Sickle Cell Disease-Genetics, Pathophysiology, Clinical Presentation and Treatment

Sickle Cell Disease in Africa: SickleInAfrica Registry in Ghana, Nigeria and Tanzania

Introduction

Sickle cell disease (SCD) is most prevalent in Sub-Saharan Africa (SSA), where incomplete patient profiles and limited management strategies hinder research and healthcare standards.

Methods

We describe the first large-scale and multinational assessment of 13,403 SCD patients enrolled from 2017-2021 across 31 facilities in Ghana, Nigeria, and Tanzania into the SickleInAfrica consortium registry. We used hierarchical regression models to estimate and analyze the demographics, adoption levels of SCD diagnosis and therapies.

Results

The average age at diagnosis was 3 months, 19 months and 3 years in Ghana, Nigeria and Tanzania respectively, reflecting differences in country-specific newborn screening programs and policies. Hydroxyurea (HU) use was highest in Ghana (21%), followed by Nigeria (12%) and Tanzania (6%), with significant variability across facilities. Sex differences in SCD management were observed, with males more likely to receive HU and blood transfusions. At the consortium level, HU initiation correlated with enrolment age rather than age at diagnosis, highlighting the need for earlier intervention.

Conclusions

Our findings highlight the potential of the SickleInAfrica registry toward enhancing understanding of regional disparities in SCD care and potential gender inequalities, emphasizing the need for enabling policies toward strengthened SCD research and improved quality of life and care of patients in Africa.

Exploration of Leucine-Rich Alpha-2 Glycoprotein 1 (LRG1) and Its Association with Proangiogenic Mediators in Sickle Cell Disease: A Potential Player in the Pathogenesis of the Disease

Objective

Leucine-rich alpha-2-glycoprotein 1 (LRG1) is a novel mediator involved in abnormal angiogenesis. We aimed to investigate circulating LRG1 levels and their relationship with proangiogenic mediators in sickle cell disease (SCD).

Materials and Methods

A total of 50 patients with SCD, with 25 in steady-state condition (SCD-SS) and 25 in periods of painful vaso-occlusive crisis (SCD-VOC), and 25 healthy controls were included in the study. Demographical and clinical data were collected from hospital records. Serum LRG1, vascular endothelial growth factor A (VEGFA), and hypoxia-inducible factor 1-alpha (HIF1A) levels were measured by enzyme-linked immunosorbent assay (ELISA), and C-reactive protein (CRP) was measured by the nephelometric method. Routine biochemical parameters were assessed using an autoanalyzer. Multinomial logistic regression was used to analyze ELISA parameters, and receiver operating characteristic (ROC) curves were constructed to determine the optimal cut-off point for HIF1A to predict VOCs in SCD patients.

Results

LRG1 and VEGFA levels were significantly higher in SCD patients than controls (p<0.001), with no difference between the SCD-SS and SCD-VOC groups. HIF1A, CRP, and lactate dehydrogenase levels differed significantly across all groups, being highest in the SCD-VOC group (p<0.001). After adjusting for age and sex, LRG1, HIF1A, and VEGFA remained elevated in the SCD groups. HIF1A correlated with CRP (r=0.351, p=0.024), but LRG1 showed no correlation with proangiogenic mediators in the SCD-VOC group. The area under the ROC curve was calculated as 0.694 (95% confidence interval: 0.542-0.845, p=0.021) and the optimal cut-off point was 494.5 pg/mL for HIF1A in predicting vaso-occlusive crises in patients with SCD.

Conclusion

Circulating LRG1 levels may reflect neutrophil activation and contribute to the cross-talk between proangiogenic mediators released in SCD.

Treating sickle cell disease in resource-limited sub-Saharan Africa: recent strategies and recommendations in addressing the gaps for the provision of evidence-based management

INTRODUCTION

The management of Sickle cell disease (SCD) in sub-Saharan Africa (SSA) suffers from the lack of universal infant and population screening, inadequate access to standard treatment and poor public health prioritization amidst unstable political systems.

AREAS COVERED

The state of evidencebased management of SCD in SSA was investigated including sustainability of international funding agencies.

EXPERT OPINION

Current efforts are fragmentary along languages lines; sometimes driven by the funder's objectives and not the national agenda. The review highlighted the role of internal and external partnerships such as SPARCO, ARISE, CONSA, as well as technology-based support for the implementation of evidence-based care for SCD. We advocate for increased funding to implement SCD comprehensive care in line with the WHO SCD Framework for Primary, Secondary, Tertiary and Specialist Comprehensive Care at state and national level. To achieve this objective, it is important that SCD, as a leading non-communicable disease in Africa, be mandated as a standing agenda for the National Council of Ministers at the African Union, WHO and other regional bodies in Africa.

Applications of Gene Editing and Nanotechnology in Stem Cell-Based Therapies for Human Diseases

Stem cell research is a dynamic and fast-advancing discipline with great promise for the treatment of diverse human disorders. The incorporation of gene editing technologies, including ZFNs, TALENs, and the CRISPR/Cas system, in conjunction with progress in nanotechnology, is fundamentally transforming stem cell therapy and research. These innovations not only provide a glimmer of optimism for patients and healthcare practitioners but also possess the capacity to radically reshape medical treatment paradigms. Gene editing and nanotechnology synergistically enhance stem cell-based therapies' precision, efficiency, and applicability, offering transformative potential for treating complex diseases and advancing regenerative medicine. Nevertheless, it is important to acknowledge that these technologies also give rise to ethical considerations and possible hazards, such as inadvertent genetic modifications and the development of genetically modified organisms, therefore creating a new age of designer infants. This review emphasizes the crucial significance of gene editing technologies and nanotechnology in the progress of stem cell treatments, particularly for degenerative pathologies and injuries. It emphasizes their capacity to restructure and comprehensively revolutionize medical treatment paradigms, providing fresh hope and optimism for patients and healthcare practitioners.

Hematopoietic Stem Cell Transplantation in Severe Pediatric Sickle Cell Disease: Outcome and long-term complications, Saudi experience at King Faisal Specialist Hospital, Riyadh, Saudi Arabia

Background

Hematopoietic stem transplantation (HSCT) from matched related donors (MRD) is offered as a curative therapeutic option in children with Sickle cell disease (SCD).

Objective

We wanted to assess the outcome and long-term complications observed in children undergoing HSCT at a single transplant center in Saudi Arabia.

Patients and Methods

One hundred and twenty-nine children were transplanted for severe Sickle cell disease (SCD) consecutively from 2006 to 2020 at our center. The main transplant indication was cerebral vasculopathy in 57 (43%), followed by the recurrent vaso-occlusive crisis (VOC) in 47 (36%). Median age at transplant was 9.1 years (range, 1.5-13.9 years). All patients received myeloablative conditioning with Busulfan, Cyclophosphamide, and Anti T-Lymphocyte Globulin (Grafalon®): BU/CY/ATG in 114 (88.4%), BU/CY in 13 (10%) and other in 2 (2%). Bone marrow was the main stem cell source in 123 (95%).

Results

All patients showed granulocyte engraftment. Acute graft-versus-host-disease (aGVHD) and chronic GVHD were observed in 26 (20%) and 12 (9%) patients, respectively. At a median follow-up of 4.36 years (range, 0.13-15.5 years), 10-year overall survival (OS) and event-free survival (EFS) of 94% and 91% was observed. The OS and EFS were significantly better in patients receiving BU/CY/ATG when compared to BU/CY (OS: 97.4%±1.5%, vs. 76.2%±12.1 P=0.003 and EFS: 94.7%±2.1% vs. 76.2%±12.1%, P=0.019).

Conclusion

HSCT for children with sickle cell disease from fully matched siblings offers the best outcome using myeloablative conditioning. However, significant toxicities were observed secondary to myeloablative regimens, in particular long-term complications, which demands exploring the use of less toxic regimens.

Risk factors associated with pain episodes among sickle cell patients that visited Mulago National Referral Hospital-Uganda

BACKGROUND

Sickle cell disease (SCD) is a chronic hematologic disease associated with increased morbidity and mortality. The study aims to investigate the suggested socio-economic and clinical factors and their contribution to the frequency of pain episodes among sickle cell patients in Uganda.

METHOD

We used pre-existing secondary data from sickle cell clinic records at Mulago referral hospital collected in 2019, with a sample of 2532 sickle cell patients. In support of the outcome being count data, the Negative Binomial Regression model was utilized to estimate how the independent factors affected the frequency of pain episodes among the patients.

RESULTS

The frequency of pain episodes was different among age groups as age group (16/24) experienced the highest number of pain episodes on average (Incidence Rate Ratio = 1.39; 95% CI = 1.277-1.522; p = 0.000) compared to young children because as individuals age, pain management declines, and repeated episodes can lead to increased sensitivity, making them more prone to pain. While increased temperature (°C) (fever) increased the frequency of pain episodes by 24% (Incidence Rate Ratio = 1.243; 95% CI = 1.147-1.348; p = 0.000), infection by 27% (Incidence Rate Ratio = 1.27; 95% CI = 1.191-1.354; p < 0.000), other chronic diseases by 11% (Incidence Rate Ratio = 1.11; 95% CI = 1.038-1.188; p < 0.002), malaria by 38% (Incidence Rate Ratio = 1.38; 95% CI = 1.036-1.836; p < 0.027). The rate of hydroxyurea usage was very high at 90%. The intake of the drug reduced the frequency of pain episodes by 34% (Incidence Rate Ratio = 0.662; 95% CI = 0.584-0.750; p < 0.000). According to the observations, there is a high chance that hydroxyurea also had a strong protective against malaria in SCD patients. Nevertheless, there was no evidence that being a male or female would influence the frequency of pain episodes among sickle cell patients.

CONCLUSIONS

These findings are expected to add to the body of knowledge in the health sector, assist in advocacy programs, inform policy, and aid in tailored interventions.

Nurses' Perceived Barriers of Optimal Pain Management of Children With Sickle Cell Disease

PURPOSE

This study aimed to investigate the barriers and lack of knowledge perceived by pediatric nurses in managing pain in children with sickle cell disease (SCD).

DESIGN

A descriptive, cross-sectional design was employed.

METHODS

In this study, 298 nurses aged between 21 and 53 years from 10 hospitals in the northern and middle regions of Jordan completed a structured, self-reporting questionnaire. Descriptive and inferential statistics were used for data analysis.

RESULTS

Nurses identified 12 perceived barriers to optimal pain management in children with SCD. The top three barriers included workload (mean rating of 7.29/10), absence of psychological support for children (mean rating of 7.13/10), and insufficient time (mean rating of 6.83/10). A lack of knowledge and training about SCD pain was also recognized as a significant barrier. Regarding nurses' perceptions of their understanding of SCD in children, less than half (41%-46%) believed they had adequate knowledge. Only 23% of nurses had received education on pain management, and only 6% had received structured education on caring for patients with SCD.

CONCLUSIONS

System-related challenges, such as heavy workloads and limited time, were significant obstacles that prevented healthcare providers from prioritizing pain management for children with SCD.

CLINICAL IMPLICATIONS

To reduce delays in SCD-related pain care and improve health outcomes, nursing policymakers, administrators, and educators must implement multilevel strategies to address the identified barriers to optimize pain management in children with SCD.

Advancing Precision Medicine: Recent Innovations in Gene Editing Technologies

The advent of gene editing has significantly advanced the field of medicine, opening new frontiers in the treatment of genetic disorders, cancer, and infectious diseases. Gene editing technology remains a dynamic and promising area of research and development. Recent advancements in protein and RNA engineering within this field have addressed critical issues such as imprecise edits, poor editing efficiency, and off-target effects. Advancements in delivery methods have allowed the achievement of therapeutic or even selection-free gene editing efficiency with reduced toxicity in primary cells, thereby enhancing the safety and efficacy of gene manipulation. This progress paves the way for transformative changes in molecular biology, medicine, and other fields. This review provides a comprehensive overview of the advancements in gene editing techniques, focusing on prime editor proteins and their engineered variants. It also explores alternative systems that expand the toolkit for precise genomic modifications and highlights the potential of these innovations in treating hematological disorders, while also discussing the limitations and challenges that remain.

Sequencing and health data resource of children of African ancestry

Purpose

Individuals who self-report as Black or African American are historically underrepresented in genome-wide studies of disease risk, a disparity particularly evident in pediatric disease research. To address this gap, Cincinnati Children's Hospital Medical Center (CCHMC) established a biorepository and developed a comprehensive DNA sequencing resource including 15,684 individuals who self-identified as African American or Black and received care at CCHMC.

Methods

Participants were enrolled through the CCHMC Discover Together Biobank and sequenced. Admixture analyses confirmed the genetic ancestry of the cohort, which was then linked to electronic medical records.

Results

High-quality genome-wide genotypes from common variants accompanied by medical recordsourced data are available through the Genomic Information Commons. This dataset performs well in genetic studies. Specifically, we replicated known associations in sickle cell disease (HBB, p = 4.05 × 10-1), anxiety (PLAA3, p = 6.93 × 10-), and asthma (PCDH15, p = 5.6 × 10-1), while also identifying novel loci associated with asthma severity.

Conclusion

We present the acquisition and quality of genetic and disease-associated data and present an analytical framework for using this resource. In partnership with a community advisory council, we have co-developed a valuable framework for data use and future research.

Erythroferrone-Driven Regulation of Hepcidin and Iron Levels in Polytransfused Sickle Cell Anaemia Patients: A Prospective Study

The interplay of erythroferrone (ERFE), hepcidin, and ferroportin is crucial for ensuring systemic iron homeostasis. This study determined the influence of ERFE on hepcidin and iron levels in polytransfused patients with sickle cell anaemia (SCA). This multicentre case-control study recruited 60 SCA participants and 30 controls (HbA), aged 2-34 years, from Tamale Teaching Hospital; Methodist Hospital, Wenchi; and Seventh Day Adventist Hospital, Sunyani, Ghana, between the periods of March to July 2023. About 4 mL of blood was collected for a full blood count using a haematology analyzer and serum ERFE, hepcidin, ferroportin, and ferritin estimation using an enzyme-linked immunosorbent assay. Data were analyzed using SPSS Version 26.0. ERFE (p < 0.001), ferroportin (p = 0.016), ferritin (p < 0.001), serum iron (p < 0.001), transferrin (p = 0.001), soluble transferrin receptor (sTFR) (p = 0.019), TWBC (p < 0.001), and platelet (p < 0.001) were significantly higher in SCA participants and hydroxyurea-naïve participants than in the control group and hydroxyurea-treated participants, respectively. Levels of hepcidin (p < 0.001), red blood cell (p < 0.001), haemoglobin (p < 0.001), and haematocrit (p < 0.001) were lower in the SCA and hydroxyurea-naïve groups than in the control and hydroxyurea-treated groups, respectively. An inverse correlation was observed between serum ERFE and hepcidin (r = -0.391, p = 0.002) and hepcidin and ferroportin (r = -0.266, p = 0.040), while ferritin (r = 0.439, p < 0.001) and ferroportin (r = 0.309, p = 0.016) showed a positive correlation with ERFE. No correlation was found between serum hepcidin and ferritin levels (r = 0.025, p = 0.853). Again, participants with regular blood transfusions had significantly higher levels of ERFE (p < 0.001) and ferritin (p = 0.002) than those with rare and no transfusions per year. None of the SCA participants had done iron testing. In conclusion, the negative impact of ERFE on hepcidin levels may exacerbate the risk of iron burden, as evident by elevated iron levels in SCA patients and the need for regular monitoring of the iron status of polytransfused SCA patients.

Unraveling the Complex Genomic Interplay of Sickle Cell Disease Among the Saudi Population: A Case-Control GWAS Analysis

Sickle cell disease (SCD) is a severe inherited blood disorder characterized by abnormal hemoglobin (HbS) that leads to varying degrees of severity, including chronic hemolysis, episodic vaso-occlusion, and damage to multiple organs, causing significant morbidity and mortality. While SCD is a monogenic disease, its complications are influenced by polygenic factors. SCD prevalence is notably high in regions including the Middle East, with Saudi Arabia reporting significant cases, particularly in the Eastern Province. Most genetic factors associated with SCD outcomes have been identified in populations predominantly from Africa or of African ancestry. This study aims to identify genetic variants that characterize Saudi SCD patients with the potential to influence disease outcomes in this population. A multicenter case-control genome-wide association study (GWAS) was conducted involving 350 adult Saudi SCD patients and 202 healthy controls. Participants were genotyped using the Affymetrix Axiom array, covering 683,030 markers. Rigorous quality control measures were applied to ensure data integrity. Fisher's exact was used to identify genetic variants with a significant difference in allele frequency (p < 5 × 10-8). Functional annotations and regulatory functions of variants were determined using the Ensembl Variant Effect Predictor (VEP) and RegulomeDB databases. The GWAS identified numerous significant genetic variants characterizing SCD cases in the Saudi population. These variants, distributed across multiple chromosomes, were found in genes with known functional consequences. A substantial proportion of the markers were detected in the olfactory receptor cluster, TRIM family, and HBB locus genes. Many of the identified genes were reported in previous studies showing significant associations with various SCD outcomes, including hemoglobin regulation, inflammation, immune response, and vascular function. The findings highlight the genetic complexity underlying SCD and its clinical manifestations. The identified variants suggest potential molecular biomarkers and therapeutic targets, enhancing our understanding of the molecular basis of SCD in the Saudi population. This is the first genetic analysis characterizing SCD patients compared to healthy individuals, uncovering genetic markers that could serve as diagnostic biomarkers and therapeutic targets. Given the known molecular mechanisms of the detected genetic loci, these provide a foundation for precision medicine in SCD management, highlighting the need for further studies to validate these results and explore their clinical implications.

Metabolic and Proteomic Divergence is Present in Spleens and Livers from Berkeley Sickle Cell Anemia and β-Thalassemia Mice

Sickle cell disease and β-Thalassemia are two of the most prevalent hemoglobinopathies worldwide. Both occur due to genetic mutations within the HBB gene and are characterized by red blood cell dysfunction, anemia, and end-organ injury. The spleen and liver are the primary organs where erythrophagocytosis, engulfing the red blood cells, occurs in these diseases. Understanding metabolism and protein composition within these tissues can therefore inform the extent of hemolysis and disease progression. We utilized a multiomics approach to highlight metabolomic and proteomic differences in the spleen and liver. The Berkley sickle cell disease (Berk-SS), heterozygous B1/B2 globin gene deletion (HbbTh3/+) a known β-Thalassemia model, and wildtype (WT, C57/Bl6) murine models were evaluated in this report. This analysis showed Berk-SS and HbbTh3/+ shared distinct antioxidant and immunosuppressive splenic phenotypes compared to WT mice with divergence in purine metabolism, gluconeogenesis, and glycolysis. In contrast, Berk-SS mice have a distinct liver pro-inflammatory phenotype not shared by HbbTh3/+ or WT mice. Together, these data emphasize that metabolic and proteomic reprogramming of the spleen and livers in Berk-SS and HbbTh3/+mice may be relevant to the individual disease processes.

Haplotype-Specific Genetic Epidemiology of Sickle Cell Anemia Patients in Accra, Ghana: Patterns, Clinical Implications, and Public Health Responses

Sickle cell disease (SCD) is a genetic disorder with a diverse spectrum of clinical presentation, often determined by inherited βS gene haplotypes. Ghana, a country with a significant SCD burden, lacks population haplotype frequency data, hindering anthropological, genetic, and clinical understanding and management of the disease. A prospective sample of 191 SCD patients (sickle cell anemia; homozygous HbSS) was recruited at the Korle-Bu Teaching Hospital, Accra. Identification of βS gene haplotypes was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Hematological tests were performed using routine laboratory procedures. Kruskal-Wallis ANOVA with Dunn post-hoc was used to compare the hematological parameters. Multinomial probability models were used to compare the frequencies of the observed haplotypes with those reported in other African countries. The Atypical haplotype was disproportionately prevalent (58%), followed by the Bantu/CAR (20%) and Benin (10%) haplotypes. Significant differences were observed between the haplotypes in lymphocyte count, platelet count, sodium and potassium levels (P < 0.001). In addition, disease severity varied significantly between haplotypes (P = 0.010), with notable differences between the Atypical and Bantu/CAR haplotypes (PFDR = 0.020). Multinomial probability testing revealed a substantial deviation from the expected haplotype distribution, highlighting significant differences in haplotype frequencies between Ghana and other African countries. The Wright-Fisher model showed that the variation in Arab-Indian haplotype frequency reached zero by the 100th generation. Our findings highlight the need to study haplotype composition in Ghana to identify population-specific risk factors and tailor public health interventions to better manage patient needs.

Spontaneous Postpartum Pneumomediastinum (Hamman's Syndrome): A Case Report and Review of Chest Pain Management in the Immediate Postpartum Period

Spontaneous pneumomediastinum is a rare condition in the postpartum period, characterized by symptoms such as dyspnea, chest pain, subcutaneous neck edema, tachycardia, crepitus, dysphonia, and dysphagia. The Valsalva maneuver, commonly performed during the second stage of vaginal delivery, has been implicated as a key precipitating factor in the pathogenesis of this condition. We report the case of a 25-year-old woman (G1P1001, 39w5d), with a history of smoking, who developed postpartum dyspnea and chest pain 24 hours following an uncomplicated vaginal delivery. A comprehensive diagnostic workup, including a CT scan with intravenous contrast, confirmed severe pneumomediastinum. The patient was managed conservatively with analgesics, supplemental oxygen, and close clinical monitoring. A follow-up chest CT performed 24 hours later demonstrated interval improvement of the pneumomediastinum and an esophagogram excluded the presence of an esophageal tear or rupture. Although spontaneous pneumomediastinum is a rare obstetric complication of normal childbirth, it can present dramatically with chest pain, dyspnea, and hemodynamic instability. Diagnosis is established through a combination of history, clinical presentation, and radiographic findings. Management is conservative and includes analgesics, rest, supplemental oxygen therapy, and bronchodilators. Importantly, other potentially life-threatening causes of postpartum chest pain and dyspnea must be carefully ruled out to ensure timely and appropriate treatment.

Clinical depression prevalence and associated factors among adolescents with sickle cell anemia in dar es salaam, tanzania: a cross-sectional study

BACKGROUND

Depression commonly arises among adolescents who have experienced long-standing psychosocial difficulties, especially those facing chronic illnesses such as sickle cell anemia (SCA). SCA is a global health concern, and Tanzania is one of the countries with a high incidence, estimated at 8,000-11,000 births per year. This study aims to assess the magnitude and factors associated with depression among adolescents with SCA.

METHODOLOGY

A cross-sectional analytical study was conducted on adolescents aged 10-19 years attending sickle cell clinics in referral hospitals in Dar-es-Salaam, Tanzania, from October 2023 to March 2024. Socio-demographic and SCA severity data were collected using pre-structured and pre-tested questionnaires. A validated Patient Health Questionnaire (PHQ-9) tool was used to screen for depression. Univariate and multivariate regression models were used to determine factors associated with clinical depression. A P value of less than 0.05 was considered statistically significant.

RESULTS

Among the 326 adolescents enrolled and screened, 49 adolescents (15%) had clinical depression, encompassing those in the moderate, moderately severe, and severe depression categories. Overall 216 (53.7%) adolescents exhibited varying degrees of depression, ranging from mild to severe. Specifically, 167 participants (38.7%) had mild depression, 44 (13.5%) had moderate depression, 4 (1.2%) had moderately severe depression, and 1 (0.3%) had severe depression. Painful episodes within the previous 12 months were significantly associated with clinical depression (aOR = 2.49) (95% CI: 1.17-5.29, p = 0.01).

CONCLUSION

Depression is common among adolescents with SCA in our setting. Painful episodes experienced within the previous 12 months were significantly associated with clinical depression. This study highlights the need to screen adolescents with SCA for depression and integrate mental health services in sickle cell clinics.

Redefining the Reference Interval and Cut-Off Values of the Hematological and Biochemical Parameters and Deriving a Sensitive Predictive Marker for Crisis Events in Sickle Cell Disease

The heterogeneity in clinical presentations in sickle cell disease (SCD) alters between crisis and steady state phases. Considering the pathophysiology, it is crucial to establish a disease-specific reference interval for hematological and biochemical parameters and identify the sensitive predictive markers for crisis. The case-control study included fifty-four healthy control, forty SCD cases in crisis state, and forty-six steady state cases. Blood samples were evaluated for complete blood count (CBC) and biochemical parameters. Red cell indices were calculated. 2.5th and 97.5th percentile values were delineated in the steady state cases as new reference interval. The new cut-off values were evaluated for sensitivity and specificity. The steady state cases reported a significant decrease in urea, sodium, Hb, Hct, and RBC count compared to the control group, whereas potassium, and red cell indices were higher. Compared to the steady state, the crisis state depicted a significant increase in urea, liver enzymes, leucocytes, inflammatory indices, and all red cell indices, whereas sodium, albumin, iron, Hb, Hct, and LMR were decreased. The revised 95 percentile ranges were sodium-132.35-143.65 mmol/L, potassium-3.75-6.09 mmol/L, albumin-2.9-5.0 g/dL, Hb-7.51-12.17 g/dL, RBC count-2.2-5.49 × 106/µL, and Hct-22.54-36.1%. Red cell indices like Ricerca, Green and King, and Huber-Heklotz could be good screening tools for crisis events with more than 70% sensitivity. Thus, the laboratory must derive a new reference interval and cut-off values at the steady state in the SCD population it is catering samples rather than comparing it with normal healthy individuals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12291-023-01158-9.

Point-of-care diagnostic test accuracy in children and adolescents with sickle cell disease: A systematic review and meta-analysis

BACKGROUND

Detection of sickle cell disease (SCD) could be improved with greater use of point-of-care testing (POCT). This review assessed the accuracy of POCTs for SCD in children and adolescents.

METHODS

We systematically searched EMBASE, PubMed, Cochrane libraries, registries and conference proceedings from inception to 28th February 2023. We included cross-sectional and case-control studies that tested for SCD using POCTs and reference tests in individuals aged 0-19. We conducted meta-analysis to assess sensitivity and specificity of individual POCTs.

FINDINGS

The review included 31 studies overall, with 20 covering lateral flow immunoassays (LFIAs) and four covering micro-engineered electrophoresis. When detecting homozygous SCD, the pooled sensitivity and specificity of the included LFIAs and micro-engineered electrophoresis POCTs was 92 % or higher in all individual meta-analyses. Sensitivities and specificities were also nearly 100 % when detecting haemoglobin SC disease for these POCTs.

INTERPRETATION

POCTs could be used to accurately diagnose SCD.

CRISPR-directed gene-editing induces genetic rearrangement within the human globin gene locus

CRISPR-Cas is a revolutionary technology but has already demonstrated significant feasibility for clinical and non-clinical applications. While the efficiency and precision of this remarkable genetic tool is unprecedented, unfortunately, a series of collateral genetic rearrangement have been reported in response to double-stranded DNA breakage. Once these molecular scissions occur, the cascade of DNA repair reactions can lead to genomic rearrangements especially if breakage takes place within a family of sequence related genes. Here, we demonstrate that CRISPR- directed gene editing near the sickle cell mutation site generates a curious genetic outcome; a footprint of the δ globin gene proximal to the CRISPR/Cas cut site(s). This rearrangement is not dependent on the presence of an exogenously added DNA template but is apparently dependent on a double strand break. Our results the highlight recombinational capacity of double strand breaks in human chromosomes where the aim is to edit a human gene.

Caregivers' Perceived Threat Of Sickle Cell Disease Complications And Its Association With Hydroxyurea Use Among Children With Sickle Cell Disease In Dar Es Salaam, Tanzania

Purpose

Tanzania is the fifth country with the highest sickle cell disease (SCD) prevalence globally. Although hydroxyurea (HU) is available, only 25% of persons with SCD are reported to use it in Tanzania. Perceived disease threat is associated with medication usage in patients with chronic diseases. We assessed the factors associated with caregivers' perceived threat of SCD complications and its relationship with HU use among children with SCD in Dar-es-Salaam.

Methods

We conducted a cross-sectional hospital-based study from May to August 2023. We enrolled 374 caregivers of health-insured children with SCD from 4 public SCD clinics. We adapted the modified original and revised Champion's Health Belief Model Scales to derive perceived threat scores. We used Mann-Whitney and Kruskal-Wallis tests to compare the outcomes across sociodemographic characteristics and regression analysis for factors associated with perceived SCD threat.

Results

The median score (InterQuartile Range) for perceived threat of SCD complications was 559 (175, 598). Sixty-one percent of caregivers had a high SCD perceived threat. The caregivers of under-five children had 141 lower median SCD threat scores than those of children aged 13-17 years, p-value < 0.001. Participants from Regional Referral Hospitals (RRH) had lower median threat scores compared to participants attending Muhimbili National Hospital (MNH), 177 for Amana RRH, 325 Temeke RRH, 585 MNH Mloganzila, and 557 MNH Upanga, p-value <0.001. Children of caregivers with high perceived SCD threat were 3.4 times more likely to use HU compared to those with low SCD threat perception (Incidence Rate Ratio 3.4, 95% CI: 2.7-4.5).

Conclusion

The perceived threat of SCD predicts the likelihood of SCD patients using HU in Dar-es-Salaam, Tanzania. We recommend health education to caregivers aiming to improve their SCD threat perception and thus improve the use of HU among children with SCD in similar settings.

Expanding Horizons of CRISPR/Cas Technology: Clinical Advancements, Therapeutic Applications, and Challenges in Gene Therapy

CRISPR-Cas technology has transformed the field of gene editing, opening new possibilities for treatment of various genetic disorders. Recent years have seen a surge in clinical trials using CRISPR-Cas-based therapies. This review examines the current landscape of CRISPR-Cas implementation in clinical trials, with data from key registries, including the Australian New Zealand Clinical Trials Registry, the Chinese Clinical Trial Register, and ClinicalTrials.gov. Emphasis is placed on the mechanism of action of tested therapies, the delivery method, and the most recent findings of each clinical trial.

A Modular Genetic Approach to Newborn Screening from Spinal Muscular Atrophy to Sickle Cell Disease-Results from Six Years of Genetic Newborn Screening

BACKGROUND/OBJECTIVES

Genetic newborn screening (NBS) has already entered the phase of common practice in many countries. In Germany, spinal muscular atrophy (SMA), severe combined immunodeficiency (SCID) and sickle cell disease (SCD) are currently a mandatory part of NBS. Here, we describe the experience of six years of genetic NBS including the prevalence of those three diseases in Germany.

METHODS

Samples and nucleic acids were extracted from dried blood spot cards, commonly used for NBS. A qPCR assay was used to detect disease-causing variants for SMA and SCD, and the detection of T-cell receptor excision circles (TRECs) was performed for SCID screening.

RESULTS

The results of the NBS of over 1 million newborns for SMA, approximately 770,000 for SCID and over 410,000 for SCD are discussed in detail. In these newborns, we have identified 121 cases of SMA, 15 cases of SCID and syndrome-based immunodeficiencies and 77 cases of SCD or β-thalassemia.

CONCLUSIONS

The flexibility of multiplex qPCR is assessed as an effective tool for incorporating different molecular genetic markers for screening. The processing of dried blood spot (DBS) filter cards for molecular genetic assays and the assays are described in detail; turn-around times and cost estimations are included to give an insight into the processes and discuss further options for optimization. The identified cases are in the range expected for the total number of screened newborns, but present a more exact view on the actual prevalences for Germany.

Individualized Homeopathic and Organopathic Supportive Management of Sickle Cell Disorder: A Case Series of Six Patients from a Particularly Vulnerable Tribal Group in India

BACKGROUND

Sickle cell disorder (SCD) is a hereditary blood disease characterized by an abnormality in the oxygen-carrying protein hemoglobin present in red blood cells. Genetic abnormality causes these cells to become sickle-shaped, with shorter lifespan. Vaso-occlusive crisis is a major symptom of SCD: it is a sudden and severe episode of pain, and occurs when sickle-shaped cells block blood flow. This blockage can lead to tissue damage, inflammation and pain.

OBJECTIVES

This case series aims to observe the clinical outcomes from prescribing individualized homeopathic medicines along with organopathic supportive medicine in the management of SCD through the analysis of case studies of six patients from a particularly vulnerable tribal group (PVTG) in India that manifests genetic predisposition for the disease.

METHOD

The patients were administered individualized homeopathic and organopathic supportive medicines, after a comprehensive door-to-door survey and subsequent screening, conducted between October 2020 and May 2023 in the Dindori and Mandla districts of the central Indian state, Madhya Pradesh. Clinical symptoms, laboratory parameters including hemoglobin, along with scores from a visual analogue scale (VAS) for pain and from the World Health Organization Quality of Life (WHOQoL) Questionnaire, were determined.

RESULTS

Individualized homeopathic and organopathic supportive management led to improvements in clinical symptoms for all six patients. Laboratory test results showed a statistically significant increase in hemoglobin level associated with treatment. The VAS for pain indicated decreased pain frequency and severity. WHOQoL scores also improved, indicating enhanced well-being for each patient. No adverse effects were reported during treatment.

CONCLUSION

This study suggests that individualized homeopathic medicine and organopathic supportive management have a beneficial role in managing SCD and may be valuable in the context of PVTGs in India. To establish a more comprehensive understanding of its efficacy, further studies should involve larger cohorts to allow for a thorough evaluation, including comparative analyses with standard therapies.

A critical review of therapeutic interventions in sickle cell disease: Progress and challenges

Sickle cell disease (SCD) is an autosomal recessive genetic disorder that occurs due to the point mutation in the β-globin gene, which results in the formation of sickle hemoglobin (HbS) in the red blood cells (RBCs). When HbS is exposed to an oxygen-depleted environment, it polymerizes, resulting in hemolysis, vaso-occlusion pain, and impaired blood flow. Still, there is no affordable cure for this inherited disease. Approved medications held promise but were met with challenges due to limited patient tolerance and undesired side effects, thereby inhibiting their ability to enhance the quality of life across various individuals with SCD. Progress has been made in understanding the pathophysiology of SCD during the past few decades, leading to the discovery of novel targets and therapies. However, there is a compelling need for research to discover medications with improved efficacy and reduced side effects. Also, more clinical investigations on various drug combinations with different mechanisms of action are needed. This review comprehensively presents therapeutic approaches for SCD, including those currently available or under investigation. It covers fundamental aspects of the disease, such as epidemiology and pathophysiology, and provides detailed discussions on various disease-modifying agents. Additionally, expert insights are offered on the future development of pharmacotherapy for SCD.

Genetic Modifiers in Sickle Cell Disease Leg Ulcers: Unveiling the Pathways associated with the development and, or progression of Leg Ulcers - A Scoping Review Protocol

This scoping review aims to assess the literature on genetic modifiers of leg ulcers in sickle cell disease, evaluating available evidence, methodologies, and research gaps. A major morbidity in sickle cell disease is the development of leg ulcers. This clinical syndrome of SCD leg ulcers (SLU) has continued to be an enigma due to its multifactorial evolution, dearth of promising guidelines on treatment, and generally unsatisfactory response to treatment. Underlying genetic susceptibilities for SLU may impact counselling, prognostication, risk of development, severity as well as response to interventions. Hence the need for this scoping review. This scoping review will collate and assess studies in English on genetic markers of SLU among all SCD age groups, genders, races, and regions. Genetic or molecular markers to be assessed among patients with sickle cell leg ulcers included, genetic markers of Inflammation, vasculopathy, tissue damage, oxidative stress, coagulopathy as well as genetic predispositions that have been studied in relation to SLUs across all countries. This includes most common biomarkers that promote development of SLU, the single nucleotide polymorphic markers (SNPs) that work through the MAPK and SMAD signaling pathway. A PubMed search of all fields for literature published in English using the strategy (sickle cell) AND (leg ulcer), and (sickle cell) AND (leg ulcer genetics) from 1998 to 2023 (last 25 years) will be undertaken. This will be modified, according to the inclusion criteria, as appropriate across other databases. The other databases will include Google Scholar, web of Knowledge, Scopus, New Zealand Science, Silver chair, Taylor and Francis+NEJM, and journals.lww.com.

Sociodemographic and Clinical Factors Predictive of Poor Health-Related Quality of Life of Children with Sickle Cell Anemia in The Gambia

Children with sickle cell anemia (SCA) experience recurrent vaso-occlusive crises and complications, significantly impacting their health-related quality of life (HRQoL). This study determined HRQoL in 130 children aged 5 -15 years with SCA in The Gambia, compared to 130 age- and sex-matched hemoglobin AA (HbAA) children. HRQoL was measured using the Pediatric Quality of Life Inventory (PedsQL), with scores below 69.7 defined as poor HRQoL. Predictors of poor HRQoL were analyzed using binary logistic regression. The mean ages of children with SCA and HbAA were similar (9.83 ± 2.79 years vs. 9.65 ± 2.84 years, p = 0.598), with a male-to-female ratio of 1.1:1. SCA children showed significantly higher rates of underweight (p = 0.019) and stunting (p = 0.045) compared to HbAA children. HRQoL scores were significantly lower in the SCA group across physical, emotional, social, school, and overall domains (p < 0.001). A majority (57.7%) of SCA children had poor HRQoL. Key predictors of poor HRQoL among SCA children included frequent pain episodes (>3 episodes in the past 12 months; odds ratio [OR] = 1.9, p = 0.028), late diagnosis of SCA (OR = 1.8, p = 0.012), and clinical stroke (OR = 69.3, p = 0.037). This study demonstrates that SCA significantly reduces HRQoL in all domains. Early diagnosis, effective pain management, and prevention of complications like stroke are critical to improving outcomes. Tailored interventions are needed to mitigate the physical and psychosocial burdens of SCA among children in The Gambia.

Children with sickle cell disease: are they protected from serious COVID-19?

Background

COVID-19, the pandemic that hit the world in 2020, resulted in millions of deaths, with the elderly and adults succumbing to the disease more often than children. However, the presence of underlying morbidities increased the risk of death. Sickle cell disease (SCD) was previously classified as a major risk factor for severe COVID-19 disease. However, presently, there are only a limited number of studies that identify the clinical course of children with SCD and COVID-19.

Methods

We conducted a retrospective observational study on children with SCD admitted due to COVID-19 at three different institutions in Saudi Arabia between March 2020 and March 2022. We studied the demographic and clinical characteristics of patients admitted to the hospital.

Results

Seventy-six patients with SCD had PCR-confirmed SARS-CoV-2 during the study period; 50.0% of our patient population were children (6-12 years old). Gender was evenly distributed, with 53.9% girls and 46.1% boys. Symptoms more commonly related to the COVID-19 infection included fever, cough, malaise, and vomiting. Chest x-ray findings revealed mild and non-specific symptoms only in approximately one-third (28) of the included children. The most common symptoms associated with SCD were vaso-occlusive crisis (47.4%) and abdominal pain (11.8%). The overall general appearance of most of the patients was reassuring. The median length of hospital stay was 4.2 ± 2.7 days. The mean white blood cell count was 11.4 ± 5.2 × 109/L, and the mean hemoglobin level was 8.3 ± 1.5 g/dl. Despite the fact that higher levels of mean D-dimer, lactate dehydrogenase, and ferritin were reported in these patients, the clinical outcome was not affected. All recruited patients received hydroxyurea as maintenance therapy. The outcome of our study was reassuring, with no significant morbidity or mortality observed among the recruited patients.

Conclusion

Despite SCD being a chronic disease with known specific complications, there has been a claim that COVID-19 infection adds further risk. The results of this study suggest that the overall outcome of COVID-19 was favorable, with no reported mortality. Further research is needed to understand the factors that contributed to this favorable outcome. In children with SCD, it is still questionable whether hydroxyurea is one of the protective factors against severe COVID-19. Validation through large-scale research is recommended.

Epigenetic Aging Associations With Psychoneurological Symptoms and Social Functioning in Adults With Sickle Cell Disease

Objective: Sickle cell disease (SCD), the most common inherited blood disorder in the United States, is associated with severe psychoneurological symptoms. While epigenetic age acceleration has been linked to psychoneurological symptom burden in other diseases, this connection is unexplored in SCD. This study aimed to assess the association between epigenetic age acceleration and psychoneurological symptom burden in SCD. Methods: In this cross-sectional study, emotional impact, pain impact, sleep impact, social functioning, and cognitive function were assessed in 87 adults living with SCD. DNA methylation data were generated from blood specimens and used to calculate epigenetic age using five clocks (Horvath, Hannum, PhenoAge, GrimAge, & DunedinPACE). Associations between epigenetic age acceleration and symptoms were assessed. Results: The sample (N = 87) had a mean (SD) chronologic age was 30.6 (8.1) years. Epigenetic age acceleration was associated with several symptom outcomes. GrimAge age acceleration (β = -0.49, p = .03) and increased DunedinPACE (β = -2.23, p = .004) were associated with worse emotional impact scores. PhenoAge (β = -0.32, p = .04) and the GrimAge (β = -0.48, p = .05) age acceleration were associated with worse pain impact scores. Increased DunedinPACE (β = -2.07 p = .04) were associated with worse sleep impact scores. Increased DunedinPACE (β = -2.87, p = .005) was associated with worse social functioning scores. We did not find associations between epigenetic age acceleration and cognitive function in this sample. Conclusion: Epigenetic age acceleration was associated with worse symptom experiences, suggesting the potential for epigenetic age acceleration as a biomarker to aid in risk stratification or targets for intervention to mitigate symptom burden in SCD.

Perceptions and preferences for genetic testing for sickle cell disease or trait: a qualitative study in Cameroon, Ghana and Tanzania

Sickle cell disease (SCD) is a single gene blood disorder characterised by frequent episodes of pain, chronic anaemic, acute chest syndrome, severe disease complications and lifelong debilitating multi-system organ damage. Genetic testing and screening programs for SCD and the sickle cell trait (SCT) are valuable for early diagnosis and management of children living with SCD, and in the identification of carriers of SCT. People with SCT are for the most part asymptomatic and mainly identified as through genetic testing or when they have a child with SCD. This qualitative study explored perceptions towards genetic testing for SCD and SCT in Cameroon, Ghana, and Tanzania. The results show a general preference for newborn screening for SCD over prenatal and premarital/preconception testing, primarily due to its simpler decision-making process and lower risk for stigmatization. Premarital testing for SCT was perceived to be of low public health value, as couples are unlikely to alter their marriage plans despite being aware of their risk of having a child with SCD. Adolescents were identified as a more suitable population for SCT testing. In the case of prenatal testing, major concerns were centred on cultural, religious, and personal values on pregnancy termination. The study revealed a gender dimension to SCD/SCT testing. Participants mentionned that women bear a heightened burden of decision making in SCD/SCT testing, face a higher risk of rejection by potential in-laws/partners if the carriers of SCT, as well as the possibility of  divorce if they have a child with SCD. The study highlights the complex cultural, ethical, religious and social dynamics surrounding genetic testing for SCD and emphasises the need for public education on SCD and the necessity of incorporating genetic and psychosocial counselling into SCD/SCT testing programs.

Evaluation of anti-sickling effects of two varieties of Cajanus cajan (L.) Huth on sickle cell beta thalassemia

ETHNO-PHARMACOLOGICAL RELEVANCE

Globally, the prevalence of sickle cell disease is on the rise, with developing countries experiencing particularly alarming mortality rate compared to developed nations. The World Health Organization (WHO) and United Nations (UN) have acknowledged sickle cell disease as a significant global public health concern. Unfortunately, a cure for this condition is yet to be discovered, and existing allopathic treatments, while offering relief, come with serious side effects. In recent times, there has been a growing interest in exploring the potential of medicinal plants for treating sickle cell disease due to their content of secondary metabolites that may impact the disease's mechanisms. Cajanus cajan, a crucial grain legume in rain-fed agriculture in semi-arid tropics, has been traditionally used in folk medicine to manage various illnesses and is suggested to possess anti-sickling properties.

AIM OF THE STUDY

The present study investigated two varieties of C. cajan for their effectiveness in treating sickle cell beta thalassemia, a variant of sickle cell disease.

MATERIALS AND METHODS

The study was divided into four groups consisting of the untreated group (group 1), group treated with standard drug (group 2), group treated with white C. cajan (group 3) and group treated with brown C. cajan (group 4). The effects of the two variety of C. cajan were measured by polymerization test, reversibility test, osmotic fragility test, deoxygenation and beta globin synthesis test.

RESULT

The results revealed that both varieties of C. cajan demonstrated a reduction in polymerization rates, reversed sickled red blood cells, increased the oxygen affinity of Hb-S/β, elevated the Fe2+/Fe3+ ratio, and maintained the membrane stability of red blood cells. Notably, the white variety exhibited superior anti-sickling properties compared to the brown variety.

CONCLUSION

This suggests that this significant leguminous crop could be utilized for the treatment and management of sickling disorders, particularly in low-income countries where conventional treatments may be financially inaccessible to patients.

Therapeutics for sickle cell disease intravascular hemolysis

Sickle cell disease (SCD) is a genetic disorder predominantly affecting individuals of African descent, with a significant global health burden. SCD is characterized by intravascular hemolysis, driven by the polymerization of mutated hemoglobin within red blood cells (RBCs), leading to vascular inflammation, organ damage, and heme toxicity. Clinical manifestations include acute pain crises, hemolytic anemia, and multi-organ dysfunction, imposing substantial morbidity and mortality challenges. Current therapeutic strategies mitigate these complications by increasing the concentration of RBCs with normal hemoglobin via transfusion, inducing fetal hemoglobin, restoring nitric oxide signaling, inhibiting platelet-endothelium interaction, and stabilizing hemoglobin in its oxygenated state. While hydroxyurea and gene therapies show promise, each faces distinct challenges. Hydroxyurea's efficacy varies among patients, and gene therapies, though effective, are limited by issues of accessibility and affordability. An emerging frontier in SCD management involves harnessing endogenous clearance mechanisms for hemolysis products. A recent work by Heggland et al. showed that CD-36-like proteins mediate heme absorption in hematophagous ectoparasite, a type of parasite that feeds on the blood of its host. This discovery underscores the need for further investigation into scavenger receptors (e.g., CD36, SR-BI, SR-BII) for their possible role in heme uptake and detoxification in mammalian species. In this review, we discussed current SCD therapeutics and the specific stages of pathophysiology they target. We identified the limitations of existing treatments and explored potential future developments for novel SCD therapies. Novel therapeutic targets, including heme scavenging pathways, hold the potential for improving outcomes and reducing the global burden of SCD.

Iron incorporation in red blood cells of pediatric sickle cell anemia: a stable isotope pilot investigation

BACKGROUND/OBJECTIVES

Sickle cell anemia (SCA) is marked by hypoxia, inflammation, and secondary iron overload (IO), which potentially modulate hepcidin, the pivotal hormone governing iron homeostasis. The aim was to evaluate the iron incorporation in red blood cells (RBC) in SCA pediatric patients, considering the presence or absence of IO.

SUBJECTS/METHODS

SCA children (n = 12; SCAtotal) ingested an oral stable iron isotope (57Fe) and iron incorporation in RBC was measured after 14 days. Patients with ≥1000 ng/mL serum ferritin were considered to present IO (SCAio+; n = 4) while the others were classified as being without IO (SCAio-; n = 8). Liver iron concentration (LIC) was determined by Magnetic Resonance Imaging (MRI) T2* method.

RESULTS

The SCAio+ group had lower iron incorporation (mean ± SD: 0.166 ± 0.04 mg; 3.33 ± 0.757%) than SCAio- patients (0.746 ± 0.303 mg; 14.9 ± 6.05%) (p = 0.024). Hepcidin was not different between groups. Iron incorporation was inversely associated with serum ferritin level (SCAtotal group: r = -0.775, p = 0.041; SCAio- group: r = -0.982; p = 0.018) and sickle hemoglobin (HbS) presented positive correlation with iron incorporation (r = 0.991; p = 0.009) in SCAio- group. LIC was positively associated with ferritin (SCAtotal: r = 0.921; p = 0.026) and C reactive protein (SCAio+: r = 0.999; p = 0.020).

CONCLUSION

SCAio+ group had lower iron incorporation in RBC than SCAio- group, suggesting that they may not need to reduce their intake of iron-rich food, as usually recommended. Conversely, a high percentage of HbS may indirectly exacerbate hypoxia and seems to increase iron incorporation in RBC.

TRIAL REGISTRATION

This trial was registered at www.ensaiosclinicos.gov.br . Identifier RBR-4b7v8pt.

Current approaches in CRISPR-Cas systems for hereditary diseases

CRISPR-Cas technologies have drastically revolutionized genetic engineering and also dramatically changed the potential for treating inherited disorders. The potential to correct genetic mutations responsible for numerous hereditary disorders from single-gene disorders to complex polygenic diseases through precise DNA editing is feasible. The tactic now employed in CRISPR-Cas systems for treating inherited disorders is the usage of particular guide RNAs to target and edit disease-causing mutations in the patient's genome. Several methods such as CRISPR-Cas9, CRISPR-Cas12, and CRISPR-Cas13 are being thoroughly researched and optimized to increase effectiveness, accuracy, and safety in gene editing. Additionally, it is predicted that CRISPR-based therapies will be able to treat complex genetic illnesses such as cancer predisposition syndromes, neurological disorders, and cardiovascular conditions in addition to single-gene disorders. The available editing tools and creation of base editing technology facilitate the simultaneous correction of many mutations or accurate nucleotide changes leading to further advances in the development of multiplex editing tools and base editing technology fiction. When combined with other paradigms such as gene therapy using stem cell treatment, CRISPR-Cas promises improved efficacy. Patient treatment and lowering side effects significantly in individual genetic profiles will guide CRISPR-based treatments. These procedures will undoubtedly lead to therapies that are both efficient and curative of a wide range of genetic diseases, ushering in a new era of precision medicine. This chapter discusses about CRISPR Cas9 mechanism and its significance in the treatment of Hereditary disorders.

Genetic Patterns of Oral Cavity Microbiome in Patients with Sickle Cell Disease

The Middle Eastern prevalence of sickle cell anemia, a genetic disorder that affects red blood cells, necessitates additional research. On a molecular level, we sought to identify and sort the oral microbiota of healthy individuals and those with sickle cell anemia. Furthermore, it is crucial to comprehend how changes in the genetic makeup of the oral microbiota impact the state of sickle cell anemia. Using next-generation sequencing, the 16S rRNA amplicon was examined using saliva samples from 36 individuals with sickle cell anemia and healthy individuals. These samples were obtained from sickle cell anemia patients (18 samples) and healthy control participants (controls, 18 samples). Various analyses are conducted using bioinformatic techniques to identify distinct species and their relative abundance. Streptococcus, followed by Fusobacterium nucleatum, Prevotella, and Veillonella were the most prevalent genera of bacteria in the saliva of the SCA and non-SCA individuals according to our findings. Rothia mucilaginosa, Prevotella scoposa, and Veillonella dispar species were the dominant species in both sickle cell anemia and non-sickle cell anemia subjects. Streptococcus salivarius, Actinomyces graevenitzii, Actinomyces odontolyticus, and Actinomyces georgiae spp. were the most prevalent bacterial spp. in the studied SCA cases. The sequencing of the 16S rRNA gene yielded relative abundance values that were visualized through a heatmap analysis. Alterations in the oral microflora's constitution can significantly affect the susceptibility of sickle cell anemia patients to develop more severe health complications. Salivary diagnosis is a potential tool for predicting and preventing oral microbiome-related diseases in the future.

Impaired phagocytosis and oxidative respiratory burst activity in sickle cell anemia leukocytes

Objectives

This case-control study investigated the mode of leukocyte function in sickle cell anemia (SCA) to delineate the underlying immunopathology for early diagnosis and mitigate the increased bacterial infection risk in this patient population.

Method

In total, 90 participants comprising 24 hemoglobin (Hb)-AA, 22 Hb-AS, 23 steady state Hb-SS and 21 vaso-occlusive crisis state Hb-SS subjects were recruited for this study. The subjects were further divided into the following six groups: Hb-AA and Hb-AS subjects as control groups, Hb-SS subjects at steady state, Hb-SS subjects in a vaso-occlusive crisis state, Hb-SS subjects undergoing medication (Meds), and Hb-SS subjects undergoing medication plus blood transfusion (Meds/BT) group, respectively. Hematological analysis, Hb electrophoresis, leukocyte ratios, and leukocyte functional assays were assessed with standard methods, and interleukin 8 (IL-8) and L-selectin levels were evaluated using enzyme-linked immunosorbent assays.

Results

Total leukocyte and monocyte counts were increased in the Hb-SS groups compared to the control groups. However, the Hb-SS groups had lower lymphocyte counts than the other groups (p < 0.005). Leukocyte viability was increased in the SCA groups, while phagocytic activities and oxidative respiratory burst were both reduced in the SCA groups (p < 0.005). Increased IL-8 levels were observed in all SCA groups (p < 0.05), whereas L-selectin levels of the Hb-SS steady and Hb-SS on Meds groups were decreased compared to the other groups (p < 0.05). The neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were higher in the SCA groups than the control groups (p < 0.05).

Conclusion

Impaired leukocyte phagocytic and oxidative respiratory burst activities constitute altered leukocyte function in SCA, which can increase their susceptibility to infections and the risk of mortality, especially during the crisis state. Novel therapeutic approaches can be tailored specifically to enhance these leukocyte functions and mitigate the increased infection risk in SCA.

Sickle Cell Disease and Gut Health: The Influence of Intestinal Parasites and the Microbiome on Angolan Children

Parasitic infections are a common problem in developing countries and can intensify morbidity in patients with sickle cell disease (SCD), increasing the severity of anemia and the need for transfusions. It has been demonstrated that both helminths and protozoa can affect gut microbiome composition. On the other hand, the presence of specific bacterial communities can also influence parasite establishment. Considering this, our aim was to associate the presence of intestinal parasites with the results of hematological analyses and microbiome composition evaluations in a population of Angolan children with and without SCD. A total of 113 stool samples were collected, and gut microbiome analysis was performed using 16S sequencing and real-time PCR to detect eight different intestinal parasites. In our population, more than half of children (55%) had at least one parasitic infection, and of these, 43% were co-infected. Giardia intestinalis and Ascaris lumbricoides were more frequently found in children from the rural area of Bengo. Moreover, SCD children with ascariasis exhibited higher values of leukocytes and neutrophils, whereas the total hemoglobin levels were lower. In regards to the gut microbiome, the presence of intestinal parasites lowered the prevalence of some beneficial bacteria, namely: Lactobacillus, Bifidobacterium, Cuneatibacter, Bacteroides uniformis, Roseburia, and Shuttleworthia. This study presents the prevalence of several intestinal parasites in a high-risk transmission area with scarce information and opens new perspectives for understanding the interaction between parasites, the microbiome, and SCD.

Radiofrequency Ablation (RFA) for Osteoid Osteoma in an 11-Year-Old Male Child With Sickle Cell Trait: A Case Report

Osteoid osteoma is a benign bone tumor that typically presents with nocturnal pain alleviated by nonsteroidal anti-inflammatory medications. The coexistence of osteoid osteoma with sickle cell anemia, a hereditary hemoglobinopathy characterized by vaso-occlusive crises and bone infarcts, poses diagnostic and therapeutic challenges due to overlapping clinical and radiological features. This condition primarily involves the long bones of the lower extremities, particularly the femur and tibia. Despite its benign nature, osteoid osteoma can significantly impact a patient's quality of life due to persistent and intense pain, often leading to substantial sleep disturbances and functional limitations.

Investigating the impact of sickle cell disease on red blood cell transport in complex capillary networks

Sickle cell disease encompasses a variety of inherited red blood cell (RBC) disorders characterized by abnormal thrombosis, microvascular occlusion, end-organ ischemia, and early mortality. Understanding how sickle RBCs drive abnormal blood flow and stress on the endothelial wall is essential to predict and prevent blockages in blood circulation. While there are studies comparing blood flow velocity and pressure via computational fluid dynamics simulations, there are still open questions about how sickle cells interact with plasma in a complex capillary network. In order to quantify the hemodynamic differences between normal and sickle cells, we introduced a sickle cell RBC model to massively parallel fluid-structure interaction software HARVEY. Notably, sickle RBCs exhibit increased margination, aggregation at the inner curvature, slower fluid velocity, higher pressure, and greater wall shear stress at standard hematocrit levels. This computational model facilitates detailed cellular modeling for hemodynamic simulations in complex capillary networks, offering predictive insight into blockage and potential vessel ruptures in patients with sickle cell disease.

Revolutionising healing: Gene Editing's breakthrough against sickle cell disease

Recent advancements in gene editing illuminate new potential therapeutic approaches for Sickle Cell Disease (SCD), a debilitating monogenic disorder caused by a point mutation in the β-globin gene. Despite the availability of several FDA-approved medications for symptomatic relief, allogeneic hematopoietic stem cell transplantation (HSCT) remains the sole curative option, underscoring a persistent need for novel treatments. This review delves into the growing field of gene editing, particularly the extensive research focused on curing haemoglobinopathies like SCD. We examine the use of techniques such as CRISPR-Cas9 and homology-directed repair, base editing, and prime editing to either correct the pathogenic variant into a non-pathogenic or wild-type one or augment fetal haemoglobin (HbF) production. The article elucidates ways to optimize these tools for efficacious gene editing with minimal off-target effects and offers insights into their effective delivery into cells. Furthermore, we explore clinical trials involving alternative SCD treatment strategies, such as LentiGlobin therapy and autologous HSCT, distilling the current findings. This review consolidates vital information for the clinical translation of gene editing for SCD, providing strategic insights for investigators eager to further the development of gene editing for SCD.

Management of diabetes mellitus patients with sickle cell anemia: Challenges and therapeutic approaches

The coexistence of diabetes mellitus (DM) and sickle cell anemia (SCA) poses significant challenges in clinical management due to the complex interactions and overlapping complications associated with both conditions. Managing diabetes in individuals with SCA requires a comprehensive approach that addresses the unique physiological and pathological aspects of both diseases. This paper reviews the challenges encountered in the management of DM in patients with SCA and explores therapeutic strategies and approaches to optimize patient care. Challenges in the management of DM in individuals with SCA stem from several factors, including the impact of hemoglobin variants on glycemic control assessment, increased susceptibility to infections, altered immune response, and complications associated with both diseases. Moreover, the coexistence of SCA and DM heightens the susceptibility to infections due to compromised immune function, emphasizing the need for vigilant preventive measures, including vaccinations and close monitoring for infectious complications. Close collaboration among healthcare providers specializing in diabetes, hematology, and other relevant fields is crucial for developing comprehensive care plans. Individualized treatment strategies that balance glycemic control, pain management, and preventive care are essential to mitigate complications and optimize the overall health outcomes of patients with both DM and SCA. In conclusion, managing diabetes in the context of SCA necessitates a nuanced and patient-centered approach. By addressing the challenges and employing tailored therapeutic strategies, healthcare providers can improve the quality of life and health outcomes for individuals affected by both conditions.

Prevalence and predictors of iron deficiency anaemia among children with sickle cell disease in Dodoma, Tanzania: a cross-sectional study

BACKGROUND

Patients with sickle cell disease (SCD) are prone to iron profile derangements. This study aimed to determine the prevalence of iron deficiency anaemia (IDA) and their predictors among children with SCD aged between 6 months and 14 years. Assessment of the prevalence of IDA and its predictors helps to understand ways of alleviating the magnitude of the problem so as to prevent possible complications such as shortness of breath and chest pain.

METHODS

This was a cross-sectional analytical hospital-based study which included 174 patients with SCD attending SCD clinics at St. Gema hospital and Dodoma regional referral hospital in Dodoma city from October 2020 to March 2021. The cut-off points for detection of IDA was serum ferritin level < 30 µg/L and low mean corpuscular volume (MCV) for age. Data were analyzed using SPSS software version 25.0. Multivariate logistic regression analysis was used to determine the predictors of IDA. P-value less than 0.05 was considered significant.

RESULTS

The prevalence of IDA in this study was (16.1%, n = 28). Family income of less than 70,000/= TZS/month (AOR = 2.2, 95% CI = 1.07-2.49, p = 0.023), being transfused with blood less than 3 times from the time of being diagnosed with SCD (AOR = 5.5, 95% CI = 1.03-8.91, p = 0.046), and eating red meat at least once per month (AOR = 3.60, 95% CI = 1.37-9.46, p = 0.010) remained the independent predictors of IDA in multivariate regression analysis.

CONCLUSION

The findings of this study have shown that, support of families with children suffering from SCD in terms of financial support for improving medical services including optimal blood transfusion and affordability of diet which is rich in iron such as red meat is imperative.

Long-Term Ovarian Function Assessment After Haematopoietic Stem Cell Transplantation in Female Sickle Cell Anaemia Survivors

BACKGROUND

Haematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for sickle cell anaemia (SCA). While HSCT offers the possibility of disease remission, it can also lead to long-term complications, including gonadal dysfunction and premature menopause.

METHODS

We conducted a retrospective cohort study of female survivors who had hydroxyurea therapy and those who underwent post-HSCT follow-up for SCA at a teaching hospital in Lagos, Nigeria, between January 2019 and December 2022. Participants were eligible if they were at least five years post-HSCT or hydroxyurea treatment and had available serum samples for markers of ovarian function measurement. Demographic and clinical data were collected from the hospital register and patients' medical records. Serum levels of oestradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and anti-Müllerian hormone (AMH) were measured using the Abbott Architect i1000SR chemiluminescent immunoassay analyzer (Abbott Diagnostics, Abbott Park, IL). Descriptive statistics and inferential analyses were used to assess the relationship between markers of ovarian function (FSH and AMH) and clinical parameters.

RESULTS

There were statistically significant differences in the median serum levels of all the assessed endocrine hormones between the HSCT and non-HSCT (hydroxyurea) groups of SCA survivors. Up to 82.6% of the SCA survivors experienced ovarian dysfunction after HSCT treatment. Impaired ovarian function in SCA survivors was associated with a longer median follow-up duration than in SCA survivors who had normal ovarian function (12.0 vs. 7.5 years, p = 0.048). There were higher odds of impaired ovarian function in the SCA survivors who had myeloablative regimens than in those who had reduced intensity conditioning regimens (94.1% vs. 50.0%, p = 0.040).

CONCLUSION

Our study highlights the significant impact of HSCT on long-term ovarian function in female SCA survivors. However, further prospective studies with larger sample sizes and longer follow-up periods are required to confirm our findings and elucidate the factors influencing ovarian function in SCA survivors of HSCT. In addition, studies are also needed to further elucidate the optimal transplant protocols and fertility preservation strategies to minimize gonadal toxicity and preserve reproductive potential in female SCA patients undergoing HSCT.

Folic Acid in the Treatment of Sickle Cell Disease: A Systematic Review

Sickle cell disease (SCD) is a group of inherited genetic disorders that is caused by a mutation in the gene that codes for hemoglobin subunit β. This systematic review aimed to evaluate the effect of folic acid in the treatment of SCD patients. We retrieved 3730 articles from PubMed, PubMed Central, Google Scholar, and ScienceDirect databases. We employed a search technique that involved framing keywords, such as folic acid, folate, and sickle cell illness, and the Medical Subject Headings (MeSH) strategy in PubMed. We chose research articles that had been published during the last 10 years, as well as case reports, systematic reviews and meta-analyses, literature reviews, randomized controlled trials, and observational studies. Exclusion criteria included paid full-text articles, abstracts, non-English studies, and patients who do not have SCD. The 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were used in the design of our systematic review. It was found that the majority of SCD patients were receiving regular folic acid supplements and that their plasma folate levels were either increased or within normal range, with no discernible impact on other clinical outcomes such as hemoglobin levels, infections, or pain crises. SCD patients produce more red blood cells than healthy individuals, and nearly all SCD patients receive daily folic acid supplements. On the other hand, not enough information is available on folic acid's potential benefits in the management of SCD; thus, there is a need for more large clinical trials.

Impact of SARS-CoV-2 infection on pain crisis and acute chest syndrome in patients with sickle cell anemia: A retrospective multi-cohort study based on US national data from 2020 to 2022

COVID-19 infection has been a significant contributor to global morbidity and mortality, especially among those patients with chronic diseases. The Centers for Disease Control and Prevention have classified sickle cell disease (SCD) as a condition that increases the risk of severe illness from COVID-19 infection. A retrospective study was conducted using the TRiNetX health research network database to identify SCA patients ( HbSS, Sbeta-thalassemia zero) who had SARS-CoV-2 infection over 2 years; these were compared with similar patients who did not have the infection in terms of demographics, pain control, and laboratory parameters COVID-19 illness impacts [ain crises and ACS, and prior vaccination against influenza and COVID-19 may represent a protective factor for developing pain crises.

Sickle Cell Anomaly Meets Leukemic Challenge: A Case Report

This case report delves into the rare occurrence of sickle cell disease (SCD) and acute myeloid leukemia (AML) coexisting in a 36-year-old patient. The initial presentation, marked by escalating fatigue, pallor, and recurrent episodes initially attributed to sickle cell disease, unveiled an unexpected discovery of AML upon bone marrow examination. The diagnostic hurdles stemming from overlapping clinical features necessitated a thorough approach incorporating hematological, molecular, and imaging studies. Managing both conditions concurrently entailed navigating complexities addressed by a multidisciplinary team, tailoring chemotherapy regimens, and implementing personalized strategies to tackle complications associated with SCD. This case underscores the significance of tailored and comprehensive approaches in diagnosing and managing patients with overlapping hematological disorders. The insights gleaned from this instance contribute to the evolving comprehension of such intricate interplays, guiding future research endeavors and enhancing the care provided to patients simultaneously grappling with SCD and acute myeloid leukemia (AML). This case study investigates the unusual medical history of a 36-year-old male patient who concurrently has acute myeloid leukemia and sickle cell disease. Since childhood, the patient has endured severe anemia, necessitating frequent red blood cell transfusions or exchange blood therapy. Additionally, the patient was prescribed hydroxyurea (HU) for approximately 26 months.

Computing Sickle Erythrocyte Health Index on quantitative phase imaging and machine learning

Sickle cell disease (SCD) is a genetic disorder characterized by abnormal hemoglobin and deformation of red blood cells (RBCs), leading to complications and reduced life expectancy. This study developed an in vitro assessment, the Sickle Erythrocyte Health Index, using quantitative phase imaging (QPI) and machine learning to model the health of RBCs in people with SCD. The health index combines assessment of cell deformation, sickle-shaped classification, and membrane flexibility to evaluate erythrocyte health. Using QPI and image processing, the percentage of sickle-shaped cells and membrane flexibility were quantified. Statistically significant differences were observed between individuals with and without SCD, indicating the impact of underlying pathophysiology on erythrocyte health. Additionally, sodium metabisulfite led to an increase in sickle-shaped cells and a decrease in flexibility in the sickle cell blood samples. Based on these findings, two approaches were used to calculate the Sickle Erythrocyte Health Index: one using hand-crafted features and one using learned features from deep learning models. Both indices showed significant differences between non-SCD and SCD groups and sensitivity to changes induced by sodium metabisulfite. The Sickle Erythrocyte Health Index has important clinical implications for SCD management and could be used by providers when making treatment decisions. Further research is warranted to evaluate the clinical utility and applicability of the Sickle Erythrocyte Health Index in diverse patient populations.

Role of hydroxyurea therapy in the prevention of organ damage in sickle cell disease: a systematic review and meta-analysis

BACKGROUND

Hydroxyurea is an affordable drug that reduces vaso-occlusive crises and transfusion requirements in sickle cell disease. However, its effectiveness in preventing chronic organ damage is still unclear. This systematic review and meta-analysis aimed to evaluate the role of hydroxyurea in preventing organ morbidity.

METHOD

We included original articles published in English from 1st January 1990 to 31st January 2023, reporting hydroxyurea therapy and organ damage from PubMed, Google Scholar, Scopus, and CrossRef databases. A total of 45 studies with 4681 sickle cell disease patients were evaluated for organ damage.

RESULTS

Our analysis showed that hydroxyurea intervention significantly lowered transcranial Doppler and tricuspid regurgitant velocity, with a standardized mean difference of - 1.03 (- 1.49; - 0.58); I 2 = 96% and - 1.37 (CI - 2.31, - 0.42); I 2 = 94%, respectively. Moreover, the pooled estimate for albuminuria showed a beneficial effect post-hydroxyurea therapy by reducing the risk of albuminuria by 58% (risk ratio of 0.42 (0.28; 0.63); I 2 = 28%).

CONCLUSION

Our study found that a hydroxyurea dose above 20 mg/kg/day with a mean rise in HbF by 18.46% post-hydroxyurea therapy had a beneficial role in reducing transcranial doppler velocity, tricuspid regurgitant velocity, albuminuria, and splenic abnormality.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023401187.

Nurses' Attitudes Concerning Analgesia Administration for Pediatric Patients with Sickle Cell Disease in Jordan: A Cross-Sectional Study

BACKGROUND

Pain management of vaso-occlusive crises is a fundamental priority in the lifelong care of children and adolescents with sickle cell disease.

AIM

This study examined nurses' attitudes towards caring for children with sickle cell disease (SCD) and SCD pain management in those with vaso-occlusive pain.

METHOD

A structured, self-reporting survey was provided to a convenience sample of 298 nurses across 10 hospitals serving Jordan's northern and middle regions. Descriptive and inferential statistics were applied for data analysis.

RESULTS

Most nurses (77%) perceived their experience caring for children with SCD as positive. Many nurses (65%) felt frustrated about caring for these children during painful episodes. Participants identified workload and inadequate time as limiting their ability to address the analgesic needs of children with SCD. Receiving structured education specialized in pain management and more years of experience in nursing significantly predicted less hesitancy in administering opioid-based analgesia.

CONCLUSIONS

The results of this study provided further insight into factors that potentially contribute to vaso-occlusive pain crises frequently being poorly managed and inadequately addressed among pediatric patients. Nurses' attitudes and understanding of SCD pain management must be addressed to advance the clinical practice of managing pain in children with SCD.

Sickle Cell Disease Update: New Treatments and Challenging Nutritional Interventions

Sickle cell disease (SCD), a distinctive and often overlooked illness in the 21st century, is a congenital blood disorder characterized by considerable phenotypic diversity. It comprises a group of disorders, with sickle cell anemia (SCA) being the most prevalent and serious genotype. Although there have been some systematic reviews of global data, worldwide statistics regarding SCD prevalence, morbidity, and mortality remain scarce. In developed countries with a lower number of sickle cell patients, cutting-edge technologies have led to the development of new treatments. However, in developing settings where sickle cell disease (SCD) is more prevalent, medical management, rather than a cure, still relies on the use of hydroxyurea, blood transfusions, and analgesics. This is a disease that affects red blood cells, consequently affecting most organs in diverse manners. We discuss its etiology and the advent of new technologies, but the aim of this study is to understand the various types of nutrition-related studies involving individuals suffering from SCD, particularly in Africa. The interplay of the environment, food, gut microbiota, along with their respective genomes collectively known as the gut microbiome, and host metabolism is responsible for mediating host metabolic phenotypes and modulating gut microbiota. In addition, it serves the purpose of providing essential nutrients. Moreover, it engages in direct interactions with host homeostasis and the immune system, as well as indirect interactions via metabolites. Nutrition interventions and nutritional care are mechanisms for addressing increased nutrient expenditures and are important aspects of supportive management for patients with SCD. Underprivileged areas in Sub-Saharan Africa should be accompanied by efforts to define and promote of the nutritional aspects of SCD. Their importance is key to maintaining well-being and quality of life, especially because new technologies and products remain limited, while the use of native medicinal plant resources is acknowledged.

Comparing Hearing Loss in Children with Adults Living with Sickle Cell Disease and Sickle Cell Traits

BACKGROUND

Hearing loss is a neurological sequelae associated with sickle cell disease (SCD) and probably sickle cell trait (SCT) in children and adults but remains understudied.

AIM

This study aimed to compare the hearing impairment among children and adults living with SCD or SCT.

METHODS

A comparative cross-sectional study conducted in four departments with SCD outpatient clinic in a tertiary hospital in Nigeria. Participants with Sickle cell disease (HbSS) and Sickle cell trait (HbAS) (cohort) and HbAA (control) had comprehensive ear and hearing assessments for sensorineural hearing loss. Audiometric results were categorized according to WHO classifications and data analysed with Statistical Analysis System (SAS 9.4).

RESULTS

A total of 212 participants (106 cohort and control, respectively), aged 6 months to 55 years, were enrolled. Of these, 35% of children with SCD and 25% with SCT had hearing impairment, while 30% of adults with SCD, 36.1% with SCT, and 11% with HbAA had hearing impairment. There was asymmetry in the hearing impairment, with the left ear more affected in children and the right ear in adults. The odds ratio (OD) of hearing impairment was higher in HbSS (2.48 (95% confidence interval (CI):1.51-4.14); P = 0.0004) and HbAS (2.28 (95% CI: 1.1-4.58); P = 0.02) participants compared with HbAA but was not statistically significant when adjusted for frequency of hospitalization, crises, blood transfusion and routine drugs in HbAS (P = 0.49) unlike HbSS (P = 0.03).

CONCLUSION

The prevalence of hearing loss among children and adults with SCD is higher than in those with HbA genotype. The frequency of hospitalization, crises, blood transfusion and taking routine drugs may influence hearing impairment in SCT but may not in SCD.