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Jankovsky N, Caulier A, Demagny J, Guitton C, Djordjevic S, Lebon D, Ouled‐Haddou H, Picard V, Garçon L. Recent advances in the pathophysiology of PIEZO1-related hereditary xerocytosis. Am J Hematol 2021; 96:1017-1026. [PMID: 33848364 DOI: 10.1002/ajh.26192] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023]
Abstract
Hereditary xerocytosis is a rare red blood cell disease related to gain-of-function mutations in the FAM38A gene, encoding PIEZO1, in 90% of cases; PIEZO1 is a broadly expressed mechano-transducer that plays a major role in many cell systems and tissues that respond to mechanical stress. In erythrocytes, PIEZO1 adapts the intracellular ionic content and cell hydration status to the mechanical constraints induced by the environment. Until recently, the pathophysiology of hereditary xerocytosis was mainly believed to be based on the "PIEZO1-Gardos channel axis" in erythrocytes, according to which PIEZO1-activating mutations induce a calcium influx that secondarily activates the Gardos channel, leading to potassium and water efflux and subsequently to red blood cell dehydration. However, recent studies have demonstrated additional roles for PIEZO1 during early erythropoiesis and reticulocyte maturation, as well as roles in other tissues and cells such as lymphatic vessels, hepatocytes, macrophages and platelets that may affect the pathophysiology of the disease. These findings, presented and discussed in this review, broaden our understanding of hereditary xerocytosis beyond that of primarily being a red blood cell disease and identify potential therapeutic targets.
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Affiliation(s)
- Nicolas Jankovsky
- UR4666 HEMATIM Université Picardie Jules Verne Amiens France
- Service d'Hématologie Clinique, CHU Amiens‐Picardie Amiens France
| | - Alexis Caulier
- UR4666 HEMATIM Université Picardie Jules Verne Amiens France
- Service d'Hématologie Clinique, CHU Amiens‐Picardie Amiens France
| | - Julien Demagny
- UR4666 HEMATIM Université Picardie Jules Verne Amiens France
- Service d'Hématologie Biologique, CHU Amiens‐Picardie Amiens France
| | - Corinne Guitton
- Service de Pédiatrie Générale, CHU Bicêtre Le Kremlin‐Bicêtre France
- Centre de référence des maladies constitutionnelles du globule rouge et de l'érythropoïèse (Filière MCGRE) Créteil France
| | | | - Delphine Lebon
- UR4666 HEMATIM Université Picardie Jules Verne Amiens France
- Service d'Hématologie Clinique, CHU Amiens‐Picardie Amiens France
| | | | - Véronique Picard
- Centre de référence des maladies constitutionnelles du globule rouge et de l'érythropoïèse (Filière MCGRE) Créteil France
- Service d'Hématologie Biologique, CHU Bicêtre Le Kremlin‐Bicêtre France
- Faculté de Pharmacie Université Paris Saclay Châtenay‐Malabry France
| | - Loïc Garçon
- UR4666 HEMATIM Université Picardie Jules Verne Amiens France
- Service d'Hématologie Biologique, CHU Amiens‐Picardie Amiens France
- Centre de référence des maladies constitutionnelles du globule rouge et de l'érythropoïèse (Filière MCGRE) Créteil France
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Zaninoni A, Fermo E, Vercellati C, Marcello AP, Barcellini W, Bianchi P. Congenital Hemolytic Anemias: Is There a Role for the Immune System? Front Immunol 2020; 11:1309. [PMID: 32655575 PMCID: PMC7324678 DOI: 10.3389/fimmu.2020.01309] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/22/2020] [Indexed: 01/19/2023] Open
Abstract
Congenital hemolytic anemias (CHAs) are a heterogeneous group of rare hereditary conditions including defects of erythrocyte membrane proteins, red cell enzymes, and disorders due to defective erythropoiesis. They are characterized by variable degree of anemia, chronic extravascular hemolysis, reduced erythrocyte life span, splenomegaly, jaundice, biliary lithiasis, and iron overload. Although few data are reported on the role of the immune system in CHAs, several immune-mediated mechanisms may be involved in the pathogenesis of these rare diseases. We reported in ~60% of patients with hereditary spherocytosis (HS), the presence of naturally-occurring autoantibodies (NAbs) directed against different membrane proteins (α- and β-spectrin, band 3, and dematin). Positive HS subjects showed a more hemolytic pattern and NAbs were more evident in aged erythrocytes. The latter is in line with the function of NAbs in the opsonization of damaged/senescent erythrocytes and their consequent removal in the spleen. Splenectomy, usually performed to reduce erythrocyte catheresis and improve Hb levels, has different efficacy in various CHAs. Median Hb increase is 3 g/dL in HS, 1.6–1.8 g/dL in pyruvate kinase deficiency (PKD), and 1 g/dL in congenital dyserythropoietic anemias (CDA) type II. Consistently with clinical severity, splenectomy is performed in 20% of HS, 45% of CDAII, and in 60% of PKD patients. Importantly, sepsis and thrombotic events have been registered, particularly in PKD with a frequency of ~7% for both. Furthermore, we analyzed the role of pro-inflammatory cytokines and found that interleukin 10 and interferon γ, and to a lesser extent interleukin 6, were increased in all CHAs compared with controls. Moreover, CDAII and enzymatic defects showed increased tumor necrosis factor-α and reduced interleukin 17. Finally, we reported that iron overload occurred in 31% of patients with membrane defects, in ~60% of CDAII cases, and in up to 82% of PKD patients (defined by MRI liver iron concentration >4 mg Fe/gdw). Hepcidin was slightly increased in CHAs compared with controls and positively correlated with ferritin and with the inflammatory cytokines interleukin 6 and interferon γ. Overall the results suggest the existence of a vicious circle between chronic hemolysis, inflammatory response, bone marrow dyserythropoiesis, and iron overload.
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Affiliation(s)
- Anna Zaninoni
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Fermo
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Vercellati
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Paola Marcello
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Wilma Barcellini
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Bianchi
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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3
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Heterogeneous phenotype of Hereditary Xerocytosis in association with PIEZO1 variants. Blood Cells Mol Dis 2020; 82:102413. [DOI: 10.1016/j.bcmd.2020.102413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 02/02/2023]
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4
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Frederiksen H. Dehydrated hereditary stomatocytosis: clinical perspectives. J Blood Med 2019; 10:183-191. [PMID: 31308777 PMCID: PMC6613601 DOI: 10.2147/jbm.s179764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/14/2019] [Indexed: 12/30/2022] Open
Abstract
Dehydrated hereditary stomatocytosis (DHSt) is a nonimmune congenital hemolytic disorder characterized by red blood cell (RBC) dehydration and lysis. It has been a recognized diagnostic entity for almost 50 years, and autosomal dominant inheritance has long been suspected, but it was not until 2011 that the first genetic alterations were identified. The current study reviews 73 articles published during 1971–2019 and focuses on clinical perspectives of the disease. All but one of the published clinical data in DHSt were either single case reports or case series. From these, it can be seen that patients with DHSt often have fully or partially compensated hemolysis with few symptoms. Despite this, iron overload is an almost universal finding even in patients without or with only sporadic blood transfusions, and this may lead to organ dysfunction. Other severe complications, such as thrombosis and perinatal fluid effusions unrelated to fetal hemoglobin concentration, may also occur. No specific treatment for symptomatic hemolysis exists, and splenectomy should be avoided as it seems to aggravate the risk of thrombosis. Recently, treatment with senicapoc has shown activity against RBC dehydration in vitro; however, it is not known if this translates into relevant clinical effects. In conclusion, despite recent advances in the understanding of pathophysiology in DHSt, options for clinical management have not improved. Entering data into international registries has the potential to fill gaps in knowledge and eventually care of these rare patients.
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Risinger M, Emberesh M, Kalfa TA. Rare Hereditary Hemolytic Anemias: Diagnostic Approach and Considerations in Management. Hematol Oncol Clin North Am 2019; 33:373-392. [PMID: 31030808 DOI: 10.1016/j.hoc.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hereditary hemolytic anemias (HHAs) comprise a heterogeneous group of anemias caused by mutations in genes coding the globins, red blood cell (RBC) membrane proteins, and RBC enzymes. Congenital dyserythropoietic anemias (CDAs) are rare disorders of erythropoiesis characterized by binucleated and multinucleated erythroblasts in bone marrow. CDAs typically present with a hemolytic phenotype, as the produced RBCs have structural defects and decreased survival and should be considered in the differential of HHAs. This article discusses the clinical presentation, laboratory findings, and management considerations for rare HHAs arising from unstable hemoglobins, RBC hydration defects, the less common RBC enzymopathies, and CDAs.
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Affiliation(s)
- Mary Risinger
- College of Nursing, University of Cincinnati, 3110 Vine Street, Cincinnati, OH 45221-0038, USA
| | - Myesa Emberesh
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7018, Cincinnati, OH 45229-3039, USA
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH 45229-3039, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Increased Red Cell KCNN4 Activity in Sporadic Hereditary Xerocytosis Associated With Enhanced Single Channel Pressure Sensitivity of PIEZO1 Mutant V598M. Hemasphere 2018; 2:e55. [PMID: 30887001 PMCID: PMC6407803 DOI: 10.1097/hs9.0000000000000055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text
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Andolfo I, Russo R, Gambale A, Iolascon A. Hereditary stomatocytosis: An underdiagnosed condition. Am J Hematol 2018; 93:107-121. [PMID: 28971506 DOI: 10.1002/ajh.24929] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
Abstract
Hereditary stomatocytoses are a wide class of hemolytic anemias characterized by alterations of ionic flux with increased cation permeability that results in inappropriate shrinkage or swelling of the erythrocytes, and water lost or gained osmotically. The last few years have been crucial for new acquisitions in this field in terms of identifying new causative genes and of studying their pathogenetic mechanisms. This review summarizes the main features of erythrocyte membrane transport diseases, dividing them into forms with either isolated erythroid phenotype (nonsyndromic) or extra-hematological manifestations (syndromic), and focusing particularly on the most recent advances regarding dehydrated forms of hereditary stomatocytosis and familial pseudohyperkalemia.
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Affiliation(s)
- Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II; Napoli Italy
- CEINGE Biotecnologie Avanzate; Napoli Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II; Napoli Italy
- CEINGE Biotecnologie Avanzate; Napoli Italy
| | - Antonella Gambale
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II; Napoli Italy
- CEINGE Biotecnologie Avanzate; Napoli Italy
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II; Napoli Italy
- CEINGE Biotecnologie Avanzate; Napoli Italy
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8
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Abstract
Mutations in the genes encoding the mechanosensitive cation channels PIEZO1 and PIEZO2 are responsible for multiple hereditary human diseases. Loss-of-function mutations in the human PIEZO1 gene cause autosomal recessive congenital lymphatic dysplasia. Gain-of-function mutations in the human PIEZO1 gene cause the autosomal dominant hemolytic anemia, hereditary xerocytosis (also known as dehydrated stomatocytosis). Loss-of-function mutations in the human PIEZO2 gene cause an autosomal recessive syndrome of muscular atrophy with perinatal respiratory distress, arthrogryposis, and scoliosis. Gain-of-function mutations in the human PIEZO2 gene cause three clinical types of autosomal dominant distal arthrogryposis. This chapter will review the hereditary diseases caused by mutations in the PIEZO genes and will discuss additional physiological systems in which PIEZO channel dysfunction may contribute to human disease pathophysiology.
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Affiliation(s)
- S L Alper
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
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Imashuku S, Muramatsu H, Sugihara T, Okuno Y, Wang X, Yoshida K, Kato A, Kato K, Tatsumi Y, Hattori A, Kita S, Oe K, Sueyoshi A, Usui T, Shiraishi Y, Chiba K, Tanaka H, Miyano S, Ogawa S, Kojima S, Kanno H. PIEZO1 gene mutation in a Japanese family with hereditary high phosphatidylcholine hemolytic anemia and hemochromatosis-induced diabetes mellitus. Int J Hematol 2016; 104:125-9. [PMID: 26971963 DOI: 10.1007/s12185-016-1970-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 12/26/2022]
Abstract
Hereditary xerocytosis (HX) or dehydrated hereditary stomatocytosis (DHS) [OMIM 194380], in which PIEZO1 gene mutation has recently been identified, is difficult to diagnose. We report here the discovery of a PIEZO1 gene mutation in a Japanese family (father, daughter, and son) who were previously diagnosed with hereditary high phosphatidylcholine hemolytic anemia (HPCHA). All of the affected family members had non-spherocytic hemolytic anemia associated with severe hemochromatosis-related diabetes mellitus. Although the causative correlation between HPCHA and PIEZO1-gene mutated HX/DHS remains to be clarified, our findings raise an important question as to whether any of the HPCHA cases previously diagnosed in Japan may have in fact been the form of hemolytic anemia known as HX/DHS with PIEZO1 gene mutation.
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Affiliation(s)
- Shinsaku Imashuku
- Divisions of Laboratory Medicine or Internal Medicine, Uji-Tokushukai Medical Center, Uji-Tokushukai Medical Center, 145 Ishibashi, Makishima-cho, Uji, Kyoto, 611-0041, Japan.
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Sugihara
- Department of Hematology, Kawasaki Medical School, Kurashiki, Japan
| | - Yusuke Okuno
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Xinan Wang
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Yoshida
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ayako Kato
- Laboratory of Medicine, Aichi Gakuin University School of Pharmacy, Nagoya, Japan
| | - Koichi Kato
- Laboratory of Medicine, Aichi Gakuin University School of Pharmacy, Nagoya, Japan
| | - Yasuaki Tatsumi
- Laboratory of Medicine, Aichi Gakuin University School of Pharmacy, Nagoya, Japan
| | - Ai Hattori
- Department of Hospital Pharmacy, Nagoya University, Nagoya, Japan
| | - Shinya Kita
- Divisions of Laboratory Medicine or Internal Medicine, Uji-Tokushukai Medical Center, Uji-Tokushukai Medical Center, 145 Ishibashi, Makishima-cho, Uji, Kyoto, 611-0041, Japan
| | - Keishi Oe
- Divisions of Laboratory Medicine or Internal Medicine, Uji-Tokushukai Medical Center, Uji-Tokushukai Medical Center, 145 Ishibashi, Makishima-cho, Uji, Kyoto, 611-0041, Japan
| | - Atsushi Sueyoshi
- Divisions of Laboratory Medicine or Internal Medicine, Uji-Tokushukai Medical Center, Uji-Tokushukai Medical Center, 145 Ishibashi, Makishima-cho, Uji, Kyoto, 611-0041, Japan
| | - Takeshi Usui
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yuichi Shiraishi
- Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kenichi Chiba
- Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroko Tanaka
- Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,Health Intelligence Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Kanno
- Department of Transfusion Medicine and Cell Processing, Tokyo Women's Medical University, Tokyo, Japan
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Archer NM, Shmukler BE, Andolfo I, Vandorpe DH, Gnanasambandam R, Higgins JM, Rivera A, Fleming MD, Sachs F, Gottlieb PA, Iolascon A, Brugnara C, Alper SL, Nathan DG. Hereditary xerocytosis revisited. Am J Hematol 2014; 89:1142-6. [PMID: 25044010 DOI: 10.1002/ajh.23799] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 06/30/2014] [Indexed: 01/16/2023]
Affiliation(s)
- Natasha M. Archer
- Division of Hematology and Oncology; Boston Children's Hospital; Boston Massachusetts
- Dana-Farber Cancer Center; Boston Massachusetts
| | - Boris E. Shmukler
- Renal Division; Beth Israel Deaconess Medical Center; Boston Massachusetts
- Molecular and Vascular Medicine Division; Beth Israel Deaconess Medical Center; Boston Massachusetts
| | - Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnologies; Federico II University of Naples; Naples Italy
- CEINGE, Advanced Biotechnologies; Naples Italy
| | - David H. Vandorpe
- Renal Division; Beth Israel Deaconess Medical Center; Boston Massachusetts
- Molecular and Vascular Medicine Division; Beth Israel Deaconess Medical Center; Boston Massachusetts
| | | | - John M. Higgins
- Department of Systems Biology; Harvard Medical School; Boston Massachusetts
- Center for Systems Biology and Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Alicia Rivera
- Department of Laboratory Medicine; Boston Children's Hospital; Boston Massachusetts
- Department of Pathology; Harvard Medical School; Boston Massachusetts
| | - Mark D. Fleming
- Department of Pathology; Harvard Medical School; Boston Massachusetts
| | - Frederick Sachs
- Department of Physiology and Biophysics; University of Buffalo; Buffalo New York
| | - Philip A. Gottlieb
- Department of Physiology and Biophysics; University of Buffalo; Buffalo New York
| | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnologies; Federico II University of Naples; Naples Italy
- CEINGE, Advanced Biotechnologies; Naples Italy
| | - Carlo Brugnara
- Department of Laboratory Medicine; Boston Children's Hospital; Boston Massachusetts
- Department of Pathology; Harvard Medical School; Boston Massachusetts
| | - Seth L. Alper
- Renal Division; Beth Israel Deaconess Medical Center; Boston Massachusetts
- Molecular and Vascular Medicine Division; Beth Israel Deaconess Medical Center; Boston Massachusetts
- Department of Medicine; Harvard Medical School; Boston Massachusetts
| | - David G. Nathan
- Division of Hematology and Oncology; Boston Children's Hospital; Boston Massachusetts
- Dana-Farber Cancer Center; Boston Massachusetts
- Department of Pediatrics; Harvard Medical School; Boston Massachusetts
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