1
|
Mbiandjeu SCT, Siciliano A, Mattè A, Federti E, Perduca M, Melisi D, Andolfo I, Amoresano A, Iolascon A, Valenti MT, Turrini F, Bovi M, Pisani A, Recchiuti A, Mattoscio D, Riccardi V, Dalle Carbonare L, Brugnara C, Mohandas N, De Franceschi L. Nrf2 Plays a Key Role in Erythropoiesis during Aging. Antioxidants (Basel) 2024; 13:454. [PMID: 38671902 PMCID: PMC11047311 DOI: 10.3390/antiox13040454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Aging is characterized by increased oxidation and reduced efficiency of cytoprotective mechanisms. Nuclear factor erythroid-2-related factor (Nrf2) is a key transcription factor, controlling the expression of multiple antioxidant proteins. Here, we show that Nrf2-/- mice displayed an age-dependent anemia, due to the combined contributions of reduced red cell lifespan and ineffective erythropoiesis, suggesting a role of Nrf2 in erythroid biology during aging. Mechanistically, we found that the expression of antioxidants during aging is mediated by activation of Nrf2 function by peroxiredoxin-2. The absence of Nrf2 resulted in persistent oxidation and overactivation of adaptive systems such as the unfolded protein response (UPR) system and autophagy in Nrf2-/- mouse erythroblasts. As Nrf2 is involved in the expression of autophagy-related proteins such as autophagy-related protein (Atg) 4-5 and p62, we found impairment of late phase of autophagy in Nrf2-/- mouse erythroblasts. The overactivation of the UPR system and impaired autophagy drove apoptosis of Nrf2-/- mouse erythroblasts via caspase-3 activation. As a proof of concept for the role of oxidation, we treated Nrf2-/- mice with astaxanthin, an antioxidant, in the form of poly (lactic-co-glycolic acid) (PLGA)-loaded nanoparticles (ATS-NPs) to improve its bioavailability. ATS-NPs ameliorated the age-dependent anemia and decreased ineffective erythropoiesis in Nrf2-/- mice. In summary, we propose that Nrf2 plays a key role in limiting age-related oxidation, ensuring erythroid maturation and growth during aging.
Collapse
Affiliation(s)
| | - Angela Siciliano
- Dipartimento Ingegneria per la Medicina di Innovazione—DIMI, University of Verona, 37134 Verona, Italy; (A.S.); (E.F.); (V.R.); (L.D.C.)
- Department of Medicine, AOUI Verona, 37134 Verona, Italy
| | - Alessandro Mattè
- Department of Medicine, University of Verona, 37134 Verona, Italy; (S.C.T.M.); (A.M.); (D.M.)
| | - Enrica Federti
- Dipartimento Ingegneria per la Medicina di Innovazione—DIMI, University of Verona, 37134 Verona, Italy; (A.S.); (E.F.); (V.R.); (L.D.C.)
- Department of Medicine, AOUI Verona, 37134 Verona, Italy
| | - Massimiliano Perduca
- Department of Biotechnology, University of Verona, 37134 Verona, Italy; (M.P.); (M.B.); (A.P.)
| | - Davide Melisi
- Department of Medicine, University of Verona, 37134 Verona, Italy; (S.C.T.M.); (A.M.); (D.M.)
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (I.A.); (A.I.)
- CEINGE Biotecnologie Avanzate, 80131 Naples, Italy
| | - Angela Amoresano
- Department of Chimical Sciences, University Federico II, 80138 Naples, Italy;
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (I.A.); (A.I.)
- CEINGE Biotecnologie Avanzate, 80131 Naples, Italy
| | | | | | - Michele Bovi
- Department of Biotechnology, University of Verona, 37134 Verona, Italy; (M.P.); (M.B.); (A.P.)
| | - Arianna Pisani
- Department of Biotechnology, University of Verona, 37134 Verona, Italy; (M.P.); (M.B.); (A.P.)
| | - Antonio Recchiuti
- Department of Medical, Oral, and Biotechnology Science, “G. d’Annunzio” University Chieti–Pescara, 66013 Chieti, Italy; (A.R.); (D.M.)
| | - Domenico Mattoscio
- Department of Medical, Oral, and Biotechnology Science, “G. d’Annunzio” University Chieti–Pescara, 66013 Chieti, Italy; (A.R.); (D.M.)
| | - Veronica Riccardi
- Dipartimento Ingegneria per la Medicina di Innovazione—DIMI, University of Verona, 37134 Verona, Italy; (A.S.); (E.F.); (V.R.); (L.D.C.)
| | - Luca Dalle Carbonare
- Dipartimento Ingegneria per la Medicina di Innovazione—DIMI, University of Verona, 37134 Verona, Italy; (A.S.); (E.F.); (V.R.); (L.D.C.)
- Department of Medicine, AOUI Verona, 37134 Verona, Italy
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, MA 02114, USA;
- Department of Pathology, Harvard Medical School, Boston, MA 02114, USA
| | - Narla Mohandas
- New York Blood Center Enterprises, New York, NY 10065, USA;
| | - Lucia De Franceschi
- Dipartimento Ingegneria per la Medicina di Innovazione—DIMI, University of Verona, 37134 Verona, Italy; (A.S.); (E.F.); (V.R.); (L.D.C.)
- Department of Medicine, AOUI Verona, 37134 Verona, Italy
| |
Collapse
|
2
|
Mattè A, Federti E, Recchiuti A, Hamza M, Ferri G, Riccardi V, Ceolan J, Passarini A, Mazzi F, Siciliano A, Bhatt DL, Coughlan D, Climax J, Gremese E, Brugnara C, De Franceschi L. Epeleuton, a novel synthetic ω-3 fatty acid, reduces the hypoxia/reperfusion stress in a mouse model of sickle cell disease. Haematologica 2023:0-0. [PMID: 38105727 DOI: 10.3324/haematol.2023.284028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Indexed: 12/19/2023] Open
Abstract
Inflammatory vasculopathy is critical in sickle cell disease (SCD)-associated organ damage. An imbalance between pro-inflammatory and pro-resolving mechanisms in response to different triggers such as hypoxia/reoxygenation or infections has been proposed to contribute to SCD disease progression. Administration of specialized pro-resolving lipid mediators may provide an effective therapeutic strategy to target inflammatory vasculopathy and to modulate inflammatory response. Epeleuton (15 hydroxy eicosapentaenoic acid ethyl ester) is a novel orally administered second-generation ω-3 fatty acid with a favorable clinical safety profile. In this study we show that epeleuton re-programs the lipidomic pattern of target organs for SCD towards a pro-resolving pattern. This protects against systemic and local inflammatory response and improves red cell features, resulting in reduced hemolysis and sickling compared with vehicle treated SCD mice. In addition, epeleuton prevents the hypoxia/reoxygenation induced activation of NF-kB with downregulation of NLRP3 inflammasome in lung, kidney, and liver. This was associated with down-regulation of vascular activation markers in epeleuton treated SCD mice when compared to vehicle treated animals. Collectively our data support the potential therapeutic utility of epeleuton and provide the rationale for the design of clinical trials to evaluate the efficacy of epeleuton in patients with SCD.
Collapse
Affiliation(s)
- Alessandro Mattè
- Department of Medicine, University of Verona and AOUI Verona, Verona
| | - Enrica Federti
- Department of Medicine, University of Verona and AOUI Verona, Verona
| | - Antonio Recchiuti
- Department of Medical, Oral, and Biotechnology Science, "G. d'Annunzio"University Chieti - Pescara
| | | | - Giulia Ferri
- Department of Medical, Oral, and Biotechnology Science, "G. d'Annunzio"University Chieti - Pescara
| | - Veronica Riccardi
- Department of Medicine, University of Verona and AOUI Verona, Verona
| | - Jacopo Ceolan
- Department of Medicine, University of Verona and AOUI Verona, Verona
| | - Alice Passarini
- Department of Medicine, University of Verona and AOUI Verona, Verona
| | - Filippo Mazzi
- Department of Medicine, University of Verona and AOUI Verona, Verona
| | - Angela Siciliano
- Department of Medicine, University of Verona and AOUI Verona, Verona
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Elisa Gremese
- Division of Clinical Immunology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Immunology Core Facility, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Department of Pathology, Harvard Medical School, Boston, MA, USA.
| | | |
Collapse
|
3
|
Matte A, Wilson AB, Gevi F, Federti E, Recchiuti A, Ferri G, Brunati AM, Pagano MA, Russo R, Leboeuf C, Janin A, Timperio AM, Iolascon A, Gremese E, Dang L, Mohandas N, Brugnara C, De Franceschi L. Mitapivat reprograms the RBC metabolome and improves anemia in a mouse model of hereditary spherocytosis. JCI Insight 2023; 8:e172656. [PMID: 37676741 PMCID: PMC10619498 DOI: 10.1172/jci.insight.172656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/05/2023] [Indexed: 09/09/2023] Open
Abstract
Hereditary spherocytosis (HS) is the most common, nonimmune, hereditary, chronic hemolytic anemia after hemoglobinopathies. The genetic defects in membrane function causing HS lead to perturbation of the RBC metabolome, with altered glycolysis. In mice genetically lacking protein 4.2 (4.2-/-; Epb42), a murine model of HS, we showed increased expression of pyruvate kinase (PK) isoforms in whole and fractioned RBCs in conjunction with abnormalities in the glycolytic pathway and in the glutathione (GSH) system. Mitapivat, a PK activator, metabolically reprogrammed 4.2-/- mouse RBCs with amelioration of glycolysis and the GSH cycle. This resulted in improved osmotic fragility, reduced phosphatidylserine positivity, amelioration of RBC cation content, reduction of Na/K/Cl cotransport and Na/H-exchange overactivation, and decrease in erythroid vesicles release in vitro. Mitapivat treatment significantly decreased erythrophagocytosis and beneficially affected iron homeostasis. In mild-to-moderate HS, the beneficial effect of splenectomy is still controversial. Here, we showed that splenectomy improves anemia in 4.2-/- mice and that mitapivat is noninferior to splenectomy. An additional benefit of mitapivat treatment was lower expression of markers of inflammatory vasculopathy in 4.2-/- mice with or without splenectomy, indicating a multisystemic action of mitapivat. These findings support the notion that mitapivat treatment should be considered for symptomatic HS.
Collapse
Affiliation(s)
- Alessandro Matte
- Department of Medicine, University of Verona, and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Anand B. Wilson
- Department of Medicine, University of Verona, and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Federica Gevi
- Department of Ecological and Biological Sciences, University of Tuscia, Viterbo, Italy
| | - Enrica Federti
- Department of Medicine, University of Verona, and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Antonio Recchiuti
- Department of Medical, Oral, and Biotechnology Science, “G.d’Annunzio” University of Chieti – Pescara, Center for Advanced Studies and Technology, Chieti, Italy
| | - Giulia Ferri
- Department of Medical, Oral, and Biotechnology Science, “G.d’Annunzio” University of Chieti – Pescara, Center for Advanced Studies and Technology, Chieti, Italy
| | | | | | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Christophe Leboeuf
- INSERM, Paris, France
- Université Paris 7 — Denis Diderot, Paris, France
- Assistance Publique — Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Anne Janin
- INSERM, Paris, France
- Université Paris 7 — Denis Diderot, Paris, France
- Assistance Publique — Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Anna Maria Timperio
- Department of Ecological and Biological Sciences, University of Tuscia, Viterbo, Italy
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Elisa Gremese
- Division of Clinical Immunology, Fondazione Policlinico Universitario A. Gemelli–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
- Immunology Core Facility, Fondazione Policlinico Universitario A. Gemelli–IRCCS, Rome, Italy
| | - Lenny Dang
- Agios Pharmaceuticals Inc., Cambridge, Massachusetts, USA
| | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucia De Franceschi
- Department of Medicine, University of Verona, and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| |
Collapse
|
4
|
Mattè A, Kosinski PA, Federti E, Dang L, Recchiuti A, Russo R, Siciliano A, Riccardi V, Janin A, Mucci M, Leboeuf C, Iolascon A, Brugnara C, De Franceschi L. Mitapivat, a pyruvate kinase activator, improves transfusion burden and reduces iron overload in β-thalassemic mice. Haematologica 2023; 108:2535-2541. [PMID: 36794508 PMCID: PMC10483370 DOI: 10.3324/haematol.2022.282614] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Not available.
Collapse
Affiliation(s)
| | | | | | - Lenny Dang
- Agios Pharmaceuticals, Inc., Cambridge, MA
| | - Antonio Recchiuti
- Dept. of Medical, Oral and Biotechnology Science, "G. d'Annunzio" University of Chieti, Chieti
| | - Roberta Russo
- Dept. of Molecular Medicine and Medical Biotechnology and CEINGE, University of Naples Federico II, Naples
| | | | | | | | - Matteo Mucci
- Dept. of Medical, Oral and Biotechnology Science, "G. d'Annunzio" University of Chieti, Chieti
| | | | - Achille Iolascon
- Dept. of Molecular Medicine and Medical Biotechnology and CEINGE, University of Naples Federico II, Naples
| | - Carlo Brugnara
- Department of Laboratory Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA (USA)
| | | |
Collapse
|
5
|
Pincez T, Lo KS, D'Orengiani ALPHD, Garrett ME, Brugnara C, Ashley-Koch AE, Telen MJ, Galacteros F, Joly P, Bartolucci P, Lettre G. Variation and impact of polygenic hematologic traits in monogenic sickle cell disease. Haematologica 2023; 108:870-881. [PMID: 36226494 PMCID: PMC9973495 DOI: 10.3324/haematol.2022.281180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 11/09/2022] Open
Abstract
Several of the complications observed in sickle cell disease (SCD) are influenced by variation in hematologic traits (HT), such as fetal hemoglobin (HbF) level and neutrophil count. Previous large-scale genome-wide association studies carried out in largely healthy individuals have identified thousands of variants associated with HT, which have then been used to develop multi-ancestry polygenic trait scores (PTS). Here, we tested whether these PTS associate with HT in SCD patients and if they can improve statistical models associated with SCD-related complications. In 2,056 SCD patients, we found that the PTS predicted less HT variance than in non-SCD individuals of African ancestry. This was particularly striking at the Duffy/DARC locus, where we observed an epistatic interaction between the SCD genotype and the Duffy null variant (rs2814778) that led to a two-fold weaker effect on neutrophil count. PTS for these HT which are measured as part of routine practice were not associated with complications in SCD. In contrast, we found that a simple PTS for HbF that includes only six variants explained a large fraction of the phenotypic variation (20.5-27.1%), associated with acute chest syndrome and stroke risk, and improved the statistical modeling of the vaso-occlusive crisis rate. Using Mendelian randomization, we found that increasing HbF by 4.8% reduces stroke risk by 39% (P=0.0006). Taken together, our results highlight the importance of validating PTS in large diseased populations before proposing their implementation in the context of precision medicine initiatives.
Collapse
Affiliation(s)
- Thomas Pincez
- Montreal Heart Institute, Montreal, Quebec, Canada; Department of Pediatrics, Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Universite de Montreal, Montreal, Quebec
| | - Ken Sin Lo
- Montreal Heart Institute, Montreal, Quebec
| | | | - Melanie E Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA
| | | | - Marilyn J Telen
- Department of Medicine, Division of Hematology, Duke University Medical Center, Durham, NC
| | - Frederic Galacteros
- Red Cell Genetic Disease Unit, Hopital Henri-Mondor, Assistance Publique-Hopitaux de Paris (AP-HP), Universite Paris Est, IMRB - U955 - Equipe no 2, Creteil
| | - Philippe Joly
- Unite Fonctionnelle 34445 'Biochimie des Pathologies Erythrocytaires', Laboratoire de Biochimie et Biologie Moleculaire Grand-Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France; Laboratoire Inter-Universitaire de Biologie de la Motricite (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge', Universite Claude Bernard Lyon 1, Comite d'Universites et d'Etablissements (COMUE), Lyon
| | - Pablo Bartolucci
- Red Cell Genetic Disease Unit, Hopital Henri-Mondor, Assistance Publique-Hopitaux de Paris (AP-HP), Universite Paris Est, IMRB - U955 - Equipe no 2, Creteil
| | - Guillaume Lettre
- Montreal Heart Institute, Montreal, Quebec, Canada; Department of Medicine, Faculty of Medicine, Universite de Montreal, Montreal, Quebec.
| |
Collapse
|
6
|
Brugnara C. Immune therapies in the treatment of multiple myeloma. Am J Hematol 2023; 98 Suppl 2:S3. [PMID: 36694279 DOI: 10.1002/ajh.26843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, and Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Brugnara C. Immune Therapies in the Treatment of Multiple Myeloma. Am J Hematol 2023. [PMID: 36660795 DOI: 10.1002/ajh.26851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Affiliation(s)
- Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, and Department of Pathology, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Minniti C, Brugnara C, Steinberg MH. HbSC disease: A time for progress. Am J Hematol 2022; 97:1390-1393. [PMID: 36073655 DOI: 10.1002/ajh.26702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Caterina Minniti
- Division of Hematology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Martin H Steinberg
- Division of Hematology and Medical Oncology, Department of Medicine, Center of Excellence for Sickle Cell Disease, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Rivera A, Nasburg JA, Shim H, Shmukler BE, Kitten J, Wohlgemuth JG, Dlott JS, Snyder LM, Brugnara C, Wulff H, Alper SL. The erythroid K-Cl cotransport inhibitor [(dihydroindenyl)oxy]acetic acid blocks erythroid Ca 2+-activated K + channel KCNN4. Am J Physiol Cell Physiol 2022; 323:C694-C705. [PMID: 35848620 PMCID: PMC9448282 DOI: 10.1152/ajpcell.00240.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022]
Abstract
Red cell volume is a major determinant of HbS concentration in sickle cell disease. Cellular deoxy-HbS concentration determines the delay time, the interval between HbS deoxygenation and deoxy-HbS polymerization. Major membrane transporter protein determinants of sickle red cell volume include the SLC12/KCC K-Cl cotransporters KCC3/SLC12A6 and KCC1/SLC12A4, and the KCNN4/KCa3.1 Ca2+-activated K+ channel (Gardos channel). Among standard inhibitors of KCC-mediated K-Cl cotransport, only [(dihydroindenyl)oxy]acetic acid (DIOA) has been reported to lack inhibitory activity against the related bumetanide-sensitive erythroid Na-K-2Cl cotransporter NKCC1/SLC12A2. DIOA has been often used to inhibit K-Cl cotransport when studying the expression and regulation of other K+ transporters and K+ channels. We report here that DIOA at concentrations routinely used to inhibit K-Cl cotransport can also abrogate activity of the KCNN4/KCa3.1 Gardos channel in human and mouse red cells and in human sickle red cells. DIOA inhibition of A23187-stimulated erythroid K+ uptake (Gardos channel activity) was chloride-independent and persisted in mouse red cells genetically devoid of the principal K-Cl cotransporters KCC3 and KCC1. DIOA also inhibited YODA1-stimulated, chloride-independent erythroid K+ uptake. In contrast, DIOA exhibited no inhibitory effect on K+ influx into A23187-treated red cells of Kcnn4-/- mice. DIOA inhibition of human KCa3.1 was validated (IC50 42 µM) by whole cell patch clamp in HEK-293 cells. RosettaLigand docking experiments identified a potential binding site for DIOA in the fenestration region of human KCa3.1. We conclude that DIOA at concentrations routinely used to inhibit K-Cl cotransport can also block the KCNN4/KCa3.1 Gardos channel in normal and sickle red cells.
Collapse
Affiliation(s)
- Alicia Rivera
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Joshua A Nasburg
- Department of Pharmacology, School of Medicine, University of California, Davis, California
| | - Heesung Shim
- Department of Pharmacology, School of Medicine, University of California, Davis, California
| | - Boris E Shmukler
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Heike Wulff
- Department of Pharmacology, School of Medicine, University of California, Davis, California
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
10
|
Federti E, Matte’ A, Hamza M, Lafferty A, Coughlan D, Weissbach M, Bhatt DL, Riccardi V, Perissinotto R, Siciliano A, Climax J, Brugnara C, De Franceschi L. P1483: EPELEUTON, A NOVEL SYNTHETIC SECOND GENERATION W-3 FATTY ACID, PROTECTS HUMANIZED SICKLE CELL MICE AGAINST HYPOXIA/REOXYGENATION ORGAN DAMAGE. Hemasphere 2022. [PMCID: PMC9429060 DOI: 10.1097/01.hs9.0000848788.30039.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
11
|
Shmukler BE, Rivera A, Nishimura K, Hsu A, Wohlgemuth JG, Dlott JS, Michael Snyder L, Brugnara C, Alper SL. Erythroid-specific inactivation of Slc12a6/Kcc3 by EpoR promoter-driven Cre expression reduces K-Cl cotransport activity in mouse erythrocytes. Physiol Rep 2022; 10:e15186. [PMID: 35274823 PMCID: PMC8915159 DOI: 10.14814/phy2.15186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
Investigation of erythrocytes from spontaneous or engineered germ‐line mutant mice has been instrumental in characterizing the physiological functions of components of the red cell cytoskeleton and membrane. However, the red blood cell expresses some proteins whose germline loss‐of‐function is embryonic‐lethal, perinatal‐lethal, or confers reduced post‐weaning viability. Promoter regions of erythroid‐specific genes have been used to engineer erythroid‐specific expression of Cre recombinase. Through breeding with mice carrying appropriately spaced insertions of loxP sequences, generation of erythroid‐specific knockouts has been carried out for signaling enzymes, transcription factors, peptide hormones, and single transmembrane span signaling receptors. We report here the use of Cre recombinase expression driven by the erythropoietin receptor (EpoR) promoter to generate EpoR‐Cre;Kcc3f/f mice, designed to express erythroid‐specific knockout of the KCC3 K‐Cl cotransporter encoded by Kcc3/Slc12A6. We confirm KCC3 as the predominant K‐Cl cotransporter of adult mouse red cells in mice with better viability than previously exhibited by Kcc3−/− germline knockouts. We demonstrate roughly proportionate preservation of K‐Cl stimulation by hypotonicity, staurosporine, and urea in the context of reduced, but not abrogated, K‐Cl function in EpoR‐Cre;Kcc3f/f mice. We also report functional evidence suggesting incomplete recombinase‐mediated excision of the Kcc3 gene in adult erythroid tissues.
Collapse
Affiliation(s)
- Boris E Shmukler
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alicia Rivera
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Katherine Nishimura
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ann Hsu
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | | | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Seth L Alper
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Brugnara C. Diagnostics with modern genomics. Am J Hematol 2021; 96:E447. [PMID: 34536026 DOI: 10.1002/ajh.26353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital Harvard Medical School Boston Massachusetts USA
| |
Collapse
|
13
|
Equey T, Sletten C, Dehnes Y, D'Onofrio G, Brugnara C, Baume N, Aikin R. Standardization of reticulocyte counts in the athlete biological passport: A practical update. Int J Lab Hematol 2021; 44:112-117. [PMID: 34709714 DOI: 10.1111/ijlh.13732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The athlete biological passport monitors blood variables over time to uncover blood doping. With the phasing in of a new series of blood analyzers, the Sysmex XN series, it was necessary to examine the comparability of results with the previously employed XT/XE series. A previous comparison between XN and XT/XE series suggested a small but significant bias between the two instruments in the measurements of RET%. Here, we examined the comparability of RET% on the XN and XT/XE platform using data collected over the first year since the transition. METHODS The comparability of results obtained from XN and XT/XE instruments was assessed using three datasets: (i) 767 blood samples measured on both instrument series in 22 WADA-accredited laboratories, (ii) 27 323 samples measured on either instrument across 31 laboratories, and (iii) 119 clinical samples and 110 anti-doping samples measured on both instruments in a single laboratory. RESULTS Analysis of the three datasets confirms the previous observation of a bias toward higher RET% values for samples measured on Sysmex XN instruments compared with the XT/XE series. Using data across a larger number of XN instruments and a larger athlete population, the current work suggests that the bias is proportional and slightly higher than previously observed across most of the range RET% values. CONCLUSION A model is proposed for the comparison of data across XN and XT/XE technologies whereby the instrument bias increases proportionally with RET% measured on Sysmex XN Series, but where the rate of increase is negatively related to IRF%.
Collapse
Affiliation(s)
| | - Camilla Sletten
- Norwegian Doping Control Laboratory, Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Yvette Dehnes
- Norwegian Doping Control Laboratory, Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | | | - Carlo Brugnara
- Department of Laboratory of Medicine, Boston Children's Hospital, & Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Reid Aikin
- World Anti-Doping Agency, Montreal, Quebec, Canada
| |
Collapse
|
14
|
Bachar N, Benbassat D, Brailovsky D, Eshel Y, Glück D, Levner D, Levy S, Pecker S, Yurkovsky E, Zait A, Sever C, Kratz A, Brugnara C. An artificial intelligence-assisted diagnostic platform for rapid near-patient hematology. Am J Hematol 2021; 96:1264-1274. [PMID: 34264525 PMCID: PMC9290600 DOI: 10.1002/ajh.26295] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022]
Abstract
Hematology analyzers capable of performing complete blood count (CBC) have lagged in their prevalence at the point‐of‐care. Sight OLO (Sight Diagnostics, Israel) is a novel hematological platform which provides a 19‐parameter, five‐part differential CBC, and is designed to address the limitations in current point‐of‐care hematology analyzers using recent advances in artificial intelligence (AI) and computer vision. Accuracy, repeatability, and flagging capabilities of OLO were compared with the Sysmex XN‐Series System (Sysmex, Japan). Matrix studies compared performance using venous, capillary and direct‐from‐fingerprick blood samples. Regression analysis shows strong concordance between OLO and the Sysmex XN, demonstrating that OLO performs with high accuracy for all CBC parameters. High repeatability and reproducibility were demonstrated for most of the testing parameters. The analytical performance of the OLO hematology analyzer was validated in a multicenter clinical laboratory setting, demonstrating its accuracy and comparability to clinical laboratory‐based hematology analyzers. Furthermore, the study demonstrated the validity of CBC analysis of samples collected directly from fingerpricks.
Collapse
Affiliation(s)
- Neta Bachar
- S.D. Sight Diagnostics LTD Tel Aviv‐Jaffa Israel
| | | | | | - Yochay Eshel
- S.D. Sight Diagnostics LTD Tel Aviv‐Jaffa Israel
| | - Dan Glück
- S.D. Sight Diagnostics LTD Tel Aviv‐Jaffa Israel
| | | | - Sarah Levy
- S.D. Sight Diagnostics LTD Tel Aviv‐Jaffa Israel
| | | | | | - Amir Zait
- S.D. Sight Diagnostics LTD Tel Aviv‐Jaffa Israel
| | - Cordelia Sever
- TriCore Reference Laboratories Albuquerque New Mexico USA
| | - Alexander Kratz
- Department of Pathology and Cell Biology Columbia University College of Physicians and Surgeons New York New York USA
- New York‐Presbyterian Hospital New York New York USA
| | - Carlo Brugnara
- Department of Laboratory Medicine Boston Children's Hospital Boston Massachusetts USA
- Department of Pathology Harvard Medical School Boston Massachusetts USA
| |
Collapse
|
15
|
Arze CA, Springer S, Dudas G, Patel S, Bhattacharyya A, Swaminathan H, Brugnara C, Delagrave S, Ong T, Kahvejian A, Echelard Y, Weinstein EG, Hajjar RJ, Andersen KG, Yozwiak NL. Global genome analysis reveals a vast and dynamic anellovirus landscape within the human virome. Cell Host Microbe 2021; 29:1305-1315.e6. [PMID: 34320399 DOI: 10.1016/j.chom.2021.07.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/23/2021] [Accepted: 06/11/2021] [Indexed: 12/14/2022]
Abstract
Anelloviruses are a ubiquitous component of healthy human viromes and remain highly prevalent after being acquired early in life. The full extent of "anellome" diversity and its evolutionary dynamics remain unexplored. We employed in-depth sequencing of blood-transfusion donor(s)-recipient pairs coupled with public genomic resources for a large-scale assembly of anellovirus genomes and used the data to characterize global and personal anellovirus diversity through time. The breadth of the anellome is much greater than previously appreciated, and individuals harbor unique anellomes and transmit lineages that can persist for several months within a diverse milieu of endemic host lineages. Anellovirus sequence diversity is shaped by extensive recombination at all levels of divergence, hindering traditional phylogenetic analyses. Our findings illuminate the transmission dynamics and vast diversity of anelloviruses and set the foundation for future studies to characterize their biology.
Collapse
Affiliation(s)
| | | | - Gytis Dudas
- Gothenburg Global Biodiversity Centre, Gothenburg 413 19, Sweden
| | | | | | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | | | - Tuyen Ong
- Ring Therapeutics, Cambridge, MA 02139, USA
| | - Avak Kahvejian
- Ring Therapeutics, Cambridge, MA 02139, USA; Flagship Pioneering, Cambridge, MA 02142, USA
| | - Yann Echelard
- Ring Therapeutics, Cambridge, MA 02139, USA; Flagship Pioneering, Cambridge, MA 02142, USA
| | - Erica G Weinstein
- Ring Therapeutics, Cambridge, MA 02139, USA; Flagship Pioneering, Cambridge, MA 02142, USA
| | - Roger J Hajjar
- Ring Therapeutics, Cambridge, MA 02139, USA; Flagship Pioneering, Cambridge, MA 02142, USA
| | | | | |
Collapse
|
16
|
Vandorpe DH, Shmukler BE, Ilboudo Y, Bhasin S, Thomas B, Rivera A, Wohlgemuth JG, Dlott JS, Snyder LM, Sieff C, Bhasin M, Lettre G, Brugnara C, Alper SL. A Grammastola spatulata mechanotoxin-4 (GsMTx4)-sensitive cation channel mediates increased cation permeability in human hereditary spherocytosis of multiple genetic etiologies. Haematologica 2021; 106:2759-2762. [PMID: 34109777 PMCID: PMC8485688 DOI: 10.3324/haematol.2021.278770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- David H Vandorpe
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | - Boris E Shmukler
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | - Yann Ilboudo
- Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada, H1T 1C8
| | - Swati Bhasin
- Division of Integrative Medicine and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | - Beena Thomas
- Division of Integrative Medicine and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | - Alicia Rivera
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | | | | | | | - Colin Sieff
- Cancer and Blood Disorders Center, Dana-Farber Cancer Center and Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA 02115
| | - Manoj Bhasin
- Division of Integrative Medicine and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | - Guillaume Lettre
- Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada, H1T 1C8
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital and Department of Pathology, Harvard Medical School, Boston, MA 02115
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215.
| |
Collapse
|
17
|
Auerbach M, Staffa SJ, Brugnara C. Using Reticulocyte Hemoglobin Equivalent as a Marker for Iron Deficiency and Responsiveness to Iron Therapy. Mayo Clin Proc 2021; 96:1510-1519. [PMID: 33952394 DOI: 10.1016/j.mayocp.2020.10.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/25/2020] [Accepted: 10/13/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the accuracy of a simplified approach for the diagnosis of iron deficiency anemia (IDA) based on the complete blood cell count (CBC) and reticulocyte analysis. PATIENTS AND METHODS Five hundred fifty-six consecutive, nonselected patients referred for diagnosis and/or treatment of anemia were included in this diagnostic study to compare the performance of reticulocyte hemoglobin equivalent (RET-He) versus traditional biochemical markers for diagnosis and treatment of IDA. Complete blood count, serum ferritin, iron, and transferrin saturation were performed as clinically indicated. Reticulocyte hemoglobin equivalent was measured with a Sysmex XN-450 analyzer on the residual CBC sample. The study period was from September 20, 2017, through and including November 15, 2018. RESULTS Patients (N=556) were studied at baseline, of whom 150 were subsequently treated with intravenous iron. Receiver operating characteristic analysis yielded an RET-He cut-off of 30.7 pg to identify IDA (area under curve, 0.733; 95% CI, 0.692 to 0.775), with 68.2% sensitivity and 69.7% specificity. Patients (n=240) were seen at follow-up, with 57 treated and 183 not treated with intravenous iron. Responsiveness was defined as a hemoglobin increase of ≥1.0 g: a combination of RET-He <28.5 pg and hemoglobin value <10.3 g/dL had 84% sensitivity and 78% specificity as response predictor (area under the curve, 0.749; 95% CI, 0.622 to 0.875). CONCLUSION Data from CBC and RET-He can identify patients with IDA, determine need for and responsiveness to intravenous iron, and reduce time for therapeutic decisions. Limitations of this study are uncontrolled design, its single-site and retrospective nature, and that it requires prospective validation.
Collapse
Affiliation(s)
- Michael Auerbach
- Department of Medicine, Georgetown University School of Medicine, Washington, DC
| | - Steven J Staffa
- Department of Anesthesia, Boston Children's Hospital, Boston, MA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, and Department of Pathology, Harvard Medical School, Boston, MA.
| |
Collapse
|
18
|
Valenti MT, Mattè A, Federti E, Puder M, Anez-Bustillos L, Deiana M, Cheri S, Minoia A, Brugnara C, Di Paolo ML, Dalle Carbonare L, De Franceschi L. Dietary ω-3 Fatty Acid Supplementation Improves Murine Sickle Cell Bone Disease and Reprograms Adipogenesis. Antioxidants (Basel) 2021; 10:antiox10050799. [PMID: 34070133 PMCID: PMC8158389 DOI: 10.3390/antiox10050799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/01/2021] [Accepted: 05/12/2021] [Indexed: 12/28/2022] Open
Abstract
Sickle cell disease (SCD) is a genetic disorder of hemoglobin, leading to chronic hemolytic anemia and multiple organ damage. Among chronic organ complications, sickle cell bone disease (SBD) has a very high prevalence, resulting in long-term disability, chronic pain and fractures. Here, we evaluated the effects of ω-3 (fish oil-based, FD)-enriched diet vs. ω-6 (soybean oil-based, SD)- supplementation on murine SBD. We exposed SCD mice to recurrent hypoxia/reoxygenation (rec H/R), a consolidated model for SBD. In rec H/R SS mice, FD improves osteoblastogenesis/osteogenic activity by downregulating osteoclast activity via miR205 down-modulation and reduces both systemic and local inflammation. We also evaluated adipogenesis in both AA and SS mice fed with either SD or FD and exposed to rec H/R. FD reduced and reprogramed adipogenesis from white to brown adipocyte tissue (BAT) in bone compartments. This was supported by increased expression of uncoupling protein 1(UCP1), a BAT marker, and up-regulation of miR455, which promotes browning of white adipose tissue. Our findings provide new insights on the mechanism of action of ω-3 fatty acid supplementation on the pathogenesis of SBD and strengthen the rationale for ω-3 fatty acid dietary supplementation in SCD as a complementary therapeutic intervention.
Collapse
Affiliation(s)
- Maria Teresa Valenti
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, 37128 Verona, Italy; (M.T.V.); (A.M.); (E.F.); (M.D.); (S.C.); (A.M.); (L.D.F.)
| | - Alessandro Mattè
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, 37128 Verona, Italy; (M.T.V.); (A.M.); (E.F.); (M.D.); (S.C.); (A.M.); (L.D.F.)
| | - Enrica Federti
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, 37128 Verona, Italy; (M.T.V.); (A.M.); (E.F.); (M.D.); (S.C.); (A.M.); (L.D.F.)
| | - Mark Puder
- Department of Surgery and The Vascular Biology Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (M.P.); (L.A.-B.)
| | - Lorenzo Anez-Bustillos
- Department of Surgery and The Vascular Biology Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (M.P.); (L.A.-B.)
| | - Michela Deiana
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, 37128 Verona, Italy; (M.T.V.); (A.M.); (E.F.); (M.D.); (S.C.); (A.M.); (L.D.F.)
| | - Samuele Cheri
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, 37128 Verona, Italy; (M.T.V.); (A.M.); (E.F.); (M.D.); (S.C.); (A.M.); (L.D.F.)
| | - Arianna Minoia
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, 37128 Verona, Italy; (M.T.V.); (A.M.); (E.F.); (M.D.); (S.C.); (A.M.); (L.D.F.)
| | - Carlo Brugnara
- Departments of Pathology and Laboratory Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | | | - Luca Dalle Carbonare
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, 37128 Verona, Italy; (M.T.V.); (A.M.); (E.F.); (M.D.); (S.C.); (A.M.); (L.D.F.)
- Correspondence: ; Tel.: +39-045-812-4401
| | - Lucia De Franceschi
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, 37128 Verona, Italy; (M.T.V.); (A.M.); (E.F.); (M.D.); (S.C.); (A.M.); (L.D.F.)
| |
Collapse
|
19
|
Taher AT, Viprakasit V, Cappellini MD, Kraus D, Cech P, Volz D, Winter E, Nave S, Dukart J, Khwaja O, Koerner A, Hermosilla R, Brugnara C. Haematological effects of oral administration of bitopertin, a glycine transport inhibitor, in patients with non-transfusion-dependent β-thalassaemia. Br J Haematol 2021; 194:474-477. [PMID: 33931857 DOI: 10.1111/bjh.17479] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ali T Taher
- Department of Internal Medicine, Division of Hematology and Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vip Viprakasit
- Department of Pediatrics and Siriraj Thalassemia Center, Division of Hematology and Oncology, Mahidol University, Bangkok, Thailand
| | | | - Dominik Kraus
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Patrick Cech
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Dietmar Volz
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Erica Winter
- Roche Pharma Research and Early Development, Roche Innovation Center New York, New York, NY, USA
| | - Stephane Nave
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Juergen Dukart
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland.,Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany.,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Omar Khwaja
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Annette Koerner
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Ricardo Hermosilla
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
20
|
Matte A, Federti E, Kung C, Kosinski PA, Narayanaswamy R, Russo R, Federico G, Carlomagno F, Desbats MA, Salviati L, Leboeuf C, Valenti MT, Turrini F, Janin A, Yu S, Beneduce E, Ronseaux S, Iatcenko I, Dang L, Ganz T, Jung CL, Iolascon A, Brugnara C, De Franceschi L. The pyruvate kinase activator mitapivat reduces hemolysis and improves anemia in a β-thalassemia mouse model. J Clin Invest 2021; 131:144206. [PMID: 33822774 DOI: 10.1172/jci144206] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/31/2021] [Indexed: 12/24/2022] Open
Abstract
Anemia in β-thalassemia is related to ineffective erythropoiesis and reduced red cell survival. Excess free heme and accumulation of unpaired α-globin chains impose substantial oxidative stress on β-thalassemic erythroblasts and erythrocytes, impacting cell metabolism. We hypothesized that increased pyruvate kinase activity induced by mitapivat (AG-348) in the Hbbth3/+ mouse model for β-thalassemia would reduce chronic hemolysis and ineffective erythropoiesis through stimulation of red cell glycolytic metabolism. Oral mitapivat administration ameliorated ineffective erythropoiesis and anemia in Hbbth3/+ mice. Increased ATP, reduced reactive oxygen species production, and reduced markers of mitochondrial dysfunction associated with improved mitochondrial clearance suggested enhanced metabolism following mitapivat administration in β-thalassemia. The amelioration of responsiveness to erythropoietin resulted in reduced soluble erythroferrone, increased liver Hamp expression, and diminished liver iron overload. Mitapivat reduced duodenal Dmt1 expression potentially by activating the pyruvate kinase M2-HIF2α axis, representing a mechanism additional to Hamp in controlling iron absorption and preventing β-thalassemia-related liver iron overload. In ex vivo studies on erythroid precursors from patients with β-thalassemia, mitapivat enhanced erythropoiesis, promoted erythroid maturation, and decreased apoptosis. Overall, pyruvate kinase activation as a treatment modality for β-thalassemia in preclinical model systems had multiple beneficial effects in the erythropoietic compartment and beyond, providing a strong scientific basis for further clinical trials.
Collapse
Affiliation(s)
- Alessandro Matte
- Department of Medicine, University of Verona, and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Enrica Federti
- Department of Medicine, University of Verona, and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Charles Kung
- Agios Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | | | | | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, and CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Giorgia Federico
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, and CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Francesca Carlomagno
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, and CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Maria Andrea Desbats
- Clinical Genetics Unit, Department of Women and Children's Health, University of Padova, and Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Leonardo Salviati
- Clinical Genetics Unit, Department of Women and Children's Health, University of Padova, and Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Christophe Leboeuf
- Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Université Paris 7 - Denis Diderot, Paris, France.,AP-HP, Hôpital Saint-Louis, Paris, France
| | - Maria Teresa Valenti
- Department of Medicine, University of Verona, and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | | | - Anne Janin
- Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Université Paris 7 - Denis Diderot, Paris, France.,AP-HP, Hôpital Saint-Louis, Paris, France
| | - Shaoxia Yu
- Agios Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Elisabetta Beneduce
- Department of Medicine, University of Verona, and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | | | - Iana Iatcenko
- Department of Medicine, University of Verona, and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Lenny Dang
- Agios Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Tomas Ganz
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Chun-Ling Jung
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, and CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucia De Franceschi
- Department of Medicine, University of Verona, and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| |
Collapse
|
21
|
Clark MA, Kanjee U, Rangel GW, Chery L, Mascarenhas A, Gomes E, Rathod PK, Brugnara C, Ferreira MU, Duraisingh MT. Plasmodium vivax infection compromises reticulocyte stability. Nat Commun 2021; 12:1629. [PMID: 33712609 PMCID: PMC7955053 DOI: 10.1038/s41467-021-21886-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/17/2021] [Indexed: 12/21/2022] Open
Abstract
The structural integrity of the host red blood cell (RBC) is crucial for propagation of Plasmodium spp. during the disease-causing blood stage of malaria infection. To assess the stability of Plasmodium vivax-infected reticulocytes, we developed a flow cytometry-based assay to measure osmotic stability within characteristically heterogeneous reticulocyte and P. vivax-infected samples. We find that erythroid osmotic stability decreases during erythropoiesis and reticulocyte maturation. Of enucleated RBCs, young reticulocytes which are preferentially infected by P. vivax, are the most osmotically stable. P. vivax infection however decreases reticulocyte stability to levels close to those of RBC disorders that cause hemolytic anemia, and to a significantly greater degree than P. falciparum destabilizes normocytes. Finally, we find that P. vivax new permeability pathways contribute to the decreased osmotic stability of infected-reticulocytes. These results reveal a vulnerability of P. vivax-infected reticulocytes that could be manipulated to allow in vitro culture and develop novel therapeutics. During Plasmodium intra-erythrocytic developmental, parasites compromise the structural integrity of host red-blood cells. Here, Clark et al. develop a flow cytometric osmotic stability assay to show that P. vivax infection destabilizes host reticulocytes, which are less stable than P. falciparum-infected normocytes.
Collapse
Affiliation(s)
- Martha A Clark
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Usheer Kanjee
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Gabriel W Rangel
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA, USA
| | - Laura Chery
- Department of Chemistry, University of Washington, Seattle, WA, USA
| | - Anjali Mascarenhas
- Malaria Evolution in South Asia (MESA)-International Centers of Excellence in Malaria Research (ICEMR), Goa Medical College, Bambolim, Goa, India
| | - Edwin Gomes
- Malaria Evolution in South Asia (MESA)-International Centers of Excellence in Malaria Research (ICEMR), Goa Medical College, Bambolim, Goa, India
| | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Marcelo U Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Manoj T Duraisingh
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
22
|
Ataga KI, Staffa SJ, Brugnara C, Stocker JW. Haemoglobin response to senicapoc in patients with sickle cell disease: a re-analysis of the Phase III trial. Br J Haematol 2021; 192:e129-e132. [PMID: 33527340 DOI: 10.1111/bjh.17345] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/29/2020] [Accepted: 01/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Scienter Center, Memphis, TN, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
23
|
Staffa SJ, Joerger JD, Henry E, Christensen RD, Brugnara C, Zurakowski D. Pediatric hematology normal ranges derived from pediatric primary care patients. Am J Hematol 2020; 95:E255-E257. [PMID: 32530536 DOI: 10.1002/ajh.25904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jill D Joerger
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Erick Henry
- Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA
- Institute for Healthcare Delivery Research, Salt Lake City, Utah, USA
| | - Robert D Christensen
- Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Malka R, Brugnara C, Cialic R, Higgins JM. Non-Parametric Combined Reference Regions and Prediction of Clinical Risk. Clin Chem 2020; 66:363-372. [PMID: 32040586 DOI: 10.1093/clinchem/hvz020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/25/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many clinical decisions depend on estimating patient risk of clinical outcomes by interpreting test results relative to reference intervals, but standard application of reference intervals suffers from two major limitations that reduce the accuracy of clinical decisions: (1) each test result is assessed separately relative to a univariate reference interval, ignoring the rich pathophysiologic information in multivariate relationships, and (2) reference intervals are intended to reflect a population's biological characteristics and are not calibrated for outcome prediction. METHODS We developed a combined reference region (CRR), derived CRRs for some pairs of complete blood count (CBC) indices (RBC, MCH, RDW, WBC, PLT), and assessed whether the CRR could enhance the univariate reference interval's prediction of a general clinical outcome, 5-year mortality risk (MR). RESULTS The CRR significantly improved MR estimation for 21/21 patient subsets defined by current univariate reference intervals. The CRR identified individuals with >2-fold increase in MR in many cases and uniformly improved the accuracy for all five pairs of tests considered. Overall, the 95% CRR identified individuals with a >7× increase in 5-year MR. CONCLUSIONS The CRR enhances the accuracy of the prediction of 5-year MR relative to current univariate reference intervals. The CRR generalizes to higher numbers of tests or biomarkers, as well as to clinical outcomes more specific than MR, and may provide a general way to use existing data to enhance the accuracy and precision of clinical decisions.
Collapse
Affiliation(s)
- Roy Malka
- Center for Systems Biology and Department of Pathology, Massachusetts General Hospital, Boston, MA.,Department of Systems Biology, Harvard Medical School, Boston, MA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Ron Cialic
- Tel Aviv Sourasky Medical Center, Tel Aviv University, Sackler Medical School, Tel Aviv, Israel
| | - John M Higgins
- Center for Systems Biology and Department of Pathology, Massachusetts General Hospital, Boston, MA.,Department of Systems Biology, Harvard Medical School, Boston, MA
| |
Collapse
|
25
|
Archer NM, Forbes PW, Dargie J, Manganella J, Licameli GR, Kenna MA, Brugnara C. Association of Blood Type With Postsurgical Mucosal Bleeding in Pediatric Patients Undergoing Tonsillectomy With or Without Adenoidectomy. JAMA Netw Open 2020; 3:e201804. [PMID: 32232448 PMCID: PMC7109594 DOI: 10.1001/jamanetworkopen.2020.1804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Blood type (BT) O has been identified as a risk factor for bleeding complications, while non-O BTs may increase risk for thromboembolic events. Limited data are available in children undergoing tonsillectomy with or without adenoidectomy. OBJECTIVE To determine whether BT O is associated with hemorrhage after tonsillectomy with or without adenoidectomy. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of patients younger than 22 years who underwent tonsillectomy with or without adenoidectomy at a single institution between January 1, 2008, and August 7, 2017. Statistical analysis was performed from November 2017 to January 2019. MAIN OUTCOMES AND MEASURES Prevalence of hemorrhage following surgery was defined as any bleeding requiring cauterization up to 1 month after the procedure. Data on sex, age, von Willebrand disease (VWD) status, BT, white blood cell counts, and platelet counts closest to date of surgery were collected from an electronic medical record system, and the association of these factors with hemorrhage following surgery was investigated. RESULTS A total of 14 951 pediatric patients (median [range] age, 5.6 [0.8-21.9] years; 6956 [46.5%] female) underwent tonsillectomy with or without adenoidectomy. Prevalence of hemorrhage following the procedure was 3.9% (578 patients) for the full cohort and 2.8% (362 of 13 065) for patients with no BT identified or preprocedure VWD panel results at baseline. Children who had a BT identified and/or a VWD panel before surgery had higher bleeding rates (BT only, 14.9% [172 of 1156]; preprocedure VWD panel only, 4.6% [28 of 607]; and BT and preprocedure VWD panel, 13.0% [16 of 123]), all of which were significantly different from the baseline bleeding rate (P < .001). While the bleeding rates in children with BT O were not statistically different from those with non-O BT (14.8% and 14.6%, respectively; P > .99), mean von Willebrand factor values were statistically different (mean [SD] von Willebrand factor antigen level in O group, 86.9 [42.4] IU/dL in the O group vs 118.0 [53.8] IU/dL in the non-O group; P = .002; and mean [SD] von Willebrand factor ristocetin-cofactor in the O group, 72.2 [44.3] IU/dL vs 112.6 [68.0] IU/dL in the non-O group; P = .001). In addition, children older than 12 years had increased bleeding rates in the full cohort (8.3% vs 3.2%), in the testing-naive cohort (6.5% vs 2.3%), and in those with a preprocedure VWD panel only (13.5% vs 3.1%) compared with children aged 12 years or younger. CONCLUSIONS AND RELEVANCE Type O blood was not a risk factor associated with hemorrhage after tonsillectomy with or without adenoidectomy despite lower baseline von Willebrand factor antigen and von Willebrand factor ristocetin-cofactor values in children with BT O vs those with non-O BT in our study cohort. No association was found between VWD status and bleeding, and there was no difference in VWD panel values in those who experienced hemorrhage vs those who did not within BT groups. Further studies elucidating the utility of von Willebrand factor values for children undergoing tonsillectomy with or without adenoidectomy are needed.
Collapse
Affiliation(s)
- Natasha M. Archer
- Pediatric Hematology, Oncology Dana-Farber, Children’s Hospital Blood Disorders and Cancer Center, Boston, Massachusetts
| | - Peter W. Forbes
- Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts
| | - Jenna Dargie
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts
| | - Juliana Manganella
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts
| | - Greg R. Licameli
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts
| | - Margaret A. Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts
| | - Carlo Brugnara
- Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|
26
|
Shmukler BE, Rivera A, Bhargava P, Nishimura K, Kim EH, Hsu A, Wohlgemuth JG, Morton J, Snyder LM, De Franceschi L, Rust MB, Hubner CA, Brugnara C, Alper SL. Genetic disruption of KCC cotransporters in a mouse model of thalassemia intermedia. Blood Cells Mol Dis 2020; 81:102389. [PMID: 31835175 PMCID: PMC7002294 DOI: 10.1016/j.bcmd.2019.102389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
β-thalassemia (β-Thal) is caused by defective β-globin production leading to globin chain imbalance, aggregation of free alpha chain in developing erythroblasts, reticulocytes, and mature circulating red blood cells. The hypochromic thalassemic red cells exhibit increased cell dehydration in association with elevated K+ leak and increased K-Cl cotransport activity, each of which has been linked to globin chain imbalance and related oxidative stress. We therefore tested the effect of genetic inactivation of K-Cl cotransporters KCC1 and KCC3 in a mouse model of β-thalassemia intermedia. In the absence of these transporters, the anemia of β-Thal mice was ameliorated, in association with increased MCV and reductions in CHCM and hyperdense cells, as well as in spleen size. The resting K+ content of β-Thal red cells was greatly increased, and Thal-associated splenomegaly slightly decreased. Lack of KCC1 and KCC3 activity in Thal red cells reduced red cell density and improved β-Thal-associated osmotic fragility. We conclude that genetic inactivation of K-Cl cotransport can reverse red cell dehydration and partially attenuate the hematologic phenotype in a mouse model of β-thalassemia.
Collapse
Affiliation(s)
- Boris E Shmukler
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America; Department of Medicine, Harvard Medical School, Boston, MA 02215, United States of America
| | - Alicia Rivera
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA 02115, United States of America; Department of Pathology, Harvard Medical School, Boston, MA 02115, United States of America
| | - Parul Bhargava
- Department of Laboratory Medicine, UCSF, San Francisco, CA, United States of America
| | - Katherine Nishimura
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Edward H Kim
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Ann Hsu
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Jay G Wohlgemuth
- Quest Diagnostics, San Juan Capistrano, CA, United States of America
| | - James Morton
- Quest Diagnostics, San Juan Capistrano, CA, United States of America
| | | | - Lucia De Franceschi
- Dept. of Medicine, Universita Verona and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Marco B Rust
- Institute of Physiological Chemistry, Philipps-Universität Marburg, Marburg, Germany
| | | | - Carlo Brugnara
- Department of Medicine, Harvard Medical School, Boston, MA 02215, United States of America; Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA 02115, United States of America
| | - Seth L Alper
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America; Department of Pathology, Harvard Medical School, Boston, MA 02115, United States of America.
| |
Collapse
|
27
|
Matte A, Federti E, Winter M, Koerner A, Harmeier A, Mazer N, Tomka T, Di Paolo ML, De Falco L, Andolfo I, Beneduce E, Iolascon A, Macias-Garcia A, Chen JJ, Janin A, Lebouef C, Turrini F, Brugnara C, De Franceschi L. Bitopertin, a selective oral GLYT1 inhibitor, improves anemia in a mouse model of β-thalassemia. JCI Insight 2019; 4:130111. [PMID: 31593554 DOI: 10.1172/jci.insight.130111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023] Open
Abstract
Anemia of β-thalassemia is caused by ineffective erythropoiesis and reduced red cell survival. Several lines of evidence indicate that iron/heme restriction is a potential therapeutic strategy for the disease. Glycine is a key initial substrate for heme and globin synthesis. We provide evidence that bitopertin, a glycine transport inhibitor administered orally, improves anemia, reduces hemolysis, diminishes ineffective erythropoiesis, and increases red cell survival in a mouse model of β-thalassemia (Hbbth3/+ mice). Bitopertin ameliorates erythroid oxidant damage, as indicated by a reduction in membrane-associated free α-globin chain aggregates, in reactive oxygen species cellular content, in membrane-bound hemichromes, and in heme-regulated inhibitor activation and eIF2α phosphorylation. The improvement of β-thalassemic ineffective erythropoiesis is associated with diminished mTOR activation and Rab5, Lamp1, and p62 accumulation, indicating an improved autophagy. Bitopertin also upregulates liver hepcidin and diminishes liver iron overload. The hematologic improvements achieved by bitopertin are blunted by the concomitant administration of the iron chelator deferiprone, suggesting that an excessive restriction of iron availability might negate the beneficial effects of bitopertin. These data provide important and clinically relevant insights into glycine restriction and reduced heme synthesis strategies for the treatment of β-thalassemia.
Collapse
Affiliation(s)
- Alessandro Matte
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Enrica Federti
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Michael Winter
- Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Annette Koerner
- Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Anja Harmeier
- Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Norman Mazer
- Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Tomas Tomka
- Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Luigia De Falco
- Department of Molecular Medicine and Medical Biotechnology, University Federico II and CEINGE, Naples, Italy
| | - Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnology, University Federico II and CEINGE, Naples, Italy
| | - Elisabetta Beneduce
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnology, University Federico II and CEINGE, Naples, Italy
| | - Alejandra Macias-Garcia
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Jane-Jane Chen
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Anne Janin
- INSERM, U1165, Paris, France.,Université Paris 7 - Denis Diderot, Paris, France.,AP-HP, Hôpital Saint-Louis, Paris, France
| | - Christhophe Lebouef
- INSERM, U1165, Paris, France.,Université Paris 7 - Denis Diderot, Paris, France.,AP-HP, Hôpital Saint-Louis, Paris, France
| | - Franco Turrini
- Department of Oncology, University of Torino, Torino, Italy
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucia De Franceschi
- Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| |
Collapse
|
28
|
Shmukler BE, Rivera A, Bhargava P, Nishimura K, Hsu A, Kim EH, Trudel M, Rust MB, Hubner CA, Brugnara C, Alper SL. Combined genetic disruption of K-Cl cotransporters and Gardos channel KCNN4 rescues erythrocyte dehydration in the SAD mouse model of sickle cell disease. Blood Cells Mol Dis 2019; 79:102346. [PMID: 31352162 PMCID: PMC6744291 DOI: 10.1016/j.bcmd.2019.102346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
Excessive red cell dehydration contributes to the pathophysiology of sickle cell disease (SCD). The densest fraction of sickle red cells (with the highest corpuscular hemoglobin concentration) undergoes the most rapid polymerization of deoxy-hemoglobin S, leading to accelerated cell sickling and increased susceptibility to endothelial activation, red cell adhesion, and vaso-occlusion. Increasing red cell volume in order to decrease red cell density can thus serve as an adjunct therapeutic goal in SCD. Regulation of circulating mouse red cell volume and density is mediated largely by the Gardos channel, KCNN4, and the K-Cl cotransporters, KCC3 and KCC1. Whereas inhibition of the Gardos channel in subjects with sickle cell disease increased red cell volume, decreased red cell density, and improved other hematological indices in subjects with SCD, specific KCC inhibitors have not been available for testing. We therefore investigated the effect of genetic inactivation of KCC3 and KCC1 in the SAD mouse model of sickle red cell dehydration, finding decreased red cell density and improved hematological indices. We describe here generation of mice genetically deficient in the three major red cell volume regulatory gene products, KCNN4, KCC3, and KCC1 in C57BL6 non-sickle and SAD sickle backgrounds. We show that combined loss-of-function of all three gene products in SAD mice leads to incrementally increased MCV, decreased CHCM and % hyperchromic cells, decreased red cell density (phthalate method), increased resistance to hypo-osmotic lysis, and increased cell K content. The data show that combined genetic deletion of the Gardos channel and K-Cl cotransporters in a mouse SCD model decreases red cell density and improves several hematological parameters, supporting the strategy of combined pharmacological inhibition of these ion transport pathways in the adjunct treatment of human SCD.
Collapse
Affiliation(s)
- Boris E Shmukler
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA 02115, United States of America
| | - Alicia Rivera
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Department of Medicine, Harvard Medical School, Boston, MA 02115, United States of America; Department of Pathology, Harvard Medical School, Boston, MA 02115, United States of America
| | - Parul Bhargava
- Department of Laboratory Medicine, UCSF, San Francisco, CA, United States of America
| | - Katherine Nishimura
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Ann Hsu
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Edward H Kim
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Marie Trudel
- Institut de Recherches Cliniques de Montreal, Molecular Genetics and Development, Faculte de Medecine, Universite of Montreal, Montreal, Quebec, Canada
| | - Marco B Rust
- Institute of Physiological Chemistry, Philipps-Universität Marburg, Marburg, Germany
| | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA 02115, United States of America; Department of Pathology, Harvard Medical School, Boston, MA 02115, United States of America
| | - Seth L Alper
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Department of Medicine, Harvard Medical School, Boston, MA 02115, United States of America.
| |
Collapse
|
29
|
Ansari Hosseinzadeh V, Brugnara C, Emani S, Khismatullin D, Holt RG. Monitoring of blood coagulation with non-contact drop oscillation rheometry. J Thromb Haemost 2019; 17:1345-1353. [PMID: 31099102 DOI: 10.1111/jth.14486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/24/2019] [Accepted: 05/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Thromboelastography is widely used as a tool to assess the coagulation status of critical-care patients. It allows observation of changes in the material properties of whole blood brought about by clot formation and clot lysis. However, contact activation of the coagulation cascade at surfaces of thromboelastographic systems leads to inherent variability and unreliability in predicting bleeding or thrombosis risks, while also requiring large sample volumes. OBJECTIVES To develop a non-contact drop oscillation rheometry (DOR) method to measure the viscoelastic properties of blood clots and to compare the results with current laboratory standard measurements. METHODS Drops of human blood and plasma (5-10 μL) were acoustically levitated. Acoustic field modulation induced drop shape oscillations, and the viscoelastic properties of the sample were calculated by measuring the resonance frequency and damping ratio. RESULTS DOR showed sensitivity to coagulation parameters. An increase in platelet count resulted in an increase in the maximum clot stiffness. An increase in the calcium ion level enhanced the coagulation rate prior to saturation. An increase in hematocrit resulted in a higher rate of clot formation and increased clot stiffness. Comparison of the results with those obtained with thromboelastography showed that coagulation started sooner with DOR, but with a lower rate and lower maximum stiffness. CONCLUSIONS DOR can be used as a monitoring tool to assess blood coagulation status. The advantages of small sample size, the lack of contact and small strain (linear viscoelasticity) makes this technique unique for real-time monitoring of blood coagulation.
Collapse
Affiliation(s)
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sirisha Emani
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Damir Khismatullin
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana
| | - R Glynn Holt
- Department of Mechanical Engineering, Boston University, Boston, Massachusetts
| |
Collapse
|
30
|
Rivera A, Vandorpe DH, Shmukler BE, Andolfo I, Iolascon A, Archer NM, Shabani E, Auerbach M, Hamerschlak N, Morton J, Wohlgemuth JG, Brugnara C, Snyder LM, Alper SL. Erythrocyte ion content and dehydration modulate maximal Gardos channel activity in KCNN4 V282M/+ hereditary xerocytosis red cells. Am J Physiol Cell Physiol 2019; 317:C287-C302. [PMID: 31091145 DOI: 10.1152/ajpcell.00074.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hereditary xerocytosis (HX) is caused by missense mutations in either the mechanosensitive cation channel PIEZO1 or the Ca2+-activated K+ channel KCNN4. All HX-associated KCNN4 mutants studied to date have revealed increased current magnitude and red cell dehydration. Baseline KCNN4 activity was increased in HX red cells heterozygous for KCNN4 mutant V282M. However, HX red cells maximally stimulated by Ca2+ ionophore A23187 or by PMCA Ca2+-ATPase inhibitor orthovanadate displayed paradoxically reduced KCNN4 activity. This reduced Ca2+-stimulated mutant KCNN4 activity in HX red cells was associated with unchanged sensitivity to KCNN4 inhibitor senicapoc and KCNN4 activator Ca2+, with slightly elevated Ca2+ uptake and reduced PMCA activity, and with decreased KCNN4 activation by calpain inhibitor PD150606. The altered intracellular monovalent cation content of HX red cells prompted experimental nystatin manipulation of red cell Na and K contents. Nystatin-mediated reduction of intracellular K+ with corresponding increase in intracellular Na+ in wild-type cells to mimic conditions of HX greatly suppressed vanadate-stimulated and A23187-stimulated KCNN4 activity in those wild-type cells. However, conferral of wild-type cation contents on HX red cells failed to restore wild-type-stimulated KCNN4 activity to those HX cells. The phenotype of reduced, maximally stimulated KCNN4 activity was shared by HX erythrocytes expressing heterozygous PIEZO1 mutants R2488Q and V598M, but not by HX erythrocytes expressing heterozygous KCNN4 mutant R352H or PIEZO1 mutant R2456H. Our data suggest that chronic KCNN4-driven red cell dehydration and intracellular cation imbalance can lead to reduced KCNN4 activity in HX and wild-type red cells.
Collapse
Affiliation(s)
- Alicia Rivera
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - David H Vandorpe
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Boris E Shmukler
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Natasha M Archer
- Division of Hematology and Oncology, Boston Children's Hospital, Dana-Farber Cancer Center, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Estela Shabani
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Nelson Hamerschlak
- Department of Hematology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - James Morton
- Quest Diagnostics, San Juan Capistrano, California
| | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital and Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - L Michael Snyder
- Quest Diagnostics, Marlborough, Massachusetts.,Departments of Medicine and Laboratory Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Seth L Alper
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts
| |
Collapse
|
31
|
Wu Y, Zeng J, Roscoe BP, Liu P, Yao Q, Lazzarotto CR, Clement MK, Cole MA, Luk K, Baricordi C, Shen AH, Ren C, Esrick EB, Manis JP, Dorfman DM, Williams DA, Biffi A, Brugnara C, Biasco L, Brendel C, Pinello L, Tsai SQ, Wolfe SA, Bauer DE. Highly efficient therapeutic gene editing of human hematopoietic stem cells. Nat Med 2019; 25:776-783. [PMID: 30911135 PMCID: PMC6512986 DOI: 10.1038/s41591-019-0401-y] [Citation(s) in RCA: 289] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/14/2019] [Indexed: 02/08/2023]
Abstract
Re-expression of the paralogous γ-globin genes (HBG1/2) could be a universal strategy to ameliorate the severe β-globin disorders sickle cell disease (SCD) and β-thalassemia by induction of fetal hemoglobin (HbF, α2γ2)1. Previously, we and others have shown that core sequences at the BCL11A erythroid enhancer are required for repression of HbF in adult-stage erythroid cells but are dispensable in non-erythroid cells2-6. CRISPR-Cas9-mediated gene modification has demonstrated variable efficiency, specificity, and persistence in hematopoietic stem cells (HSCs). Here, we demonstrate that Cas9:sgRNA ribonucleoprotein (RNP)-mediated cleavage within a GATA1 binding site at the +58 BCL11A erythroid enhancer results in highly penetrant disruption of this motif, reduction of BCL11A expression, and induction of fetal γ-globin. We optimize conditions for selection-free on-target editing in patient-derived HSCs as a nearly complete reaction lacking detectable genotoxicity or deleterious impact on stem cell function. HSCs preferentially undergo non-homologous compared with microhomology-mediated end joining repair. Erythroid progeny of edited engrafting SCD HSCs express therapeutic levels of HbF and resist sickling, while those from patients with β-thalassemia show restored globin chain balance. Non-homologous end joining repair-based BCL11A enhancer editing approaching complete allelic disruption in HSCs is a practicable therapeutic strategy to produce durable HbF induction.
Collapse
Affiliation(s)
- Yuxuan Wu
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai, China
| | - Jing Zeng
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Benjamin P. Roscoe
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA
| | - Pengpeng Liu
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA
| | - Qiuming Yao
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
- Molecular Pathology Unit, Center for Cancer Research, and Center for Computational and Integrative Biology, Massachusetts General Hospital, Department of Pathology, Harvard Medical School, Boston, Massachusetts 02129, USA
| | - Cicera R. Lazzarotto
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - M. Kendell Clement
- Molecular Pathology Unit, Center for Cancer Research, and Center for Computational and Integrative Biology, Massachusetts General Hospital, Department of Pathology, Harvard Medical School, Boston, Massachusetts 02129, USA
| | - Mitchel A. Cole
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Kevin Luk
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA
| | - Cristina Baricordi
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
- Gene Therapy Program, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center
| | - Anne H. Shen
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Chunyan Ren
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Erica B. Esrick
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - John P. Manis
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - David M. Dorfman
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - David A. Williams
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Alessandra Biffi
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
- Gene Therapy Program, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center
| | - Carlo Brugnara
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Luca Biasco
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
- Gene Therapy Program, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center
- University College of London, Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, London, UK
| | - Christian Brendel
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
- Gene Therapy Program, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center
| | - Luca Pinello
- Molecular Pathology Unit, Center for Cancer Research, and Center for Computational and Integrative Biology, Massachusetts General Hospital, Department of Pathology, Harvard Medical School, Boston, Massachusetts 02129, USA
| | - Shengdar Q. Tsai
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Scot A. Wolfe
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA
| | - Daniel E. Bauer
- Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| |
Collapse
|
32
|
Bao EL, Lareau CA, Brugnara C, Fulcher IR, Barau C, Moutereau S, Habibi A, Badaoui B, Berkenou J, Bartolucci P, Galactéros F, Platt OS, Mahaney M, Sankaran VG. Heritability of fetal hemoglobin, white cell count, and other clinical traits from a sickle cell disease family cohort. Am J Hematol 2019; 94:522-527. [PMID: 30680775 DOI: 10.1002/ajh.25421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 11/11/2022]
Abstract
Sickle cell disease (SCD) is the most common monogenic disorder in the world. Notably, there is extensive clinical heterogeneity in SCD that cannot be fully accounted for by known factors, and in particular, the extent to which the phenotypic diversity of SCD can be explained by genetic variation has not been reliably quantified. Here, in a family-based cohort of 449 patients with SCD and 755 relatives, we first show that 5 known modifiers affect 11 adverse outcomes in SCD to varying degrees. We then utilize a restricted maximum likelihood procedure to estimate the heritability of 20 hematologic traits, including fetal hemoglobin (HbF) and white blood cell count (WBC), in the clinically relevant context of inheritance from healthy carriers to SCD patients. We report novel estimations of heritability for HbF at 31.6% (±5.4%) and WBC at 41.2% (±6.8%) in our cohort. Finally, we demonstrate shared genetic bases between HbF, WBC, and other hematologic traits, but surprisingly little overlap between HbF and WBC themselves. In total, our analyses show that HbF and WBC have significant heritable components among individuals with SCD and their relatives, demonstrating the value of using family-based studies to better understand modifiers of SCD.
Collapse
Affiliation(s)
- Erik L. Bao
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric OncologyDana‐Farber Cancer Institute, Harvard Medical School Boston Massachusetts
- Broad Institute of MIT and Harvard Cambridge Massachusetts
- Harvard‐MIT Health Sciences and TechnologyHarvard Medical School Boston Massachusetts
| | - Caleb A. Lareau
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric OncologyDana‐Farber Cancer Institute, Harvard Medical School Boston Massachusetts
- Broad Institute of MIT and Harvard Cambridge Massachusetts
- Program in Biological and Biomedical SciencesHarvard University Cambridge Massachusetts
| | - Carlo Brugnara
- Department of Laboratory MedicineBoston Children's Hospital, Harvard Medical School Boston Massachusetts
| | - Isabel R. Fulcher
- Department of BiostatisticsHarvard T.H. Chan School of Public Health Boston Massachusetts
| | - Caroline Barau
- Plateforme de Ressources BiologiquesHopital Universitaire Henri Mondor Créteil France
| | - Stephane Moutereau
- Service de Biochimie, Assistance Publique–Hôpitaux de ParisHôpitaux Universitaires Henri Mondor Créteil France
| | - Anoosha Habibi
- Red Cell Genetic Disease UnitHôpital Henri‐Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris Est IMRB ‐ U955 ‐ Equipe n°2 Créteil France
| | - Bouchra Badaoui
- Département d'Hématologie et d'Immunologie BiologiquesAssistance Publique–Hôpitaux de Paris, Hôpitaux universitaires Henri Mondor Créteil France
| | - Jugurtha Berkenou
- Red Cell Genetic Disease UnitHôpital Henri‐Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris Est IMRB ‐ U955 ‐ Equipe n°2 Créteil France
| | - Pablo Bartolucci
- Red Cell Genetic Disease UnitHôpital Henri‐Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris Est IMRB ‐ U955 ‐ Equipe n°2 Créteil France
| | - Frédéric Galactéros
- Red Cell Genetic Disease UnitHôpital Henri‐Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris Est IMRB ‐ U955 ‐ Equipe n°2 Créteil France
| | - Orah S. Platt
- Department of Laboratory MedicineBoston Children's Hospital, Harvard Medical School Boston Massachusetts
| | - Michael Mahaney
- South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley Brownsville Texas
| | - Vijay G. Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric OncologyDana‐Farber Cancer Institute, Harvard Medical School Boston Massachusetts
- Broad Institute of MIT and Harvard Cambridge Massachusetts
| |
Collapse
|
33
|
Andolfo I, Russo R, Rosato BE, Manna F, Gambale A, Brugnara C, Iolascon A. Genotype-phenotype correlation and risk stratification in a cohort of 123 hereditary stomatocytosis patients. Am J Hematol 2018; 93:1509-1517. [PMID: 30187933 DOI: 10.1002/ajh.25276] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 01/06/2023]
Abstract
Hereditary stomatocytoses (HSts) are a wide spectrum of hemolytic anemias in which the erythrocyte membrane cation permeability is increased. Dehydrated hereditary stomatocytosis is the most frequent among HSts. It is caused by missense mutations in PIEZO1 and KCNN4 genes. We described 123 patients enrolled in our Genetic Unit from 2013 to 2017. Overall HSt subjects exhibit macrocytic mild anemia. We found that PIEZO1 is the most frequent mutated gene within our families (47% of pedigrees). In 59.1% of cases the mutations localized in the nonpore protein domain, while in 40.9% of patients they localized in the central pore region. The genotype-phenotype correlation analysis on 29 PIEZO1-patients demonstrated that most of severely affected patients carried mutations in the pore domain, suggesting that the severity of this condition is related to the pore properties and intracellular domain that could be responsible of interactions with intracellular components. This is the first cohort study on a large set of hereditary stomatocytosis patients, stratified according to their causative gene useful for diagnosis, prognosis, and management of these patients.
Collapse
Affiliation(s)
- Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Barbara Eleni Rosato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Francesco Manna
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Antonella Gambale
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| |
Collapse
|
34
|
Hosseinzadeh VA, Brugnara C, Holt RG. Shape oscillations of single blood drops: applications to human blood and sickle cell disease. Sci Rep 2018; 8:16794. [PMID: 30429489 PMCID: PMC6235873 DOI: 10.1038/s41598-018-34600-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/09/2018] [Indexed: 11/09/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited blood disorder associated with severe anemia, vessel occlusion, poor oxygen transport and organ failure. The presence of stiff and often sickle-shaped red blood cells is the hallmark of SCD and is believed to contribute to impaired blood rheology and organ damage. Most existing measurement techniques of blood and red blood cell physical properties require sample contact and/or large sample volume, which is problematic for pediatric patients. Acoustic levitation allows rheological measurements in a single drop of blood, simultaneously eliminating the need for both contact containment and manipulation of samples. The technique shows that the shape oscillation of blood drops is able to assess blood viscosity in normal and SCD blood and demonstrates an abnormally increased viscosity in SCD when compared with normal controls. Furthermore, the technique is sensitive enough to detect viscosity changes induced by hydroxyurea treatment, and their dependence on the total fetal hemoglobin content of the sample. Thus this technique may hold promise as a monitoring tool for assessing changes in blood rheology in sickle cell and other hematological diseases.
Collapse
Affiliation(s)
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - R Glynn Holt
- Department of Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA.
| |
Collapse
|
35
|
Ilboudo Y, Bartolucci P, Garrett ME, Ashley-Koch A, Telen M, Brugnara C, Galactéros F, Lettre G. A common functional PIEZO1 deletion allele associates with red blood cell density in sickle cell disease patients. Am J Hematol 2018; 93:E362-E365. [PMID: 30105803 DOI: 10.1002/ajh.25245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/06/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Yann Ilboudo
- Faculty of Medicine; Université de Montréal; Montreal Quebec Canada
- Montreal Heart Institute; Montreal Quebec Canada
| | - Pablo Bartolucci
- Red Cell Genetic Disease Unit; Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP); Créteil France
| | - Melanie E. Garrett
- Center for Human Disease Modeling; Duke University Medical Center; Durham North Carolina
- Department of Medicine, Division of Hematology; Duke University Medical Center; Durham North Carolina
| | - Allison Ashley-Koch
- Center for Human Disease Modeling; Duke University Medical Center; Durham North Carolina
- Department of Medicine, Division of Hematology; Duke University Medical Center; Durham North Carolina
| | - Marilyn Telen
- Center for Human Disease Modeling; Duke University Medical Center; Durham North Carolina
- Department of Medicine, Division of Hematology; Duke University Medical Center; Durham North Carolina
| | - Carlo Brugnara
- Department of Laboratory Medicine; Boston Children's Hospital; Boston Massachusetts
| | - Frédéric Galactéros
- Red Cell Genetic Disease Unit; Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP); Créteil France
| | - Guillaume Lettre
- Faculty of Medicine; Université de Montréal; Montreal Quebec Canada
- Montreal Heart Institute; Montreal Quebec Canada
| |
Collapse
|
36
|
Wish JB, Aronoff GR, Bacon BR, Brugnara C, Eckardt KU, Ganz T, Macdougall IC, Núñez J, Perahia AJ, Wood JC. Positive Iron Balance in Chronic Kidney Disease: How Much is Too Much and How to Tell? Am J Nephrol 2018; 47:72-83. [PMID: 29439253 DOI: 10.1159/000486968] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/15/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Regulation of body iron occurs at cellular, tissue, and systemic levels. In healthy individuals, iron absorption and losses are minimal, creating a virtually closed system. In the setting of chronic kidney disease and hemodialysis (HD), increased iron losses, reduced iron absorption, and limited iron availability lead to iron deficiency. Intravenous (IV) iron therapy is frequently prescribed to replace lost iron, but determining an individual's iron balance and stores can be challenging and imprecise, contributing to uncertainty about the long-term safety of IV iron therapy. SUMMARY Patients on HD receiving judicious doses of IV iron are likely to be in a state of positive iron balance, yet this does not appear to confer an overt risk for clinically relevant iron toxicity. The concomitant use of iron with erythropoiesis-stimulating agents, the use of maintenance iron dosing regimens, and the reticuloendothelial distribution of hepatic iron deposition likely minimize the potential for iron toxicity in patients on HD. Key Messages: Because no single diagnostic test can, at present, accurately assess iron status and risk for toxicity, clinicians need to take an integrative approach to avoid iron doses that impose excessive exposure while ensuring sufficient replenishment of iron stores capable of overcoming hepcidin blockade and allowing for effective erythropoiesis.
Collapse
Affiliation(s)
- Jay B Wish
- Division of Nephrology, Indiana University Health, Indianapolis, Indiana, USA
| | - George R Aronoff
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
- DaVita Kidney Care, Denver, Colorado, USA
| | - Bruce R Bacon
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital and Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin, Berlin, Germany
| | - Tomas Ganz
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Iain C Macdougall
- Department of Renal Medicine, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Julio Núñez
- Cardiology Service, Hospital Clínico Universitario, INCLIVA, CIBERCV and University of Valencia, Valencia, Spain
| | - Adam J Perahia
- NorthStar Strategic Consulting, LLC, Gladstone, New Jersey, USA
| | - John C Wood
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, USA
| |
Collapse
|
37
|
Abstract
Cell dehydration is a distinguishing characteristic of sickle cell disease and an important contributor to disease pathophysiology. Due to the unique dependence of Hb S polymerization on cellular Hb S concentration, cell dehydration promotes polymerization and sickling. In double heterozygosis for Hb S and C (SC disease) dehydration is the determining factor in disease pathophysiology. Three major ion transport pathways are involved in sickle cell dehydration: the K-Cl cotransport (KCC), the Gardos channel (KCNN4) and Psickle, the polymerization induced membrane permeability, most likely mediated by the mechano-sensitive ion channel PIEZO1. Each of these pathways exhibit unique characteristics in regulation by oxygen tension, intracellular and extracellular environment, and functional expression in reticulocytes and mature red cells. The unique dependence of K-Cl cotransport on intracellular Mg and the abnormal reduction of erythrocyte Mg content in SS and SC cells had led to clinical studies assessing the effect of oral Mg supplementation. Inhibition of Gardos channel by clotrimazole and senicapoc has led to Phase 1,2,3 trials in patients with sickle cell disease. While none of these studies has resulted in the approval of a novel therapy for SS disease, they have highlighted the key role played by these pathways in disease pathophysiology.
Collapse
Affiliation(s)
- Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
38
|
Kaufman HW, Niles JK, Gallagher DR, Rivera A, Alper SL, Brugnara C, Snyder LM. Revised prevalence estimate of possible Hereditary Xerocytosis as derived from a large U.S. Laboratory database. Am J Hematol 2018; 93:E9-E12. [PMID: 28971500 DOI: 10.1002/ajh.24923] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | - Alicia Rivera
- Division of Nephrology and Vascular Biology Research Center; Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School; Boston Massachusetts 02215
| | - Seth L. Alper
- Division of Nephrology and Vascular Biology Research Center; Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School; Boston Massachusetts 02215
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital and Department of Pathology; Harvard Medical School; Boston Massachusetts 02115
| | | |
Collapse
|
39
|
Abstract
Maintaining a positive iron balance is essential for female athletes to avoid the effects of iron deficiency and anaemia and to maintain or improve performance. A major function of iron is in the production of the oxygen and carbon dioxide carrying molecule, haemoglobin, via erythropoiesis. Iron balance is under the control of a number of factors including the peptide hormone hepcidin, dietary iron intake and absorption, environmental stressors (e.g. altitude), exercise, menstrual blood loss and genetics. Menstruating females, particularly those with heavy menstrual bleeding are at an elevated risk of iron deficiency. Haemoglobin concentration [Hb] and serum ferritin (sFer) are traditionally used to identify iron deficiency, however, in isolation these may have limited value in athletes due to: (1) the effects of fluctuations in plasma volume in response to training or the environment on [Hb], (2) the influence of inflammation on sFer and (3) the absence of sport, gender and individually specific normative data. A more detailed and longitudinal examination of haematology, menstrual cycle pattern, biochemistry, exercise physiology, environmental factors and training load can offer a superior characterisation of iron status and help to direct appropriate interventions that will avoid iron deficiency or iron overload. Supplementation is often required in iron deficiency; however, nutritional strategies to increase iron intake, rest and descent from altitude can also be effective and will help to prevent future iron deficient episodes. In severe cases or where there is a time-critical need, such as major championships, iron injections may be appropriate.
Collapse
Affiliation(s)
- Charles R Pedlar
- a School of Sport, Health and Applied Science , St Mary's University , Twickenham , UK.,b Cardiovascular Performance Program , Massachusetts General Hospital , Boston , MA , USA
| | - Carlo Brugnara
- c Department of Laboratory Medicine , Boston Children's Hospital , Boston , MA , USA
| | - Georgie Bruinvels
- a School of Sport, Health and Applied Science , St Mary's University , Twickenham , UK
| | - Richard Burden
- a School of Sport, Health and Applied Science , St Mary's University , Twickenham , UK
| |
Collapse
|
40
|
Hod EA, Brugnara C, Pilichowska M, Sandhaus LM, Luu HS, Forest SK, Netterwald JC, Reynafarje GM, Kratz A. Automated cell counts on CSF samples: A multicenter performance evaluation of the GloCyte system. Int J Lab Hematol 2017; 40:56-65. [PMID: 28880455 DOI: 10.1111/ijlh.12728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/15/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Automated cell counters have replaced manual enumeration of cells in blood and most body fluids. However, due to the unreliability of automated methods at very low cell counts, most laboratories continue to perform labor-intensive manual counts on many or all cerebrospinal fluid (CSF) samples. This multicenter clinical trial investigated if the GloCyte System (Advanced Instruments, Norwood, MA), a recently FDA-approved automated cell counter, which concentrates and enumerates red blood cells (RBCs) and total nucleated cells (TNCs), is sufficiently accurate and precise at very low cell counts to replace all manual CSF counts. METHODS The GloCyte System concentrates CSF and stains RBCs with fluorochrome-labeled antibodies and TNCs with nucleic acid dyes. RBCs and TNCs are then counted by digital image analysis. Residual adult and pediatric CSF samples obtained for clinical analysis at five different medical centers were used for the study. Cell counts were performed by the manual hemocytometer method and with the GloCyte System following the same protocol at all sites. The limits of the blank, detection, and quantitation, as well as precision and accuracy of the GloCyte, were determined. RESULTS The GloCyte detected as few as 1 TNC/μL and 1 RBC/μL, and reliably counted as low as 3 TNCs/μL and 2 RBCs/μL. The total coefficient of variation was less than 20%. Comparison with cell counts obtained with a hemocytometer showed good correlation (>97%) between the GloCyte and the hemocytometer, including at very low cell counts. CONCLUSIONS The GloCyte instrument is a precise, accurate, and stable system to obtain red cell and nucleated cell counts in CSF samples. It allows for the automated enumeration of even very low cell numbers, which is crucial for CSF analysis. These results suggest that GloCyte is an acceptable alternative to the manual method for all CSF samples, including those with normal cell counts.
Collapse
Affiliation(s)
- E A Hod
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - C Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, and Harvard Medical School, Boston, MA, USA
| | | | - L M Sandhaus
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - H S Luu
- Children's Medical Center Dallas, Dallas, TX, USA
| | - S K Forest
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - J C Netterwald
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - A Kratz
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
41
|
Rivera A, Vandorpe DH, Shmukler BE, Gallagher DR, Fikry CC, Kuypers FA, Brugnara C, Snyder LM, Alper SL. Erythrocytes from hereditary xerocytosis patients heterozygous for KCNN4 V282M exhibit increased spontaneous Gardos channel-like activity inhibited by senicapoc. Am J Hematol 2017; 92:E108-E110. [PMID: 28295477 DOI: 10.1002/ajh.24716] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Alicia Rivera
- Division of Nephrology; Beth Israel Deaconess Medical Center; Boston Massachusetts USA
- Department of Medicine; Harvard Medical School; Boston Massachusetts USA
| | - David H. Vandorpe
- Division of Nephrology; Beth Israel Deaconess Medical Center; Boston Massachusetts USA
- Department of Medicine; Harvard Medical School; Boston Massachusetts USA
| | - Boris E. Shmukler
- Division of Nephrology; Beth Israel Deaconess Medical Center; Boston Massachusetts USA
- Department of Medicine; Harvard Medical School; Boston Massachusetts USA
| | | | | | - Frans A. Kuypers
- Childrens' Hospital of Oakland Research Institute; Oakland California USA
| | - Carlo Brugnara
- Division of Laboratory Medicine; Boston Childrens' Hospital, Harvard Medical School; Boston Massachusetts USA
- Department of Pathology; Harvard Medical School; Boston Massachusetts USA
| | - L. Michael Snyder
- Quest Diagnostics; Marlborough Massachusetts USA
- Departments of Medicine and Pathology; UMass Memorial Medical Center; Worcester Massachusetts USA
| | - Seth L. Alper
- Division of Nephrology; Beth Israel Deaconess Medical Center; Boston Massachusetts USA
- Department of Medicine; Harvard Medical School; Boston Massachusetts USA
| |
Collapse
|
42
|
Ilboudo Y, Bartolucci P, Rivera A, Sedzro JC, Beaudoin M, Trudel M, Alper SL, Brugnara C, Galactéros F, Lettre G. Genome-wide association study of erythrocyte density in sickle cell disease patients. Blood Cells Mol Dis 2017; 65:60-65. [PMID: 28552477 DOI: 10.1016/j.bcmd.2017.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 05/10/2017] [Accepted: 05/10/2017] [Indexed: 12/14/2022]
Abstract
Deoxy-hemoglobin S polymerization into rigid fibers is the direct cause of the clinical sequelae observed in sickle cell disease (SCD). The rate of polymerization of sickle hemoglobin is determined primarily by intracellular hemoglobin concentration, itself dependent on the amount of sickle hemoglobin and on red blood cell (RBC) volume. Dense, dehydrated RBC (DRBC) are observed in SCD patients, and their number correlates with hemolytic parameters and complications such as renal dysfunction, leg ulcers and priapism. To identify new genes involved in RBC hydration in SCD, we performed the first genome-wide association study for DRBC in 374 sickle cell anemia (HbSS) patients. We did not find genome-wide significant results, indicating that variants that modulate DRBC have modest-to-weak effects. A secondary analysis demonstrated a nominal association (P=0.003) between DRBC in SCD patients and a variant associated with mean corpuscular hemoglobin concentration (MCHC) in non-anemic individuals. This intronic variant controls the expression of ATP2B4, the main calcium pump in erythrocytes. Our study highlights ATP2B4 as a promising target for modulation of RBC hydration in SCD patients.
Collapse
Affiliation(s)
- Yann Ilboudo
- Faculty of Medicine, Program in Bioinformatics, Université de Montréal, Montreal, Quebec, Canada; Montreal Heart Institute, Montreal, Quebec, Canada
| | - Pablo Bartolucci
- Red Cell Genetic Disease Unit, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Est, IMRB - U955 - Equipe no 2, Créteil, France
| | - Alicia Rivera
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, USA; Department of Medicine, Harvard Medical School, Boston, USA
| | | | | | - Marie Trudel
- Faculty of Medicine, Department of Medicine and Department of Biochemistry, Université de Montréal, Montreal, Quebec, Canada; Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, USA; Department of Medicine, Harvard Medical School, Boston, USA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Frédéric Galactéros
- Red Cell Genetic Disease Unit, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Est, IMRB - U955 - Equipe no 2, Créteil, France
| | - Guillaume Lettre
- Faculty of Medicine, Program in Bioinformatics, Université de Montréal, Montreal, Quebec, Canada; Montreal Heart Institute, Montreal, Quebec, Canada.
| |
Collapse
|
43
|
Pedlar CR, Higgins JM, Brown M, Shave R, Michaud-Finch J, Otto J, Chaudhury A, Burden R, Moore B, Brugnara C, Baggish AL. Haematological Responses to Detraining Following the Boston Marathon. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517779.64307.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
44
|
Canver MC, Lessard S, Pinello L, Wu Y, Ilboudo Y, Stern EN, Needleman AJ, Galactéros F, Brugnara C, Kutlar A, McKenzie C, Reid M, Chen DD, Das PP, A Cole M, Zeng J, Kurita R, Nakamura Y, Yuan GC, Lettre G, Bauer DE, Orkin SH. Variant-aware saturating mutagenesis using multiple Cas9 nucleases identifies regulatory elements at trait-associated loci. Nat Genet 2017; 49:625-634. [PMID: 28218758 PMCID: PMC5374001 DOI: 10.1038/ng.3793] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/25/2017] [Indexed: 02/06/2023]
Abstract
Cas9-mediated, high-throughput, saturating in situ mutagenesis permits fine-mapping of function across genomic segments. Disease- and trait-associated variants from genome-wide association studies largely cluster in regulatory DNA. Here we demonstrate the use of multiple designer nucleases and variant-aware library design to interrogate trait-associated regulatory DNA at high resolution. We developed a computational tool for the creation of saturating mutagenesis libraries with single or combinatorial nucleases with incorporation of variants. We applied this methodology to the HBS1L-MYB intergenic region, a locus associated with red blood cell traits, including fetal hemoglobin levels. This approach identified putative regulatory elements that control MYB expression. Analysis of genomic copy number highlighted potential false positive regions, which emphasizes the importance of off-target analysis in design of saturating mutagenesis experiments. Taken together, these data establish a widely applicable high-throughput and high-resolution methodology to reliably identify minimal functional sequences within large regions of disease- and trait-associated DNA.
Collapse
Affiliation(s)
- Matthew C Canver
- Division of Hematology/Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute; Harvard Stem Cell Institute; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Lessard
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Luca Pinello
- Department of Molecular Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yuxuan Wu
- Division of Hematology/Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute; Harvard Stem Cell Institute; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Yann Ilboudo
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Emily N Stern
- Division of Hematology/Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute; Harvard Stem Cell Institute; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Austen J Needleman
- Division of Hematology/Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute; Harvard Stem Cell Institute; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Frédéric Galactéros
- Red Cell Genetic Disease Unit, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), UPeC, IMRB U955 Equipe no. 2, Créteil, France
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Abdullah Kutlar
- Department of Medicine, Sickle Cell Center, Augusta University, Augusta, Georgia, USA
| | - Colin McKenzie
- The Caribbean Institute for Health Research, University of the West Indies, Mona, Kingston, Jamaica
| | - Marvin Reid
- The Caribbean Institute for Health Research, University of the West Indies, Mona, Kingston, Jamaica
| | - Diane D Chen
- Division of Hematology/Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute; Harvard Stem Cell Institute; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Partha Pratim Das
- Division of Hematology/Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute; Harvard Stem Cell Institute; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchel A Cole
- Division of Hematology/Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute; Harvard Stem Cell Institute; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Jing Zeng
- Division of Hematology/Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute; Harvard Stem Cell Institute; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryo Kurita
- Department of Research and Development, Central Blood Institute, Japanese Red Cross Society, Tokyo, Japan
| | - Yukio Nakamura
- Cell Engineering Division, RIKEN BioResource Center, Tsukuba, Japan.,Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Guo-Cheng Yuan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Guillaume Lettre
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Daniel E Bauer
- Division of Hematology/Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute; Harvard Stem Cell Institute; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Stuart H Orkin
- Division of Hematology/Oncology, Boston Children's Hospital; Department of Pediatric Oncology, Dana-Farber Cancer Institute; Harvard Stem Cell Institute; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Howard Hughes Medical Institute, Boston, Massachusetts, USA
| |
Collapse
|
45
|
Hennek JW, Kumar AA, Wiltschko AB, Patton MR, Lee SYR, Brugnara C, Adams RP, Whitesides GM. Diagnosis of iron deficiency anemia using density-based fractionation of red blood cells. Lab Chip 2016; 16:3929-3939. [PMID: 27713998 DOI: 10.1039/c6lc00875e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Iron deficiency anemia (IDA) is a nutritional disorder that impacts over one billion people worldwide; it may cause permanent cognitive impairment in children, fatigue in adults, and suboptimal outcomes in pregnancy. IDA can be diagnosed by detection of red blood cells (RBCs) that are characteristically small (microcytic) and deficient in hemoglobin (hypochromic), typically by examining the results of a complete blood count performed by a hematology analyzer. These instruments are expensive, not portable, and require trained personnel; they are, therefore, unavailable in many low-resource settings. This paper describes a low-cost and rapid method to diagnose IDA using aqueous multiphase systems (AMPS)-thermodynamically stable mixtures of biocompatible polymers and salt that spontaneously form discrete layers having sharp steps in density. AMPS are preloaded into a microhematocrit tube and used with a drop of blood from a fingerstick. After only two minutes in a low-cost centrifuge, the tests (n = 152) were read by eye with a sensitivity of 84% (72-93%) and a specificity of 78% (68-86%), corresponding to an area under the curve (AUC) of 0.89. The AMPS test outperforms diagnosis by hemoglobin alone (AUC = 0.73) and is comparable to methods used in clinics like reticulocyte hemoglobin concentration (AUC = 0.91). Standard machine learning tools were used to analyze images of the resulting tests captured by a standard desktop scanner to 1) slightly improve diagnosis of IDA-sensitivity of 90% (83-96%) and a specificity of 77% (64-87%), and 2) predict several important red blood cell parameters, such as mean corpuscular hemoglobin concentration. These results suggest that the use of AMPS combined with machine learning provides an approach to developing point-of-care hematology.
Collapse
Affiliation(s)
| | | | - Alex B Wiltschko
- School of Engineering and Applied Sciences, USA and Department of Neurobiology, Harvard Medical School, USA
| | | | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital and Department of Pathology, Harvard Medical School, USA.
| | | | - George M Whitesides
- Department of Chemistry and Chemical Biology, USA and Wyss Institute for Biologically Inspired Engineering, USA
| |
Collapse
|
46
|
Affiliation(s)
- Giuseppe D'onofrio
- Research Center for the Development and Clinical Evaluation of Automated Methods in Hematology, Department of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy; Departments of Laboratory Medicine and Pathology, Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gina Zini
- Research Center for the Development and Clinical Evaluation of Automated Methods in Hematology, Department of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy; Departments of Laboratory Medicine and Pathology, Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Carlo Brugnara
- Research Center for the Development and Clinical Evaluation of Automated Methods in Hematology, Department of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy; Departments of Laboratory Medicine and Pathology, Children's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
47
|
Andolfo I, Russo R, Manna F, De Rosa G, Gambale A, Zouwail S, Detta N, Pardo CL, Alper SL, Brugnara C, Sharma AK, De Franceschi L, Iolascon A. Functional characterization of novel ABCB6 mutations and their clinical implications in familial pseudohyperkalemia. Haematologica 2016; 101:909-17. [PMID: 27151991 DOI: 10.3324/haematol.2016.142372] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/29/2016] [Indexed: 11/09/2022] Open
Abstract
Isolated familial pseudohyperkalemia is a dominant red cell trait characterized by cold-induced 'passive leak' of red cell potassium ions into plasma. The causative gene of this condition is ABCB6, which encodes an erythrocyte membrane ABC transporter protein bearing the Langereis blood group antigen system. In this study analyzing three new families, we report the first functional characterization of ABCB6 mutants, including the homozygous mutation V454A, heterozygous mutation R276W, and compound heterozygous mutations R276W and R723Q (in trans). All these mutations are annotated in public databases, suggesting that familial pseudohyperkalemia could be common in the general population. Indeed, we identified variant R276W in one of 327 random blood donors (0.3%). Four weeks' storage of heterozygous R276W blood cells resulted in massive loss of potassium compared to that from healthy control red blood cells. Moreover, measurement of cation flux demonstrated greater loss of potassium or rubidium ions from HEK-293 cells expressing ABCB6 mutants than from cells expressing wild-type ABCB6. The R276W/R723Q mutations elicited greater cellular potassium ion efflux than did the other mutants tested. In conclusion, ABCB6 missense mutations in red blood cells from subjects with familial pseudohyperkalemia show elevated potassium ion efflux. The prevalence of such individuals in the blood donor population is moderate. The fact that storage of blood from these subjects leads to significantly increased levels of potassium in the plasma could have serious clinical implications for neonates and infants receiving large-volume transfusions of whole blood. Genetic tests for familial pseudohyperkalemia could be added to blood donor pre-screening. Further study of ABCB6 function and trafficking could be informative for the study of other pathologies of red blood cell hydration.
Collapse
Affiliation(s)
- Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Italy CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Roberta Russo
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Italy CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Francesco Manna
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Italy CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Gianluca De Rosa
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Italy CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Antonella Gambale
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Italy CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Soha Zouwail
- Department of Biochemistry and Immunology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK and Department of Medical Biochemistry, School of Medicine, Alexandria University, Egypt
| | | | - Catia Lo Pardo
- Servizio Immunotrasfusionale, "A. Cardarelli" Hospital, Naples, Italy
| | - Seth L Alper
- Division of Nephrology and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital and Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Alok K Sharma
- Division of Nephrology and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Italy CEINGE, Biotecnologie Avanzate, Naples, Italy
| |
Collapse
|
48
|
Brugnara C. The American Journal of Hematology turns 40. Am J Hematol 2016; 91:4. [PMID: 26575091 DOI: 10.1002/ajh.24237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/09/2022]
|
49
|
Giani FC, Fiorini C, Wakabayashi A, Ludwig LS, Salem RM, Jobaliya CD, Regan SN, Ulirsch JC, Liang G, Steinberg-Shemer O, Guo MH, Esko T, Tong W, Brugnara C, Hirschhorn JN, Weiss MJ, Zon LI, Chou ST, French DL, Musunuru K, Sankaran VG. Targeted Application of Human Genetic Variation Can Improve Red Blood Cell Production from Stem Cells. Cell Stem Cell 2015; 18:73-78. [PMID: 26607381 DOI: 10.1016/j.stem.2015.09.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/11/2015] [Accepted: 09/20/2015] [Indexed: 12/25/2022]
Abstract
Multipotent and pluripotent stem cells are potential sources for cell and tissue replacement therapies. For example, stem cell-derived red blood cells (RBCs) are a potential alternative to donated blood, but yield and quality remain a challenge. Here, we show that application of insight from human population genetic studies can enhance RBC production from stem cells. The SH2B3 gene encodes a negative regulator of cytokine signaling and naturally occurring loss-of-function variants in this gene increase RBC counts in vivo. Targeted suppression of SH2B3 in primary human hematopoietic stem and progenitor cells enhanced the maturation and overall yield of in-vitro-derived RBCs. Moreover, inactivation of SH2B3 by CRISPR/Cas9 genome editing in human pluripotent stem cells allowed enhanced erythroid cell expansion with preserved differentiation. Our findings therefore highlight the potential for combining human genome variation studies with genome editing approaches to improve cell and tissue production for regenerative medicine.
Collapse
Affiliation(s)
- Felix C Giani
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Neonatology, Charité-Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Claudia Fiorini
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Aoi Wakabayashi
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Leif S Ludwig
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Neonatology, Charité-Universitätsmedizin Berlin, Berlin 10117, Germany.,Institute for Chemistry and Biochemistry, Freie Universität Berlin, Berlin 14195, Germany
| | - Rany M Salem
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Chintan D Jobaliya
- Departments of Pathology and Laboratory Medicine and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Stephanie N Regan
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA
| | - Jacob C Ulirsch
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Ge Liang
- Departments of Pathology and Laboratory Medicine and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Orna Steinberg-Shemer
- Departments of Pathology and Laboratory Medicine and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael H Guo
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Tõnu Esko
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Wei Tong
- Departments of Pathology and Laboratory Medicine and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Joel N Hirschhorn
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mitchell J Weiss
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Leonard I Zon
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA
| | - Stella T Chou
- Departments of Pathology and Laboratory Medicine and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Deborah L French
- Departments of Pathology and Laboratory Medicine and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kiran Musunuru
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| |
Collapse
|
50
|
Andolfo I, Russo R, Manna F, Shmukler BE, Gambale A, Vitiello G, De Rosa G, Brugnara C, Alper SL, Snyder LM, Iolascon A. Novel Gardos channel mutations linked to dehydrated hereditary stomatocytosis (xerocytosis). Am J Hematol 2015; 90:921-6. [PMID: 26178367 DOI: 10.1002/ajh.24117] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023]
Abstract
Dehydrated hereditary stomatocytosis (DHSt) is an autosomal dominant congenital hemolytic anemia with moderate splenomegaly and often compensated hemolysis. Affected red cells are characterized by a nonspecific cation leak of the red cell membrane, reflected in elevated sodium content, decreased potassium content, elevated MCHC and MCV, and decreased osmotic fragility. The majority of symptomatic DHSt cases reported to date have been associated with gain-of-function mutations in the mechanosensitive cation channel gene, PIEZO1. A recent study has identified two families with DHSt associated with a single mutation in the KCNN4 gene encoding the Gardos channel (KCa3.1), the erythroid Ca(2+) -sensitive K(+) channel of intermediate conductance, also expressed in many other cell types. We present here, in the second report of DHSt associated with KCNN4 mutations, two previously undiagnosed DHSt families. Family NA exhibited the same de novo missense mutation as that recently described, suggesting a hot spot codon for DHSt mutations. Family WO carried a novel, inherited missense mutation in the ion transport domain of the channel. The patients' mild hemolytic anemia did not improve post-splenectomy, but splenectomy led to no serious thromboembolic events. We further characterized the expression of KCNN4 in the mutated patients and during erythroid differentiation of CD34+ cells and K562 cells. We also analyzed KCNN4 expression during mouse embryonic development.
Collapse
Affiliation(s)
- Immacolata Andolfo
- Department Of Molecular Medicine And Medical Biotechnologies; “Federico II” University Of Naples; Naples Italy
- Biotecnologie Avanzate; CEINGE; Naples Italy
| | - Roberta Russo
- Department Of Molecular Medicine And Medical Biotechnologies; “Federico II” University Of Naples; Naples Italy
- Biotecnologie Avanzate; CEINGE; Naples Italy
| | - Francesco Manna
- Department Of Molecular Medicine And Medical Biotechnologies; “Federico II” University Of Naples; Naples Italy
- Biotecnologie Avanzate; CEINGE; Naples Italy
| | - Boris E. Shmukler
- Renal Division And Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School; Boston Massachusetts
- Department Of Medicine, Harvard Medical School; Boston Massachusetts
| | - Antonella Gambale
- Department Of Molecular Medicine And Medical Biotechnologies; “Federico II” University Of Naples; Naples Italy
- Biotecnologie Avanzate; CEINGE; Naples Italy
| | - Giuseppina Vitiello
- Biotecnologie Avanzate; CEINGE; Naples Italy
- Medical Genetics Unit; Policlinico Tor Vergata University Hospital; Viale Oxford Rome Italy
| | - Gianluca De Rosa
- Department Of Molecular Medicine And Medical Biotechnologies; “Federico II” University Of Naples; Naples Italy
- Biotecnologie Avanzate; CEINGE; Naples Italy
| | - Carlo Brugnara
- Department Of Laboratory Medicine, Boston Children's Hospital And Department Of Pathology; Harvard Medical School; Boston Massachusetts
| | - Seth L. Alper
- Renal Division And Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School; Boston Massachusetts
| | - L. Michael Snyder
- Dept Of Hospital Laboratories; University Of Massachusetts Medical Center; Worcester MA
- Quest Diagnositics, LLC MA; Marlborough Massachusetts
| | - Achille Iolascon
- Department Of Molecular Medicine And Medical Biotechnologies; “Federico II” University Of Naples; Naples Italy
- Biotecnologie Avanzate; CEINGE; Naples Italy
| |
Collapse
|