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Braniecki S, Vichinsky E, Walters MC, Shenoy S, Shi Q, Moore TB, Talano JA, Parsons SK, Flower A, Panarella A, Fabricatore S, Morris E, Mahanti H, Milner J, McKinstry RC, Duncan CN, van de Ven C, Cairo MS. Neurocognitive outcome in children with sickle cell disease after myeloimmunoablative conditioning and haploidentical hematopoietic stem cell transplantation: a non-randomized clinical trial. Front Neurol 2024; 15:1263373. [PMID: 38841694 PMCID: PMC11151850 DOI: 10.3389/fneur.2024.1263373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
Background Due to the risk of cerebral vascular injury, children and adolescents with high-risk sickle cell disease (SCD) experience neurocognitive decline over time. Haploidentical stem cell transplantation (HISCT) from human leukocyte antigen-matched sibling donors may slow or stop progression of neurocognitive changes. Objectives The study is to determine if HISCT can ameliorate SCD-associated neurocognitive changes and prevent neurocognitive progression, determine which specific areas of neurocognitive functioning are particularly vulnerable to SCD, and determine if there are age-related differences in neurocognitive functioning over time. Methods We performed neurocognitive and neuroimaging in SCD recipients following HISCT. Children and adolescents with high-risk SCD who received parental HISCT utilizing CD34+ enrichment and mononuclear cell (T-cell) addback following myeloimmunoablative conditioning received cognitive evaluations and neuroimaging at three time points: pre-transplant, 1 and 2 years post-transplant. Results Nineteen participants (13.1 ± 1.2 years [3.3-20.0]) received HISCT. At 2 years post-transplant, neuroimaging and cognitive function were stable. Regarding age-related differences pre-transplantation, older children (≥13 years) had already experienced significant decreases in language functioning (p < 0.023), verbal intelligence quotient (p < 0.05), non-verbal intelligence quotient (p < 0.006), and processing speed (p < 0.05), but normalized post-HISCT in all categories. Conclusion Thus, HISCT has the potential to ameliorate SCD-associated neurocognitive changes and prevent neurocognitive progression. Further studies are required to determine if neurocognitive performance remains stable beyond 2 years post-HISCT.Clinical trial registration: The study was conducted under an investigator IND (14359) (MSC) and registered at clinicaltrials.gov (NCT01461837).
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Affiliation(s)
- Suzanne Braniecki
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Elliott Vichinsky
- Department of Pediatrics, UCSF Benioff Children’s Hospital, Oakland, CA, United States
| | - Mark C. Walters
- Department of Pediatrics, UCSF Benioff Children’s Hospital, Oakland, CA, United States
| | - Shalini Shenoy
- Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Qiuhu Shi
- Department of Epidemiology, New York Medical College, Valhalla, NY, United States
| | - Theodore B. Moore
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Julie-An Talano
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Susan K. Parsons
- Department of Medicine and Pediatrics, Tufts Medical Center, Boston, MA, United States
| | - Allyson Flower
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Anne Panarella
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Sandra Fabricatore
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Erin Morris
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Harshini Mahanti
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Jordan Milner
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Robert C. McKinstry
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Radiology, Washington University, St Louis, MO, United States
| | - Christine N. Duncan
- Dana-Faber/Children’s Cancer and Blood Disorders Center, Boston, MA, United States
| | - Carmella van de Ven
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Mitchell S. Cairo
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
- Department of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Pathology, New York Medical College, Valhalla, NY, United States
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, United States
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, United States
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Abdi SS, De Haan M, Kirkham FJ. Neuroimaging and Cognitive Function in Sickle Cell Disease: A Systematic Review. CHILDREN 2023; 10:children10030532. [PMID: 36980090 PMCID: PMC10047189 DOI: 10.3390/children10030532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023]
Abstract
Sickle cell disease (SCD) is the most common inherited single-gene disease. Complications include chronic anaemia, reduced oxygen-carrying capability, and cerebral vasculopathy, resulting in silent cerebral infarction, stroke, and cognitive dysfunction with impairments in measures of executive function, attention, reasoning, language, memory, and IQ. This systematic review aims to investigate the association between neuroimaging findings and cognition in children with SCD. Searches of PubMed and Embase were conducted in March 2022. Studies were included if participants were <18 years, if original data were published in English between 1960 and 2022, if any genotype of SCD was included, and if the relationship between cognition and neuroimaging was examined. Exclusion criteria included case studies, editorials, and reviews. Quality was assessed using the Critical Appraisal Skills Programme Case Control Checklist. A total of 303 articles were retrieved; 33 met the eligibility criteria. The presence of overt or silent strokes, elevated blood flow velocities, abnormal functional connectivity, and decreased fMRI activation were associated with neuropsychological deficits in children with SCD when compared to controls. There is a critical need to address the disease manifestations of SCD early, as damage appears to begin at a young age. Most studies were cross-sectional, restricting the interpretation of the directionality of relationships. Future research employing longitudinal neuroimaging and neuropsychological assessments could improve our understanding of the cumulative consequences of SCD on the developing brain.
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Affiliation(s)
- Suad S. Abdi
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Michelle De Haan
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Fenella J. Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK
- Child Health, University Hospital Southampton, Southampton SO16 6YD, UK
- Correspondence:
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Steen RG, Fineberg-Buchner C, Hankins G, Weiss L, Prifitera A, Mulhern RK. Cognitive deficits in children with sickle cell disease. J Child Neurol 2005; 20:102-7. [PMID: 15794173 DOI: 10.1177/08830738050200020301] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We tested a hypothesis that children with sickle cell disease who are completely normal by magnetic resonance imaging can still be cognitively impaired, as predicted by a model of diffuse brain injury. Fifty-four patients with hemoglobin SS (average age 10.9 years +/- 2.9 years SD) were examined with the Wechsler Intelligence Scale for Children-III (WISC-III) and were randomly matched by age, race, and gender with healthy children from the Wechsler normative database. Patients were also imaged at 1.5 Tesla with standard imaging sequences. Among 30 patients who were normal by magnetic resonance imaging, there were substantial deficits in Wechsler Full-Scale IQ, Verbal IQ, and Performance IQ (all P < .01) compared with African-American controls. The patient Wechsler Full-Scale IQ was 12.9 points lower than that of controls and decreased as a function of age (probability = .014). The findings suggest that there is diffuse brain injury in patients and that patient deficits increase with age.
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Affiliation(s)
- R Grant Steen
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Prengler M, Pavlakis SG, Prohovnik I, Adams RJ. Sickle cell disease: the neurological complications. Ann Neurol 2002; 51:543-52. [PMID: 12112099 DOI: 10.1002/ana.10192] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The genetic cause of sickle cell disease has been known for decades, yet the reasons for its clinical variability are not fully understood. The neurological complications result from one point mutation that causes vasculopathy of both large and small vessels. Anemia and the resultant cerebral hyperemia produce conditions of hemodynamic insufficiency. Sickled cells adhere to the endothelium, contributing to a cascade of activated inflammatory cells and clotting factors, which result in a nidus for thrombus formation. Because the cerebrovascular reserve becomes exhausted, the capacity for compensatory cerebral mechanisms is severely limited. There is evidence of small-vessel sludging, and a relative deficiency of nitric oxide in these vessels further reduces compensatory vasodilatation. Both clinical strokes and silent infarcts occur, affecting motor and cognitive function. New data suggest that, in addition to sickle cell disease, other factors, both environmental (eg, hypoxia and inflammation) and genetic (eg, mutations resulting in thrombogenesis), may contribute to a patient's stroke risk. The stroke risk is polygenic, and sickle cell disease can be considered a model for all cerebrovascular disease. This complex disease underscores the potential intellectual and practical distance between the determination of molecular genetics and effective clinical application and therapeutics.
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Affiliation(s)
- Mara Prengler
- Neurosciences Unit, Institute of Child Health, University College and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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Steen RG, Hu XJ, Elliott VE, Miles MA, Jones S, Wang WC. Kindergarten readiness skills in children with sickle cell disease: evidence of early neurocognitive damage? J Child Neurol 2002; 17:111-6. [PMID: 11952070 DOI: 10.1177/088307380201700204] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Young children with sickle cell disease are at risk of brain damage, including stroke. We tested the hypothesis that such patients are also at risk of cognitive impairment. We characterized the cognitive ability of kindergarten children to minimize the effect of disease-related school absence. The Memphis City Schools use the Developing Skills Checklist, a teacher-administered test given in the classroom, to assess kindergarten-appropriate skills. Data were obtained for 34 patients, who were matched to controls by gender, race, date of birth, school, and approximate income. Two controls were selected for each patient, and paired t-tests were used to compare patient's scores to composite control scores. Patients scored lower than controls in auditory discrimination (P < .01), and there was a trend (P < .10) toward lower patient scores in language. Deficits cannot be attributed to school absence and may predict academic problems for patients with sickle cell disease.
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Affiliation(s)
- R Grant Steen
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
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