic Diseases Laboratory, Sao Paulo, Brazil
| | - Lidiane de Souza Torres
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Genetic Diseases Laboratory, Sao Paulo, Brazil
| | - Jessika Viviani Okumura
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Genetic Diseases Laboratory, Sao Paulo, Brazil
| | - Willian Marcel Barberino
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Genetic Diseases Laboratory, Sao Paulo, Brazil
| | - Renan Garcia de Oliveira
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Genetic Diseases Laboratory, Sao Paulo, Brazil
| | - Vanessa Urbinatti Teixeira
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Genetic Diseases Laboratory, Sao Paulo, Brazil
| | | | - Eduardo Alves de Almeida
- UNESP - Sao Paulo State University, Department of Chemistry and Environmental Sciences, Sao Paulo, Brazil; FURB - Fundação Universidade Regional de Blumenau, Department of Natural Sciences, Santa Catarina, Brazil
| | - Claudia Regina Bonini-Domingos
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Genetic Diseases Laboratory, Sao Paulo, Brazil
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33
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Association of circulating transcriptomic profiles with mortality in sickle cell disease. Blood 2017; 129:3009-3016. [PMID: 28373264 DOI: 10.1182/blood-2016-11-752279] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/27/2017] [Indexed: 12/27/2022] Open
Abstract
Sickle cell disease (SCD) complications are associated with increased morbidity and risk of mortality. We sought to identify a circulating transcriptomic profile predictive of these poor outcomes in SCD. Training and testing cohorts consisting of adult patients with SCD were recruited and prospectively followed. A pathway-based signature derived from grouping peripheral blood mononuclear cell transcriptomes distinguished 2 patient clusters with differences in survival in the training cohort. These findings were validated in a testing cohort in which the association between cluster 1 molecular profiling and mortality remained significant in a fully adjusted model. In a third cohort of West African children with SCD, cluster 1 differentiated SCD severity using a published scoring index. Finally, a risk score composed of assigning weights to cluster 1 profiling, along with established clinical risk factors using tricuspid regurgitation velocity, white blood cell count, history of acute chest syndrome, and hemoglobin levels, demonstrated a higher hazard ratio for mortality in both the training and testing cohorts compared with clinical risk factors or cluster 1 data alone. Circulating transcriptomic profiles are a powerful method to risk-stratify severity of disease and poor outcomes in both children and adults, respectively, with SCD and highlight potential associated molecular pathways.
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34
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da Silva DGH, Belini-Junior E, de Souza Torres L, Okumura JV, Barberino WM, de Oliveira RG, Teixeira VU, de Castro Lobo CL, de Almeida EA, Bonini-Domingos CR. Relationship between adenosine deaminase polymorphism (c.22G > A) and oxidative stress in sickle cell anemia. Meta Gene 2017. [DOI: 10.1016/j.mgene.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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35
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Thein SL. Genetic Basis and Genetic Modifiers of β-Thalassemia and Sickle Cell Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1013:27-57. [PMID: 29127676 DOI: 10.1007/978-1-4939-7299-9_2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
β-thalassemia and sickle cell disease (SCD) are prototypical Mendelian single gene disorders, both caused by mutations affecting the adult β-globin gene. Despite the apparent genetic simplicity, both disorders display a remarkable spectrum of phenotypic severity and share two major genetic modifiers-α-globin genotype and innate ability to produce fetal hemoglobin (HbF, α2γ2).This article provides an overview of the genetic basis for SCD and β-thalassemia, and genetic modifiers identified through phenotype correlation studies. Identification of the genetic variants modifying HbF production in combination with α-globin genotype provide some prediction of disease severity for β-thalassemia and SCD but generation of a personalized genetic risk score to inform prognosis and guide management requires a larger panel of genetic modifiers yet to be discovered.Nonetheless, genetic studies have been successful in characterizing some of the key variants and pathways involved in HbF regulation, providing new therapeutic targets for HbF reactivation.
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Affiliation(s)
- Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10, Room 6S241 MSC 1589, 10 Center Dr., Bethesda, MD, 20892-1589, USA.
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36
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Sickle cell anemia mice develop a unique cardiomyopathy with restrictive physiology. Proc Natl Acad Sci U S A 2016; 113:E5182-91. [PMID: 27503873 DOI: 10.1073/pnas.1600311113] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cardiopulmonary complications are the leading cause of mortality in sickle cell anemia (SCA). Elevated tricuspid regurgitant jet velocity, pulmonary hypertension, diastolic, and autonomic dysfunction have all been described, but a unifying pathophysiology and mechanism explaining the poor prognosis and propensity to sudden death has been elusive. Herein, SCA mice underwent a longitudinal comprehensive cardiac analysis, combining state-of-the-art cardiac imaging with electrocardiography, histopathology, and molecular analysis to determine the basis of cardiac dysfunction. We show that in SCA mice, anemia-induced hyperdynamic physiology was gradually superimposed with restrictive physiology, characterized by progressive left atrial enlargement and diastolic dysfunction with preserved systolic function. This phenomenon was absent in WT mice with experimentally induced chronic anemia of similar degree and duration. Restrictive physiology was associated with microscopic cardiomyocyte loss and secondary fibrosis detectable as increased extracellular volume by cardiac-MRI. Ultrastructural mitochondrial changes were consistent with severe chronic hypoxia/ischemia and sarcomere diastolic-length was shortened. Transcriptome analysis revealed up-regulation of genes involving angiogenesis, extracellular-matrix, circadian-rhythm, oxidative stress, and hypoxia, whereas ion-channel transport and cardiac conduction were down-regulated. Indeed, progressive corrected QT prolongation, arrhythmias, and ischemic changes were noted in SCA mice before sudden death. Sudden cardiac death is common in humans with restrictive cardiomyopathies and long QT syndromes. Our findings may thus provide a unifying cardiac pathophysiology that explains the reported cardiac abnormalities and sudden death seen in humans with SCA.
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Benites BD, Bastos SO, Baldanzi G, dos Santos ADO, Ramos CD, Costa FF, Gilli SCO, Saad STO. Sickle cell/β-thalassemia: Comparison of Sβ0and Sβ+Brazilian patients followed at a single institution. Hematology 2016; 21:623-629. [DOI: 10.1080/10245332.2016.1187843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | - Gabriel Baldanzi
- Hematology and Hemotherapy Center, University of Campinas, Brazil
| | | | - Celso Dario Ramos
- Division of Nuclear Medicine, Department of Radiology, University of Campinas, Brazil
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Goodman SR, Pace BS, Hansen KC, D'alessandro A, Xia Y, Daescu O, Glatt SJ. Minireview: Multiomic candidate biomarkers for clinical manifestations of sickle cell severity: Early steps to precision medicine. Exp Biol Med (Maywood) 2016; 241:772-81. [PMID: 27022133 DOI: 10.1177/1535370216640150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In this review, we provide a description of those candidate biomarkers which have been demonstrated by multiple-omics approaches to vary in correlation with specific clinical manifestations of sickle cell severity. We believe that future clinical analyses of severity phenotype will require a multiomic analysis, or an omics stack approach, which includes integrated interactomics. It will also require the analysis of big data sets. These candidate biomarkers, whether they are individual or panels of functionally linked markers, will require future validation in large prospective and retrospective clinical studies. Once validated, the hope is that informative biomarkers will be used for the identification of individuals most likely to experience severe complications, and thereby be applied for the design of patient-specific therapeutic approaches and response to treatment. This would be the beginning of precision medicine for sickle cell disease.
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Affiliation(s)
- Steven R Goodman
- Department of Pediatrics and Department of Physiology, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Betty S Pace
- Department of Pediatrics, Augusta University, Augusta, GA 30912, USA
| | - Kirk C Hansen
- Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, CO 80202, USA
| | - Angelo D'alessandro
- Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, CO 80202, USA
| | - Yang Xia
- Biochemistry and Molecular Biology Department, University of Texas at Houston, TX 77030, USA
| | - Ovidiu Daescu
- University of Texas at Dallas, Richardson, TX 75080, USA
| | - Stephen J Glatt
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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Olenscki Gilli SC, Pericole FV, Benites BD, Sippert EÂ, Castilho LM, Addas-Carvalho M, Olalla Saad ST. Cytokine polymorphisms in sickle cell disease and the relationship with cytokine expression. Exp Hematol 2016; 44:583-9. [PMID: 27026283 DOI: 10.1016/j.exphem.2016.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/02/2016] [Accepted: 03/20/2016] [Indexed: 01/21/2023]
Abstract
Sickle cell disease is a chronic inflammatory condition characterized by elevated levels of inflammatory cytokines, which may be regulated by genetic polymorphisms and could be associated with diverse disease presentations and alloimmunization. The aim of this study was to evaluate Treg and Th17 cell frequencies, cytokine gene polymorphisms, and their association with cytokine expression profile in patients with sickle cell disease. For that purpose, we evaluated the IL intron 3 variable number tandem repeat (VNTR, genotypes 1.1, 1.2, 2.2, and 2.3), IL4-T590C>T, IL6-174G>C, TNFα-308G>A, IL10-819T>C, IL10-592A>C, and IL10-1082A>G polymorphisms and their correlation with TGFβ, IL4, IL6, and IL10 gene expression in sickle cell patients. We observed a significant decrease in Treg frequency together with a substantial increase in Th17 response in patients with sickle cell disease compared with healthy controls (p < 0.001 and p = 0.014, respectively). There was also a higher prevalence of the IL4-590T/T genotype in patients with sickle cell disease than in Afro-Brazilian descendent controls (p < 0.001) and higher expression of IL4 in patients with the 1.1 genotype of IL4 intron 3 VNTR (p = 0.06). Significantly greater gene expression of TGFβ, IL6, and IL10 was observed in sickle cell patients when compared with controls (p = 0.01, 0.03, and <0.001, respectively). Moreover, higher levels of interleukin-6 and -10 were observed in the group of alloimmunized patients. These new data bring insights into the deregulation in the immune system affecting sickle cell patients and must be further investigated in larger cohorts to better characterize individual variations in immune responses and new markers for disease morbidity.
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Affiliation(s)
- Simone Cristina Olenscki Gilli
- Hematology and Hemotherapy Center, University of Campinas, HEMOCENTRO- UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas, São Paulo, Brazil
| | - Fernando Vieira Pericole
- Hematology and Hemotherapy Center, University of Campinas, HEMOCENTRO- UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas, São Paulo, Brazil
| | - Bruno Deltreggia Benites
- Hematology and Hemotherapy Center, University of Campinas, HEMOCENTRO- UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas, São Paulo, Brazil.
| | - Emilia Ângela Sippert
- Hematology and Hemotherapy Center, University of Campinas, HEMOCENTRO- UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas, São Paulo, Brazil
| | - Lilian Maria Castilho
- Hematology and Hemotherapy Center, University of Campinas, HEMOCENTRO- UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas, São Paulo, Brazil
| | - Marcelo Addas-Carvalho
- Hematology and Hemotherapy Center, University of Campinas, HEMOCENTRO- UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas, São Paulo, Brazil
| | - Sara Teresinha Olalla Saad
- Hematology and Hemotherapy Center, University of Campinas, HEMOCENTRO- UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas, São Paulo, Brazil
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Niss O, Quinn CT, Lane A, Daily J, Khoury PR, Bakeer N, Kimball TR, Towbin JA, Malik P, Taylor MD. Cardiomyopathy With Restrictive Physiology in Sickle Cell Disease. JACC Cardiovasc Imaging 2016; 9:243-52. [PMID: 26897687 DOI: 10.1016/j.jcmg.2015.05.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/21/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study was to identify a unifying cardiac pathophysiology that explains the cardiac pathological features in sickle cell disease (SCD). BACKGROUND Cardiopulmonary complications, the leading cause of adult death in SCD, are associated with heart chamber dilation, diastolic dysfunction, elevated tricuspid regurgitant jet velocity (TRV), and pulmonary hypertension. However, no unifying cardiac pathophysiology has been identified to explain these findings. METHODS In a 2-part study, we first examined patients with SCD who underwent screening echocardiography during steady state at our institution. We then conducted a meta-analysis of cardiac studies in SCD. RESULTS In the 134 patients with SCD studied (median age 11 years), significant enlargement of the left atrial volume was present (z-score 3.1, p = 0.002), shortening fraction was normal (37.6 ± 4.7%), and lateral and septal ratios of mitral velocity to early diastolic velocity of the mitral annulus (E/e') were severely abnormal in 8% and 14% of patients, respectively, indicating impaired diastolic function. Both TRV and lateral E/e' correlated with enlarged left atrial volume in SCD (p = 0.003 and p = 0.006, respectively). Meta-analysis of 68 studies confirmed significant left atrial diameter enlargement in patients with SCD compared with controls, evidence of diastolic dysfunction and enlarged left ventricular end-diastolic dimension with normal shortening fraction. The majority of patients with catheter-confirmed pulmonary hypertension had mild pulmonary venous hypertension consistent with restrictive cardiac physiology. CONCLUSIONS Patients with SCD have a unique form of cardiomyopathy with restrictive physiology that is superimposed on hyperdynamic physiology and is characterized by diastolic dysfunction, left atrial dilation, and normal systolic function. This combination results in mild, secondary, pulmonary venous hypertension and elevated TRV. Sudden death is common in other forms of restrictive cardiomyopathy. Our finding of this unique restrictive cardiomyopathy may explain the increased mortality rates and sudden death seen in patients with SCD with mildly elevated TRV.
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MESH Headings
- Adolescent
- Anemia, Sickle Cell/complications
- Anemia, Sickle Cell/diagnosis
- Anemia, Sickle Cell/mortality
- Arterial Pressure
- Atrial Function, Left
- Cardiomyopathies/diagnostic imaging
- Cardiomyopathies/etiology
- Cardiomyopathies/mortality
- Cardiomyopathies/physiopathology
- Child
- Echocardiography, Doppler
- Female
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Predictive Value of Tests
- Prognosis
- Pulmonary Veins/physiopathology
- Retrospective Studies
- Risk Factors
- Tricuspid Valve/physiopathology
- Venous Pressure
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Right
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Affiliation(s)
- Omar Niss
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Charles T Quinn
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adam Lane
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joshua Daily
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Philip R Khoury
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nihal Bakeer
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Thomas R Kimball
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey A Towbin
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Punam Malik
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael D Taylor
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Shimauti EL, Silva DGH, de Souza EM, de Almeida EA, Leal FP, Bonini-Domingos CR. Prevalence of β(S)-globin gene haplotypes, α-thalassemia (3.7 kb deletion) and redox status in patients with sickle cell anemia in the state of Paraná, Brazil. Genet Mol Biol 2015; 38:316-23. [PMID: 26500435 PMCID: PMC4612597 DOI: 10.1590/s1415-475738320140231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 02/24/2015] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to determine the frequency of beta S-globin gene (βS globin) haplotypes and alpha thalassemia with 3.7 kb deletion (−α3.7kb thalassemia) in the northwest region of Paraná state, and to investigate the oxidative and clinical-hematological profile of βS globin carriers in this population. Of the 77 samples analyzed, 17 were Hb SS, 30 were Hb AS and 30 were Hb AA. The βSglobin haplotypes and −α3.7kb thalassemia were identified using polymerase chain reaction.Trolox equivalent antioxidant capacity (TEAC) and lipid peroxidation (LPO) were assessed spectophotometrically. Serum melatonin levels were determined using high-performance liquid chromatography coupled to coulometric electrochemical detection. The haplotype frequencies in the SS individuals were as follows: Bantu- 21 (62%), Benin - 11 (32%) and Atypical- 2 (6%). Bantu/Benin was the most frequent genotype. Of the 47 SS and AS individuals assessed, 17% (n = 8) had the −α3.7kb mutation. Clinical manifestations, as well as serum melatonin, TEAC and LPO levels did not differ between Bantu/Bantu and Bantu/Benin individuals (p > 0.05). Both genotypes were associated with high LPO and TEAC levels and decreased melatonin concentration. These data suggest that the level of oxidative stress in patients with Bantu/Bantu and Bantu/Benin genotypes may overload the antioxidant capacity.
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Affiliation(s)
- Eliana LitsukoTomimatsu Shimauti
- Laboratório de Hemoglobinas e Genética das Doenças Hematológicas, Departamento de Biologia, Universidade Estadual Paulista "Júlio de Mesquita Filho", São José do Rio Preto, SP, Brazil. ; Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, PR, Brazil
| | - Danilo Grunig Humberto Silva
- Departamento de Química e Ciências Ambientais, Universidade Estadual Paulista "Júlio de Mesquita Filho", São José do Rio Preto, SP, Brazil
| | | | - Eduardo Alves de Almeida
- Departamento de Química e Ciências Ambientais, Universidade Estadual Paulista "Júlio de Mesquita Filho", São José do Rio Preto, SP, Brazil
| | | | - Claudia Regina Bonini-Domingos
- Laboratório de Hemoglobinas e Genética das Doenças Hematológicas, Departamento de Biologia, Universidade Estadual Paulista "Júlio de Mesquita Filho", São José do Rio Preto, SP, Brazil
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Lustosa Souza CR, Azevedo Shimmoto MM, Vicari P, Mecabo G, Arruda MM, Figueiredo MS. Klotho gene polymorphisms and their association with sickle cell disease phenotypes. Rev Bras Hematol Hemoter 2015; 37:275-6. [PMID: 26190435 PMCID: PMC4519699 DOI: 10.1016/j.bjhh.2015.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/04/2015] [Accepted: 02/04/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | - Perla Vicari
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Grazielle Mecabo
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Belini Junior E, Silva DGH, Torres LDS, Okumura JV, Lobo CLDC, Bonini-Domingos CR. Severity of Brazilian sickle cell disease patients: severity scores and feasibility of the Bayesian network model use. Blood Cells Mol Dis 2015; 54:321-7. [PMID: 25842370 DOI: 10.1016/j.bcmd.2015.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 10/23/2022]
Abstract
The integration of the several clinical and laboratory dimensions and the influence of each parameter on the sickle cell disease (SCD)-related mortality is useful for predicting the phenotype of an individual. This study evaluated the feasibility of the SCD severity calculator use to measure disease severity in Brazilian patients. The study group was composed of 500 SCD patients (440 HbSS and 60 HbSC) diagnosed by molecular biology. We observed a decrease in severity scores in 72 SCD patients assessed before and after the hydroxyurea (HU) use. Furthermore, the HU influenced the increase of mean corpuscular volume (MCV) and HbF concentration, and the decrease of leukocytes and total bilirubin. We found 180 (36.0%) patients with intermediate phenotype, 170 (34.0%) mild phenotype and 150 (30.0%) with severe phenotype. Patients with ages >40 years had higher mean score (0.778±0.177) than patients between 18 and 40 years (0.562±0.152) and patients between 5 and 17 years (0.322±0.145). We observe that there is a tendency of individuals with leg ulcers, avascular necrosis and cardiac complications with increasing age. Correlation analysis showed relations between severity scores with leukocytes, reticulocytes, bilirubin, lactate dehydrogenase, HbS, hemoglobin and hematocrit (p<0.05). Several comparisons involving age groups, SCD genotype and phenotypic classification had satisfactory results and this classification will be used for future studies involving genetic polymorphisms, response to treatment with HU and oxidative stress markers in SCD.
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Affiliation(s)
- Edis Belini Junior
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Diseases Genetic Laboratory, Sao Paulo, Brazil.
| | - Danilo Grünig Humberto Silva
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Diseases Genetic Laboratory, Sao Paulo, Brazil
| | - Lidiane de Souza Torres
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Diseases Genetic Laboratory, Sao Paulo, Brazil
| | - Jéssika Viviani Okumura
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Diseases Genetic Laboratory, Sao Paulo, Brazil
| | | | - Claudia Regina Bonini-Domingos
- UNESP - Sao Paulo State University, Department of Biology, Hemoglobin and Hematologic Diseases Genetic Laboratory, Sao Paulo, Brazil
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Abstract
Supplemental Digital Content is Available in the Text. Some sickle cell anemia (SCA) patients suffer significantly worse phenotypes than others. Causes of such disparities are incompletely understood. Comorbid chronic inflammation likely is a factor. Recently, mast cell (MC) activation (creating an inflammatory state) was found to be a significant factor in sickle pathobiology and pain in a murine SCA model. Also, a new realm of relatively noncytoproliferative MC disease termed MC activation syndrome (MCAS) has been identified recently. MCAS has not previously been described in SCA. Some SCA patients experience pain patterns and other morbidities more congruent with MCAS than traditional SCA pathobiology (eg, vasoocclusion). Presented here are 32 poor-phenotype SCA patients who met MCAS diagnostic criteria; all improved with MCAS-targeted therapy. As hydroxyurea benefits some MCAS patients (particularly SCA-like pain), its benefit in SCA may be partly attributable to treatment of unrecognized MCAS. Further study will better characterize MCAS in SCA and identify optimal therapy.
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Comment on "Molecular analysis and association with clinical and laboratory manifestations in children with sickle cell anemia". Rev Bras Hematol Hemoter 2014; 36:315-8. [PMID: 25305161 PMCID: PMC4318385 DOI: 10.1016/j.bjhh.2014.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 12/30/2022] Open
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Abstract
Life expectancy in sickle cell disease (SCD) has increased substantially and thus women with SCD are almost universally reaching child-bearing age. Studies on potential complications during pregnancy have generated mixed data; however, it is generally accepted that women with SCD are at higher risk for adverse pregnancy outcomes and maternal mortality. It is therefore critical that their care be provided by a team that includes a hematologist and a maternal-fetal medicine specialist. Despite the published risks, women with SCD are capable of successful pregnancy outcomes with proper education and well-coordinated multidisciplinary care. Further investigation is needed to standardize management.
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Affiliation(s)
- Biree Andemariam
- Division of Hematology-Oncology, Lea Center for Hematologic Disorders, Adult Sickle Cell Clinical and Research Center, University of Connecticut Health Center, Farmington, CT 06030, USA.
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Stoll M, Rühle F, Nowak-Göttl U. Advances in understanding stroke risk in children--a geneticist's view. Br J Haematol 2013; 164:636-45. [PMID: 24354735 DOI: 10.1111/bjh.12706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/13/2013] [Indexed: 12/28/2022]
Abstract
The advent of the genomic era has provided novel insights into the genetic architecture of common complex diseases, such as thrombophilia and stroke. Since 2006, a growing number of genome wide association studies (GWAS) for common complex diseases have revealed new candidate loci and genomic regions that play an important role in disease aetiology and progression. While GWAS on the above mentioned traits are abundant in adults, similar studies in paediatric study cohorts are lagging behind. However, genetic research in this important clinical area has gained momentum and starts to provide us with exciting insights into the genetic underpinnings of stroke with paediatric onset. Here we review recent advances in genetic association studies underlying stroke in children and aim to translate the results to clinical utility. These studies comprise candidate gene approaches and GWAS, and represent the current status on what we have learnt about the genetic architecture underlying paediatric stroke, and how this may affect medical practice in the years to come.
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Affiliation(s)
- Monika Stoll
- Genetic Epidemiology, University of Muenster, Muenster, Germany
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Silva DGH, Belini Junior E, Carrocini GCDS, Torres LDS, Ricci Júnior O, Lobo CLDC, Bonini-Domingos CR, de Almeida EA. Genetic and biochemical markers of hydroxyurea therapeutic response in sickle cell anemia. BMC MEDICAL GENETICS 2013; 14:108. [PMID: 24106994 PMCID: PMC3851873 DOI: 10.1186/1471-2350-14-108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 10/02/2013] [Indexed: 12/22/2022]
Abstract
Background Sickle cell anemia (SCA) presents a complex pathophysiology which can be affected by a number of modifying factors, including genetic and biochemical ones. In Brazil, there have been no studies verifying βS-haplotypes effect on oxidative stress parameters. This study evaluated βS-haplotypes and Hb F levels effects on oxidative stress markers and their relationship with hydroxyurea (HU) treatment in SCA patients. Methods The studied group was composed by 28 SCA patients. Thirteen of these patients were treated with HU and 15 of them were not. We used molecular methodology (PCR-RFLP) for hemoglobin S genotype confirmation and haplotypes identification. Biochemical parameters were measured using spectrophotometric methods (Thiobarbituric-acid-reactive substances and Trolox equivalent antioxidant capacity levels, catalase and GST activities) and plasma glutathione levels by High-performance liquid chromatography coupled to electrochemical detection. Results We found the highest frequency of Bantu haplotype (48.2%) which was followed by Benin (32.1%). We observed also the presence of Cameroon haplotype, rare in Brazilian population and 19.7% of atypical haplotypes. The protective Hb F effect was confirmed in SCA patients because these patients showed an increase in Hb F levels that resulted in a 41.3% decrease on the lipid peroxidation levels (r =−0.74, p=0.01). Other biochemical parameters have not shown differential expression according to patient’s haplotypes. Bantu haplotype presence was related to the highest lipid peroxidation levels in patients (p < 0,01), but it also conferred a differential response to HU treatment, raising Hb F levels in 52.6% (p = 0.03) when compared with the group with the same molecular profile without HU usage. Conclusions SCA patients with Bantu haplotype showed the worst oxidative status. However these patients also demonstrated a better response to the treatment with HU. Such treatment seems to have presented a “haplotype-dependent” pharmacological effect.
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Paul R, Minniti CP, Nouraie M, Luchtman-Jones L, Campbell A, Rana S, Onyekwere O, Darbari DS, Ajayi O, Arteta M, Ensing G, Sable C, Dham N, Kato GJ, Gladwin MT, Castro OL, Gordeuk VR. Clinical correlates of acute pulmonary events in children and adolescents with sickle cell disease. Eur J Haematol 2013; 91:62-8. [PMID: 23560516 DOI: 10.1111/ejh.12118] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We aimed to identify risk factors for acute pulmonary events in children and adolescents in the Pulmonary Hypertension and the Hypoxic Response in SCD (PUSH) study. METHODS Patients with hemoglobin SS (n = 376) and other sickle cell genotypes (n = 127) aged 3-20 yrs were studied at four centers in a cross-sectional manner. A subgroup (n = 293) was followed for a median of 21 months (range 9-35). RESULTS A patient-reported history of one or more acute pulmonary events, either acute chest syndrome (ACS) or pneumonia, was obtained in 195 hemoglobin SS patients (52%) and 51 patients with other genotypes (40%). By logistic regression, history of acute pulmonary events was independently associated with patient-reported history of asthma (P < 0.0001), older age (P = 0.001), >3 severe pain episodes in the preceding 12 months (P = 0.002), higher tricuspid regurgitation velocity (TRV) (P = 0.028), and higher white blood cell (WBC) count (P = 0.043) among hemoglobin SS patients. History of acute pulmonary events was associated with >3 severe pain episodes (P = 0.009) among patients with other genotypes. During follow-up, 43 patients (15%) had at least one new ACS episode including 11 without a baseline history of acute pulmonary events. History of acute pulmonary events (odds ratio 5.0; P < 0.0001) and younger age (odds ratio 0.9; P = 0.007) were independently associated with developing a new episode during follow-up. CONCLUSIONS Asthma history, frequent pain, and higher values for TRV and WBC count were independently associated with history of acute pulmonary events in hemoglobin SS patients and frequent pain was associated in those with other genotypes. Measures to reduce pain episodes and control asthma may help to decrease the incidence of acute pulmonary events in SCD.
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50
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Thein SL. Genetic association studies in β-hemoglobinopathies. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2013; 2013:354-361. [PMID: 24319204 DOI: 10.1182/asheducation-2013.1.354] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Characterization of the molecular basis of the β-thalassemias and sickle cell disease (SCD) clearly showed that individuals with the same β-globin genotypes can have extremely diverse clinical severity. Two key modifiers, an innate ability to produce fetal hemoglobin and coinheritance of α-thalassemia, both derived from family and population studies, affect the pathophysiology of both disorders at the primary level. In the past 2 decades, scientific research had applied genetic approaches to identify additional genetic modifiers. The review summarizes recent genetic studies and key genetic modifiers identified and traces the story of fetal hemoglobin genetics, which has led to an emerging network of globin gene regulation. The discoveries have provided insights on new targets for therapeutic intervention and raise possibilities of developing fetal hemoglobin predictive diagnostics for predicting disease severity in the newborn and for integration into prenatal diagnosis to better inform genetic counseling.
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Affiliation(s)
- Swee Lay Thein
- 1Department of Haematological Medicine, King's College Hospital National Health Service Foundation Trust, King's College London School of Medicine, London, United Kingdom
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