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Yee MEM, Zerra PE, McCoy JW, Covington ML, Stowell SR, Joiner CH, Lough CM, Delvadia BB, Josephson CD, Roback JD, Fasano RM. Post-transfusion biotin-labeled red blood cell survival studies in pediatric sickle cell disease with antibodies of uncertain significance. Transfusion 2024. [PMID: 38506450 DOI: 10.1111/trf.17800] [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: 11/13/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Red blood cell (RBC) antibodies are common in multiply transfused patients with sickle cell disease (SCD). Unlike RBC alloantibodies, the potential of autoantibodies to cause post-transfusion hemolysis may be uncertain. Biotin-labeling provides a direct measurement of red cell survival (RCS) over time, thus can be used to assess the clinical significance of RBC antibodies. Antibodies to biotinylated RBC (B-RBC) occasionally are detected after exposure, which may impact B-RBC survival in subsequent RCS studies. STUDY DESIGN AND METHODS Pediatric patients with SCD receiving monthly chronic transfusions underwent RCS studies, receiving aliquots of allogeneic RBC labeled at distinct densities of biotin (2-18 μg/mL). B-RBC survival was followed for 4 months post-transfusion, and B-RBC antibody screening for 6 months. Patients with warm autoantibodies (WAA) or B-RBC antibodies are reported here. RESULTS RBC antibodies were detected during RCS in four patients: one with WAA, one with WAA followed by B-RBC-specific antibodies, and two with transient B-RBC antibodies within the first 5 weeks of exposure. B-RBC half-lives (T50 ) ranged 37.6-61.7 days (mean 47.8 days). There was no evidence of increased hemolysis or accelerated B-RBC clearance in the presence of WAA or B-RBC antibodies. DISCUSSION Biotinylation of allogenic RBC can be used to assess the possible effects of RBC antibodies on transfusion survival in individual cases, particularly when it is uncertain if the detected antibodies may result in hemolysis. In the cases presented here, neither WAA nor B-RBC antibodies were associated with significant shortening of B-RBC survival in individuals with SCD.
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Affiliation(s)
- Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patricia E Zerra
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James W McCoy
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mischa L Covington
- Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sean R Stowell
- Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Clinton H Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher M Lough
- Medical Services, Lifesouth Community Blood Centers, Gainesville, Florida, USA
| | | | - Cassandra D Josephson
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John D Roback
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ross M Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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2
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Gbotosho OT, Li W, Joiner CH, Brown LAS, Hyacinth HI. The inflammatory profiles of pulmonary alveolar macrophages and alveolar type 2 cells in SCD. Exp Biol Med (Maywood) 2023; 248:1013-1023. [PMID: 37012678 PMCID: PMC10581160 DOI: 10.1177/15353702231157940] [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: 11/05/2022] [Accepted: 01/15/2023] [Indexed: 04/05/2023] Open
Abstract
The lung microenvironment plays a crucial role in maintaining lung homeostasis as well as the initiation and resolution of both acute and chronic lung injury. Acute chest syndrome (ACS) is a complication of sickle cell disease (SCD) like acute lung injury. Both the endothelial cells and peripheral blood mononuclear cells are known to secrete proinflammatory cytokines elevated during ACS episodes. However, in SCD, the lung microenvironment that may favor excessive production of proinflammatory cytokines and the contribution of other lung resident cells, such as alveolar macrophages and alveolar type 2 epithelial (AT-2) cells, to ACS pathogenesis is not completely understood. Here, we sought to understand the pulmonary microenvironment and the proinflammatory profile of lung alveolar macrophages (LAMs) and AT-2 cells at steady state in Townes sickle cell (SS) mice compared to control mice (AA). In addition, we examined lung function and micromechanics molecules essential for pulmonary epithelial barrier function in these mice. Our results showed that bronchoalveolar lavage (BAL) fluid in SS mice had elevated protein levels of pro-inflammatory cytokines interleukin (IL)-1β and IL-12 (p ⩽ 0.05) compared to AA controls. We showed for the first time, significantly increased protein levels of inflammatory mediators (Human antigen R (HuR), Toll-like receptor 4 (TLR4), MyD88, and PU.1) in AT-2 cells (1.4 to 2.2-fold) and LAM (17-21%) isolated from SS mice compared to AA control mice at steady state. There were also low levels of anti-inflammatory transcription factors (Nrf2 and PPARy) in SS mice compared to AA controls (p ⩽ 0.05). Finally, we found impaired lung function and a dysregulated composition of surfactant proteins (B and C). Our results demonstrate that SS mice at steady state had a compromised lung microenvironment with elevated expression of proinflammatory cytokines by AT-2 cells and LAM, as well as dysregulated expression of surfactant proteins necessary for maintaining the alveolar barrier integrity and lung function.
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Affiliation(s)
- Oluwabukola T Gbotosho
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Wei Li
- Aflac Cancer & Blood Disorders Center of Children’s Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Clinton H Joiner
- Aflac Cancer & Blood Disorders Center of Children’s Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Lou Ann S Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Hyacinth I Hyacinth
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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3
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Lee SY, Brothers RO, Turrentine KB, Quadri A, Sathialingam E, Cowdrick KR, Gillespie S, Bai S, Goldman-Yassen AE, Joiner CH, Brown RC, Buckley EM. Quantifying the Cerebral Hemometabolic Response to Blood Transfusion in Pediatric Sickle Cell Disease With Diffuse Optical Spectroscopies. Front Neurol 2022; 13:869117. [PMID: 35847200 PMCID: PMC9283827 DOI: 10.3389/fneur.2022.869117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Red blood cell transfusions are common in patients with sickle cell disease who are at increased risk of stroke. Unfortunately, transfusion thresholds needed to sufficiently dilute sickle red blood cells and adequately restore oxygen delivery to the brain are not well defined. Previous work has shown that transfusion is associated with a reduction in oxygen extraction fraction and cerebral blood flow, both of which are abnormally increased in sickle patients. These reductions are thought to alleviate hemometabolic stress by improving the brain's ability to respond to increased metabolic demand, thereby reducing susceptibility to ischemic injury. Monitoring the cerebral hemometabolic response to transfusion may enable individualized management of transfusion thresholds. Diffuse optical spectroscopies may present a low-cost, non-invasive means to monitor this response. In this study, children with SCD undergoing chronic transfusion therapy were recruited. Diffuse optical spectroscopies (namely, diffuse correlation spectroscopy combined with frequency domain near-infrared spectroscopy) were used to quantify oxygen extraction fraction (OEF), cerebral blood volume (CBV), an index of cerebral blood flow (CBFi), and an index of cerebral oxygen metabolism (CMRO2i) in the frontal cortex immediately before and after transfusion. A subset of patients receiving regular monthly transfusions were measured during a subsequent transfusion. Data was captured from 35 transfusions in 23 patients. Transfusion increased median blood hemoglobin levels (Hb) from 9.1 to 11.7 g/dL (p < 0.001) and decreased median sickle hemoglobin (HbS) from 30.9 to 21.7% (p < 0.001). Transfusion decreased OEF by median 5.9% (p < 0.001), CBFi by median 21.2% (p = 0.020), and CBV by median 18.2% (p < 0.001). CMRO2i did not statistically change from pre-transfusion levels (p > 0.05). Multivariable analysis revealed varying degrees of associations between outcomes (i.e., OEF, CBFi, CBV, and CMRO2i), Hb, and demographics. OEF, CBFi, and CBV were all negatively associated with Hb, while CMRO2i was only associated with age. These results demonstrate that diffuse optical spectroscopies are sensitive to the expected decreases of oxygen extraction, blood flow, and blood volume after transfusion. Diffuse optical spectroscopies may be a promising bedside tool for real-time monitoring and goal-directed therapy to reduce stroke risk for sickle cell disease.
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Affiliation(s)
- Seung Yup Lee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- Department of Electrical and Computer Engineering, Kennesaw State University, Marietta, GA, United States
| | - Rowan O. Brothers
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Katherine B. Turrentine
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Ayesha Quadri
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Eashani Sathialingam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Kyle R. Cowdrick
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Scott Gillespie
- Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, GA, United States
| | - Shasha Bai
- Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, GA, United States
| | - Adam E. Goldman-Yassen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Clinton H. Joiner
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - R. Clark Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Erin M. Buckley
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Children's Research Scholar, Children's Healthcare of Atlanta, Atlanta, GA, United States
- *Correspondence: Erin M. Buckley
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George PE, Stokes CL, Bassit LC, Chahroudi A, Figueroa J, Griffiths MA, Heilman S, Ku DN, Nehl EJ, Leong T, Levy JM, Kempker RR, Mannino RG, Mavigner M, Park SI, Rao A, Rebolledo PA, Roback JD, Rogers BB, Schinazi RF, Suessmith AB, Sullivan J, Tyburski EA, Vos MB, Waggoner JJ, Wang YF(W, Madsen J, Wechsler DS, Joiner CH, Martin GS, Lam WA. Covid-19 will not "magically disappear": Why access to widespread testing is paramount. Am J Hematol 2021; 96:174-178. [PMID: 33576528 PMCID: PMC7753266 DOI: 10.1002/ajh.26059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Paul E. George
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta Emory University School of Medicine, Department of Pediatrics Atlanta Georgia USA
| | - Claire L. Stokes
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta Emory University School of Medicine, Department of Pediatrics Atlanta Georgia USA
| | - Leda C. Bassit
- Laboratory of Biochemical Pharmacology, Department of Pediatrics Children's Healthcare of Atlanta, The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Emory University School of Medicine Atlanta Georgia USA
| | - Ann Chahroudi
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Emory University School of Medicine Atlanta Georgia USA
| | - Janet Figueroa
- The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Emory University School of Medicine Atlanta Georgia USA
| | - Mark A. Griffiths
- Children's Healthcare of Atlanta Emory University School of Medicine Atlanta Georgia USA
| | - Stacy Heilman
- The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Emory University School of Medicine Atlanta Georgia USA
| | - David N. Ku
- GWW School of Mechanical Engineering The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Georgia Institute of Technology Atlanta Georgia USA
| | - Eric J. Nehl
- Emory University Rollins School of Public Health, Georgia Clinical & Translational Science Alliance, Atlanta, Georgia, The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Atlanta Georgia USA
| | - Traci Leong
- The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Emory University Rollins School of Public Health Atlanta Georgia USA
| | - Joshua M. Levy
- The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Emory University School of Medicine Atlanta Georgia USA
| | - Russell R. Kempker
- The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Emory University School of Medicine Atlanta Georgia USA
| | - Robert G. Mannino
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta Emory University School of Medicine, Department of Pediatrics, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Atlanta Georgia USA
| | - Maud Mavigner
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Emory University School of Medicine Atlanta Georgia USA
| | - Sunita I. Park
- Children's Healthcare of Atlanta The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Emory University School of Medicine Atlanta Georgia USA
| | - Anuradha Rao
- The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Emory University School of Medicine Atlanta Georgia USA
| | - Paulina A. Rebolledo
- The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Emory University School of Medicine, Emory University Rollins School of Public Health Atlanta Georgia USA
| | - John D. Roback
- Center for Transfusion and Cellular Therapies Emory University School of Medicine, The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Atlanta Georgia USA
| | - Beverly B. Rogers
- Children's Healthcare of Atlanta The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Emory University School of Medicine Atlanta Georgia USA
| | - Raymond F. Schinazi
- Laboratory of Biochemical Pharmacology, Department of Pediatrics Children's Healthcare of Atlanta, The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Emory University School of Medicine Atlanta Georgia USA
| | - Allie B. Suessmith
- Emory University Laney Graduate School, The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Emory University School of Medicine Atlanta Georgia USA
| | - Julie Sullivan
- The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Emory University School of Medicine Atlanta Georgia USA
| | - Erika A. Tyburski
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta Emory University School of Medicine, Department of Pediatrics, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Atlanta Georgia USA
| | - Miriam B. Vos
- Emory University Laney Graduate School, The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies, Emory University School of Medicine Atlanta Georgia USA
| | - Jesse J. Waggoner
- Emory University School of Medicine, Division of Infectious Diseases Atlanta Georgia
| | - Yun F. (Wayne) Wang
- The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Emory University School of Medicine Atlanta Georgia USA
| | - Jen Madsen
- The MITRE Corporation McLean Virginia USA
| | - Daniel S. Wechsler
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta Emory University School of Medicine, Department of Pediatrics Atlanta Georgia USA
| | - Clinton H. Joiner
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta Emory University School of Medicine, Department of Pediatrics Atlanta Georgia USA
| | - Greg S. Martin
- The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Emory University School of Medicine Atlanta Georgia USA
| | - Wilbur A. Lam
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta Emory University School of Medicine, Department of Pediatrics, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, The Atlanta Center for Microsystems‐Engineered Point‐of‐Care Technologies Atlanta Georgia USA
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Chonat S, Graciaa S, Shin HS, Newton JG, Quarmyne MO, Boudreaux J, Tang A, Zerra PE, Rollins MR, Josephson CD, Brown C, Joiner CH, Fasano RM, Stowell SR. Eculizumab for complement mediated thrombotic microangiopathy in sickle cell disease. Haematologica 2020; 105:2887-2891. [PMID: 33256394 PMCID: PMC7716365 DOI: 10.3324/haematol.2020.262006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Satheesh Chonat
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center
| | | | - H. Stella Shin
- Department of Pediatrics, Emory University School of Medicine
- Division of Pediatric Nephrology, Children’s Healthcare of Atlanta
| | - Joanna G. Newton
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center
| | - Maa-Ohui Quarmyne
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center
| | - Jeanne Boudreaux
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center
| | - Amy Tang
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center
| | - Patricia E. Zerra
- Aflac Cancer and Blood Disorders Center
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Margo R. Rollins
- Aflac Cancer and Blood Disorders Center
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Cassandra D. Josephson
- Aflac Cancer and Blood Disorders Center
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Clark Brown
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center
| | - Clinton H. Joiner
- Department of Pediatrics, Emory University School of Medicine
- Aflac Cancer and Blood Disorders Center
| | - Ross M. Fasano
- Aflac Cancer and Blood Disorders Center
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sean R. Stowell
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Lee SY, Cowdrick KR, Sanders B, Sathialingam E, McCracken CE, Lam WA, Joiner CH, Buckley EM. Noninvasive optical assessment of resting-state cerebral blood flow in children with sickle cell disease. Neurophotonics 2019; 6:035006. [PMID: 31482101 PMCID: PMC6699550 DOI: 10.1117/1.nph.6.3.035006] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/24/2019] [Indexed: 05/08/2023]
Abstract
Sickle cell disease (SCD) is a genetic blood disorder that has profound effects on the brain. Chronic anemia combined with both macro- and microvascular perfusion abnormalities that arise from stenosis or occlusion of blood vessels increased blood viscosity, adherence of red blood cells to the vascular endothelium, and impaired autoregulatory mechanisms in SCD patients all culminate in susceptibility to cerebral infarction. Indeed, the risk of stroke is 250 times higher in children with SCD than in the general population. Unfortunately, while transcranial Doppler ultrasound (TCD) has been widely clinically adopted to longitudinally monitor macrovascular perfusion in these patients, routine clinical screening of microvascular perfusion abnormalities is challenging with current modalities (e.g., positron emission tomography and magnetic resonance imaging) given their high-cost, requirement for sedation in children < 6 year, and need for trained personnel. We assess the feasibility of a low-cost, noninvasive optical technique known as diffuse correlation spectroscopy (DCS) to quantify an index of resting-state cortical cerebral blood flow (BFI) in 11 children with SCD along with 11 sex- and age-matched healthy controls. As expected, BFI was significantly higher in SCD subjects compared to healthy controls ( p < 0.001 ). Within SCD subjects, BFI was inversely proportional to resting-state arterial hemoglobin levels ( p = 0.012 ), consistent with expected anemia-induced compensatory vasodilation that aims to maintain adequate oxygen delivery to the tissue. Further, in a subset of patients measured with TCD ( n = 7 ), DCS-measured blood flow was correlated with TCD-measured blood flow velocity in middle cerebral artery ( R s = 0.68 ), although the trend was not statistically significant ( p = 0.11 ). These results are consistent with those of several previous studies using traditional neuroimaging techniques, suggesting that DCS may be a promising low-cost tool for assessment of tissue-level CBF in pediatric SCD.
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Affiliation(s)
- Seung Yup Lee
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Kyle R. Cowdrick
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Bharat Sanders
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Eashani Sathialingam
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Courtney E. McCracken
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
| | - Wilbur A. Lam
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
| | - Clinton H. Joiner
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, Georgia, United States
| | - Erin M. Buckley
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
- Children’s Healthcare of Atlanta, Children’s Research Scholar, Atlanta, Georgia, United States
- Address all correspondence to Erin M. Buckley, E-mail:
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7
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Naik RP, Smith-Whitley K, Hassell KL, Umeh NI, de Montalembert M, Sahota P, Haywood C, Jenkins J, Lloyd-Puryear MA, Joiner CH, Bonham VL, Kato GJ. Clinical Outcomes Associated With Sickle Cell Trait: A Systematic Review. Ann Intern Med 2018; 169:619-627. [PMID: 30383109 PMCID: PMC6487193 DOI: 10.7326/m18-1161] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [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: 12/25/2022] Open
Abstract
Background Although sickle cell trait (SCT) is largely a benign carrier state, it may increase risk for certain clinical outcomes. Purpose To evaluate associations between SCT and clinical outcomes in children and adults. Data Sources English-language searches of PubMed, CINAHL, the Cochrane Library, Current Contents Connect, Scopus, and Embase (1 January 1970 to 30 June 2018) and bibliographies of review articles. Study Selection Observational controlled studies (published in English) in children or adults that examined an association between SCT and any of 24 clinical outcomes specified a priori in the following 6 categories: exertion-related injury; renal, vascular, pediatric, and surgery- or trauma-related outcomes; and overall mortality. Data Extraction A single reviewer extracted study data, which was checked by another; 2 reviewers independently assessed study quality; and strength of evidence was assessed by consensus. Data Synthesis Of 7083 screened studies, 41 met inclusion criteria. High-strength evidence supported a positive association between SCT and risk for pulmonary embolism, proteinuria, and chronic kidney disease. Moderate-strength evidence supported a positive association between SCT and exertional rhabdomyolysis and a null association between SCT and deep venous thrombosis, heart failure or cardiomyopathy, stroke, and pediatric height or weight. Absolute risks for thromboembolism and rhabdomyolysis were small. For the remaining 15 clinical outcomes, data were insufficient or strength of evidence was low. Limitation Publication bias was possible, and high-quality evidence was scant. Conclusion Sickle cell trait is a risk factor for a few adverse health outcomes, such as pulmonary embolism, kidney disease, and exertional rhabdomyolysis, but does not seem to be associated with such complications as heart failure and stroke. Insufficient data or low-strength evidence exists for most speculated complications of SCT. Primary Funding Source National Human Genome Research Institute.
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Affiliation(s)
| | - Kim Smith-Whitley
- Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, Pennsylvania
| | | | - Nkeiruka I. Umeh
- National Human Genome Research Institute of the National Institutes
of Health, Bethesda, Maryland
| | | | - Puneet Sahota
- Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, Pennsylvania
| | - Carlton Haywood
- University of Pennsylvania, Philadelphia, Pennsylvania; Johns
Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - Jean Jenkins
- National Human Genome Research Institute of the National Institutes
of Health, Bethesda, Maryland
| | | | | | - Vence L. Bonham
- National Human Genome Research Institute of the National
Institutes of Health, Bethesda, Maryland
| | - Gregory J. Kato
- Vascular Medicine Institute at the University of Pittsburgh School
of Medicine, Pittsburgh, Pennsylvania
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8
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Chonat S, Quarmyne MO, Bennett CM, Dean CL, Joiner CH, Fasano RM, Stowell SR. Contribution of alternative complement pathway to delayed hemolytic transfusion reaction in sickle cell disease. Haematologica 2018; 103:e483-e485. [PMID: 29794144 DOI: 10.3324/haematol.2018.194670] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Satheesh Chonat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA .,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Maa-Ohui Quarmyne
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Caroline M Bennett
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Christina L Dean
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Clinton H Joiner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ross M Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sean R Stowell
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
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9
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Qiu Y, Ahn B, Sakurai Y, Hansen CE, Tran R, Mimche PN, Mannino RG, Ciciliano JC, Lamb TJ, Joiner CH, Ofori-Acquah SF, Lam WA. Microvasculature-on-a-chip for the long-term study of endothelial barrier dysfunction and microvascular obstruction in disease. Nat Biomed Eng 2018; 2:453-463. [PMID: 30533277 PMCID: PMC6286070 DOI: 10.1038/s41551-018-0224-z] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [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] [Indexed: 12/26/2022]
Abstract
Alterations in the mechanical properties of erythrocytes occurring in inflammatory and hematologic disorders such as sickle cell disease (SCD) and malaria often lead to increased endothelial permeability, haemolysis, and microvascular obstruction. However, the associations among these pathological phenomena remain unknown. Here, we report a perfusable, endothelialized microvasculature-on-a-chip featuring an interpenetrating-polymer-network hydrogel that recapitulates the stiffness of blood-vessel intima, basement membrane self-deposition and self-healing endothelial barrier function for longer than 1 month. The microsystem enables the real-time visualization, with high spatiotemporal resolution, of microvascular obstruction and endothelial permeability under physiological flow conditions. We found how extracellular heme, a hemolytic byproduct, induces delayed but reversible endothelial permeability in a dose-dependent manner, and demonstrate that endothelial interactions with SCD or malaria-infected erythrocytes cause reversible microchannel occlusion and increased in situ endothelial permeability. The microvasculature-on-a-chip enables mechanistic insight into the endothelial barrier dysfunction associated with SCD, malaria and other inflammatory and haematological diseases.
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Affiliation(s)
- Yongzhi Qiu
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Byungwook Ahn
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yumiko Sakurai
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Caroline E Hansen
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA.,Department of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA, USA
| | - Reginald Tran
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Patrice N Mimche
- Department of Pathology, University of Utah, Salt Lake City, UT, United States
| | - Robert G Mannino
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jordan C Ciciliano
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Tracey J Lamb
- Department of Pathology, University of Utah, Salt Lake City, UT, United States
| | - Clinton H Joiner
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Solomon F Ofori-Acquah
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Translational and International Hematology, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA.,School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Wilbur A Lam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA. .,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA. .,Winship Cancer Institute, Emory University, Atlanta, GA, USA. .,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.
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10
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Carden MA, Fay M, Sakurai Y, McFarland B, Blanche S, DiPrete C, Joiner CH, Sulchek T, Lam WA. Normal saline is associated with increased sickle red cell stiffness and prolonged transit times in a microfluidic model of the capillary system. Microcirculation 2018; 24. [PMID: 28106307 DOI: 10.1111/micc.12353] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 12/14/2016] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Vaso-occlusive crisis (VOC) is a complex process that occurs in patients with sickle cell disease (SCD) and is often associated with pain and urgent hospitalization. A major instigator of VOC is microvascular obstruction by pathologically stiffened sickle red blood cells (RBCs), and thus, therapy relies heavily on optimizing intravenous fluid (IVF) hydration to increase RBC deformability. However, no evidence-based guidelines regarding the choice of IVF currently exist. We therefore analyzed alterations in biomechanical properties of sickle RBCs isolated from patients with homozygous SCD (hemoglobin SS) after exposure to different osmolarities of clinical IVF formulations. METHODS Atomic force microscopy (AFM) was used to assess stiffness of RBCs after exposure to different IVFs. A microfluidic model of the human capillary system was used to assess transit time (TT) and propensity to occlusion after exposure to the different IVF formulations. RESULTS Sickle RBCs exposed to normal saline (NS) had increased stiffness, TTs, and propensity to microchannel occlusion compared to other osmolarities. CONCLUSION NS, an IVF formulation often used to treat patients with SCD during VOC, may induce localized microvascular obstruction due to alterations of sickle RBC biomechanical properties.
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Affiliation(s)
- Marcus A Carden
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Meredith Fay
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yumiko Sakurai
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Brynn McFarland
- Georgia Tech School of Chemical & Biomolecular Engineering, Atlanta, GA, USA
| | - Sydney Blanche
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Caleb DiPrete
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Clinton H Joiner
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Todd Sulchek
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Wilbur A Lam
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
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11
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Risinger M, Glogowska E, Chonat S, Zhang K, Dagaonkar N, Joiner CH, Quinn CT, Kalfa TA, Gallagher PG. Hereditary xerocytosis: Diagnostic considerations. Am J Hematol 2018; 93:E67-E69. [PMID: 29210095 DOI: 10.1002/ajh.24996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Mary Risinger
- College of Nursing; University of Cincinnati; Cincinnati Ohio
| | - Edyta Glogowska
- Department of Pediatrics; Yale University School of Medicine; New Haven Connecticut
- Department of Pathology; Yale University School of Medicine; New Haven Connecticut
- Department of Genetics; Yale University School of Medicine; New Haven Connecticut
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine; Atlanta Georgia
| | - Kejian Zhang
- Molecular Genetics Laboratory; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Neha Dagaonkar
- Molecular Genetics Laboratory; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Clinton H. Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine; Atlanta Georgia
| | - Charles T. Quinn
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Theodosia A. Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Patrick G. Gallagher
- Department of Pediatrics; Yale University School of Medicine; New Haven Connecticut
- Department of Pathology; Yale University School of Medicine; New Haven Connecticut
- Department of Genetics; Yale University School of Medicine; New Haven Connecticut
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12
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Sun YY, Lee J, Huang H, Wagner MB, Joiner CH, Archer DR, Kuan CY. Abstract TMP106: Humanized Sickle Mice Are Sensitive to Hypoxia-Ischemia-Induced Stroke, but Respond to Tissue Plasminogen Activator Treatment. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tmp106] [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] [Indexed: 11/16/2022]
Abstract
Introduction:
Stroke, a devastating complication in children with Sickle Cell Anemia (SCA), consists of silent cerebral infarct (SCI) and large overt stroke. The current management relies on blood transfusion without the use of thrombolytic agents. However, a recent study showed that co-existent SCA does not impact the safety of tissue plasminogen activator (tPA) treatment. This finding calls for systemic analysis of the effects of thrombolysis in experimental stroke.
Hypothesis:
We hypothesize that sickle mice are highly vulnerable to hypoxia/ischemia-induced stroke, but respond to tPA-thrombolytic therapy.
Methods:
Townes sickle mice (knock-in/out mice that express the human α, γ, and sickle-β hemoglobin genes) were subjected to Doppler measurement of the carotid artery and evaluated for their responses to repetitive-mild hypoxia-ischemia (rmHI) and transient hypoxia-ischemia (tHI)-induced stroke at 3 and 6 months of age, respectively. The effects of tPA treatment after tHI in sickle mice were also examined.
Results:
First, 3-month-old sickle mice of SS genotype with a higher resistive index (RI) in common carotid artery were also prone to rmHI-induced cerebral infarct and mortality. Second, 6-month-old SS mice developed elevated flow velocity and greater RI without stenosis of the carotid artery akin to those previously implicated in large overt stroke in SCA. Finally, 6-month-old SS mice endured 20-min, but manifested enhanced leukocyte and platelet adherence to cerebral blood vessel, as well as, extensive vascular perfusion deficits and fibrin deposition at 4 h post-injury, followed by greatly increased mortality than AA and AS mice at 24 h recovery (p<0.0001, n>8 for each group). Importantly, intravenous tPA treatment at 0.5 h post-tHI markedly improved vascular reperfusion, mitigated fibrin deposition, and cut the mortality of SS mice by nearly 60%.
Conclusions:
Humanized sickle mice develop hyper-coagulation and hypersensitivity to HI-induced stroke without large-vessel obstructive vasculopathy at up to 6 months of age. Elevated RI may be an early ultrasonic marker for sickle cell vasculopathy and the risk of SCI in SCA. Future studies are warranted to confirm the therapeutic benefits of thrombolytic stroke therapy in SCA.
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Affiliation(s)
- Yu-Yo Sun
- Dept of Pediatrics, Emory Univ Sch of Medicine, Atlanta, GA
| | - Jolly Lee
- Emory Univ Sch of Medicine, Atlanta, GA
| | - Henry Huang
- Dept of Pediatrics, Emory Univ Sch of Medicine, Atlanta, GA
| | - Mary B Wagner
- Dept of Pediatrics, Emory Univ Sch of Medicine, Atlanta, GA
| | | | - David R Archer
- Dept of Pediatrics, Emory Univ Sch of Medicine, Atlanta, GA
| | - Chia-Yi Kuan
- Dept of Pediatrics, Emory Univ Sch of Medicine, Atlanta, GA
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13
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Carden MA, Patil P, Ahmad ME, Lam WA, Joiner CH, Morris CR. Variations in pediatric emergency medicine physician practices for intravenous fluid management in children with sickle cell disease and vaso-occlusive pain: A single institution experience. Pediatr Blood Cancer 2018; 65. [PMID: 28766843 DOI: 10.1002/pbc.26742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Marcus A Carden
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, Georgia
| | | | - Mekaal E Ahmad
- Children's Healthcare of Atlanta, Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wilbur A Lam
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, Georgia
| | - Clinton H Joiner
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, Georgia
| | - Claudia R Morris
- Children's Healthcare of Atlanta, Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
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14
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Carden MA, Fay ME, Lu X, Mannino RG, Sakurai Y, Ciciliano JC, Hansen CE, Chonat S, Joiner CH, Wood DK, Lam WA. Extracellular fluid tonicity impacts sickle red blood cell deformability and adhesion. Blood 2017; 130:2654-2663. [PMID: 28978568 PMCID: PMC5731085 DOI: 10.1182/blood-2017-04-780635] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 04/23/2017] [Accepted: 09/24/2017] [Indexed: 01/04/2023] Open
Abstract
Abnormal sickle red blood cell (sRBC) biomechanics, including pathological deformability and adhesion, correlate with clinical severity in sickle cell disease (SCD). Clinical intravenous fluids (IVFs) of various tonicities are often used during treatment of vaso-occlusive pain episodes (VOE), the major cause of morbidity in SCD. However, evidence-based guidelines are lacking, and there is no consensus regarding which IVFs to use during VOE. Further, it is unknown how altering extracellular fluid tonicity with IVFs affects sRBC biomechanics in the microcirculation, where vaso-occlusion takes place. Here, we report how altering extracellular fluid tonicity with admixtures of clinical IVFs affects sRBC biomechanical properties by leveraging novel in vitro microfluidic models of the microcirculation, including 1 capable of deoxygenating the sRBC environment to monitor changes in microchannel occlusion risk and an "endothelialized" microvascular model that measures alterations in sRBC/endothelium adhesion under postcapillary venular conditions. Admixtures with higher tonicities (sodium = 141 mEq/L) affected sRBC biomechanics by decreasing sRBC deformability, increasing sRBC occlusion under normoxic and hypoxic conditions, and increasing sRBC adhesion in our microfluidic human microvasculature models. Admixtures with excessive hypotonicity (sodium = 103 mEq/L), in contrast, decreased sRBC adhesion, but overswelling prolonged sRBC transit times in capillary-sized microchannels. Admixtures with intermediate tonicities (sodium = 111-122 mEq/L) resulted in optimal changes in sRBC biomechanics, thereby reducing the risk for vaso-occlusion in our models. These results have significant translational implications for patients with SCD and warrant a large-scale prospective clinical study addressing optimal IVF management during VOE in SCD.
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Affiliation(s)
- Marcus A Carden
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA
| | - Meredith E Fay
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA
| | - Xinran Lu
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN
| | - Robert G Mannino
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA
| | - Yumiko Sakurai
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA
| | - Jordan C Ciciliano
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- Woodruff School of Mechanical Engineering, Petit Institute for Bioengineering and Bioscience, and
| | - Caroline E Hansen
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA
| | - Satheesh Chonat
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
| | - Clinton H Joiner
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
| | - David K Wood
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN
| | - Wilbur A Lam
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA
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15
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Tehseen S, Joiner CH, Lane PA, Yee ME. Changes in urine albumin to creatinine ratio with the initiation of hydroxyurea therapy among children and adolescents with sickle cell disease. Pediatr Blood Cancer 2017; 64. [PMID: 28612449 DOI: 10.1002/pbc.26665] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/27/2017] [Accepted: 05/06/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Renal damage is a progressive complication of sickle cell disease (SCD) that begins in childhood and may progress to renal failure and early mortality in 12% of adults with hemoglobin SS (HbSS) SCD. Early sickle nephropathy is characterized by hyperfiltration and microalbuminuria; therefore, urine albumin to creatinine ratio (ACR) is an effective screening tool for its detection. PROCEDURE This study investigated the effect of hydroxyurea (HU) therapy on urine ACR levels among children with SCD. A retrospective review was conducted to identify all patients with HbSS or HbSβ0 thalassemia of age 7-18 years who began HU therapy in 2011-2013; a control group of patients not on HU were matched by age and baseline hemoglobin. All urine ACR measurements ≤24 months prior to and ≥24 months after HU initiation were recorded. RESULTS There were 63 eligible patients on HU and 13 (25%) with albuminuria prior to HU initiation. Among those with baseline albuminuria, the median ACR was 96 mg/g prior to HU, 39 mg/g at 1 year (P = 0.02), and 25 mg/g at 2 years (P = 0.03). Albuminuria normalized in 37.5% (6/16) after 1 year and 61% (8/13) after 2 years of HU therapy. Among those without albuminuria prior to HU, 13% (6/47) developed albuminuria during HU therapy. Sixteen percent (13/80) of control patients had albuminuria in the beginning of study period, which normalized in 15% (two of 13) of patients at 1-year follow up. CONCLUSION Introduction of HU is associated with significant decreases in urine ACR in children with SCD and albuminuria.
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Affiliation(s)
- Sarah Tehseen
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia
| | - Clinton H Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia
| | - Peter A Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia
| | - Marianne E Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia
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16
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Sun YY, Lee J, Huang H, Wagner MB, Joiner CH, Archer DR, Kuan CY. Sickle Mice Are Sensitive to Hypoxia/Ischemia-Induced Stroke but Respond to Tissue-Type Plasminogen Activator Treatment. Stroke 2017; 48:3347-3355. [PMID: 29127268 DOI: 10.1161/strokeaha.117.018334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 06/09/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The effects of lytic stroke therapy in patients with sickle cell anemia are unknown, although a recent study suggested that coexistent sickle cell anemia does not increase the risk of cerebral hemorrhage. This finding calls for systemic analysis of the effects of thrombolytic stroke therapy, first in humanized sickle mice, and then in patients. There is also a need for additional predictive markers of sickle cell anemia-associated vasculopathy. METHODS We used Doppler ultrasound to examine the carotid artery of Townes sickle mice tested their responses to repetitive mild hypoxia-ischemia- and transient hypoxia-ischemia-induced stroke at 3 or 6 months of age, respectively. We also examined the effects of tPA (tissue-type plasminogen activator) treatment in transient hypoxia-ischemia-injured sickle mice. RESULTS Three-month-old sickle cell (SS) mice showed elevated resistive index in the carotid artery and higher sensitivity to repetitive mild hypoxia-ischemia-induced cerebral infarct. Six-month-old SS mice showed greater resistive index and increased flow velocity without obstructive vasculopathy in the carotid artery. Instead, the cerebral vascular wall in SS mice showed ectopic expression of PAI-1 (plasminogen activator inhibitor-1) and P-selectin, suggesting a proadhesive and prothrombotic propensity. Indeed, SS mice showed enhanced leukocyte and platelet adherence to the cerebral vascular wall, broader fibrin deposition, and higher mortality after transient hypoxia-ischemia. Yet, post-transient hypoxia-ischemia treatment with tPA reduced thrombosis and mortality in SS mice. CONCLUSIONS Sickle mice are sensitive to hypoxia/ischemia-induced cerebral infarct but benefit from thrombolytic treatment. An increased resistive index in carotid arteries may be an early marker of sickle cell vasculopathy.
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Affiliation(s)
- Yu-Yo Sun
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (Y.-Y.S., J.L., H.H., C.-Y.K., C.H.J., D.R.A., M.B.W.); Center for Neurodegenerative Diseases (Y.-Y.S., J.L., H.H., C.-Y.K.); Aflac Cancer and Blood Disorders Center, Atlanta, GA (C.H.J., D.R.A.); Children's Heart Research and Outcomes Center, Emory University School of Medicine, Atlanta, GA (M.B.W.); and Children's Healthcare of Atlanta, GA (M.B.W.)
| | - Jolly Lee
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (Y.-Y.S., J.L., H.H., C.-Y.K., C.H.J., D.R.A., M.B.W.); Center for Neurodegenerative Diseases (Y.-Y.S., J.L., H.H., C.-Y.K.); Aflac Cancer and Blood Disorders Center, Atlanta, GA (C.H.J., D.R.A.); Children's Heart Research and Outcomes Center, Emory University School of Medicine, Atlanta, GA (M.B.W.); and Children's Healthcare of Atlanta, GA (M.B.W.)
| | - Henry Huang
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (Y.-Y.S., J.L., H.H., C.-Y.K., C.H.J., D.R.A., M.B.W.); Center for Neurodegenerative Diseases (Y.-Y.S., J.L., H.H., C.-Y.K.); Aflac Cancer and Blood Disorders Center, Atlanta, GA (C.H.J., D.R.A.); Children's Heart Research and Outcomes Center, Emory University School of Medicine, Atlanta, GA (M.B.W.); and Children's Healthcare of Atlanta, GA (M.B.W.)
| | - Mary B Wagner
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (Y.-Y.S., J.L., H.H., C.-Y.K., C.H.J., D.R.A., M.B.W.); Center for Neurodegenerative Diseases (Y.-Y.S., J.L., H.H., C.-Y.K.); Aflac Cancer and Blood Disorders Center, Atlanta, GA (C.H.J., D.R.A.); Children's Heart Research and Outcomes Center, Emory University School of Medicine, Atlanta, GA (M.B.W.); and Children's Healthcare of Atlanta, GA (M.B.W.)
| | - Clinton H Joiner
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (Y.-Y.S., J.L., H.H., C.-Y.K., C.H.J., D.R.A., M.B.W.); Center for Neurodegenerative Diseases (Y.-Y.S., J.L., H.H., C.-Y.K.); Aflac Cancer and Blood Disorders Center, Atlanta, GA (C.H.J., D.R.A.); Children's Heart Research and Outcomes Center, Emory University School of Medicine, Atlanta, GA (M.B.W.); and Children's Healthcare of Atlanta, GA (M.B.W.)
| | - David R Archer
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (Y.-Y.S., J.L., H.H., C.-Y.K., C.H.J., D.R.A., M.B.W.); Center for Neurodegenerative Diseases (Y.-Y.S., J.L., H.H., C.-Y.K.); Aflac Cancer and Blood Disorders Center, Atlanta, GA (C.H.J., D.R.A.); Children's Heart Research and Outcomes Center, Emory University School of Medicine, Atlanta, GA (M.B.W.); and Children's Healthcare of Atlanta, GA (M.B.W.)
| | - Chia-Yi Kuan
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (Y.-Y.S., J.L., H.H., C.-Y.K., C.H.J., D.R.A., M.B.W.); Center for Neurodegenerative Diseases (Y.-Y.S., J.L., H.H., C.-Y.K.); Aflac Cancer and Blood Disorders Center, Atlanta, GA (C.H.J., D.R.A.); Children's Heart Research and Outcomes Center, Emory University School of Medicine, Atlanta, GA (M.B.W.); and Children's Healthcare of Atlanta, GA (M.B.W.).
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17
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Yee MEM, Lane PA, Archer DR, Joiner CH, Eckman JR, Guasch A. Estimation of glomerular filtration rate using serum cystatin C and creatinine in adults with sickle cell anemia. Am J Hematol 2017; 92:E598-E599. [PMID: 28670697 DOI: 10.1002/ajh.24840] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Marianne E. M. Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - David R. Archer
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - Clinton H. Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - James R. Eckman
- Department of Hematology and Oncology; Winship Cancer Institute, Emory University School of Medicine; Atlanta Georgia
| | - Antonio Guasch
- Department of Medicine; Renal Division, Emory University School of Medicine; Atlanta Georgia
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18
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Yee ME, Lane PA, Archer DR, Joiner CH, Eckman JR, Guasch A. Losartan therapy decreases albuminuria with stable glomerular filtration and permselectivity in sickle cell anemia. Blood Cells Mol Dis 2017; 69:65-70. [PMID: 28951038 DOI: 10.1016/j.bcmd.2017.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 08/29/2017] [Accepted: 09/20/2017] [Indexed: 01/06/2023]
Abstract
Sickle cell nephropathy begins with hyperfiltration and microalbuminuria and may progress to renal failure. The aim of this study was to determine the effects of losartan on glomerular function and albumin excretion in sickle cell anemia (SCA). Individuals with SCA on hydroxyurea with persistent albuminuria were enrolled in a 1-year study of losartan. Glomerular filtration rate (GFR) measured by iohexol clearance, albumin excretion rate (AER), and fractional clearance of dextran were assessed at baseline, short-term (1-2month), and long-term (≥12month) intervals. Twelve subjects (6 microalbuminuria, 6 macroalbuminuria) completed short-term studies; 8 completed long-term studies. Baseline GFR was 112ml/min/1.73m2 (71-147ml/min/1.73m2). AER decreased significantly at the short-term (median decrease -134 mcg/min, p=0.0063). GFR was not significantly-different at short-term or long-term intervals. Dextran clearance improved for diameters smaller than albumin (<36Å) but not larger sizes. Losartan therapy for ≥1year in sickle nephropathy results in lower albumin excretion with stable GFR. Filtration of neutral molecules ≥36Å was not changed by losartan, suggesting that the effect of losartan is a mechanism other than alteration of glomerular filtration size-selectivity.
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Affiliation(s)
- Marianne E Yee
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.
| | - Peter A Lane
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - David R Archer
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Clinton H Joiner
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - James R Eckman
- Emory University, Department of Medicine, Hematology/Oncology, Atlanta, GA, United States
| | - Antonio Guasch
- Department of Medicine, Renal Division, Emory University, Atlanta, GA, United States
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19
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Quarmyne MO, Dong W, Theodore R, Anand S, Barry V, Adisa O, Buchanan ID, Bost J, Brown RC, Joiner CH, Lane PA. Hydroxyurea effectiveness in children and adolescents with sickle cell anemia: A large retrospective, population-based cohort. Am J Hematol 2017; 92:77-81. [PMID: 27761932 DOI: 10.1002/ajh.24587] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 11/11/2022]
Abstract
The clinical efficacy of hydroxyurea in patients with sickle cell anemia (SCA) has been well established. However, data about its clinical effectiveness in practice is limited. We evaluated the clinical effectiveness of hydroxyurea in a large pediatric population using a retrospective cohort, pre-post treatment study design to control for disease severity selection bias. The cohort included children with SCA (SS, Sβ0 thalassemia) who received care at Children's Healthcare of Atlanta (CHOA) and who initiated hydroxyurea in 2009-2011. Children on chronic transfusions, or children with inadequate follow up data and/or children who had taken hydroxyurea in the 3 years prior were excluded. For each patient healthcare utilization, laboratory values, and clinical outcomes for the 2-year period prior to hydroxyurea initiation were compared to those 2 years after initiation. Of 211 children with SCA who initiated hydroxyurea in 2009-2011, 134 met eligibility criteria. After initiation of hydroxyurea, rates of hospitalizations, pain encounters, and emergency department visits were reduced by 47% (<0.0001), 36% (P = 0.0001) and 43% (P < 0.0001), respectively. Average hemoglobin levels increased by 0.7 g/dl (P < 0.0001). Hydroxyurea effectiveness was similar across gender, insurance types and age, although there was a slightly greater reduction in hospitalizations in younger children. Am. J. Hematol. 92:77-81, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Maa-Ohui Quarmyne
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Wei Dong
- Connance, Inc; Waltham Massachusetts
| | - Rodney Theodore
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
| | - Sonia Anand
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
| | - Vaughn Barry
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Olufolake Adisa
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Iris D. Buchanan
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics, Morehouse School of Medicine; Atlanta Georgia
| | - James Bost
- Outcomes Center; Children's Healthcare of Atlanta; Atlanta Georgia
| | - Robert C. Brown
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Clinton H. Joiner
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
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20
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Quinn CT, Smith EP, Arbabi S, Khera PK, Lindsell CJ, Niss O, Joiner CH, Franco RS, Cohen RM. Biochemical surrogate markers of hemolysis do not correlate with directly measured erythrocyte survival in sickle cell anemia. Am J Hematol 2016; 91:1195-1201. [PMID: 27648808 DOI: 10.1002/ajh.24562] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/17/2016] [Indexed: 01/18/2023]
Abstract
Hemolysis is a key feature of sickle cell anemia (HbSS). Direct quantitation of hemolysis could be used as an objective outcome in clinical trials of new therapeutics for HbSS and would also enable better human studies of the pathogenesis of complications of HbSS that are ostensibly hemolysis-related, such as pulmonary hypertension. However, contemporary human studies in HbSS have used only surrogate markers of hemolysis rather than direct measurements of RBC survival. We directly quantified hemolysis in HbSS by measuring survival of an age cohort of RBCs labeled with a stable isotope, administered orally as 15 N-glycine, a metabolic precursor of heme. The atomic excess of 15 N in heme extracted from blood was monitored by mass spectrometry over time. We performed 13 labeling experiments in 11 individuals with HbSS. Mean RBC survival was 31.9 days (range 14.1-53.6). Both HbF level, a known determinant of hemolysis, and absolute reticulocyte count (ARC), an index of the marrow's response to hemolysis, correlated with directly measured RBC survival (r = 0.61, P < 0.002; r = -0.84, P < 0.001). However, commonly used biochemical surrogates of hemolysis (LDH, AST, bilirubin, and plasma free hemoglobin) did not correlate with directly measured RBC survival. These biochemical surrogates should be interpreted cautiously, at best, in clinical trials and human physiologic studies in HbSS. ARC was the best correlate of total hemolysis, but only 70% of the variation in RBC survival was reflected in this marker. If greater accuracy is required in human studies, 15 N-glycine RBC labeling can directly and accurately quantify hemolysis. Am. J. Hematol. 91:1195-1201, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Charles T. Quinn
- Division of HematologyCincinnati Children's Hospital Medical CenterCincinnati OH
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnati OH
| | - Eric P. Smith
- Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnati OH
| | - Shahriar Arbabi
- Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnati OH
| | - Paramjit K. Khera
- Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnati OH
| | | | - Omar Niss
- Division of HematologyCincinnati Children's Hospital Medical CenterCincinnati OH
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnati OH
| | - Clinton H. Joiner
- Aflac Cancer and Blood Disorders Center, Emory University School of MedicineAtlanta GA
| | - Robert S. Franco
- Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnati OH
| | - Robert M. Cohen
- Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnati OH
- Cincinnati Veterans Affairs Medical CenterCincinnati OH
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21
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Barber LA, Palascak MB, Qi X, Joiner CH, Franco RS. Activation of protein kinase C by phorbol ester increases red blood cell scramblase activity and external phosphatidylserine. Eur J Haematol 2015; 95:405-10. [PMID: 25600460 DOI: 10.1111/ejh.12506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 01/02/2023]
Abstract
Externalization of phosphatidylserine (PS) is thought to contribute to sickle cell disease (SCD) pathophysiology. The red blood cell (RBC) aminophospholipid translocase (APLT) mediates the transport of PS from the outer to the inner RBC membrane leaflet to maintain an asymmetric distribution of PL, while phospholipid scramblase (PLSCR) equilibrates PL across the RBC membrane, promoting PS externalization. We previously identified an association between PS externalization level and PLSCR activity in sickle RBC under basal conditions. Other studies showed that activation of protein kinase C (PKC) by PMA (phorbol-12-myristate-13-acetate) causes increased external PS on RBC. Therefore, we hypothesized that PMA-activated PKC stimulates PLSCR activity in RBC and thereby contributes to increased PS externalization. In the current studies, we show that PMA treatment causes immediate and variable PLSCR activation and subsequent PS externalization in control and sickle RBC. While TfR+ sickle reticulocytes display some endogenous PLSCR activity, we observed a robust activation of PLSCR in sickle reticulocytes treated with PMA. The PKC inhibitor, chelerythrine (Chel), significantly inhibited PMA-dependent PLSCR activation and PS externalization. Chel also inhibited endogenous PLSCR activity in sickle reticulocytes. These data provide evidence that PKC mediates PS externalization in RBC through activation of PLSCR.
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Affiliation(s)
- Latorya A Barber
- Division of Internal Medicine-Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mary B Palascak
- Division of Internal Medicine-Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Xiaoyang Qi
- Division of Internal Medicine-Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Clinton H Joiner
- Department of Pediatrics, Division of Hematology Oncology, Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA, USA
| | - Robert S Franco
- Division of Internal Medicine-Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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22
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Khera PK, Smith EP, Lindsell CJ, Rogge MC, Haggerty S, Wagner DA, Palascak MB, Mehta S, Hibbert JM, Joiner CH, Franco RS, Cohen RM. Use of an oral stable isotope label to confirm variation in red blood cell mean age that influences HbA1c interpretation. Am J Hematol 2015; 90:50-55. [PMID: 25293624 DOI: 10.1002/ajh.23866] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/24/2014] [Accepted: 10/02/2014] [Indexed: 01/22/2023]
Abstract
HbA1c is commonly used to monitor glycemic control. However, there is growing evidence that the relationship between HbA1c and mean blood glucose (MBG) is influenced by variation in red blood cell (RBC) lifespan in hematologically normal individuals. Correction of HbA1c for mean RBC age (MRBC ) requires a noninvasive, accurate, and affordable method to measure RBC survival. In this study, we evaluated whether a stable isotope approach would satisfy these requirements. RBC lifespan and MRBC were determined in a group of nine hematologically normal diabetic and nondiabetic subjects using oral (15) N-glycine to label heme in an age cohort of RBC. The MRBC was 58.7 ± 9.1 (2SD) days and RBC lifespan was 106 ± 21 (2SD) days. This degree of variation (±15-20%) is consistent with previous studies using other techniques. In a subset of seven subjects, MRBC determined with the biotin label technique were available from approximately five years prior, and strongly correlated with the stable isotope values (R(2) = 0.79). This study suggests that the MRBC is stable over time but varies substantially among individuals, and supports the importance of its variation in HbA1c interpretation. The characteristics of the stable isotope method support its suitability for studies to directly evaluate the impact of variation in MRBC on the interpretation of HbA1c.
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Affiliation(s)
- Paramjit K. Khera
- Division of Endocrinology, Diabetes & Metabolism; Department of Internal Medicine, University of Cincinnati College of Medicine; Cincinnati Ohio USA
| | - Eric P. Smith
- Division of Endocrinology, Diabetes & Metabolism; Department of Internal Medicine, University of Cincinnati College of Medicine; Cincinnati Ohio USA
| | - Christopher J. Lindsell
- Department of Emergency Medicine; University of Cincinnati College of Medicine; Cincinnati Ohio USA
| | | | - Shannon Haggerty
- Division of Endocrinology, Diabetes & Metabolism; Department of Internal Medicine, University of Cincinnati College of Medicine; Cincinnati Ohio USA
| | | | - Mary B. Palascak
- Division of Hematology, Department of Internal Medicine; University of Cincinnati College of Medicine
| | - Shilpa Mehta
- Division of Endocrinology, Diabetes & Metabolism; Department of Internal Medicine, University of Cincinnati College of Medicine; Cincinnati Ohio USA
| | - Jacqueline M. Hibbert
- Department of Microbiology, Biochemistry & Immunology; Morehouse School of Medicine; Atlanta Georgia
| | - Clinton H. Joiner
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center; Emory University; Atlanta Georgia
| | - Robert S. Franco
- Division of Hematology, Department of Internal Medicine; University of Cincinnati College of Medicine
| | - Robert M. Cohen
- Division of Endocrinology, Diabetes & Metabolism; Department of Internal Medicine, University of Cincinnati College of Medicine; Cincinnati Ohio USA
- Department of Medicine; Cincinnati VA Medical Center; Cincinnati OH
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23
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Gonsalves CS, Crable S, Chandra S, Li W, Kalra VK, Joiner CH. Angiogenic growth factors augment K-Cl cotransporter expression in erythroid cells via hypoxia-inducible factor-1α. Am J Hematol 2014; 89:273-81. [PMID: 24227191 PMCID: PMC4223994 DOI: 10.1002/ajh.23631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 08/08/2013] [Revised: 11/01/2013] [Accepted: 11/11/2013] [Indexed: 01/22/2023]
Abstract
The potassium chloride cotransporters (KCC) family of proteins are widely expressed and are involved in the transepithelial movement of potassium and chloride ions and the regulation of cell volume. KCC activity is high in reticulocytes, and contributes to the dehydration of sickle red blood cells. Because plasma levels of both vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) are elevated in sickle cell individuals, and VEGF has been shown to increase KCC expression in other cells, we hypothesized that VEGF and PlGF influence KCC expression in erythroid cells. Both VEGF and PlGF treatment of human erythroid K562 cells increased both mRNA and protein levels of KCC1, KCC3b, and KCC4. VEGF- and PlGF-mediated cellular signaling involved VEGF-R1 and downstream effectors, specifically, PI-3 kinase, p38 MAP kinase, mTOR, NADPH-oxidase, JNK kinase, and HIF-1α. VEGF and PlGF-mediated transcription of KCC3b and KCC4 involved hypoxia response element (HRE) motifs in their promoters, as demonstrated by promoter analysis, EMSA and ChiP. These results were corroborated in vivo by adenoviral-mediated overexpression of PlGF in normal mice, which led to increased expression of mKCC3 and mKCC4 in erythroid precursors. Our studies show that VEGF and PlGF regulate transcription of KCC3b and KCC4 in erythroid cells via activation of HIF-1α, independent of hypoxia. These studies provide novel therapeutic targets for regulation of cell volume in RBC precursors, and thus, amelioration of dehydration in RBCs in sickle cell disease.
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Affiliation(s)
- Caryn S Gonsalves
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical CenterCincinnati, Ohio
- Department of Biochemistry and Molecular Biology, Keck School of Medicine of the University of Southern CaliforniaLos Angeles, California
| | - Scott Crable
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical CenterCincinnati, Ohio
| | - Sharat Chandra
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical CenterCincinnati, Ohio
| | - Wei Li
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory UniversityAtlanta, Georgia
| | - Vijay K Kalra
- Department of Biochemistry and Molecular Biology, Keck School of Medicine of the University of Southern CaliforniaLos Angeles, California
| | - Clinton H Joiner
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical CenterCincinnati, Ohio
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory UniversityAtlanta, Georgia
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24
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Franco RS, Puchulu-Campanella ME, Barber LA, Palascak MB, Joiner CH, Low PS, Cohen RM. Changes in the properties of normal human red blood cells during in vivo aging. Am J Hematol 2013; 88:44-51. [PMID: 23115087 PMCID: PMC4067949 DOI: 10.1002/ajh.23344] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [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: 06/18/2012] [Revised: 09/12/2012] [Accepted: 09/17/2012] [Indexed: 11/10/2022]
Abstract
The changes in red blood cells (RBC) as they age and the mechanisms for their eventual removal have been of interest for many years. Proposed age-related changes include dehydration with increased density and decreased size, increased membrane IgG, loss of membrane phospholipid asymmetry, and decreased activity of KCl cotransport. The biotin RBC label allows unambiguous identification of older cells and exploration of their properties as they age. Autologous normal human RBC were labeled ex vivo and, after reinfusion, compared with unlabeled RBC throughout their lifespan. RBC density increased with age, with most of the change in the first weeks. Near the end of their lifespan, RBC had increased surface IgG. However, there was no evidence for elevated external phosphatidylserine (PS) even though older RBC had significantly lower activity of aminophospholipid translocase (APLT). KCl cotransport activity persisted well past the reticulocyte stage, but eventually decreased as the RBC became older. These studies place limitations on the use of density fractionation for the study of older human RBC, and do not support loss of phospholipid asymmetry as a mechanism for human RBC senescence. However, increased levels of IgG were associated with older RBC, and may contribute to their removal from the circulation.
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Affiliation(s)
- Robert S Franco
- Internal Medicine Hem/Onc, Purdue University, West Lafayette, Indiana, USA.
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25
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De Franceschi L, Franco RS, Bertoldi M, Brugnara C, Matté A, Siciliano A, Wieschhaus AJ, Chishti AH, Joiner CH. Pharmacological inhibition of calpain-1 prevents red cell dehydration and reduces Gardos channel activity in a mouse model of sickle cell disease. FASEB J 2012; 27:750-9. [PMID: 23085996 DOI: 10.1096/fj.12-217836] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sickle cell disease (SCD) is a globally distributed hereditary red blood cell (RBC) disorder. One of the hallmarks of SCD is the presence of circulating dense RBCs, which are important in SCD-related clinical manifestations. In human dense sickle cells, we found reduced calpastatin activity and protein expression compared to either healthy RBCs or unfractionated sickle cells, suggesting an imbalance between activator and inhibitor of calpain-1 in favor of activator in dense sickle cells. Calpain-1 is a nonlysosomal cysteine proteinase that modulates multiple cell functions through the selective cleavage of proteins. To investigate the relevance of this observation in vivo, we evaluated the effects of the orally active inhibitor of calpain-1, BDA-410 (30 mg/kg/d), on RBCs from SAD mice, a mouse model for SCD. In SAD mice, BDA-410 improved RBC morphology, reduced RBC density (D(20); from 1106 ± 0.001 to 1100 ± 0.001 g/ml; P<0.05) and increased RBC-K(+) content (from 364 ± 10 to 429 ± 12.3 mmol/kg Hb; P<0.05), markedly reduced the activity of the Ca(2+)-activated K(+)channel (Gardos channel), and decreased membrane association of peroxiredoxin-2. The inhibitory effect of calphostin C, a specific inhibitor of protein kinase C (PKC), on the Gardos channel was eliminated after BDA-410 treatment, which suggests that calpain-1 inhibition affects the PKC-dependent fraction of the Gardos channel. BDA-410 prevented hypoxia-induced RBC dehydration and K(+) loss in SAD mice. These data suggest a potential role of BDA-410 as a novel therapeutic agent for treatment of SCD.
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Goldsmith JC, Bonham VL, Joiner CH, Kato GJ, Noonan AS, Steinberg MH. Framing the research agenda for sickle cell trait: building on the current understanding of clinical events and their potential implications. Am J Hematol 2012; 87:340-6. [PMID: 22307997 PMCID: PMC3513289 DOI: 10.1002/ajh.22271] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [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: 11/25/2011] [Accepted: 12/01/2011] [Indexed: 02/02/2023]
Abstract
Sickle Cell Trait (HbAS), the heterozygous state for the sickle hemoglobin beta globin gene is carried by as many as 100 million individuals including up to 25% of the population in some regions of the world (World Health Organization, Provisional agenda item 4.8, EB117/34 (22 December 2005) or World Health Organization, Provisional agenda item 11.4 (24 April 2006)). Persons with HbAS have some resistance to falciparum malaria infection in early childhood (Piel FB, Patil AP, Howes RE, et al., Nat Commun 2010;1104:1-7 and Aidoo M, Terlouw DJ, Kolczak M, et al., Lancet 2002;359:1311-1312) and as a result individuals with HbAS living in malarial endemic regions of Africa have a survival advantage over individuals with HbAA. Reports from the US emphasize possible health risks for individuals with HbAS including increased incidence of renal failure and malignancy, thromboembolic disorders, splenic infarction as a high altitude complication, and exercise-related sudden death. The National Heart, Lung, and Blood Institute, National Institutes of Health convened a workshop in Bethesda, Maryland on June 3-4, 2010, Framing the Research Agenda for Sickle Cell Trait, to review the clinical manifestations of HbAS, discuss the exercise-related sudden death reports in HbAS, and examine the public health, societal, and ethical implications of policies regarding HbAS. The goal of the workshop was to identify potential research questions to address knowledge gaps.
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Affiliation(s)
- Jonathan C Goldsmith
- Blood Diseases Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-7950, USA.
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27
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George A, Benton J, Pratt J, Kim MO, Kalinyak KA, Kalfa TA, Joiner CH. The impact of the 2009 H1N1 influenza pandemic on pediatric patients with sickle cell disease. Pediatr Blood Cancer 2011; 57:648-53. [PMID: 21360656 PMCID: PMC4474377 DOI: 10.1002/pbc.23030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 12/17/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Respiratory infections are associated with clinically significant illness in patients with sickle cell disease (SCD). The 2009 H1N1 pandemic was perceived as a significant threat to this population. METHODS We undertook a chart review of all patients with SCD followed at our institution to identify those with confirmed H1N1 infection. Further chart and laboratory data was collected on affected patients to analyze clinical courses and the factors that correlated with disease severity. RESULTS Approximately half of the patients with confirmed H1N1 infection were managed successfully on an outpatient basis with oseltamivir therapy. Among the patients admitted, the most common diagnosis was acute chest syndrome (ACS). Most admitted patients had uncomplicated clinical courses, with a median length of admission of 3 days and no mortality or requirement for mechanical ventilation. A past history of ACS or reactive airway disease correlated with a higher rate of admission and of ACS incidence during the acute illness. Chronic transfusion therapy or hydroxyurea therapy with high hemoglobin F levels had a strong inverse correlation with incidence of ACS. CONCLUSIONS Our results indicate that that in general the impact of the H1N1 influenza pandemic on patients with SCD was mild but that past clinical history correlated with the severity of illness. Additionally, effective hydroxyurea therapy and chronic transfusion therapy appeared to be protective against the incidence of ACS. Our results suggest guidelines for the management of patients with SCD during future influenza pandemics as well as during seasonal influenza epidemics.
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Affiliation(s)
- Alex George
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
| | - Jennifer Benton
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jesse Pratt
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Mi-Ok Kim
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Karen A. Kalinyak
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Theodosia A. Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Clinton H. Joiner
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Pan D, Kalfa TA, Wang D, Risinger M, Crable S, Ottlinger A, Chandra S, Mount DB, Hübner CA, Franco RS, Joiner CH. K-Cl cotransporter gene expression during human and murine erythroid differentiation. J Biol Chem 2011; 286:30492-30503. [PMID: 21733850 PMCID: PMC3162409 DOI: 10.1074/jbc.m110.206516] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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: 12/20/2010] [Revised: 06/23/2011] [Indexed: 11/06/2022] Open
Abstract
The K-Cl cotransporter (KCC) regulates red blood cell (RBC) volume, especially in reticulocytes. Western blot analysis of RBC membranes revealed KCC1, KCC3, and KCC4 proteins in mouse and human cells, with higher levels in reticulocytes. KCC content was higher in sickle versus normal RBC, but the correlation with reticulocyte count was poor, with inter-individual variability in KCC isoform ratios. Messenger RNA for each isoform was measured by real time RT-quantitative PCR. In human reticulocytes, KCC3a mRNA levels were consistently the highest, 1-7-fold higher than KCC4, the second most abundant species. Message levels for KCC1 and KCC3b were low. The ratios of KCC RNA levels varied among individuals but were similar in sickle and normal RBC. During in vivo maturation of human erythroblasts, KCC3a RNA was expressed consistently, whereas KCC1 and KCC3b levels declined, and KCC4 message first increased and then decreased. In mouse erythroblasts, a similar pattern for KCC3 and KCC1 expression during in vivo differentiation was observed, with low KCC4 RNA throughout despite the presence of KCC4 protein in mature RBC. During differentiation of mouse erythroleukemia cells, protein levels of KCCs paralleled increasing mRNA levels. Functional properties of KCCs expressed in HEK293 cells were similar to each other and to those in human RBC. However, the anion dependence of KCC in RBC resembled most closely that of KCC3. The results suggest that KCC3 is the dominant isoform in erythrocytes, with variable expression of KCC1 and KCC4 among individuals that could result in modulation of KCC activity.
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Affiliation(s)
- Dao Pan
- Molecular and Cell Therapy Program, Division of Experimental Hematology, Cincinnati, Ohio 45229; the Departments of Pediatrics, Cincinnati, Ohio 45267.
| | - Theodosia A Kalfa
- the Departments of Pediatrics, Cincinnati, Ohio 45267; Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 45229
| | - Daren Wang
- Molecular and Cell Therapy Program, Division of Experimental Hematology, Cincinnati, Ohio 45229
| | - Mary Risinger
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 45229
| | - Scott Crable
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 45229
| | - Anna Ottlinger
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 45229
| | - Sharat Chandra
- the Departments of Pediatrics, Cincinnati, Ohio 45267; Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 45229
| | - David B Mount
- Renal Division, Brigham and Women's Hospital, Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, Massachusetts 02115
| | - Christian A Hübner
- Department of Clinical Chemistry, University Hospital of the Friedrich-Schiller-University, D-07747 Jena, Germany
| | - Robert S Franco
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 45229; Internal Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio 45267
| | - Clinton H Joiner
- the Departments of Pediatrics, Cincinnati, Ohio 45267; Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 45229.
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Hammill AM, Risinger MA, Joiner CH, Keddache M, Kalfa TA. Compound heterozygosity for two novel mutations in the erythrocyte protein 4.2 gene causing spherocytosis in a Caucasian patient. Br J Haematol 2011; 152:780-3. [PMID: 21275958 DOI: 10.1111/j.1365-2141.2010.08516.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yang MQ, Laflamme K, Gotea V, Joiner CH, Seidel NE, Wong C, Petrykowska HM, Lichtenberg J, Lee S, Welch L, Gallagher PG, Bodine DM, Elnitski L. Genome-wide detection of a TFIID localization element from an initial human disease mutation. Nucleic Acids Res 2010; 39:2175-87. [PMID: 21071415 PMCID: PMC3064768 DOI: 10.1093/nar/gkq1035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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] [Indexed: 12/15/2022] Open
Abstract
Eukaryotic core promoters are often characterized by the presence of consensus motifs such as the TATA box or initiator elements, which attract and direct the transcriptional machinery to the transcription start site. However, many human promoters have none of the known core promoter motifs, suggesting that undiscovered promoter motifs exist in the genome. We previously identified a mutation in the human Ankyrin-1 (ANK-1) promoter that causes the disease ankyrin-deficient Hereditary Spherocytosis (HS). Although the ANK-1 promoter is CpG rich, no discernable basal promoter elements had been identified. We showed that the HS mutation disrupted the binding of the transcription factor TFIID, the major component of the pre-initiation complex. We hypothesized that the mutation identified a candidate promoter element with a more widespread role in gene regulation. We examined 17,181 human promoters for the experimentally validated binding site, called the TFIID localization sequence (DLS) and found three times as many promoters containing DLS than TATA motifs. Mutational analyses of DLS sequences confirmed their functional significance, as did the addition of a DLS site to a minimal Sp1 promoter. Our results demonstrate that novel promoter elements can be identified on a genome-wide scale through observations of regulatory disruptions that cause human disease.
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Affiliation(s)
- Mary Q Yang
- Genome Technology Branch, National Human Genome Research Institute, National Institutes of Health, Rockville, MD 20852, USA
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Affiliation(s)
- Melissa Rayburg
- Department of Pediatrics, Cincinnati Comprehensive Sickle Cell Center, Ohio, USA
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32
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Rinehart J, Maksimova YD, Tanis JE, Stone KL, Hodson CA, Zhang J, Risinger M, Pan W, Wu D, Colangelo CM, Forbush B, Joiner CH, Gulcicek EE, Gallagher PG, Lifton RP. Sites of regulated phosphorylation that control K-Cl cotransporter activity. Cell 2009; 138:525-36. [PMID: 19665974 PMCID: PMC2811214 DOI: 10.1016/j.cell.2009.05.031] [Citation(s) in RCA: 225] [Impact Index Per Article: 15.0] [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: 08/07/2008] [Revised: 12/29/2008] [Accepted: 05/07/2009] [Indexed: 10/20/2022]
Abstract
Modulation of intracellular chloride concentration ([Cl(-)](i)) plays a fundamental role in cell volume regulation and neuronal response to GABA. Cl(-) exit via K-Cl cotransporters (KCCs) is a major determinant of [Cl(-)](I); however, mechanisms governing KCC activities are poorly understood. We identified two sites in KCC3 that are rapidly dephosphorylated in hypotonic conditions in cultured cells and human red blood cells in parallel with increased transport activity. Alanine substitutions at these sites result in constitutively active cotransport. These sites are highly phosphorylated in plasma membrane KCC3 in isotonic conditions, suggesting that dephosphorylation increases KCC3's intrinsic transport activity. Reduction of WNK1 expression via RNA interference reduces phosphorylation at these sites. Homologous sites are phosphorylated in all human KCCs. KCC2 is partially phosphorylated in neonatal mouse brain and dephosphorylated in parallel with KCC2 activation. These findings provide insight into regulation of [Cl(-)](i) and have implications for control of cell volume and neuronal function.
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Affiliation(s)
- Jesse Rinehart
- Department of Genetics, Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT 06510, USA
- Yale/National Heart, Lung, and Blood Institute Proteomics Center, Yale University, New Haven, CT 06511, USA
| | - Yelena D. Maksimova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Jessica E. Tanis
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Kathryn L. Stone
- Yale/National Heart, Lung, and Blood Institute Proteomics Center, Yale University, New Haven, CT 06511, USA
- Keck Biotechnology Resource Laboratory, Yale University, New Haven, CT 06511, USA
| | - Caleb A. Hodson
- Department of Genetics, Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Junhui Zhang
- Department of Genetics, Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Mary Risinger
- Cincinnati Comprehensive Sickle Cell Center, Division of Hematology/Oncology, University of Cincinnati College of Medicine and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Weijun Pan
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Dianqing Wu
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Christopher M. Colangelo
- Yale/National Heart, Lung, and Blood Institute Proteomics Center, Yale University, New Haven, CT 06511, USA
- Keck Biotechnology Resource Laboratory, Yale University, New Haven, CT 06511, USA
| | - Biff Forbush
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Clinton H. Joiner
- Cincinnati Comprehensive Sickle Cell Center, Division of Hematology/Oncology, University of Cincinnati College of Medicine and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Erol E. Gulcicek
- Yale/National Heart, Lung, and Blood Institute Proteomics Center, Yale University, New Haven, CT 06511, USA
- Keck Biotechnology Resource Laboratory, Yale University, New Haven, CT 06511, USA
| | - Patrick G. Gallagher
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Richard P. Lifton
- Department of Genetics, Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT 06510, USA
- Yale/National Heart, Lung, and Blood Institute Proteomics Center, Yale University, New Haven, CT 06511, USA
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Barber LA, Palascak MB, Joiner CH, Franco RS. Aminophospholipid translocase and phospholipid scramblase activities in sickle erythrocyte subpopulations. Br J Haematol 2009; 146:447-55. [DOI: 10.1111/j.1365-2141.2009.07760.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khera PK, Joiner CH, Carruthers A, Lindsell CJ, Smith EP, Franco RS, Holmes YR, Cohen RM. Evidence for interindividual heterogeneity in the glucose gradient across the human red blood cell membrane and its relationship to hemoglobin glycation. Diabetes 2008; 57:2445-52. [PMID: 18591386 PMCID: PMC2518496 DOI: 10.2337/db07-1820] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether interindividual heterogeneity in the erythrocyte (red blood cell [RBC]) transmembrane glucose gradient might explain discordances between A1C and glycemic control based on measured fructosamine. RESEARCH DESIGN AND METHODS We modeled the relationship between plasma glucose and RBC glucose as the concentration distribution (C(i)-to-C(o) ratio) of a nonmetabolizable glucose analog (14)C-3-O-methyl glucose ((14)C-3OMG) inside (C(i)) and outside (C(o)) RBCs in vitro. We examined the relationship between that distribution and the degree of glycation of hemoglobin in comparison with glycation of serum proteins (fructosamine), the glycation gap. A1C, fructosamine, and in vitro determination of the (14)C-3OMG distribution in glucose-depleted RBCs were measured in 26 fasted subjects. RESULTS The C(i)-to-C(o) ratio 0.89 +/- 0.07 for 3-O-methyl-d-glucopyranose (3OMG) ranged widely (0.72-1.04, n = 26). In contrast, urea C(i)-to-C(o) (1.015 +/- 0.022 [range 0.98-1.07], P < 0.0001) did not. Concerning mechanism, in a representative subset of subjects, the C(i)-to-C(o) ratio was retained in RBC ghosts, was not dependent on ATP or external cations, and was reestablished after reversal of the glucose gradient. The 3OMG C(i)-to-C(o) ratio was not correlated with serum fructosamine, suggesting that it was independent of mean plasma glucose. However, C(i)-to-C(o) did correlate with A1C (R(2) = 0.19) and with the glycation gap (R(2) = 0.20), consistent with a model in which differences in internal glucose concentration at a given mean plasma glucose contribute to differences in A1C for given level of glycemic control. CONCLUSIONS The data demonstrate interindividual heterogeneity in glucose gradients across RBC membranes that may affect hemoglobin glycation and have implications for diabetes complications risk and risk assessment.
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Affiliation(s)
- Paramjit K Khera
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Abstract
New methods for labeling red blood cells (RBC) and monitoring their survival have made it possible to explore changes in the properties of RBC as they age in the circulation. We have adapted a method, originally developed for studying wild animals, to calculate the age of a random sample of labeled RBC from their survival curve. We also show how this method can be expanded to allow continuous calculation of the mean age of the labeled RBC population at any time after labeling. It is expected that this analytical approach will be useful in the study of age-dependent RBC changes.
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Affiliation(s)
- Christopher J Lindsell
- Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
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Roszell NJ, Danton MJ, Jiang M, Witte D, Daugherty C, Grimes T, Girdler B, Anderson KP, Franco RS, Degen JL, Joiner CH. Fibrinogen deficiency, but not plasminogen deficiency, increases mortality synergistically in combination with sickle hemoglobin SAD in transgenic mice. Am J Hematol 2007; 82:1044-8. [PMID: 17722076 DOI: 10.1002/ajh.20982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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] [Indexed: 11/08/2022]
Abstract
Patients with sickle cell disease exhibit both acute and chronic activation of the coagulation and fibrinolytic systems. To test the relationship between sickle cell pathology and activation of the hemostatic system, mice with targeted deletions of plasminogen (Plg) or fibrinogen (Fib) were crossed with transgenic mice expressing Hb SAD [beta(6Glu-Val) (HbS), beta(23Val-Ile) (HbAntilles), and beta(121Glu-Gln) (HbD-Punjab)]. Fibrinogen deficiency dramatically reduced the survival of mice with Hb SAD to a much greater degree than mice with normal hemoglobin. The combination of Hb SAD and fibrinogen deficiency had a greater effect on mortality than that obtained by adding the mortality risks of each defect alone. The deleterious effect of the combination of Hb SAD and fibrinogen deficiency on mortality was accelerated by hypoxia. The excess mortality associated with plasminogen deficiency was identical in SAD and control mice. The adverse effect of fibrinogen deficiency on mortality in SAD mice is not consistent with the simple hypothesis that fibrin deposition is uniformly deleterious in the context of vaso-occlusive sickle cell disease. Rather, our findings suggest that the contribution of fibrinogen to tissue repair may in some contexts limit sickle cell disease pathophysiology.
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Affiliation(s)
- Nancy J Roszell
- Comprehensive Sickle Cell Center, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
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Kalfa TA, Pushkaran S, Mohandas N, Hartwig JH, Fowler VM, Johnson JF, Joiner CH, Williams DA, Zheng Y. Rac GTPases regulate the morphology and deformability of the erythrocyte cytoskeleton. Blood 2006; 108:3637-45. [PMID: 16882712 PMCID: PMC1895472 DOI: 10.1182/blood-2006-03-005942] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [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: 03/02/2006] [Accepted: 07/12/2006] [Indexed: 11/20/2022] Open
Abstract
Actin oligomers are a significant structural component of the erythrocyte cytoskeleton. Rac1 and Rac2 GTPases regulate actin structures and have multiple overlapping as well as distinct roles in hematopoietic cells; therefore, we studied their role in red blood cells (RBCs). Conditional gene targeting with a loxP-flanked Rac1 gene allowed Crerecombinase-induced deletion of Rac1 on a Rac2 null genetic background. The Rac1(-/-);Rac2(-/-) mice developed microcytic anemia with a hemoglobin drop of about 20% and significant anisocytosis and poikilocytosis. Reticulocytes increased more than 2-fold. Rac1(-/-);Rac2(-/-) RBCs stained with rhodamine-phalloidin demonstrated F-actin meshwork gaps and aggregates under confocal microscopy. Transmission electron microscopy of the cytoskeleton demonstrated junctional aggregates and pronounced irregularity of the hexagonal spectrin scaffold. Ektacytometry confirmed that these cytoskeletal changes in Rac1(-/-);Rac2(-/-) erythrocytes were associated with significantly decreased cellular deformability. The composition of the cytoskeletal proteins was altered with an increased actin-to-spectrin ratio and increased phosphorylation (Ser724) of adducin, an F-actin capping protein. Actin and phosphorylated adducin of Rac1(-/-);Rac2(-/-) erythrocytes were more easily extractable by Triton X-100, indicating weaker association to the cytoskeleton. Thus, deficiency of Rac1 and Rac2 GTPases in mice alters actin assembly in RBCs and causes microcytic anemia with reticulocytosis, implicating Rac GTPases as dynamic regulators of the erythrocyte cytoskeleton organization.
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Affiliation(s)
- Theodosia A Kalfa
- Division of Experimental Hematology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7015, Cincinnati, OH 45229, USA.
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Abstract
KCl cotransport (KCC) activity contributes to pathologic dehydration in sickle (SS) red blood cells (RBCs). KCC activation by urea was measured in SS and normal (AA) RBCs as Cl-dependent Rb influx. KCC-mediated volume reduction was assessed by measuring reticulocyte cellular hemoglobin concentration (CHC) cytometrically. Urea activated KCC fluxes in fresh RBCs to levels seen in swollen cells, although SS RBCs required lower urea concentrations than did normal (AA) RBCs. Little additional KCC stimulation by urea occurred in swollen AA or SS RBCs. The pH dependence of KCC in "euvolemic" SS RBCs treated with urea was similar to that in swollen cells. Urea triggered volume reduction in SS and AA reticulocytes, establishing a higher CHC. Volume reduction was Cl dependent and was limited by the KCC inhibitor, dihydro-indenyl-oxyalkanoic acid. Final CHC depended on urea concentration, but not on initial CHC. Under all activation conditions, volume reduction was exaggerated in SS reticulocytes and produced higher CHCs than in AA reticulocytes. The sulfhydryl-reducing agent, dithiothreitol, normalized the sensitivity of KCC activation to urea in SS RBCs and mitigated the urea-stimulated volume decrease in SS reticulocytes, suggesting that the dysfunctional activity of KCC in SS RBCs was due in part to reversible sulfhydryl oxidation.
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Affiliation(s)
- Clinton H Joiner
- Cincinnati Comprehensive Sickle Cell Center, Division of Hematology/Oncology, University of Cincinnati College of Medicine, and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH 45229, USA.
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Abstract
The determinants of sickle red blood cell (RBC) life span have not been well-defined but may include both intrinsic factors (eg, the tendency to sickle) and extrinsic factors (eg, the capacity of the reticuloendothelial system to remove defective RBCs). Fetal hemoglobin (HbF) is heterogeneously distributed among sickle RBCs; F cells contain 20% to 25% HbF, whereas the remainder have no detectable HbF (non-F cells). Autologous sickle RBCs were labeled with biotin and reinfused to determine overall survival, non-F- and F-cell survival, and time-dependent changes in HbF content (%HbF) for the surviving F cells. A total of 10 patients were enrolled, including 2 who were studied before and after the percentage of F cells was increased by treatment with hydroxyurea. As expected, F cells survived longer in all subjects. Non-F-cell survival correlated inversely with the percentage of F cells, with the time for 30% cell survival ranging from 6 days in patients with more than 88% F cells to 16 days in patients with less than 16% F cells. As the biotin-labeled RBCs aged in the circulation, the HbF content of the surviving F-cell population increased by 0.28%/d +/- 0.21%/d, indicating that within the F-cell population those with higher HbF content survived longer.
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Affiliation(s)
- Robert S Franco
- Division of Hematology/Oncology, University of Cincinnati College of Medicine, The Vontz Center for Molecular Studies, 3125 Eden Ave, Ohio 45267-0508, USA.
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Crable SC, Hammond SM, Papes R, Rettig RK, Zhou GP, Gallagher PG, Joiner CH, Anderson KP. Multiple isoforms of the KC1 cotransporter are expressed in sickle and normal erythroid cells. Exp Hematol 2005; 33:624-31. [PMID: 15911086 DOI: 10.1016/j.exphem.2005.02.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [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: 01/03/2005] [Revised: 02/24/2005] [Accepted: 02/28/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The KCl cotransporter (KCC) plays an important role in cellular cation and volume regulation and contributes to the process of volume reduction that accompanies reticulocyte maturation. In human red cells containing sickle hemoglobin, KCl cotransporter activity is high compared to normal cells, and contributes to the deleterious dehydration of sickle reticulocytes. To date, genes for four KCC isoforms have been identified. As a step toward determining which isoform(s) is responsible for the Cl-dependent K fluxes in reticulocytes, human erythroid cells were examined for the presence of various KCC isoform transcripts. METHODS In vitro differentiated erythroid precursors, and reticulocytes isolated from normal individuals and sickle patients, were examined by reverse-transcriptase PCR for the expression of KCC isoforms. Transient transfection experiments were subsequently performed to characterize a novel KCC1 promoter. RESULTS Expression of multiple isoforms was detected, with transcripts for KCC1, 3, and 4 detected in all samples of erythroid cells. Two N-terminal splicing variants were detected for both KCC1 and 3. Sickle hemoglobin containing reticulocytes demonstrated KCC isoform expression patterns similar to wild-type cells, except for a consistent difference in the relative abundance of one KCC1 splice variant. This N-terminal variant initiates from a newly described promoter in the KCC1 gene. CONCLUSION Three KCC genes are expressed in human red cells. Splicing variants arising from the KCC1 and 3 genes are also evident. Structure/function studies of mouse KCC1 suggest that these natural variants could profoundly affect overall cotransporter activity in the red cell.
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Affiliation(s)
- Scott C Crable
- Comprehensive Sickle Cell Center, Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
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Abstract
Abstract
KCl cotransport (KCC) activation by cell swelling and pH was compared in sickle (SS) and normal (AA) red blood cells (RBCs). KCC fluxes had the same relationship to mean corpuscular hemoglobin concentration (MCHC) in SS and AA RBCs when normalized to the maximal volume-stimulated (VSmax) flux (MCHC < 270 g/L [27 g/dL]). Acid-stimulated (pH 6.9) KCC flux in SS RBCs was 60% to 70% of VSmax KCC versus 20% in AA RBCs. Density gradients were used to track changes in reticulocyte MCHC during KCC-mediated regulatory volume decrease (RVD). Swelling to MCHC of 260 g/L (26 g/dL) produced Cl-dependent RVD that resulted in higher MCHC in SS than AA reticulocytes. In acid pH, RVD was also greater in SS than AA reticulocytes. Sulfhydryl reduction by dithiothreitol (DTT) lowered VSmax KCC flux in AA and SS RBCs by one third but did not alter swelling-induced RVD. DTT lowered acid-activated KCC in SS RBCs by 50% and diminished acid-induced RVD in SS reticulocytes. Thus, swelling activation of KCC is normal in SS RBCs but KCC-mediated RVD produces higher MCHC in SS than AA reticulocytes. Acid activation of KCC is exaggerated in SS RBCs and causes dehydration in SS reticulocytes. KCC response to acid stimulation was mitigated by DTT, suggesting that it arises from sulfhydryl oxidation.
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Affiliation(s)
- Clinton H Joiner
- Cincinnati Comprehensive Sickle Cell Center, Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039, USA.
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Yasin Z, Witting S, Palascak MB, Joiner CH, Rucknagel DL, Franco RS. Phosphatidylserine externalization in sickle red blood cells: associations with cell age, density, and hemoglobin F. Blood 2003; 102:365-70. [PMID: 12609840 DOI: 10.1182/blood-2002-11-3416] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [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] [Indexed: 11/20/2022] Open
Abstract
Phosphatidylserine (PS) is normally confined to the cytoplasmic leaflet of the red blood cell (RBC) membrane, but some sickle RBCs expose PS in the outer leaflet (PS+ cells). This study examined the relationships among PS externalization, fetal hemoglobin content, hydration state, and cell age. Sickle RBCs exhibit a wide range of PS externalization. Those with low-level exposure (type 1 PS+) include many young transferrin-receptor-positive (TfR+) cells. This is not specific for sickle cell disease because many nonsickle TfR+ cells are also PS+. RBCs with higher PS exposure (type 2 PS+) appear to be more specific for sickle cell disease. Their formation is most likely sickling dependent because type 2 PS+ dense sickle cells have a lower percentage of fetal hemoglobin (HbF) than PS- cells in the same density fraction (1.7 vs 2.9; n = 8; P <.01). In vivo experiments using biotin-labeled sickle cells showed a sharp decrease in the percentage of circulating, labeled PS+ cells in the first 24 hours after reinfusion. This decrease was confined to type 1 PS+ cells and was thus consistent with the reversal of PS exposure in very young cells. As the labeled cells aged in the circulation, the percentages of type 1 and type 2 PS+ cells increased. These studies indicate that PS externalization in sickle cells may be low level, as observed in many immature cells, or high level, which is associated with dehydration and appears to be more specific for sickle RBCs.
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Affiliation(s)
- Zahida Yasin
- Vontz Center for Molecular Studies, Hematology/Oncology Division ML#0508, Department of Internal Medicine, University of Cincinnati College of Medicine, 3125 Eden Avenue, Cincinnati, OH, USA.
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Merciris P, Claussen WJ, Joiner CH, Giraud F. Regulation of K-Cl cotransport by Syk and Src protein tyrosine kinases in deoxygenated sickle cells. Pflugers Arch 2003; 446:232-8. [PMID: 12739161 DOI: 10.1007/s00424-003-1025-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [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: 12/09/2002] [Accepted: 01/24/2003] [Indexed: 10/22/2022]
Abstract
Protein tyrosine kinases (PTK) of the Src family are thought to suppress K-Cl cotransport (KCC) activity via negative regulation of protein phosphatases. However, some PTK inhibitors reduce KCC activity, suggesting opposite regulation by different PTK families. We have reported previously that deoxygenation of sickle cells stimulates KCC and activates Syk (a Syk family PTK), but not Lyn (an Src family PTK). In this study the same results were obtained when PTK activities were measured under the conditions used to measure KCC activity and which prevent any change in intracellular [Mg(2+)]. Methyl-2,5-dihydroxycinnamate (DHC), a PTK inhibitor, was more selective for Syk than Lyn, while staurosporine (ST), a broad-specificity protein kinase inhibitor, inhibited Lyn more than Syk. Deoxygenation or 4-amino-5-(4-chlorophenyl)-7-( t-butyl)pyrazolo[3,4- d] pyrimidine (pp2, a specific Src inhibitor) stimulated KCC independently. These effects were not additive and were inhibited by DHC. In contrast, ST-induced KCC activation was resistant to DHC, suggesting a different pathway of activation. Overall, these data indicate that Syk activity is required for KCC activation, either induced by deoxygenation of sickle cells, or mediated by Src inhibition in oxygenated cells, and that Syk and Src PTKs exert opposing and interconnected regulatory effects on the activity of the transporter.
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Affiliation(s)
- P Merciris
- Biomembranes et Messagers Cellulaires, Centre National de la Recherche Scientifique UMR 8619, Bat 440, Université Paris XI, 91405, Orsay Cedex, France
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Abstract
OBJECTIVE Discordances between HbA1c and other measures of glycemic control are common in clinical practice and remain unexplained. We developed a measure of discordance between HbA1c and fructosamine (FA) (glycosylated serum proteins) to conduct a systematic evaluation. We termed this the glycosylation gap (GG) and sought to determine its relationship to diabetic nephropathy. RESEARCH DESIGN AND METHODS Measurements of HbA1c and FA on the same sample in 153 people were used to calculate GG, defined as the difference between measured HbA1c and HbA1c predicted from FA based on the population regression of HbA1c on FA. RESULTS GG had a broad distribution (range, -3.2% to 5.5%); 40% of samples had values indicating major differences in prediction of complications risk by the measured versus predicted HbA1c. GG was highly correlated (r = 0.81) between measurements repeated in 65 patients 23 +/- 2 weeks apart, indicating that the discordances are reliable and not explained by differences in turnover of underlying proteins. In 40 patients with type 1 diabetes of >or = 15 years' duration, an increase in GG by 1% was associated with a 2.9-fold greater frequency of increasing nephropathy stage (P = 0.0014). GG was -0.8 +/- 0.2% in subjects with no nephropathy, -0.3 +/- 0.2% with microalbuminuria/hypertension, and 0.7 +/- 0.3% in subjects with proteinuria or renal dysfunction (P < 0.05). GG correlated better with nephropathy than did either HbA1c or FA alone in this population. CONCLUSIONS The glycosylation gap may be a useful clinical research tool for evaluating physiologic sources of variation in diabetic complications beyond glycemic control.
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Affiliation(s)
- Robert M Cohen
- Division of Endocrinology, Department of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio 45267-0547, USA.
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Abstract
Recent studies have identified older, low-density sickle red blood cells (SSRBCs) that were resistant to dehydration by valinomycin, a K(+) ionophore. These cells, thought to derive from dense SSRBCs that have rehydrated, may represent a terminal cellular phase. To study rehydration, we subjected dense SSRBCs (rho > 1.107 g/cc) to either oxygenated incubation or rapid oxygenated/deoxygenated (oxy/deoxy) cycling (70 seconds per cycle). Light cells (rho < 1.087 g/cc) were generated during both oxy incubation (2.9% +/- 2.1%; n = 42) and oxy/deoxy cycling (5.3% +/- 2.4%; n = 42). The rehydrated cells were K(+)-depleted (K(+) = 20 +/- 14 mmol/kg hemoglobin [Hb]) and Na(+)-loaded (Na(+) = 394 +/- 106 mmol/kg Hb), and had high levels of external phosphatidylserine. In the presence of external calcium, the generation of rehydrated SSRBCs was inhibited during oxy/deoxy cycling, but the percentage with external phosphatidylserine increased. The calcium-mediated inhibition of rehydration was reversed by charybdotoxin, implying that rehydration was delayed in some cells by the Ca(++)-activated K(+) channel. Preincubation of dense SSRBCs with DIDS (4,4'-di-isothiocyanato-2,2'-disulfostilbene) inhibited the generation of light cells during fast oxy/deoxy cycling, but not during oxy incubation. These results suggest that the sickling-induced pathway, previously implicated in SSRBC dehydration, may be involved in the deoxy-dependent component of rehydration for dense, K(+)-depleted cells. Light-cell generation was inhibited by 1 mM bumetanide during both oxy incubation and oxy/deoxy cycling, providing evidence that a bumetanide-sensitive, deoxy-independent pathway, previously described in circulating light SSRBCs, also contributes to the rehydration of high-density SSRBCs.
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Affiliation(s)
- J David Holtzclaw
- Department of Aerospace Engineering, University of Cincinnati College of Engineering; the Cincinnati Comprehensive Sickle Cell Center, Cincinnati, OH 4526. -0508, USA
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Affiliation(s)
- G P Zhou
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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Abstract
Sickling-induced cation fluxes contribute to cellular dehydration of sickle red blood cells (SS RBCs), which in turn potentiates sickling. This study examined the inhibition by dipyridamole of the sickling-induced fluxes of Na(+), K(+), and Ca(++) in vitro. At 2% hematocrit, 10 microM dipyridamole inhibited 65% of the increase in net fluxes of Na(+) and K(+) produced by deoxygenation of SS RBCs. Sickle-induced Ca(++) influx, assayed as (45)Ca(++) uptake in quin-2-loaded SS RBCs, was also partially blocked by dipyridamole, with a dose response similar to that of Na(+) and K(+) fluxes. In addition, dipyridamole inhibited the Ca(++)-activated K(+) flux (via the Gardos pathway) in SS RBCs, measured as net K(+) efflux in oxygenated cells exposed to ionophore A23187 in the presence of external Ca(++), but this effect resulted from reduced anion conductance, rather than from a direct effect on the K(+) channel. The degree of inhibition of sickling-induced fluxes was dependent on hematocrit, and up to 30% of dipyridamole was bound to RBC membranes at 2% hematocrit. RBC membrane content of dipyridamole was measured fluorometrically and correlated with sickling-induced flux inhibition at various concentrations of drug. Membrane drug content in patients taking dipyridamole for other clinical indications was similar to that producing inhibition of sickling-induced fluxes in vitro. These data suggest that dipyridamole might inhibit sickling-induced fluxes of Na(+), K(+), and Ca(++) in vivo and therefore have potential as a pharmacological agent to reduce SS RBC dehydration. (Blood. 2001;97:3976-3983)
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Affiliation(s)
- C H Joiner
- Cincinnati Comprehensive Sickle Cell Center, Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.
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Affiliation(s)
- C H Joiner
- Cincinnati Comprehensive Sickle Cell Center, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Franco RS, Yasin Z, Lohmann JM, Palascak MB, Nemeth TA, Weiner M, Joiner CH, Rucknagel DL. The survival characteristics of dense sickle cells. Blood 2000; 96:3610-7. [PMID: 11071661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Sickle red blood cells (RBCs) become depleted of potassium, leading to dehydration and abnormally elevated cellular density. The increased sickling that results is important for both hemolysis and vasocclusion. In this study, sickle cells were subjected to high-speed centrifugation, and the bottom 15% were isolated. This procedure removed light cells and to a variable degree enriched cells that were denser than normal to produce a high-density-enriched (HDE) population of sickle cells. Autologous HDE cells from 3 subjects were labeled with biotin and re-infused. The following determinations were performed: (1) the survival and density changes of HDE cells; (2) the amount of fetal hemoglobin (HbF) in labeled cells after magnetic isolation; (3) the percentage of labeled F cells; (4) the percentage of labeled cells displaying external phosphatidylserine (PS). For patients with 3.5%, 4.5%, and 24% HbF in the HDE RBCs, the circulation half-time was 40, 80, and 180 hours, respectively. The percentage of HbF (measured in all 3 subjects) and of F cells (measured in 2 subjects) in labeled RBCs increased with time after re-infusion, indicating that HDE F cells have longer in vivo survival than HDE non-F cells. The percentage of PS(+), biotin-labeled HDE cells showed no consistent increase or decrease with time after re-infusion. These data provide evidence that HDE sickle cells, especially those that do not contain HbF, have a very short in vivo survival, and that the percentage of PS(+) cells in a re-infused HDE population does not change in a consistent manner as these cells age in the circulation.
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Affiliation(s)
- R S Franco
- University of Cincinnati College of Medicine, Children's Hospital Research Foundation, and Cincinnati Comprehensive Sickle Cell Center, Cincinnati, OH, USA.
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