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Cappellini MD, Scaramellini N, Motta I. Iron status in chronic inflammatory disease: therapeutic implications. Pol Arch Intern Med 2023; 133. [PMID: 36779522 DOI: 10.20452/pamw.16430] [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: 02/14/2023]
Abstract
Anemia of inflammation (AI) is a very frequent clinical condition affecting globally more than a billion people with chronic inflammatory disorders, such as chronic kidney disease, heart failure, and inflammatory bowel disease. It is usually associated with iron deficiency (ID), which imposes a severe additional burden on the recovery from the primary disease. The pathophysiology of iron dysregulation that may ultimately lead to absolute iron deficiency anemia (IDA) during inflammation is multifactorial and includes reduced iron absorption in the bowel, iron retention in macrophages of the reticuloendothelial system, reduction in circulatory half‑life of erythrocytes, inadequate production and activity of erythropoietin, and impaired proliferation and differentiation of erythroid progenitor cells. These result in hypoferremia and iron-restricted erythropoiesis. AI is mostly mild to moderate, normochromic and normocytic with normal or even increased ferritin levels. The current treatment options for AI include iron replacement therapy, treatment with erythropoiesis‑stimulating agents, and red blood cell transfusion. ID management is based on oral or intravenous iron preparations. Given the pathophysiology, treatment with oral iron, although widely used, presents several limitations that impact its effectiveness in patients with chronic inflammatory conditions. Instead, intravenous iron preparations are a valuable option for patients with chronic inflammatory diseases, as they overcome reduced bowel absorption. Novel therapeutic approaches include downregulation of hepcidin synthesis and function, and stabilization of the hypoxia‑inducible factor via inhibition of prolyl hydroxylase domain. Several studies in vitro and in vivo are ongoing; however, the results in humans are still elusive.
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Affiliation(s)
- Maria D Cappellini
- Department of Clinical Science and Community, University of Milan, Fondazione IRCCS Ca Granda Policlinico, Milan, Italy.
| | - Natalia Scaramellini
- Department of Clinical Science and Community, University of Milan, Fondazione IRCCS Ca Granda Policlinico, Milan, Italy,Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Unit of Medicine and Metabolic Disease, Milan, Italy
| | - Irene Motta
- Department of Clinical Science and Community, University of Milan, Fondazione IRCCS Ca Granda Policlinico, Milan, Italy,Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Unit of Medicine and Metabolic Disease, Milan, Italy
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Musallam KM, Cappellini MD, Viprakasit V, Kattamis A, Rivella S, Taher AT. Revisiting the non-transfusion-dependent (NTDT) vs. transfusion-dependent (TDT) thalassemia classification 10 years later. Am J Hematol 2021; 96:E54-E56. [PMID: 33219703 DOI: 10.1002/ajh.26056] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Maria D. Cappellini
- Department of Clinical Sciences and Community University of Milan Milan Italy
| | - Vip Viprakasit
- Department of Pediatrics & Thalassemia Center, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok Thailand
| | - Antonis Kattamis
- First Department of Pediatrics National and Kapodistrian University of Athens Athens Greece
| | - Stefano Rivella
- Department of Pediatrics, Division of Hematology Raymond G. Perelman Center for Cellular and Molecular Therapeutics; Abramson Research Center at The Children's Hospital of Philadelphia (CHOP); Cell and Molecular Biology Affinity Group (CAMB), Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Ali T. Taher
- Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
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Motta I, Migone De Amicis M, Pinto VM, Balocco M, Longo F, Bonetti F, Gianesin B, Graziadei G, Cappellini MD, De Franceschi L, Piga A, Forni GL. SARS-CoV-2 infection in beta thalassemia: Preliminary data from the Italian experience. Am J Hematol 2020; 95:E198-E199. [PMID: 32311145 PMCID: PMC7264660 DOI: 10.1002/ajh.25840] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Irene Motta
- Department of Clinical Sciences and Community HealthUniversità Degli Studi di Milano Milan Italy
- Department of Internal MedicineUOC Medicina Generale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan Italy
| | - Margherita Migone De Amicis
- Department of Internal MedicineUOC Medicina Generale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan Italy
| | - Valeria M. Pinto
- Hemoglobinopathies and Congenital Anemia Center, Ospedale Galliera Genoa Italy
| | - Manuela Balocco
- Hemoglobinopathies and Congenital Anemia Center, Ospedale Galliera Genoa Italy
| | - Filomena Longo
- Department of Clinical and Biological SciencesUniversity of Turin Turin Italy
| | - Federico Bonetti
- Pediatric Haematology OncologyFondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | - Giovanna Graziadei
- Department of Internal MedicineUOC Medicina Generale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan Italy
| | - Maria D. Cappellini
- Department of Clinical Sciences and Community HealthUniversità Degli Studi di Milano Milan Italy
| | - Lucia De Franceschi
- Department of MedicinePoliclinico GB Rossi, Università di Verona Verona Italy
| | - Antonio Piga
- Department of Clinical and Biological SciencesUniversity of Turin Turin Italy
| | - Gian L. Forni
- Hemoglobinopathies and Congenital Anemia Center, Ospedale Galliera Genoa Italy
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Abstract
Iron deficiency anaemia is a global health concern affecting children, women and the elderly, whilst also being a common comorbidity in multiple medical conditions. The aetiology is variable and attributed to several risk factors decreasing iron intake and absorption or increasing demand and loss, with multiple aetiologies often coexisting in an individual patient. Although presenting symptoms may be nonspecific, there is emerging evidence on the detrimental effects of iron deficiency anaemia on clinical outcomes across several medical conditions. Increased awareness about the consequences and prevalence of iron deficiency anaemia can aid early detection and management. Diagnosis can be easily made by measurement of haemoglobin and serum ferritin levels, whilst in chronic inflammatory conditions, diagnosis may be more challenging and necessitates consideration of higher serum ferritin thresholds and evaluation of transferrin saturation. Oral and intravenous formulations of iron supplementation are available, and several patient and disease-related factors need to be considered before management decisions are made. This review provides recent updates and guidance on the diagnosis and management of iron deficiency anaemia in multiple clinical settings.
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Affiliation(s)
- M D Cappellini
- Department of Clinical Sciences and Community, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy
| | | | - A T Taher
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
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Torlasco C, Mollica C, Cassinerio E, Ruffino E, Milazzo A, Quattrocchi G, Sormani P, Abdel-Gadir A, Giannattasio C, Parati G, Cappellini MD, Moon JC, Pedrotti P. P426Left atrial size and function assessment through CMR in thalassemia major patients. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Torlasco
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - C Mollica
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - E Cassinerio
- IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Ruffino
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - A Milazzo
- Niguarda Ca" Granda Hospital, Milan, Italy
| | | | - P Sormani
- Niguarda Ca" Granda Hospital, Milan, Italy
| | - A Abdel-Gadir
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | | | - G Parati
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - M D Cappellini
- IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - P Pedrotti
- Niguarda Ca" Granda Hospital, Milan, Italy
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Chen B, Whatley S, Badminton M, Aarsand AK, Anderson KE, Bissell DM, Bonkovsky HL, Cappellini MD, Floderus Y, Friesema ECH, Gouya L, Harper P, Kauppinen R, Loskove Y, Martásek P, Phillips JD, Puy H, Sandberg S, Schmitt C, To-Figueras J, Weiss Y, Yasuda M, Deybach JC, Desnick RJ. International Porphyria Molecular Diagnostic Collaborative: an evidence-based database of verified pathogenic and benign variants for the porphyrias. Genet Med 2019; 21:2605-2613. [PMID: 31073229 DOI: 10.1038/s41436-019-0537-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/26/2019] [Indexed: 11/09/2022] Open
Abstract
With the advent of precision and genomic medicine, a critical issue is whether a disease gene variant is pathogenic or benign. Such is the case for the three autosomal dominant acute hepatic porphyrias (AHPs), including acute intermittent porphyria, hereditary coproporphyria, and variegate porphyria, each resulting from the half-normal enzymatic activities of hydroxymethylbilane synthase, coproporphyrinogen oxidase, and protoporphyrinogen oxidase, respectively. To date, there is no public database that documents the likely pathogenicity of variants causing the porphyrias, and more specifically, the AHPs with biochemically and clinically verified information. Therefore, an international collaborative with the European Porphyria Network and the National Institutes of Health/National Center for Advancing Translational Sciences/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NCATS/NIDDK)-sponsored Porphyrias Consortium of porphyria diagnostic experts is establishing an online database that will collate biochemical and clinical evidence verifying the pathogenicity of the published and newly identified variants in the AHP-causing genes. The overall goal of the International Porphyria Molecular Diagnostic Collaborative is to determine the pathogenic and benign variants for all eight porphyrias. Here we describe the overall objectives and the initial efforts to validate pathogenic and benign variants in the respective heme biosynthetic genes causing the AHPs.
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Affiliation(s)
- Brenden Chen
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sharon Whatley
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - Michael Badminton
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
| | - Aasne K Aarsand
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Karl E Anderson
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Maria D Cappellini
- Dipartimento di Medicina Interna, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Ylva Floderus
- Porphyria Centre Sweden, Centre for Inherited Metabolic Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Edith C H Friesema
- Porphyria Center Rotterdam, Center for Lysosomal and Metabolic Disorders, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Laurent Gouya
- Centre Français des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes and Centre de Recherche sur l'Inflammation, UMR1149 INSERM, Université Paris Diderot, Paris, France
| | - Pauline Harper
- Porphyria Centre Sweden, Centre for Inherited Metabolic Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Raili Kauppinen
- Porphyria Research Unit, Department of Medicine, University Central Hospital of Helsinki, Helsinki, Finland
| | - Yonina Loskove
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pavel Martásek
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - John D Phillips
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hervé Puy
- Centre Français des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes and Centre de Recherche sur l'Inflammation, UMR1149 INSERM, Université Paris Diderot, Paris, France
| | - Sverre Sandberg
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,The Norwegian Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconness Hospital, Bergen Medical Faculty, University of Bergen, Bergen, Norway
| | - Caroline Schmitt
- Centre Français des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes and Centre de Recherche sur l'Inflammation, UMR1149 INSERM, Université Paris Diderot, Paris, France
| | - Jordi To-Figueras
- Biochemistry and Molecular Genetics Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Yedidyah Weiss
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Makiko Yasuda
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean-Charles Deybach
- Centre Français des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes and Centre de Recherche sur l'Inflammation, UMR1149 INSERM, Université Paris Diderot, Paris, France.
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Serafino S, Consonni D, Migone De Amicis M, Sisto F, Domeniconi G, Formica S, Zarantonello M, Maraschini A, Cappellini MD, Spigaglia P, Barbanti F, Castaldi S, Fabio G. Clinical outcomes of Clostridium difficile infection according to strain type. A prospective study in medical wards. Eur J Intern Med 2018; 54:21-26. [PMID: 29650357 DOI: 10.1016/j.ejim.2018.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/16/2018] [Accepted: 03/26/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe clinical characteristics and outcome of Clostridium difficile infection (CDI) patients in Internal Medicine, to identify ribotypes (RTs); to evaluate the association between RT and patient clinical characteristics and report outcome. METHODS One year prospective cohort study. Clinical data, Barthel Index (BI) and outcomes were collected for all inpatients suffering from CDI (n = 148) in hospital wards in Northern Italy. 84 fecal samples were analysed for molecular typing. RESULTS 12 RTs were identified, predominantly RT018 (42.9%, n = 36/84) and RT356/607 (40.5%, n = 34/84). Patients with dementia were more frequent among those infected by RT018 [55.6% (n = 20/36) vs. 32.4% (n = 11/34), p = 0.05]. The median BI score of patients with RT018 was lower than BI score of patients with RT356/607 [10 (IQR 0-32) vs. 15 (IQR 5-50), p = 0.06]. RT018 infection was associated to higher levels of C-reactive protein [7.2 mg/dl (IQR 4.1-14.7) vs. 4.0 mg/dl (IQR 2.2-6.8), p = 0.01] and white blood cells ≥15,000/dl [33.3% (n = 12/36) vs. 14.7% (n = 5/34) of patients, p = 0.07]. Higher mortality was noted among RT018 infected patients. We found a continuous mortality increase according to the ATLAS score. CONCLUSIONS Our results confirm that RT018 and RT356/607 are the two major RTs causing CDI in older patients with a high degree of disability in Northern Italy and RT018 is associated with more serious outcomes.
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Affiliation(s)
- S Serafino
- Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy.
| | - D Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Migone De Amicis
- Post Graduate School in Internal Medicine, University of Milan, Milan, Italy
| | - F Sisto
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - G Domeniconi
- Post graduate School in Public Health, Department Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - S Formica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M Zarantonello
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - A Maraschini
- Microbiology Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M D Cappellini
- Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - P Spigaglia
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - F Barbanti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - S Castaldi
- Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biological Sciences for Health, University of Milan, Italy
| | - G Fabio
- Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Sampietro M, Camerino G, Romano M, Cappellini MD, Fiorelli G, Brambati B, Guerneri S, Ferrari M, Travi M, Krachmalnicoff A, Mannucci PM. Combined Use of DNA Probes in First-Trimester Prenatal Diagnosis of Hemophilia A. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryFirst-trimester prenatal diagnoses of hemophilia A were heretofore obtained by using either intragenic factor VIII markers or linked cxtragcnic polymorphic markers. Postulating that the combined use of all the available intragenic and extragenic markers can render such diagnoses more frequently feasible and more reliable, we carried out ten first-trimester prenatal diagnoses in male fetuses at risk for hemophilia A by DNA analysis of chorionic villus employing in combination the intragenic Bcl I polymorphism and the St 14 (DXS 52) or DX 13 (DXS 15) extragenic probes. A diagnosis of hemophilia was obtained in three fetuses, with a diagnosis of normal fetus obtained in the remaining seven. Seven diagnoses are confirmed by factor VIII assays carried out at the time of abortion, in the mid-Trimester or at birth. A factor VIII probe recognizing Bcl I polymorphism was useful in 4 of 6 diagnoses; St 14, in 5 of 6; and DX 13 in 3 of 5. In two cases, St 14 was the only useful probe for diagnosis. Even though no recombination between extragenic probes and factor VIII gene was detected in this study, when only extragenic markers were informative we advised diagnostic confirmation on fetal plasma obtained by fetoscopy. Hence, first-trimester prenatal diagnosis of hemophilia A is feasible for the great majority of fetuses at risk through combined use of all the available intragenic and extragenic probes, providing key family members are available.
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Affiliation(s)
- M Sampietro
- The Institute of Internal Medicine and the A. Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milano, Milano, Italy
| | - G Camerino
- The Department of Genetics and Microbiology, University of Pavia, Milano, Italy
| | - M Romano
- The Institute of Internal Medicine and the A. Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milano, Milano, Italy
| | - M D Cappellini
- The Institute of Internal Medicine and the A. Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milano, Milano, Italy
| | - G Fiorelli
- The Institute of Internal Medicine and the A. Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milano, Milano, Italy
| | - B Brambati
- The First Obstetric Clinic, University of Milano, Milano, Italy
| | - S Guerneri
- The First Obstetric Clinic, University of Milano, Milano, Italy
| | - M Ferrari
- The Hematology and Clinical Research Laboratory, Istituti Clinici di Perfezionamento, Milano, Italy
| | - M Travi
- The Hematology and Clinical Research Laboratory, Istituti Clinici di Perfezionamento, Milano, Italy
| | - A Krachmalnicoff
- The Institute of Internal Medicine and the A. Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milano, Milano, Italy
| | - P M Mannucci
- The Institute of Internal Medicine and the A. Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milano, Milano, Italy
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Dell’Arti L, Barteselli G, Riva L, Carini E, Graziadei G, Benatti E, Invernizzi A, Cappellini MD, Viola F. Sickle cell maculopathy: Identification of systemic risk factors, and microstructural analysis of individual retinal layers of the macula. PLoS One 2018; 13:e0193582. [PMID: 29494697 PMCID: PMC5832302 DOI: 10.1371/journal.pone.0193582] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/14/2018] [Indexed: 12/27/2022] Open
Abstract
Purpose To identify systemic risk factors for sickle cell maculopathy, and to analyze the microstructure of the macula of Sickle Cell Disease (SCD) patients by using automated segmentation of individual retinal layers. Methods Thirty consecutive patients with SCD and 30 matched controls underwent spectral-domain optical coherence tomography (SD-OCT) and automated thickness measurement for each retinal layer; thicknesses for SCD patients were then compared to normal controls. Demographic data, systemic data, and lab results were collected for each SCD patient; multivariate logistic regression analysis was used to identify potential risk factors for sickle cell maculopathy. Results Ongoing chelation treatment (p = 0.0187) was the most predictive factor for the presence of sickle cell maculopathy; the odds were 94.2% lower when chelation was present. HbF level tended to influence sickle cell maculopathy (p = 0.0775); the odds decreased by 12.9% when HbF increased by 1%. Sickle cell maculopathy was detected in 43% of SCD patients as patchy areas of retinal thinning on SD-OCT thickness map, mostly located temporally to the macula, especially in eyes with more advanced forms of sickle cell retinopathy (p = 0.003). In comparison to controls, SCD patients had a subtle thinning of the overall macula and temporal retina compared to controls (most p<0.0001), involving inner and outer retinal layers. Thickening of the retinal pigment epithelium was also detected in SCD eyes (p<0.0001). Conclusions Chronic chelation therapy and, potentially, high levels of HbF are possible protective factors for the presence of sickle cell maculopathy, especially for patients with more advanced forms of sickle cell retinopathy. A subtle thinning of the overall macula occurs in SCD patients and involves multiple retinal layers, suggesting that ischemic vasculopathy may happen in both superficial and deep capillary plexi. Thinning of the outer retinal layers suggests that an ischemic insult of the choriocapillaris may also occur in SCD patients.
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Affiliation(s)
- Laura Dell’Arti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulio Barteselli
- Genentech Inc, South San Francisco, California, United States of America
| | - Lorenzo Riva
- Ophthalmological Unit, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Carini
- Ophthalmological Unit, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Graziadei
- Rare Diseases Center, Department of Medicine and Medical Specialties, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Benatti
- Ophthalmological Unit, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Maria D. Cappellini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Rare Diseases Center, Department of Medicine and Medical Specialties, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Ca’ Granda Foundation, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- * E-mail:
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Torlasco C, Cassinerio E, Roghi A, Faini A, Capecchi M, Abdel-Gadir A, Giannattasio C, Parati G, Moon JC, Cappellini MD, Pedrotti P. Role of T1 mapping as a complementary tool to T2* for non-invasive cardiac iron overload assessment. PLoS One 2018; 13:e0192890. [PMID: 29466447 PMCID: PMC5821344 DOI: 10.1371/journal.pone.0192890] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 01/08/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Iron overload-related heart failure is the principal cause of death in transfusion dependent patients, including those with Thalassemia Major. Linking cardiac siderosis measured by T2* to therapy improves outcomes. T1 mapping can also measure iron; preliminary data suggests it may have higher sensitivity for iron, particularly for early overload (the conventional cut-point for no iron by T2* is 20ms, but this is believed insensitive). We compared T1 mapping to T2* in cardiac iron overload. METHODS In a prospectively large single centre study of 138 Thalassemia Major patients and 32 healthy controls, we compared T1 mapping to dark blood and bright blood T2* acquired at 1.5T. Linear regression analysis was used to assess the association of T2* and T1. A "moving window" approach was taken to understand the strength of the association at different levels of iron overload. RESULTS The relationship between T2* (here dark blood) and T1 is described by a log-log linear regression, which can be split in three different slopes: 1) T2* low, <20ms, r2 = 0.92; 2) T2* = 20-30ms, r2 = 0.48; 3) T2*>30ms, weak relationship. All subjects with T2*<20ms had low T1; among those with T2*>20ms, 38% had low T1 with most of the subjects in the T2* range 20-30ms having a low T1. CONCLUSIONS In established cardiac iron overload, T1 and T2* are concordant. However, in the 20-30ms T2* range, T1 mapping appears to detect iron. These data support previous suggestions that T1 detects missed iron in 1 out of 3 subjects with normal T2*, and that T1 mapping is complementary to T2*. The clinical significance of a low T1 with normal T2* should be further investigated.
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Affiliation(s)
- Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Elena Cassinerio
- Rare Diseases Centre, Department of Medicine and Medical Specialities, “Ca’ Granda” Foundation IRCCS, Milan, Italy
| | - Alberto Roghi
- Cardiology 4, Department of Cardiology and Cardiovascular Surgery, Niguarda Hospital, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Marco Capecchi
- Rare Diseases Centre, Department of Medicine and Medical Specialities, “Ca’ Granda” Foundation IRCCS, Milan, Italy
| | - Amna Abdel-Gadir
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Cristina Giannattasio
- Cardiology 4, Department of Cardiology and Cardiovascular Surgery, Niguarda Hospital, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - James C. Moon
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Maria D. Cappellini
- Rare Diseases Centre, Department of Medicine and Medical Specialities, “Ca’ Granda” Foundation IRCCS, Milan, Italy
| | - Patrizia Pedrotti
- Cardiology 4, Department of Cardiology and Cardiovascular Surgery, Niguarda Hospital, Milan, Italy
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11
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D’Ambrosio R, Maggioni M, Donato MF, Lampertico P, Cappellini MD, Graziadei G. Decompensated Cirrhosis and Sickle Cell Disease: Case Reports and Review of the Literature. Hemoglobin 2017; 41:131-133. [DOI: 10.1080/03630269.2017.1341420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Roberta D’Ambrosio
- Divisione di Gastroenterologia ed Epatologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italia
| | - Marco Maggioni
- Divisione di Anatomia Patologica, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italia
| | - Maria F. Donato
- Divisione di Gastroenterologia ed Epatologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italia
| | - Pietro Lampertico
- Divisione di Gastroenterologia ed Epatologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italia
| | - Maria D. Cappellini
- Centro per le Malattie Rare, Divisione di Medicina Interna, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italia
| | - Giovanna Graziadei
- Centro per le Malattie Rare, Divisione di Medicina Interna, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italia
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12
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Baldini M, Casirati G, Ulivieri FM, Cassinerio E, Khouri Chalouhi K, Poggiali E, Borin L, Burghignoli V, Cesana BM, Cappellini MD. Skeletal involvement in type 1 Gaucher disease: Not just bone mineral density. Blood Cells Mol Dis 2017; 68:148-152. [PMID: 28693786 DOI: 10.1016/j.bcmd.2017.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 11/28/2022]
Abstract
Gaucher disease is characterized by multi-organ infiltration of phospholipid-laden macrophages. Bone involvement is characterized by typical deformities, osteopenia/osteoporosis, pathological fractures, and bone marrow infiltration (avascular osteonecrosis, infarction). Estimation of skeletal disease includes bone quality that contributes substantially to bone strength. We studied 23 type 1 Gaucher patients (median age 22years, range 3-73) on Enzyme Replacement Therapy from 2months to 26years (median 7years); 4 patients had pathological fractures, 10 bone infarctions, 6 avascular osteonecrosis. We noninvasively assessed bone quality by trabecular microarchitecture and macroscopic geometry, using two innovative dual-energy X-ray absorptiometry tools: Trabecular Bone Score (TBS) and Hip Structural Analysis (HSA). Bone quality parameters distinguished the patients with skeletal complications. TBS was significantly lower in patients with avascular osteonecrosis (p=0.049) and pathological fractures (p=0.024), while it could not identify those with bone infarctions. Among HSA parameters, the Cross Sectional Area of the intertrochanteric region and the Buckling Ratio of the narrow neck allowed the distinction of patients with avascular osteonecrosis. BMD was low in 11 patients (50%); neither BMD nor HSA were associated with pathological fractures. The combined evaluation of bone quality and bone quantity is useful to identify GD patients with more severe skeletal involvement.
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Affiliation(s)
- M Baldini
- UOC Medicina Interna, Foundation IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy.
| | - G Casirati
- UOC Medicina Interna, Foundation IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy; Hematology and Bone Marrow Transplantation Unit, Vita-Salute San Raffaele University, Milan, Italy
| | - F M Ulivieri
- Bone Metabolic Unit, Department of Nuclear Medicine, Foundation IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy
| | - E Cassinerio
- UOC Medicina Interna, Foundation IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy
| | - K Khouri Chalouhi
- Scuola di Specializzazione in Radiodiagnostica, University of Milan, Milan, Italy
| | - E Poggiali
- UOC Medicina Interna, Foundation IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy
| | - L Borin
- Department of Hematology, Ospedale San Gerardo, Monza, Italy
| | - V Burghignoli
- Radiology Unit, Foundation IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy
| | - B M Cesana
- University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - M D Cappellini
- UOC Medicina Interna, Foundation IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Science and Community Health, University of Milan, Milan, Italy
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13
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Halawi R, Cappellini MD, Taher A. A higher prevalence of hematologic malignancies in patients with thalassemia: Background and culprits. Am J Hematol 2017; 92:414-416. [PMID: 28195443 DOI: 10.1002/ajh.24682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Racha Halawi
- Emory University School of MedicineAtlanta Georgia USA
| | | | - Ali Taher
- American University of Beirut Medical CenterBeirut Lebanon
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14
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Cassinerio E, Baldini IM, Alameddine RS, Marcon A, Borroni R, Ossola W, Taher A, Cappellini MD. Pregnancy in patients with thalassemia major: a cohort study and conclusions for an adequate care management approach. Ann Hematol 2017; 96:1015-1021. [PMID: 28321530 DOI: 10.1007/s00277-017-2979-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/09/2017] [Indexed: 01/26/2023]
Abstract
An improvement in quality of life and survival occurred among thalassemia major (TM) patients: pregnancy in such patients has become a reality. Safe pregnancy and delivery require efforts to ensure the best outcomes. Between 2007 and 2016, 30 TM patients had 37 pregnancies. We analyzed the hematological parameters before, during, and after pregnancies and in 19 patients a cardiovascular magnetic resonance (CMR) T2* was performed. The mean age at first pregnancy was 30 ± 4 years; the current mean age is 35 ± 5 years. Twenty-four patients (80%) had a single pregnancy, five patients (17%) had two pregnancies, and one patient (3%) became pregnant three times. Seventeen pregnancies (46%) were spontaneous, 20 (64%) needed gonadotrophin-induced ovulation and/or reproductive technologies. All pregnancies resulted in live births. Seven were twin pregnancies (19%). The mean gestational hemoglobin was 9.2 ± 0.5 g/dl, lower than pre- and postpregnancy (9.8 ± 1 g/dl, p = ns and 9.6 ± 1 g/dl, p = 0.02, respectively). Median ferritin levels increased progressively (1071, range 409-5724 ng/ml, before pregnancy vs 2231, range 836-6918 ng/ml, after pregnancy, p < 0.0001). CMR before pregnancy showed a normal cardiac T2* (mean 35.34 ± 8.90 ms) and a mean liver iron concentration (LIC) of 3.37 ± 2.11 mg/g dry weight (dw). After pregnancy, the mean cardiac T2* was 31.06 ± 13.26 ms and the mean LIC was significantly increased (9.06 ± 5.75 mg/g dw, p = 0.0001). Pregnancy is possible and safe in thalassemia major. During pregnancy, iron accumulates, especially in the liver; a prompt resumption of chelation after delivery is mandatory.
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Affiliation(s)
- E Cassinerio
- Rare Diseases Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy.
| | - I M Baldini
- Rare Diseases Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy
| | - R S Alameddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - A Marcon
- Rare Diseases Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy
| | - R Borroni
- Infertility Unit, "Ca' Granda" Foundation IRCCS, Milan, Italy
| | - W Ossola
- Department of Obstetrics and Gynecology "L. Mangiagalli", "Ca' Granda" Foundation IRCCS, Milan, Italy
| | - A Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - M D Cappellini
- Rare Diseases Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
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15
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Baldini M, Marcon A, Ulivieri FM, Seghezzi S, Cassin R, Messina C, Cappellini MD, Graziadei G. Bone quality in beta-thalassemia intermedia: relationships with bone quantity and endocrine and hematologic variables. Ann Hematol 2017; 96:995-1003. [PMID: 28321531 DOI: 10.1007/s00277-017-2959-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/16/2017] [Indexed: 01/19/2023]
Abstract
We report the first evaluation of bone quality in 70 thalassemia intermedia (TI) patients (37 males, 33 females, age 41 ± 12 years). Thirty-three patients (47%) had been transfused, 34 (49%) had been splenectomized, 39 (56%) were on iron chelation therapy, and 11 (16%) were on hydroxyurea. Mean hemoglobin was 9.2 ± 1.5 g/dl, median ferritin 537 ng/dl (range 14-4893), and mean liver iron concentration 7.6 ± 6.4 mg Fe/g dw. Fifteen patients (21%) had endocrinopathies, and 29 (41%) had vitamin D deficiency. Bone quantity (bone mineral density, BMD) and bone quality (trabecular bone score, TBS) were evaluated by densitometry. In 53/70 patients (76%), osteopathy was found (osteoporosis in 26/53, osteopenia in 27/53). BMD values were higher in the never-transfused patients and in the not-chelated group. A highly significant correlation was found between splenectomy and BMD at all the sites, with lower values in the splenectomized patients. TBS values were significantly lower in TI patients than in 65 non-thalassemic controls (1.22 vs 1.36, p < 0.01), mainly in those splenectomized and in the transfused and chelated groups (p < 0.01). TBS did not correlate with liver iron concentration values. Our data disclose the major role of non-invasive bone quality evaluation in TI patients, especially those with the worst health state, to obtain a comprehensive assessment of fracture risk. Splenectomy seems to play a major part in bone complications.
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Affiliation(s)
- Marina Baldini
- Rare Diseases Center, Department of Medicine and Medical Specialties, Ca' Granda Foundation IRCCS Ospedale Maggiore Policlinico, Milan, Italy. .,UO Medicina Interna, Padiglione Granelli, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122, Milan, Italy.
| | - A Marcon
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - F M Ulivieri
- Nuclear Medicine, Bone Metabolic Unit, Ca' Granda Foundation IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - S Seghezzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - R Cassin
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C Messina
- Scuola di Specializzazione in Radiodiagnostica, University of Milan, Milan, Italy
| | - M D Cappellini
- Rare Diseases Center, Department of Medicine and Medical Specialties, Ca' Granda Foundation IRCCS Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Graziadei
- Rare Diseases Center, Department of Medicine and Medical Specialties, Ca' Granda Foundation IRCCS Ospedale Maggiore Policlinico, Milan, Italy
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16
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Saliba AN, Musallam KM, Cappellini MD, Graziadei G, Daar S, Viprakasit V, Taher AT. Serum ferritin values between 300 and 800 ng/mL in nontransfusion-dependent thalassemia: A probability curve to guide clinical decision making when MRI is unavailable. Am J Hematol 2017; 92:E35-E37. [PMID: 28052365 DOI: 10.1002/ajh.24628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Antoine N. Saliba
- Department of MedicineIndiana University School of MedicineIndianapolis, Indiana United States
| | - Khaled M. Musallam
- Department of Internal MedicineAmerican University of Beirut Medical CenterBeirut Lebanon
- Department of Clinical Sciences and CommunityUniversity of Milan, IRCCS Ca’ Granda Foundation Maggiore Policlinico HospitalMilan Italy
| | - Maria D. Cappellini
- Department of Clinical Sciences and CommunityUniversity of Milan, IRCCS Ca’ Granda Foundation Maggiore Policlinico HospitalMilan Italy
| | - Giovanna Graziadei
- Department of Clinical Sciences and CommunityUniversity of Milan, IRCCS Ca’ Granda Foundation Maggiore Policlinico HospitalMilan Italy
| | - Shahina Daar
- Department of Hematology, College of Medicine & Health SciencesSultan Qaboos University Oman
| | - Vip Viprakasit
- Department of Pediatrics & Thalassemia Center, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkok Thailand
| | - Ali T. Taher
- Department of Internal MedicineAmerican University of Beirut Medical CenterBeirut Lebanon
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17
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Porter JB, El-Alfy M, Viprakasit V, Giraudier S, Chan LL, Lai Y, El-Ali A, Han J, Cappellini MD. Utility of labile plasma iron and transferrin saturation in addition to serum ferritin as iron overload markers in different underlying anemias before and after deferasirox treatment. Eur J Haematol 2015; 96:19-26. [PMID: 25691036 DOI: 10.1111/ejh.12540] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2012] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Plasma markers in addition to serum ferritin (SF) may be useful for the assessment of iron overload; however, predictive utility may differ depending on underlying, transfusion-dependent, anemias. METHODS Data were collected before and after 1 year of deferasirox treatment (end of study; EOS) from the large, 1-year EPIC (Evaluation of Patients' Iron Chelation with Exjade(®) ) study. Trends were evaluated between liver iron concentration (LIC), transferrin saturation (TfSat), predose labile plasma iron (LPI) and their relationship to SF categories in 1530 patients: thalassemia major (TM; n = 1114), myelodysplastic syndromes (MDS, n = 336), and sickle-cell disease (SCD, n = 80). RESULTS Baseline and EOS SF values showed a clear and similar relationship to LIC for all disease groups. TfSat also showed a relationship to SF, most clearly in patients with SCD, where TfSat was lowest in the lowest relative SF category. Unlike SF or LIC, TfSat did not decrease at EOS in any disease group. Baseline LPI was raised in TM and MDS, but not in patients with SCD, decreasing at EOS in both patient groups. After 1 year of chelation therapy, there was a significant trend for greater LPI reduction in patients with TM achieving LIC <7 mg Fe/g dw (P = 0.0137). CONCLUSIONS Despite limitations, SF showed the clearest relationship, of the plasma markers evaluated, to LIC before and after 1 year of deferasirox in patients with TM, MDS, and SCD. In patients with TM, changes in LPI with chelation show a significant relationship to EOS LIC and may provide an additional indicator of chelation response (clinicaltrials.gov identifier: NCT00171821).
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Affiliation(s)
| | | | | | | | - Lee Lee Chan
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Yongrong Lai
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | | | - Jackie Han
- Novartis Pharmaceuticals, East Hanover, NJ, USA
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18
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Mallat NS, Wehbe D, Haddad A, Cappellini MD, Marcon A, Koussa S, Abboud MR, Radwan A, Taher AT. Priapism, an emerging complication in β-thalassemia intermedia patients. Hemoglobin 2015; 38:351-4. [PMID: 25271993 DOI: 10.3109/03630269.2014.960087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The increase in survival rate of β-thalassemia (β-thal) patients allowed for the appearance and manifestation of several complications in almost every organ system. Priapism in β-thal patients is rarely reported in the literature. We herein report and investigate the occurrence of two cases of priapism in two young patients with β-thal intermedia (β-TI). The potential mechanisms are due to either a cellular mechanism involving a thrombus obstructing the efferent venules of the corpora cavernosa leading to priapism, or a recently elucidated functional mechanism that causes alteration of nitric oxide (NO) response of the penis, ultimately causing priapism. This should incite clinicians for a close follow-up and monitoring of high risk patients who are susceptible to developing priapism.
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Affiliation(s)
- Naji S Mallat
- Department of Internal Medicine, American University of Beirut , Beirut , Lebanon
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19
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Shamoon RP, Al-Allawi NAS, Cappellini MD, Di Pierro E, Brancaleoni V, Granata F. Molecular Basis of β-Thalassemia Intermedia in Erbil Province of Iraqi Kurdistan. Hemoglobin 2015; 39:178-83. [PMID: 25902180 DOI: 10.3109/03630269.2015.1032415] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
β-Thalassemia intermedia (β-TI) is a clinical term describing a range of clinical phenotypes that are intermediate in severity between the carrier state and β-thalassemia major (β-TM). To characterize the molecular basis of β-TI in Erbil Province, Northern Iraq, 83 unrelated patients were investigated. Detection of β-globin gene mutations was carried out by reverse hybridization assay and direct gene sequencing. All patients were screened for the XmnI polymorphism by direct sequencing of HBG2 ((G)γ promoter gene). Detection of α-globin gene deletions and triplication was carried out using the reverse hybridization assay. Four main molecular patterns were identified in association with the β-TI phenotype, namely: β(+)/β(+) (38.5%), β(+)/β(0) (21.6%), β(0)/β(0) (31.3%), and β(0)/wild type (8.4%). IVS-I-6 (T > C) was the most frequently encountered mutation (55 alleles, 34.6%), followed by IVS-II-1 (G > A) and codon 8 (-AA); furthermore, we report for the first time from Iraq two β(+) mutations, -87 (C > G) and 5' untranslated region (5'UTR) +22 (G > A). The XmnI polymorphism was detected in 47.0% of patients, mainly in association with the β(0)/β(0) genotype. The α-globin gene deletions were encountered in four cases, including one case with (- -(FIL)) double gene deletion, a report that is the first from our country. The α-globin gene triplication was detected in five of the seven heterozygous β-thalassemia (β-thal) patients. Similar to other Mediterranean countries, inheritance of mild β-globin mutations was the main molecular pattern underlying β-TI in our patients followed by the ameliorating effect of the XmnI polymorphism.
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Affiliation(s)
- Rawand P Shamoon
- Department of Pathology, College of Medicine, Hawler Medical University , Erbil , Iraq
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20
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Fargion S, Fracanzani AL, Cislaghi V, Levi S, Cappellini MD, Fiorelli G. Characteristics of the membrane receptor for human H-ferritin. Curr Stud Hematol Blood Transfus 2015:164-70. [PMID: 1659511 DOI: 10.1159/000419356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Fargion
- Institute of Internal Medicine, Milan, Italy
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21
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Brancaleoni V, Balwani M, Granata F, Graziadei G, Missineo P, Fiorentino V, Fustinoni S, Cappellini MD, Naik H, Desnick RJ, Di Pierro E. X-chromosomal inactivation directly influences the phenotypic manifestation of X-linked protoporphyria. Clin Genet 2015; 89:20-6. [PMID: 25615817 DOI: 10.1111/cge.12562] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 11/25/2014] [Revised: 01/09/2015] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Abstract
X-linked protoporphyria (XLP), a rare erythropoietic porphyria, results from terminal exon gain-of-function mutations in the ALAS2 gene causing increased ALAS2 activity and markedly increased erythrocyte protoporphyrin levels. Patients present with severe cutaneous photosensitivity and may develop liver dysfunction. XLP was originally reported as X-linked dominant with 100% penetrance in males and females. We characterized 11 heterozygous females from six unrelated XLP families and show markedly varying phenotypic and biochemical heterogeneity, reflecting the degree of X-chromosomal inactivation of the mutant gene. ALAS2 sequencing identified the specific mutation and confirmed heterozygosity among the females. Clinical history, plasma and erythrocyte protoporphyrin levels were determined. Methylation assays of the androgen receptor and zinc-finger MYM type 3 short tandem repeat polymorphisms estimated each heterozygotes X-chromosomal inactivation pattern. Heterozygotes with equal or increased skewing, favoring expression of the wild-type allele had no clinical symptoms and only slightly increased erythrocyte protoporphyrin concentrations and/or frequency of protoporphyrin-containing peripheral blood fluorocytes. When the wild-type allele was preferentially inactivated, heterozygous females manifested the disease phenotype and had both higher erythrocyte protoporphyrin levels and circulating fluorocytes. These findings confirm that the previous dominant classification of XLP is inappropriate and genetically misleading, as the disorder is more appropriately designated XLP.
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Affiliation(s)
- V Brancaleoni
- Fondazione IRCCS "Cà-Granda" Ospedale Maggiore Policlinico, U.O. di Medicina Interna, Milano, Italy
| | - M Balwani
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - F Granata
- Fondazione IRCCS "Cà-Granda" Ospedale Maggiore Policlinico, U.O. di Medicina Interna, Milano, Italy
| | - G Graziadei
- Fondazione IRCCS "Cà-Granda" Ospedale Maggiore Policlinico, U.O. di Medicina Interna, Milano, Italy
| | - P Missineo
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
| | - V Fiorentino
- Fondazione IRCCS "Cà-Granda" Ospedale Maggiore Policlinico, U.O. di Medicina Interna, Milano, Italy
| | - S Fustinoni
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
| | - M D Cappellini
- Fondazione IRCCS "Cà-Granda" Ospedale Maggiore Policlinico, U.O. di Medicina Interna, Milano, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
| | - H Naik
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E Di Pierro
- Fondazione IRCCS "Cà-Granda" Ospedale Maggiore Policlinico, U.O. di Medicina Interna, Milano, Italy
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22
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Baldini M, Ulivieri FM, Forti S, Serafino S, Seghezzi S, Marcon A, Giarda F, Messina C, Cassinerio E, Aubry-Rozier B, Hans D, Cappellini MD. Spine bone texture assessed by trabecular bone score (TBS) to evaluate bone health in thalassemia major. Calcif Tissue Int 2014; 95:540-6. [PMID: 25348077 DOI: 10.1007/s00223-014-9919-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/10/2014] [Indexed: 02/03/2023]
Abstract
Due to the increasing survival of thalassemic patients, osteopathy is a mounting clinical problem. Low bone mass alone cannot account for the high fracture risk described; impaired bone quality has been speculated but so far it cannot be demonstrated noninvasively. We studied bone quality in thalassemia major using trabecular bone score (TBS), a novel texture measurement extracted from spine dual-energy X-ray absorptiometry (DXA), proposed in postmenopausal and secondary osteoporosis as an indirect index of microarchitecture. TBS was evaluated in 124 adult thalassemics (age range 19-56 years), followed-up with optimal transfusional and therapeutical regimens, and in 65 non-thalassemic patients (22-52 years) undergoing DXA for different bone diseases. TBS was lower in thalassemic patients (1.04 ± 0.12 [range 0.80-1.30]) versus controls (1.34 ± 0.11 [1.06-1.52]) (p < 0.001), and correlated with BMD. TBS and BMD values correlated with age, indicating that thalassemia negatively affects both bone quality and quantity, especially as the patient gets older. TBS was 1.02 ± 0.11 [0.80-1.28] in the osteoporotic thalassemic patients, 1.08 ± 0.12 [0.82-1.30] in the osteopenic ones and 1.15 ± 0.10 [0.96-1.26] in those with normal BMD. No gender differences were found (males: 1.02 ± 0.13 [0.80-1.30], females 1.05 ± 0.11 [0.80-1.30]), nor between patients with and without endocrine-metabolic disorders affecting bone metabolism. Our findings from a large population with thalassemia major show that TBS is a valuable tool to assess noninvasively bone quality, and it may be related to fragility fracture risk in thalassemic osteopathy.
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Affiliation(s)
- M Baldini
- Rare Diseases Center, Department of Medicine and Medical Specialities, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,
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Derchi G, Balocco M, Bina P, Caruso V, D'Ascola DG, Littera R, Origa R, Cappellini MD, Forni GL. Efficacy and safety of sildenafil for the treatment of severe pulmonary hypertension in patients with hemoglobinopathies: results from a long-term follow up. Haematologica 2014; 99:e17-8. [PMID: 24497563 DOI: 10.3324/haematol.2013.095810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Ronzoni L, Aghemo A, Rumi MG, Prati G, Colancecco A, Porretti L, Monico S, Colombo M, Cappellini MD. Ribavirin suppresses erythroid differentiation and proliferation in chronic hepatitis C patients. J Viral Hepat 2014; 21:416-23. [PMID: 24750239 DOI: 10.1111/jvh.12158] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Indexed: 01/29/2023]
Abstract
Combination therapy with pegylated interferon (pegIFN) plus ribavirin (RBV) is the standard of care for chronic hepatitis C. One of the major treatment-related side effects is anaemia, attributed to RBV-induced haemolysis. However, haemolysis biomarkers are not present in all patients supporting the existence of other pathogenetic mechanisms. We studied the role of RBV in inducing haemolysis and its effects on erythropoiesis. In 18 hepatitis C virus (HCV) genotype 2 patients treated with pegIFN-alpha-2a (180 mcg/week) plus RBV (800 mg/day) for 24 weeks and in 10 hepatitis B virus (HBV) patients treated with pegIFN-alpha-2a (180 mcg/week) for 48 weeks, haemolysis was assessed by serum LDH, haptoglobin and reticulocyte count. Erythropoiesis was evaluated both ex vivo, analysing the clonogenic activity of patients' erythroid progenitors, as well as in vitro adding pegIFN and RBV to liquid cultures obtained from CD34+ cells of healthy volunteers. The majority of patients developed anaemia; the week 4 mean haemoglobin decrease was greater in HCV than in HBV patients (1.7 vs 0.47 g/dL, P = 0.01). Only three HCV patients (17%) and no HBV patients showed signs of haemolysis. The 15 nonhaemolytic HCV patients and all HBV patients showed a delay in erythroid differentiation, with a reduction in colony number and a relative increase in undifferentiated colony percentage. Haemolytic HCV patients had an increase in colony number at week 4 of therapy. In vitro, erythroid cell proliferation and differentiation were inhibited by both pegIFN and RBV. Both pegIFN and RBV have an inhibitory effect on erythroid proliferation and differentiation.
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Affiliation(s)
- L Ronzoni
- Department of Clinical Sciences and Community, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Cassinerio E, Orofino N, Roghi A, Duca L, Poggiali E, Fraquelli M, Zanaboni L, Cappellini MD. Combination of deferasirox and deferoxamine in clinical practice: an alternative scheme of chelation in thalassemia major patients. Blood Cells Mol Dis 2014; 53:164-7. [PMID: 24846580 DOI: 10.1016/j.bcmd.2014.04.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/13/2014] [Accepted: 04/20/2014] [Indexed: 11/25/2022]
Abstract
The availability of three iron chelators improved the scenario of chelation therapy for transfusion-dependent thalassemia (TDT) patients, allowing tailoring of drugs according to the goals expected for each patient. The use of Deferiprone/Deferoxamine (DFP/DFO) combined in different schemes has been reported since many years. Only recently data from combination of Deferasirox/Deferoxamine (DFX/DFO) have been reported showing that it can be safe and efficacious to remove iron overload, particularly in patients who do not respond adequately to a single chelating agent. We investigated the efficacy, tolerability and safety of combined DFX/DFO in thalassemia major patients. Ten TDT patients have started DFX/DFO for different reasons: 1) lack of efficacy in removing liver/cardiac iron with monotherapy; 2) agranulocytosis on DFP; and 3) adverse events with elevated doses of monotherapies. The study design included: cardiac and hepatic T2* magnetic resonance (CMR), transient elastography evaluation (Fibroscan), biochemical evaluation, and audiometric and ocular examinations. The drugs' starting doses were: DFO 32 ± 4 mg/kg/day for 3-4 days a week and DFX 20 ± 2 mg/kg/day. Seven patients completed the one-year follow-up period. At baseline the mean pre-transfusional Hb level was 9.4 ± 0.4 g/dl, the mean iron intake was 0.40 ± 0.10mg/kg/day, the median ferritin level was 2254 ng/ml (range 644-17,681 ng/ml). Data available at 1 year showed no alteration of renal/hepatic function and no adverse events. A marked reduction in LIC (6.54 vs 11.44 mg/g dw at baseline) and in median ferritin (1346 vs 2254 ng/ml at baseline) was achieved. A concomitant reduction of non-transferrin-bound iron (NTBI) at six months was observed (2.1 ± 1.0 vs 1.7 ± 1.2 μM). An improvement in cardiac T2* values was detected (26.34 ± 15.85 vs 19.85 ± 12.06 at baseline). At 1 year an increased dose of DFX was administered (27 ± 6 mg/kg/day vs 20 ± 2 mg/kg/day at baseline, p=0.01) with a stable dose of DFO (32 ± 4 mg/kg/day). Combined or alternated DFX/DFO can be considered when monotherapy is not able to remove the iron overload or in the presence of adverse events.
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Affiliation(s)
- E Cassinerio
- Rare Disease Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy
| | - N Orofino
- Rare Disease Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy
| | - A Roghi
- CMR Unit, Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - L Duca
- Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy
| | - E Poggiali
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - M Fraquelli
- Second Division of Gastroenterology, "Ca' Granda" Foundation IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy
| | - L Zanaboni
- Rare Disease Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy
| | - M D Cappellini
- Rare Disease Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy; Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
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Barteselli G, Dell'arti L, Finger RP, Charbel Issa P, Marcon A, Vezzola D, Mapelli C, Cassinerio E, Cappellini MD, Ratiglia R, Viola F. The spectrum of ocular alterations in patients with β-thalassemia syndromes suggests a pathology similar to pseudoxanthoma elasticum. Ophthalmology 2013; 121:709-18. [PMID: 24314836 DOI: 10.1016/j.ophtha.2013.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/06/2013] [Accepted: 10/07/2013] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To determine the prevalence and spectrum of ocular fundus abnormalities in patients with β-thalassemia and to investigate risk factors for their development. DESIGN Cross-sectional, observational study. PARTICIPANTS A total of 255 patients with β-thalassemia major (TM) and β-thalassemia intermedia (TI) were consecutively recruited and investigated. METHODS Patients underwent best correct visual acuity, indirect ophthalmoscopy, and fundus photography, including fundus autofluorescence (FAF) and near-infrared reflectance imaging using a confocal scanning laser ophthalmoscope (cSLO). Hematologic parameters were determined, including mean ferritin levels, aspartate amino transferase, alanine amino transferase, calcium, pre-transfusion hemoglobin, history of splenectomy, and liver iron concentration. Factors associated with the ocular phenotype were assessed using logistic regression. MAIN OUTCOME MEASURES Ocular phenotype as determined by clinical examination and used multimodal imaging. RESULTS A total of 153 patients (60.0%) affected by TM and 102 patients (40.0%) affected by TI participated, of whom 216 (84.7%) were receiving iron-chelating therapy. Ocular fundus abnormalities characteristic of pseudoxanthoma elasticum (PXE) were detected by cSLO in 70 of 255 patients (27.8%) and included peau d'orange (19.6%), angioid streaks (12.9%), pattern dystrophy-like changes (7.5%), and optic disc drusen (2.0%). Pseudoxanthoma elasticum-like changes were more frequent in patients with TI (P<0.001). Patients with PXE-like fundus changes were older than patients without these fundus changes (P<0.001). In both patients with TI and TM, age (P = 0.001) and splenectomy (P = 0.001) had the strongest association with presence of PXE-like fundus changes in multivariate analyses. A total of 43 of 255 patients (16.9%) showed increased retinal vascular tortuosity independently of the PXE-like fundus changes, which was associated with aspartate amino transferase (P = 0.036), hemoglobin (P = 0.008), and ferritin levels (P = 0.005). CONCLUSIONS Pseudoxanthoma elasticum-like fundus changes are a frequent finding in patients with β-thalassemia. In TI, these changes increase with duration or severity of the disease. This particular ocular phenotype suggests an ocular pathology similar to PXE. Retinal vascular tortuosity may be an additional disease manifestation independent of the PXE-like syndrome. Patients with long-standing disease requiring iron-chelating treatment and a history of splenectomy need regular ophthalmic checkups because they are at risk of developing PXE-like fundus changes and potentially of subsequent choroidal neovascularization.
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Affiliation(s)
- Giulio Barteselli
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Laura Dell'arti
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Robert P Finger
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | | | - Alessia Marcon
- Rare Diseases Center, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Diego Vezzola
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Chiara Mapelli
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elena Cassinerio
- Rare Diseases Center, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Maria D Cappellini
- Rare Diseases Center, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Roberto Ratiglia
- Rare Diseases Center, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Viola
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
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Sun CC, Vaja V, Chen S, Theurl I, Stepanek A, Brown DE, Cappellini MD, Weiss G, Hong CC, Lin HY, Babitt JL. A hepcidin lowering agent mobilizes iron for incorporation into red blood cells in an adenine-induced kidney disease model of anemia in rats. Nephrol Dial Transplant 2013; 28:1733-43. [PMID: 23345622 DOI: 10.1093/ndt/gfs584] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Anemia is a common complication of chronic kidney disease (CKD) that negatively impacts the quality of life and is associated with numerous adverse outcomes. Excess levels of the iron regulatory hormone hepcidin are thought to contribute to anemia in CKD patients by decreasing iron availability from the diet and from body stores. Adenine treatment in rats has been proposed as an animal model of anemia of CKD with high hepcidin levels that mirrors the condition in human patients. METHODS We developed a modified adenine-induced kidney disease model with a higher survival rate than previously reported models, while maintaining persistent kidney disease and anemia. We then tested whether the small molecule bone morphogenetic protein (BMP) inhibitor LDN-193189, which was previously shown to lower hepcidin levels in rodents, mobilized iron into the plasma and improved iron-restricted erythropoiesis in this model. RESULTS Adenine-treated rats exhibited increased hepatic hepcidin mRNA, decreased serum iron, increased spleen iron content, low hemoglobin (Hb) and inappropriately low erythropoietin (EPO) levels relative to the degree of anemia. LDN-193189 administration to adenine-treated rats lowered hepatic hepcidin mRNA, mobilized stored iron into plasma and increased Hb content of reticulocytes. CONCLUSIONS Our data suggest that hepcidin lowering agents may provide a new therapeutic strategy to improve iron availability for erythropoiesis in CKD.
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Affiliation(s)
- Chia Chi Sun
- Program in Anemia Signaling Research, Division of Nephrology, Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Iron overload due to increased intestinal iron absorption represents an important clinical problem in patients with non-transfusion-dependent thalassemia (NTDT), particularly as they advance in age. Current models for iron metabolism in patients with beta (β)-thalassemia intermedia (TI) suggest that suppression of serum hepcidin results in increased iron absorption and release of iron from the reticuloendothelial system, leading to depletion of macrophage iron, relatively low levels of serum ferritin, and liver iron loading. The clinical consequences of iron overload in patients with NTDT are multifactorial and include endocrinopathy, bone disease, thromboembolism, pulmonary hypertension, cerebrovascular and neuronal damage, liver fibrosis or cirrhosis, and increased risk of hepatocellular carcinoma. Although serum ferritin levels correlate with liver iron concentration (LIC), they underestimate iron load in these patients compared with transfusion-dependent patients with equivalent LIC. Therefore, direct measurement of LIC is recommended with chelation therapy as indicated.
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Affiliation(s)
- Khaled M Musallam
- IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy
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Harteveld CL, Refaldi C, Giambona A, Ruivenkamp CAL, Hoffer MJV, Pijpe J, De Knijff P, Borgna-Pignatti C, Maggio A, Cappellini MD, Giordano PC. Mosaic segmental uniparental isodisomy and progressive clonal selection: a common mechanism of late onset β-thalassemia major. Haematologica 2012; 98:691-5. [PMID: 22983591 DOI: 10.3324/haematol.2012.065219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Genomic DNA of 3 patients, born as healthy carriers and developing a late-onset severe transfusion-dependent beta-thalassemia major was studied by high-density genome wide SNP array analysis. A mosaic loss of heterozygosity for almost the entire 11p was found, not attributable to deletions but involving mosaicism for segmental paternal isodisomy of 11p. Mitotic recombination leading to mosaic segmental uniparental isodisomy on chromosome 11p in multiple tissues has been described as a molecular disease mechanism for a subset of sporadic Beckwith-Wiedemann syndrome cases. A similar mechanism also seems to be involved in causing late-onset disease in carriers of recessive mutations in other genes located in 11p, such as late-onset beta-thalassemia major and sickle cell disease. We suggest that the loss of maternally imprinted IGF-2 and H19 genes may account for the selective advantage of hematopoietic cells containing this segmental paternal isodisomy of 11p carrying the β-thalassemia mutation.
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Affiliation(s)
- Cornelis L Harteveld
- Center for Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
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Viola F, Barteselli G, Dell'Arti L, Vezzola D, Villani E, Mapelli C, Zanaboni L, Cappellini MD, Ratiglia R. Abnormal Fundus Autofluorescence Results of Patients in Long-term Treatment with Deferoxamine. Ophthalmology 2012; 119:1693-700. [DOI: 10.1016/j.ophtha.2012.01.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 10/28/2022] Open
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Taher AT, Cappellini MD, Musallam KM. Recent advances and treatment challenges in patients with non-transfusion-dependent thalassemia. Blood Rev 2012; 26 Suppl 1:S1-2. [DOI: 10.1016/s0268-960x(12)00028-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mariotti C, Fancellu R, Caldarazzo S, Nanetti L, Di Bella D, Plumari M, Lauria G, Cappellini MD, Duca L, Solari A, Taroni F. Erythropoietin in Friedreich ataxia: no effect on frataxin in a randomized controlled trial. Mov Disord 2012; 27:446-9. [PMID: 22411849 DOI: 10.1002/mds.24066] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 10/26/2011] [Accepted: 11/14/2011] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND Friedreich ataxia is a rare disease caused by GAA-trinucleotide-repeat expansions in the frataxin gene, leading to marked reduction of qualitatively normal frataxin protein. Recently, human recombinant erythropoietin was reported to increase frataxin levels in patients with Friedreich ataxia. METHODS We performed a 6-month, randomized placebo-controlled, double-blind, dose-response pilot trial to assess the safety and efficacy of erythropoietin in increasing frataxin levels. Sixteen adult patient with Friedreich ataxia were randomly assigned to erythropoietin (n = 11) or matching placebo (n = 5). All patients continued Idebenone treatment (5 mg/kg/day). Treatment consisted of a 6-month scaling-up phase, in which erythropoietin was administered intravenously at the following doses: 20,000 IU every 3 weeks, 40,000 IU every 3 weeks, and 40,000 IU every 2 weeks. RESULTS Erythropoietin treatment was safe and well tolerated, but did not result in any significant hematological, clinical, or biochemical effects in Friedreich ataxia patients.
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Affiliation(s)
- Caterina Mariotti
- SOSD Genetics of Neurodegenerative and Metabolic Diseases, Fondazione IRCCS, Istituto Neurologico Carlo Besta, Milan, Italy.
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Punzo F, Bertoli-Avella AM, Scianguetta S, Della Ragione F, Casale M, Ronzoni L, Cappellini MD, Forni G, Oostra BA, Perrotta S. Congenital dyserythropoietic anemia type II: molecular analysis and expression of the SEC23B gene. Orphanet J Rare Dis 2011; 6:89. [PMID: 22208203 PMCID: PMC3269369 DOI: 10.1186/1750-1172-6-89] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 12/30/2011] [Indexed: 11/21/2022] Open
Abstract
Background Congenital dyserythropoietic anemia type II (CDAII), the most common form of CDA, is an autosomal recessive condition. CDAII diagnosis is based on invasive, expensive, and time consuming tests that are available only in specialized laboratories. The recent identification of SEC23B mutations as the cause of CDAII opens new possibilities for the molecular diagnosis of the disease. The aim of this study was to characterize molecular genomic SEC23B defects in 16 unrelated patients affected by CDAII and correlate the identified genetic alterations with SEC23B transcript and protein levels in erythroid precursors. Methods SEC23B was sequenced in 16 patients, their relatives and 100 control participants. SEC23B transcript level were studied by quantitative PCR (qPCR) in peripheral erythroid precursors and lymphocytes from the patients and healthy control participants. Sec23B protein content was analyzed by immunoblotting in samples of erythroblast cells from CDAII patients and healthy controls. Results All of the investigated cases carried SEC23B mutations on both alleles, with the exception of two patients in which a single heterozygous mutation was found. We identified 15 different SEC23B mutations, of which four represent novel mutations: p.Gln214Stop, p.Thr485Ala, p.Val637Gly, and p.Ser727Phe. The CDAII patients exhibited a 40-60% decrease of SEC23B mRNA levels in erythroid precursors when compared with the corresponding cell type from healthy participants. The largest decrease was observed in compound heterozygote patients with missense/nonsense mutations. In three patients, Sec23B protein levels were evaluated in erythroid precursors and found to be strictly correlated with the reduction observed at the transcript level. We also demonstrate that Sec23B mRNA expression levels in lymphocytes and erythroblasts are similar. Conclusions In this study, we identified four novel SEC23B mutations associated with CDAII disease. We also demonstrate that the genetic alteration results in a significant decrease of SEC23B transcript in erythroid precursors. Similar down-regulation was observed in peripheral lymphocytes, suggesting that the use of these cells might be sufficient in the identification of Sec23B gene alterations. Finally, we demonstrate that decreased Sec23B protein levels in erythroid precursors correlate with down-regulation of the SEC23B mRNA transcript.
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Affiliation(s)
- Francesca Punzo
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands
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Piga A, Serra M, Longo F, Forni G, Quarta G, Cappellini MD, Galanello R. Changing patterns of splenectomy in transfusion-dependent thalassemia patients. Am J Hematol 2011; 86:808-10. [PMID: 21850661 DOI: 10.1002/ajh.22102] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dentali F, Romualdi E, Ageno W, Cappellini MD, Mannucci PM. Thalassemia trait and arterial thromboembolic events: a systematic review and a meta-analysis of the literature. J Thromb Haemost 2011; 9:917-21. [PMID: 21382170 DOI: 10.1111/j.1538-7836.2011.04253.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND An increased risk of venous thromboembolic events has been reported in thalassemic patients, in particular in patients with thalassemia intermedia. The association between β-thalassemia trait and atherothrombotic cardiovascular events is not well established. METHODS In a systematic review and meta-analysis of the literature, we evaluated the association between β-thalassemia trait and arterial cardiovascular disease. Studies were identified from the MEDLINE and EMBASE (until July 2010) electronic databases. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with a random-effects model. Statistical heterogeneity was evaluated with the I(2) statistic. RESULTS Of the 354 identified articles, eight case-control studies were eligible for the analysis. β-Thalassemia trait was associated with a reduced risk of arterial cardiovascular disease (OR 0.45; 95% CI 0.45-0.60). Heterogeneity among studies was low (I(2) = 13%). The protective effect of β-thalassemia trait was confined to male patients (OR 0.39; 95% CI 0.24-0.62), and was not observed in female subjects (OR 0.89; 95% CI 0.52-1.53). CONCLUSIONS β-Thalassemia trait may act as a protective factor against the development of arterial cardiovascular and cerebrovascular disease in male subjects. Larger prospective studies are necessary to confirm these preliminary findings and to further investigate the mechanisms underlying this protective effect.
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Affiliation(s)
- F Dentali
- Research Center on Thromboembolic Disorders and on Antithrombotic Therapies, Department of Clinical Medicine, University of Insubria, Varese, Italy.
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Delbini P, Vaja V, Graziadei G, Duca L, Nava I, Refaldi C, Cappellini MD. Genetic variability of TMPRSS6 and its association with iron deficiency anaemia. Br J Haematol 2010; 151:281–4. [PMID: 20738301 DOI: 10.1111/j.1365-2141.2010.08349.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Transmembrane Protease, Serine 6 (TMPRSS6) has an important role in iron homeostasis and its mutations, performed in TMPRSS6-deficient mice, have been recently associated with iron-refractory iron deficiency anaemia (IRIDA). Several variants of TMPRSS6 have been already identified; however the role of polymorphisms and TMPRSS6 haplotypes, causing iron deficiency anaemia, have not yet been investigated. This study sequenced the TMPRSS6 gene in 16 subjects with IRIDA phenotype and identified 27 DNA polymorphisms. Eight single nucleotide polymorphisms and four haplotypes were significantly associated with iron-refractory anaemia (P < 0·001). Our preliminary results suggest a possible association between specific haplotypes of TMPRSS6 and IRIDA.
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Affiliation(s)
- Paola Delbini
- Fondazione IRCCS ‘‘Ca’ Granda’’-Ospedale Maggiore Policlinico, University of Milan, Italy
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Taher AT, Musallam KM, Karimi M, El-Beshlawy A, Belhoul K, Daar S, Saned M, Cesaretti C, Cappellini MD. Splenectomy and thrombosis: the case of thalassemia intermedia. J Thromb Haemost 2010; 8:2152-8. [PMID: 20546125 DOI: 10.1111/j.1538-7836.2010.03940.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hypercoagulability in splenectomized patients with thalassemia intermedia (TI) has been extensively evaluated. However, clinical and laboratory characteristics of patients who eventually develop overt thromboembolic events (TEE) are poorly studied. PATIENTS/METHODS Three Groups of TI patients (n=73 each) were retrospectively identified from a registry involving six centers across the Middle East and Italy: Group I, all splenectomized patients with a documented TEE; Group II, age- and sex-matched splenectomized patients without TEE; and Group III, age- and sex-matched non-splenectomized patients without TEE. Retrieved data included demographics, laboratory parameters, clinical complications, and received treatments that may influence TEE development, and reflected the period prior to TEE occurrence in Group I. RESULTS The mean age of Group I patients at development of TEE was 33.1±11.7years, with a male to female ratio of 33:40. TEE were predominantly venous (95%) while four patients (5%) had documented stroke. Among studied parameters, Group I patients were more likely to have a nucleated red blood cell (NRBC) count ≥300×10(6) L(-1) , a platelet count ≥500×10(9) L(-1) and evidence of pulmonary hypertension (PHT), or be transfusion naïve. The median time to thrombosis following splenectomy was 8years. Patients with an NRBC count ≥300×10(6) L(-1) , a platelet count ≥500×10(9) L(-1) , or who were transfusion naive also had a shorter time to thrombosis following splenectomy. CONCLUSION Splenectomized TI patients who will develop TEE may be identified early on by high NRBC and platelet counts, evidence of PHT, and transfusion naivety.
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Affiliation(s)
- A T Taher
- Department of Internal Medicine, Hematology-Oncology Division, American University of Beirut Medical Center, Beirut, Lebanon.
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Boschetti C, Cappellini MD, Colombi M, Villa A, Grande R, Vercellati C, Radaelli F, Caspani L, Zanella A. An unusual febrile nonhemolytic reaction occurred after transfusion in a thalassemia major patient with asymptomatic Plasmodium falciparum infection. Transfusion 2010; 51:469-72. [DOI: 10.1111/j.1537-2995.2010.02853.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Chronic iron overload from frequent blood transfusions to treat patients with severe anemias leads to significant morbidity and mortality. Although desferrioxamine, the current standard of care, is an effective iron chelator with long-term evidence, it requires tedious subcutaneous infusion that reflects negatively on patient compliance. Deferiprone opened the horizon for an era of oral iron chelators. Although collective evidence proved its efficacy, safety issues are still of high concern and require regular monitoring. The experience with these two drugs helps better delineate the optimal goals of iron chelation therapy and the ideal iron chelator.
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Abstract
Our understanding of the molecular and pathophysiological mechanisms underlying the disease process in patients with thalassemia intermedia (TI) has substantially increased over the past decade. TI encompasses a wide clinical spectrum of beta-thalassemia phenotypes. Some TI patients are asymptomatic until adult life, whereas others are symptomatic from as young as 2 years. A number of clinical complications commonly associated with TI are rarely seen in thalassemia major, including extramedullary hematopoiesis, leg ulcers, gallstones, thrombosis, and pulmonary hypertension. There are a number of options currently available for managing patients with TI, including transfusion therapy, iron chelation therapy, modulation of fetal hemoglobin production, and hematopoietic stem cell transplantation. However, at present, there are no clear guidelines for an orchestrated optimal treatment plan.
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Taher AT, Musallam KM, El-Beshlawy A, Karimi M, Daar S, Belhoul K, Saned MS, Graziadei G, Cappellini MD. Age-related complications in treatment-naïve patients with thalassaemia intermedia. Br J Haematol 2010; 150:486-9. [PMID: 20456362 DOI: 10.1111/j.1365-2141.2010.08220.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Scacchi M, Danesi L, Cattaneo A, Valassi E, Pecori Giraldi F, Radaelli P, Ambrogio A, D'Angelo E, Mirra N, Zanaboni L, Cappellini MD, Cavagnini F. The pituitary-adrenal axis in adult thalassaemic patients. Eur J Endocrinol 2010; 162:43-8. [PMID: 19820036 DOI: 10.1530/eje-09-0646] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We previously described in young thalassaemic patients an altered cortisol and ACTH responsiveness suggesting an impaired adrenocortical reserve. Owing to iron overload, a worsening of adrenal function should be expected in adult patients. DESIGN In 124 adults with beta-thalassaemia, urinary free cortisol (UFC) and plasma ACTH levels were determined and compared with those measured in 150 controls. In 45 patients, cortisol was measured in response to: i) tetracosactide 1 microg as an i.v. bolus (low-dose test, LDT) and ii) tetracosactide 250 microg infused i.v. over 8 h (high-dose test, HDT). RESULTS UFC and serum cortisol were within the reference range in all patients. Conversely, basal plasma ACTH values were above the upper limit of the normal range in 19 patients. There were no statistically significant differences in the mean values of UFC, basal serum cortisol and plasma ACTH between patients and controls. A subnormal cortisol response to the LDT was registered in 18 out of 56 patients. Three of these patients also displayed a subnormal response to the HDT, together with elevated baseline plasma ACTH levels. In the LDT, a positive correlation was found between basal and peak cortisol values (P<0.0001). The latter were negatively correlated with basal ACTH values in both LDT (P<0.0001) and HDT (P<0.0001). CONCLUSIONS Adult thalassaemic patients often present a subtle impairment of adrenocortical function. This may become clinically relevant in case of major stressful events. Thus, we recommend an assessment of adrenocortical function in all adult thalassaemic patients.
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Affiliation(s)
- Massimo Scacchi
- Chair of Endocrinology, Università degli Studi di Milano, Division of Endocrinology and Metabolic Diseases, Ospedale San Luca IRCCS, Istituto Auxologico Italiano, Milan, Italy
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Taher A, Cappellini MD, Vichinsky E, Galanello R, Piga A, Lawniczek T, Clark J, Habr D, Porter JB. Efficacy and safety of deferasirox doses of >30 mg/kg per d in patients with transfusion-dependent anaemia and iron overload. Br J Haematol 2009; 147:752-9. [PMID: 19764988 PMCID: PMC2779992 DOI: 10.1111/j.1365-2141.2009.07908.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [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: 01/19/2023]
Abstract
The highest approved dose of deferasirox is currently 30 mg/kg per d in many countries; however, some patients require escalation above 30 mg/kg per d to achieve their therapeutic goals. This retrospective analysis investigated the efficacy (based on change in serum ferritin levels) and safety of deferasirox >30 mg/kg per d in adult and paediatric patients with transfusion-dependent anaemias, including β-thalassaemia, sickle cell disease and the myelodysplastic syndromes. In total, 264 patients pooled from four clinical trials received doses of >30 mg/kg per d; median exposure to deferasirox >30 mg/kg per d was 36 weeks. In the overall population there was a statistically significant median decrease in serum ferritin of 440 μg/l (P< 0·0001) from pre-dose-escalation to the time-of-analysis; significant decreases were also observed in adult and paediatric patients, as well as β-thalassaemia patients. The adverse event profile in patients who received deferasirox doses of >30 mg/kg per d was consistent with previously published data. There was no worsening of renal or liver function following dose escalation. Deferasirox >30 mg/kg per d effectively reduced iron burden to levels lower than those achieved prior to dose escalation in patients with transfusion-dependent anaemias. This has important implications for patients who are heavily transfused and may require higher doses to reduce body iron burden.
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Affiliation(s)
- Ali Taher
- Department of Internal Medicine, Haematology-Oncology Division, American University of Beirut, Medical Centre, Beirut, Lebanon.
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Abstract
BACKGROUND The quantity of iron in body is carefully regulated, primarily by control of iron absorption, and excess total body iron can be extremely toxic. Since humans have no mechanism for elimination of excess iron, multiple transfusions of red blood cells, which are required for the management of a number of disorders, inevitably result in iron overload. Cumulative iron overload, in turn, leads to iron toxicity with organ dysfunction and damage. MATERIALS This review examines the relationship between iron metabolism and hematologic disorders treated with multiple transfusions, with emphasis on the diagnosis and current methods of management of iron overload and toxicity in transfusion-dependent patients. Primarily using key words, we identified and reviewed more than 100 pertinent articles in English and other languages in the Medline database plus an additional number of abstracts of presentations at recent meetings of relevant scientific associations. RESULTS Transfusion-dependent disorders include those characterized by decreased red blood cell production, increased red blood cell destruction, or chronic blood loss. Patients receiving chronic transfusion therapy should be screened and monitored for iron overload, yet in our opinion, this is not always done routinely. Once iron overload has been identified, it should be treated to reduce the risk of morbidity and mortality from iron toxicity, which particularly affects the liver and heart. CONCLUSION Increased awareness of the risks of iron overload from chronic transfusion therapy should result in greater use of interventions such as iron chelation to reduce total body iron and the risk of long-term sequelae.
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Affiliation(s)
- A Shander
- Department of Anesthesiology, Critical Care Medicine, and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA.
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Di Pierro E, Brancaleoni V, Stanzial F, Benedicenti F, Castellan C, Cappellini MD. Novel human pathological mutations. Gene symbol: HMBS. Disease: Porphyria, acute intermittent. Hum Genet 2009; 126:339. [PMID: 19694018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Elena Di Pierro
- Internal Medicine, Maggiore Policlinico Foundation IRCCS-University of Milan, Milano, Italy.
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Ausenda S, Di Pierro E, Brancaleoni V, Tavazzi D, Cappellini MD. Novel human pathological mutations. Gene symbol: CPOX. Disease: Coproporphyria. Hum Genet 2009; 126:342. [PMID: 19694028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Sabrina Ausenda
- Milano, Fondazione Ospedale Maggiore Policlinico MA RE-Università degli Studi di Milano, Milano, Italy
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Nassar AH, Musallam KM, Cappellini MD, Taher AT. Pregnancy and risk of venous thromboembolism in developing countries. Br J Haematol 2009; 146:691-2. [PMID: 19622093 DOI: 10.1111/j.1365-2141.2009.07817.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Taher A, Musallam KM, El Rassi F, Duca L, Inati A, Koussa S, Cappellini MD. Levels of non-transferrin-bound iron as an index of iron overload in patients with thalassaemia intermedia. Br J Haematol 2009; 146:569-72. [PMID: 19604239 DOI: 10.1111/j.1365-2141.2009.07810.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Non-transferrin-bound iron (NTBI) was evaluated as an index of iron overload in a cross-sectional randomised study in 74 non-transfused patients with thalassaemia intermedia (TI). Mean NTBI (2.92 +/- 3.43 micromol/l), serum ferritin (1023 +/- 780 ng/ml) and liver iron concentration (LIC; 9.0 +/- 7.4 mg Fe/g dry weight) were increased above reference-range levels. Significant positive correlations occurred between mean NTBI and LIC (Pearson correlation 0.36; P = 0.002) and serum ferritin (Pearson correlation 0.421; P < 0.0001); with higher levels observed in splenectomised patients. NTBI assessment has potential as a simple reliable approach to determining iron status in TI.
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Affiliation(s)
- Ali Taher
- Department of Internal Medicine, Haematology-Oncology Division, American University of Beirut Medical Centre, Beirut, Lebanon.
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Di Pierro E, Ventura P, Brancaleoni V, Moriondo V, Marchini S, Tavazzi D, Nascimbeni F, Ferrari MC, Rocchi E, Cappellini MD. Clinical, biochemical and genetic characteristics of Variegate Porphyria in Italy. Cell Mol Biol (Noisy-le-grand) 2009; 55:79-88. [PMID: 19656455] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 05/15/2009] [Indexed: 05/28/2023]
Abstract
Variegate Porphyria (VP) is an autosomal dominant disorder found worldwide but is rare in Italy. In this study we provide an overview of clinical, biochemical and genetic background of 33 Italian VP patients diagnosed in the last fifteen years. About 70% of patients had experienced clinical symptoms: 43.4% had photosensivity, 8.7% acute attacks and 47.8% both. Among the 33 patients, 14 different mutations were identified. Of these only 6 defects have been previously described in other countries and 8 are unique having been identified for the first time in Italy. Two of these, the c.851G>T and the c.1013C>G, were found in two and four unrelated families respectively. No mutation has been found in homozygosis and no significant correlation has been observed between specific clinical and biochemical manifestations and the type of mutation. In contrast, normal faecal protoporphyrin excretion was high predictive of silent phenotype. Normal urinary excretion of PBG and ALA, predicted absence of neurovisceral symptoms. This paper represents the first compilation of data on genotype-phenotype relation in Italian patients with VP.
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Affiliation(s)
- E Di Pierro
- Dipartimento di Medicina Interna, Università degli Studi di Milano - Fondazione Ospedale Maggiore Policlinico Mangiagalli e Regina Elena IRCCS Milano, Italy.
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Di Pierro E, Besana V, Brancaleoni V, Fasulo MR, Cesaretti C, Cappellini MD. Novel human pathological mutations. Gene symbol: HMBS. Disease: porphyria, acute intermittent. Hum Genet 2009; 125:347. [PMID: 19320027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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