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Means RT. Memoriam: Sanford B. Krantz, MD 1934-2023. Am J Med Sci 2024; 367:149-150. [PMID: 38122987 DOI: 10.1016/j.amjms.2023.12.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Robert T Means
- Departments of Internal Medicine, Medical Education, and Pathology, James H. Quillen College of Medicine, Johnson City, TN, USA.
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Means RT. Pure red cell aplasia: The second hundred years. Am J Med Sci 2023; 366:160-166. [PMID: 37327996 DOI: 10.1016/j.amjms.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
Pure red cell aplasia (PRCA) is a rare hematologic syndrome, characterized by an isolated normocytic anemia with severe reticulocytopenia, and defined by absence or near absence of erythroid precursors in the bone marrow. First described in 1922, PRCA may be a primary autoimmune or clonal myeloid or lymphoid disorder, but may also be secondary to other disorders of immune dysregulation/autoimmunity, to infections, to neoplasms, or to drugs. Insights from the study of PRCA have helped illuminate the understanding of the regulation of erythropoiesis. This review summarizes the classification, diagnostic, and therapeutic approach to PRCA as it begins its second century, with a particular focus on opportunities and challenges provided by new developments in the role of T-cells and T-cell regulatory mutations; the role of clonal hematopoiesis; and new developments in therapy for refractory PRCA and PRCA associated with ABO incompatible stem cell transplantation.
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Affiliation(s)
- Robert T Means
- Departments of Internal Medicine, Medical Education, and Pathology, James H. Quillen College of Medicine, Johnson City, TN, USA.
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Means RT. Ineffective erythropoiesis and osteoporosis in thalassemia: Mechanistic insights? Am J Med Sci 2023:S0002-9629(23)01171-0. [PMID: 37149035 DOI: 10.1016/j.amjms.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Robert T Means
- Departments of Internal Medicine and Pathology, James H. Quillen College of Medicine, Johnson City, TN, USA.
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Al-Samkari H, Glaspy JA, Means RT, Chertow GM, Auerbach M. Risks for Anaphylaxis With Intravenous Iron Formulations. Ann Intern Med 2022; 175:W143. [PMID: 36375165 DOI: 10.7326/l22-0282] [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: 11/16/2022] Open
Affiliation(s)
- Hanny Al-Samkari
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John A Glaspy
- University of California, Los Angeles, Los Angeles, California
| | - Robert T Means
- East Tennessee State University, Johnson City, Tennessee
| | - Glenn M Chertow
- Stanford University School of Medicine, Palo Alto, California
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Means RT. New agents for sickle cell disease: patient perceptions of benefit in the real world. J Investig Med 2022; 70:1210-1211. [PMID: 35732335 DOI: 10.1136/jim-2022-002464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Robert T Means
- Internal Medicine and Pathology, James H Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
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Affiliation(s)
- Robert T Means
- Department of Internal Medicine (Hematology) and Pathology, East Tennessee State University, Johnson City, Tennessee, USA
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Abstract
Discussion of the hematologic complications of vaccination for severe acute respiratory syndrome coronavirus-2 (COVID-19) has primarily focused on the development of vaccine-associated immune thrombosis with thrombocytopenia (VITT). Other hematologic complications are uncommon. We report the case of a patient who developed immunoglobulin G (IgG)-mediated autoimmune hemolytic anemia (AIHA) after the Moderna COVID-19 messenger ribonucleic acid (mRNA) vaccine.
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Means RT. Update on pure red cell aplasia: etiology, diagnosis, and treatment. Clin Adv Hematol Oncol 2022; 20:18-21. [PMID: 35060958] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Robert T Means
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
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Means RT. Yet another amyloidosis. J Investig Med 2021; 70:347. [PMID: 34965957 DOI: 10.1136/jim-2021-002221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Robert T Means
- Office of the Dean, East Tennessee State University, Johnson City, Tennessee, USA
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Means RT. Lymphoma classification: morphology to molecular. J Investig Med 2020; 68:319-320. [PMID: 31992657 DOI: 10.1136/jim-2019-001266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Robert T Means
- Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA .,Department of Medical Education, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA.,Department of Pathology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
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Means RT. Iron Deficiency and Iron Deficiency Anemia: Implications and Impact in Pregnancy, Fetal Development, and Early Childhood Parameters. Nutrients 2020; 12:nu12020447. [PMID: 32053933 PMCID: PMC7071168 DOI: 10.3390/nu12020447] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/16/2022] Open
Abstract
A normal pregnancy consumes 500–800 mg of iron from the mother. Premenopausal women have a high incidence of marginal iron stores or iron deficiency (ID), with or without anemia, particularly in the less developed world. Although pregnancy is associated with a “physiologic” anemia largely related to maternal volume expansion; it is paradoxically associated with an increase in erythrocyte production and erythrocyte mass/kg. ID is a limiting factor for this erythrocyte mass expansion and can contribute to adverse pregnancy outcomes. This review summarizes erythrocyte and iron balance observed in pregnancy; its implications and impact on mother and child; and provides an overview of approaches to the recognition of ID in pregnancy and its management, including clinically relevant questions for further investigation.
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Affiliation(s)
- Robert T. Means
- Departments of Internal Medicine, Medical Education, and Pathology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA; ; Tel.: +1-423-439-6499; Fax: +1-423-439-6470
- Internal Medicine, Building 2/Room 109, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
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Abstract
Pure red cell aplasia (PRCA) is a syndrome defined by a normocytic normochromic anemia with severe reticulocytopenia and marked reduction or absence of erythroid precursors from the bone marrow. Diamond-Blackfan anemia is a congenital form of PRCA. Acquired PRCA may be either a primary disorder or secondary to some other disorder or agent. Primary acquired PRCA is an autoimmune disorder that is frequently antibody-mediated. Myelodysplastic syndromes may also present with the morphologic appearance of PRCA. Secondary acquired PRCA may be associated with collagen vascular/autoimmune disorders such as systemic lupus erythematosus; lymphoproliferative disorders such as chronic lymphocytic leukemia or large granular lymphocyte leukemia; infections, particularly B19 parvovirus; thymoma and other solid tumors; or a variety of other disorders, drugs, or toxic agents. The therapeutic approach to PRCA typically involves immunosuppression, but specific pathogenic subtypes are associated with specific therapeutic approaches. Cyclosporine A, with or without concurrent corticosteroids, appears to be the single most effective immunosuppressive agent.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Anemia, Diamond-Blackfan/drug therapy
- Anemia, Diamond-Blackfan/immunology
- Anemia, Diamond-Blackfan/pathology
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/immunology
- Autoimmune Diseases/pathology
- Cyclosporine/therapeutic use
- Humans
- Immunosuppressive Agents/therapeutic use
- Leukemia, Large Granular Lymphocytic/drug therapy
- Leukemia, Large Granular Lymphocytic/immunology
- Leukemia, Large Granular Lymphocytic/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Myelodysplastic Syndromes/drug therapy
- Myelodysplastic Syndromes/etiology
- Myelodysplastic Syndromes/immunology
- Myelodysplastic Syndromes/pathology
- Parvoviridae Infections/drug therapy
- Parvoviridae Infections/immunology
- Parvoviridae Infections/pathology
- Parvovirus B19, Human/immunology
- Thymoma/drug therapy
- Thymoma/immunology
- Thymoma/pathology
- Vasculitis/drug therapy
- Vasculitis/immunology
- Vasculitis/pathology
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Affiliation(s)
- Robert T Means
- Office of the Dean, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN
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Means RT. Desiderata: Founders' Medal Award Acceptance. Am J Med Sci 2016; 352:9-10. [PMID: 27432031 DOI: 10.1016/j.amjms.2016.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Robert T Means
- Office of the Dean, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee.
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Means RT. The Greatest Hematologist in the World. Am J Med Sci 2016; 351:323-4. [PMID: 26992268 DOI: 10.1016/j.amjms.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Robert T Means
- Office of the Dean, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee.
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Affiliation(s)
- Robert T Means
- Office of the Dean and the Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, C200 Stanton Gerber Hall, P.O. Box 70694, Johnson City, TN 37614, USA
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Christopher KL, Wiggins AT, Van Meter EM, Means RT, Hayslip JW, Roach JP. Differences in vitamin D nutritional status between newly diagnosed cancer patients from rural or urban settings in Kentucky. Nutr Cancer 2014; 65:653-8. [PMID: 23859032 DOI: 10.1080/01635581.2013.789117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although poor nutritional status and weight loss in cancer patients is known to affect outcomes, little is known about malnutrition differences based on geographic location. We investigated nutritional and inflammatory status of 220 newly diagnosed adults with solid tumors at the University of Kentucky's Markey Cancer Center during December 2008 through October 2011. Chi-square tests were used to determine any associations between suboptimal nutritional levels and rural-urban areas of residence. Out of the 13 lab values collected, the only significant difference between rural and urban participants was found for vitamin D resulting in more rural subjects (67.4%) having a suboptimal vitamin D status as compared to those residing in urban areas (53.3%, P = 0.04). Controlling for baseline demographics including age, race, sex, body mass index, nutritional status, and type of cancer, logistic regression analyses concluded those in rural areas had nearly a twofold increase in the odds of having a suboptimal vitamin D level compared to those in urban areas (odd's ratio = 1.97; 95% confidence interval = 1.04, 3.74). Further investigation into the rural-urban differences in vitamin D needs to be investigated in order to improve outcomes during cancer treatment.
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Affiliation(s)
- K L Christopher
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky 40536, USA
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Means RT. Anemia of inflammation: clinical insights from mechanisms. Rinsho Ketsueki 2013; 54:1596-1602. [PMID: 24064808] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Robert T Means
- University of Kentucky College of Medicine and the Department of Veterans Affairs Medical Center
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Affiliation(s)
- Robert T Means
- University of Kentucky College of Medicine, Lexington, KY, USA.
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Abstract
Polycythemia vera (PV) was first described nearly 120 years ago. In the subsequent century, the clinical syndrome of PV, its natural history, its treatment, and many critical pathogenetic features of the disease were characterized. The discovery of the Janus-associated kinase - 2 mutation JAK2 V617F and the characterization of its role in myeloproliferative neoplasms have substantially changed the diagnostic paradigm for PV, and have potential to lead to new therapy and new pathogenetic insights.
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Affiliation(s)
- Robert T. Means
- Department of Internal Medicine and Markey Cancer Center, University of Kentucky, Lexington KY, USA
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Means RT, Moliterno DJ, Allison GR, Perman JA, Lofgren RP, Karpf M, Debeer FC. The evolution of a Department of Internal Medicine under an integrated clinical enterprise model: the University of Kentucky experience. Acad Med 2010; 85:531-537. [PMID: 20182134 DOI: 10.1097/acm.0b013e3181ccd9ac] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The impact on the Department of Internal Medicine of the emergence of the University of Kentucky Healthcare Enterprise as an integrated clinical model has been enormous. In fiscal year 2004, the department was financially insolvent and on the verge of implementing plans to decrease faculty from 127 to 65. Since that time, the department has changed dramatically with a corresponding improvement in its clinical, academic, and financial activity. The department has grown to 175 faculty, with a healthy financial outlook and a shared vision with the clinical enterprise. Departmental clinical growth has been accompanied by growth in extramural research funding. The clinical growth of the department, in turn, supported the growth of the integrated clinical enterprise overall.The purpose of this article is to present a case history of the impact of transition to an integrated clinical enterprise financial model on the clinical, research, and educational functions of a department of internal medicine, and the opportunities and lessons learned from this transition. The implementation of an enterprise model allowed revival and expansion of the clinical programs of the department. This expansion did not occur at the expense of the research and educational missions of the department but, rather, was associated with improved performance in these areas. The processes which were established during the conversion to the enterprise model, which involve strategic planning, monitoring of plan implementation, recalibration of objectives, financial transparency, and accountability of leadership and faculty, may better prepare the institution to face the challenges of the rapidly changing economic environment.
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Affiliation(s)
- Robert T Means
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
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Means RT. Higher red blood cell distribution width was associated with increased risk of mortality in adults > or =45 years of age. ACTA ACUST UNITED AC 2009; 14:151. [PMID: 19794026 DOI: 10.1136/ebm.14.5.151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dallalio G, Means RT. Placental growth factor attenuates suppression of erythroid colony formation by interferon. Transl Res 2008; 152:233-8. [PMID: 19010294 PMCID: PMC2605315 DOI: 10.1016/j.trsl.2008.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 09/30/2008] [Accepted: 10/01/2008] [Indexed: 02/02/2023]
Abstract
Placental growth factor (PlGF) is a member of the vascular endothelial growth factor family and is associated with inflammation and with pathologic angiogenesis. PlGF is released from marrow erythroid cells, and serum PlGF concentrations have been reported to distinguish sickle cell patients from healthy controls. We observed that erythroid colony forming units (CFU-Es) from homozygous sickle cell (SS) patients are less sensitive to inhibition by rhgammaIFN than those from healthy controls, and the contribution of PlGF to this process was evaluated. At 10-1000-pg/mL concentrations, PlGF neither inhibits nor enhances CFU-E colony formation, and no differences were observed between the responses of SS patients or healthy controls. rhPlGF 100 pg/mL reversed the inhibitory effects of rhgammaIFN on CFU-E colony formation. rhPlGF significantly attenuated rhgammaIFN induction of the Fas ligand in an erythroid cell line (HCD57). Both HCD57 cells and CD36+ human marrow cells express Flt-1, which is a receptor for PlGF. A neutralizing antibody against Flt-1 partially attenuated the IFN-protective effect of rhPlGF, although this effect was not statistically significant. In conclusion, increased PlGF concentrations in the marrow of SS patients may protect erythroid progenitors from cytokine-induced inhibition of colony formation, and it may be a mechanism by which erythropoiesis in sickle cell disease is preserved despite concurrent inflammation.
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Affiliation(s)
- Gail Dallalio
- Medical and Research Services, Lexington Department of Veterans Affairs Medical Center, USA
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Abstract
Inflammation plays a significant role in the clinical manifestations of sickle cell anemia. In studies of anemic patients with other clinical syndromes, measurement of the concentrations of cytokine mediators of inflammation in bone marrow aspirates has provided unique correlations with clinical and laboratory parameters. We determined concentrations of interleukin (IL)-1, IL-6, tumor necrosis factor (TNF), and placental growth factor (PlGF) in bone marrow aspirates from six homozygous sickle cell (SS) patients who were not acutely ill and who were not receiving hydroxyurea, erythropoietin, or chronic transfusion and compared them with specimens from seven healthy controls. We also measured concentrations of soluble transferrin receptor (sTfR) and of marrow erythroid colony-forming units (CFU-E) as markers of erythropoietic activity. sTfR concentration was significantly higher in SS patients (p = .024). CFU-E concentration was not significantly different between the two groups. Bone marrow concentrations of IL-6 and IL-1 did not differ between the study groups. TNF was undetectable in all specimens, plasma or marrow. Bone marrow PlGF concentrations were significantly higher in SS patients (p = .004). Since PlGF is a product of erythroid cells, the ratio of marrow PlGF to marrow sTfR was determined and found to be significantly greater in SS patients. This suggests that the observed difference in marrow PlGF concentrations does not reflect increased erythropoiesis but rather represents increased PlGF production per erythroid unit.
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Affiliation(s)
- Gail Dallalio
- Veterans Affairs Medical Center, University of Kentucky, Lexington/Markey Cancer Center, KY 40502, USA
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Abstract
The anemia of chronic disease (ACD) results from 3 major processes: slightly shortened red cell survival, impaired reticuloendothelial system iron mobilization, and impaired erythropoiesis. Hepcidin is an acute-phase protein with specific iron regulatory properties, which, along with the anemia seen with increased hepcidin expression, have led many to consider it the major mediator of ACD. However, if hepcidin is the major factor responsible for ACD, then it should also contribute to the impaired erythropoiesis observed in this syndrome. Erythroid colony formation in vitro was inhibited by hepcidin at erythropoietin (Epo) concentrations less than or equal to 0.5 U/mL but not at Epo 1.0 U/mL. At Epo concentrations of 0.3 U/mL, HCD57 erythroleukemia cells exposed to hepcidin exhibit decreased expression of the antiapoptotic protein pBad compared with controls. These studies suggest that hepcidin may contribute to anemia in ACD not only through effects on iron metabolism, but also through inhibition of erythroid progenitor proliferation and survival.
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Affiliation(s)
- Gail Dallalio
- Medical Service (111), VA Medical Center Rm A 429, 1101 Veterans Dr, Lexington, KY.
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Abstract
A 75-year-old African American man with a history of gastroesophageal reflux reported chest pain during an episode of intravascular hemolysis. Although the electrocardiogram and echocardiogram were unchanged from baseline, cardiac troponin I was persistently elevated. Cardiac catheterization showed no critical disease, and the elevated troponin was attributed to interference by free hemoglobin and/or bilirubin. Hemoglobinemia and hyperbilirubinemia may produce either false-positive or false-negative troponin levels, depending on the assay used and the form or subunit of troponin measured. In the presence of hemolysis, troponin levels must be interpreted with caution.
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Affiliation(s)
- Nziavake Masimasi
- Medical Service and Hematology/Oncology Division, VA Medical Center, Lexington, KY 40502, USA
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Abstract
Hepcidin is a cytokine-induced antibacterial protein which is produced in the liver, circulates in the blood, and is excreted in the urine. It is a major regulator of iron balance in the intestinal mucosa, and appears to have a significant role in the pathogenesis of haemochromatosis and related disorders. Hepcidin appears to be a major contributor to the hypoferraemia associated with inflammation. Serum ferritin concentration is strongly correlated with hepcidin protein levels in either urine or serum, and certain patients with hepatic adenomas exhibit a microcytic, hypoferraemic hepcidin-dependent anaemia. For these reasons, it has been proposed that hepcidin is a primary factor in the pathogenesis of the anaemia of chronic disease (ACD), a cytokine-mediated anaemia commonly encountered in clinical practice and characterized by hypoferraemia with adequate reticuloendothelial iron stores. However, the pathogenetic basis of ACD is not entirely due to changes in iron metabolism, but also involves abnormalities in red cell survival and the erythropoietic response to anaemia. In this review, the evidence for involvement of hepcidin as a major mediator of ACD is evaluated. Hepcidin appears to be a major factor in the systemic iron abnormalities seen in ACD; whether it contributes to the other aspects of the pathogenesis of the syndrome requires further investigation.
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Affiliation(s)
- Robert T Means
- Medical Service, VA Medical Center, Lexington, KY 40502, USA.
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Abstract
The anaemia of chronic disease (ACD) is a common haematologic syndrome characterized by hypoferraemia with adequate reticuloendothelial iron stores. Frequently, serum ferritin concentration in these patients is elevated. The pathogenesis of ACD involves abnormalities in red cell survival, the erythropoietic response to anaemia, and in iron metabolism. Hepcidin is an antibacterial protein produced in the liver which can be found in blood or urine, and which participates in host defense. Recent studies have demonstrated that hepcidin is a key regulator of iron balance in the intestinal mucosa, and that abnormalities in hepcidin gene expression are associated with clinical abnormalities in iron parameters and, in some cases, with anaemia. Hepcidin is an acute-phase reacting protein, and it has been suggested that hepcidin is the key mediator of ACD. Investigation of hepcidin production in either serum or urine demonstrates a strong correlation with serum ferritin concentration. Differences between the hepcidin concentrations observed in ACD (or syndromes resembling ACD) and those observed in iron deficiency may depend on the definition used for the anaemia syndrome. It seems very likely that hepcidin is a major contributor to iron abnormalities characteristic of ACD; whether it contributes to the pathogenesis of the syndrome in a broader sense remains to be determined by further investigation.
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Affiliation(s)
- Robert T Means
- Hematology/Oncology Division, Department of Medicine, Ralph H. Johnson VA Medical Center and the Medical University of South Carolina, 903 CSB, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
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Chaudhary UB, Shannon S, Curry N, Keane TE, Means RT. 203 PRELIMINARY RESULTS OF A PHASE II TRIAL OF IRINOTECAN (I) AND GEMCITABINE (G) IN PATIENTS WITH LOCALLY ADVANCED OR METASTATIC BLADDER CANCER. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The hepatic antimicrobial protein, hepcidin, is implicated in duodenal iron absorption and mobilization. Overexpression of the hepcidin gene is associated with a hypoferraemic, microcytic, iron-refractory anaemia. On the basis of these observations, it has been proposed that hepcidin is a mediator of the common clinical syndrome, anaemia of chronic disease (ACD), and recent findings evaluating urinary hepcidin production in patients support this hypothesis. In the present report, serum hepcidin concentrations were measured in 55 specimens submitted for ferritin determination, and in 37 specimens collected from anaemic patients undergoing diagnostic bone marrow examination. The serum hepcidin concentration exhibited a statistically significant correlation with serum ferritin concentrations in both patient subsets. No statistically significant correlations were observed between serum hepcidin and other laboratory markers of iron status or anaemia diagnosis. Serum hepcidin does not appear to correlate as well with clinical diagnosis as urinary hepcidin, suggesting that a better understanding of the clearance and metabolism of this protein is required to understand fully its potential contribution to the pathogenesis of ACD.
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Affiliation(s)
- Gail Dallalio
- Hematology Oncology Division, Department of Medicine, Ralph H. Johnson VA Medical Center and the Medical University of South Carolina, Charleston, SC 29425, USA.
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Abstract
Evidence of increased oxidative stress is a hallmark of many chronic diseases associated with anemia. The current study was undertaken to evaluate the effects of oxidative stress on erythroid colony formation in vitro by bone marrow light density mononuclear cells (LDMN) and by peripheral blood derived cells enriched for erythroid colony forming units (CFU-E), and how these effects can be modified by a cytokine implicated in the anemia of chronic disease. When blood-derived and marrow cells were cultured with 50 microM H(2)O(2), CFU-E colony formation by blood-derived cells but not by marrow cells was significantly inhibited, suggesting a protective effect of marrow accessory cells. This inhibitory effect on peripheral blood-derived CFU-E was shown to be caspase-dependent. rhgammaIFN at concentrations which did not inhibit CFU-E colony formation sensitized LDMN marrow cells to inhibition by H(2)O(2). Exposure of LDMN marrow cells to rhgammaIFN at concentrations of 10 U/mL or higher significantly decreased the concentration of thioredoxin (Trx) in cell supernatant. Addition of recombinant Trx to LDMN marrow cells cultured with H(2)O(2) and rhgammaIFN partially (although not completely) reversed inhibition of CFU-E colony formation. These findings suggest that inflammatory cytokines implicated in the pathogenesis of the anemia of chronic disease may exert their effects at least in part through modulation of oxidative stress.
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Affiliation(s)
- Gail Dallalio
- Hematology/Oncology Division, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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Means RT. Recent developments in the anemia of chronic disease. Curr Hematol Rep 2003; 2:116-21. [PMID: 12901142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The anemia of chronic disease (ACD) is a hypoproliferative anemia defined by a low serum or plasma iron concentration in the presence of adequate reticuloendothelial iron stores. It is been established that ACD results from the effects of cytokines that mediate the immune or inflammatory response. During the past 3 years, the clinical scope of this syndrome has been expanded beyond the traditional chronic infectious, inflammatory, or neoplastic diseases to include other, often acute, syndromes in which the same pathogenetic mechanisms are operating. An improved understanding of the use of the soluble transferrin receptor concentration in clinical medicine has enhanced the ability to diagnose ACD, and further experience with the use of recombinant human erythropoietin in the management of severely affected patients with ACD has provided a basis for rational and effective management. Ongoing studies of the mechanisms contributing to the development of ACD continue to elucidate the pathogenesis of this common and clinically significant syndrome.
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Affiliation(s)
- Robert T Means
- Hematology/Oncology Division, Medical University of South Carolina, 903 CSB, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
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Laer AV, Dallalio G, McKenzie SW, Means RT. Thioredoxin and Protein Nitrotyrosine in Bone Marrow Supernatant From Patients With Human Immunodeficiency Virus Infection. J Investig Med 2002. [DOI: 10.2310/6650.2002.33512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Van Laer A, Dallalio G, McKenzie SW, Means RT. Thioredoxin and protein nitrotyrosine in bone marrow supernatant from patients with human immunodeficiency virus infection. J Investig Med 2002; 50:10-8. [PMID: 11813824 DOI: 0.2310/6650.2002.33512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Balance and imbalance between oxidant stress and antioxidants contributes to the manifestations of human immunodeficiency virus (HIV) infection. Previously, we demonstrated a characteristic cytokine pattern in marrow supernatant from HIV patients who underwent diagnostic examinations. METHODS In this report, we have determined the protein nitrotyrosine (pNT) concentration (an indicator of nitric oxide-superoxide interaction) as well as the concentration of the redox enzyme thioredoxin (Trx) in marrow supernatant from HIV patients, healthy controls, and other patients, and in serum from comparable subjects. RESULTS pNT concentrations were similar in serum and marrow supernatant and did not differ between subject subsets. Trx concentrations in both marrow supernatant and serum were higher for HIV patients than for other subjects; serum Trx concentrations were significantly higher than marrow Trx concentrations for the non-HIV patients and controls. The ratios of pNT/Trx concentrations in serum were similar in all subsets tested. In marrow aspirate, however, these ratios differed widely and significantly, with the highest values observed in non-HIV patients and the lowest in HIV patients. Only for HIV patients were serum and marrow supernatant pNT/Trx ratios similar. In HIV patients, marrow Trx concentrations correlated with CD4 count, CD4/CD8 ratio, and marrow colony-forming unit E (CFU-E) concentration; marrow pNT concentration correlated with the concentration of tumor necrosis factor in marrow supernatant, and with platelet count. No correlations were observed in other subject subsets. CONCLUSIONS These findings suggest that there is a degree of local regulation of the redox state of the marrow microenvironment that varies with the patients' clinical statuses, and which is associated with effects on hematopoiesis.
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Affiliation(s)
- A Van Laer
- Division of Hematology/Oncology, Ralph H. Johnson VA Medical Center and the Medical University of South Carolina, Charleston 29425, USA
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Abstract
BACKGROUND Correction of anemia in hemodialysis patients is seldom completely attained, and the response of parameters other than hemoglobin concentration to anemia correction has not been evaluated in detail. METHODS Laboratory parameters that suggest iron deficiency occurred in 10-15% of 206 recombinant human erythropoietin (rhEPO)-treated patients. Oral iron was given for 9 months and intravenous iron thereafter on a patient-specific basis when iron deficiency was evident. Eighty-seven hemodialysis patients with data for 12 months were followed for another 12 months. A computerized information system enabled data management and analysis. RESULTS With oral iron, serum ferritin decreased (P < 0.001), indicating further iron depletion. With intravenous iron, hemoglobin increased, evidence of iron deficiency decreased, and less rhEPO was needed. Striking macrocytosis appeared. Serum albumin and serum creatinine/kg body weight (an index of muscle mass) increased, while blood pressure decreased. Data were reanalyzed in four mean corpuscular volume (MCV) quartiles and two ferritin subsets at study onset. Iron deficient erythropoiesis (low MCV, mean corpuscular hemoglobin [MCH], and transferrin saturation) was striking in quartile 1; low ferritin was prevalent in all quartiles. With intravenous iron, hemoglobin increased only in quartile 1, the quartile with the greatest decrease (52%) in rhEPO dose. MCV increased in all quartiles (P < 0.001). Serum albumin increased in all MCV quartiles and both ferritin subsets, but significant creatinine/kg increase and blood pressure decrease occurred only in the low-ferritin subset. CONCLUSIONS Macrocytosis occurred with intravenous iron replacement. The universal MCV increase suggests unrecognized, inadequately treated, folic acid deficiency unmasked by an adequate iron supply. There was also improved well being. Effects were most clearly evident in patients with deficient iron stores.
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Affiliation(s)
- V E Pollak
- Department of Medicine, University of Colorado Health Sciences Center, Denver, USA.
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Abstract
Anaemia is a common finding in infected individuals, and in many cases is an indicator of disease activity and/or duration. The term 'anaemia of infection' refers to a specific syndrome related to the more broadly defined 'anaemia of chronic disease'. In this syndrome, cytokines produced as part of the host response to infection induce anaemia by well-defined pathophysiological mechanisms. In this chapter, the diagnosis, significance, pathophysiology and treatment of the anaemia of infection will be reviewed. Other mechanisms which can produce anaemia in infected individuals will also be reviewed.
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Affiliation(s)
- R T Means
- Hematology/Oncology Division, Medical University of South Carolina, 903 CSB, Charleston, SC 29425, USA
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Dallalio G, North M, McKenzie SW, Means RT. Cytokine and cytokine receptor concentrations in bone marrow supernatant from patients with HIV: correlation with hematologic parameters. J Investig Med 1999; 47:477-83. [PMID: 10572378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND To determine the concentrations of tumor necrosis factor (TNF) alpha, soluble TNF receptors (sTNFR), interleukin (IL)-1 beta, gamma-interferon (IFN), macrophage inflammatory protein (MIP)-1 alpha, MIP-1 beta, and RANTES to which hematopoietic progenitors are exposed in vivo in HIV patients and the correlation of these concentrations with hematologic parameters, cytokine and cytokine receptor concentrations were measured by ELISA in bone marrow aspirate supernatants from 19 HIV patients undergoing diagnostic evaluation and 14 healthy paid volunteer controls. IL-1 beta and gamma-IFN were rarely detectable. All cytokines/receptors detectable in marrow supernatant, except RANTES, showed mean concentrations 1.6- to 6.2-fold higher in patients with HIV compared to healthy controls. METHODS Elevated TNF-alpha and MIP-1 beta were associated with marrow involvement by lymphoma, Hodgkin disease, or mycobacterial infection. Concentrations of all cytokines/receptors measured correlated with the severity of anemia. CD8+ lymphocytes were inversely correlated with concentrations of all cytokines measured other than MIP-1 alpha. To identify differences specific to HIV infection, marrow supernatant cytokine concentrations were also evaluated in 9 non-HIV patients undergoing diagnostic marrow examination. Significant differences were observed in TNF alpha, MIP-1 alpha, and IL-1 beta concentrations. RESULTS These studies demonstrate that concentrations of these cytokines and receptors are elevated in bone marrow supernatant of HIV-infected patients with hematologic abnormalities, and that these concentrations correlate with clinical parameters in these patients. CONCLUSIONS Evaluation of local concentrations of cytokines may be relevant to understanding tissue-specific pathology in HIV-infected individuals.
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Affiliation(s)
- G Dallalio
- Division of Hematology/Oncology, Ralph H. Johnson VA Medical Center, Charleston SC, USA
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Mendenhall CL, Finkelman F, Means RT, Sherman KE, Nguyen VT, Grossman CE, Morris SC, Rouster S, Roselle GA. Cytokine response to BCG infection in alcohol-fed mice. Alcohol 1999; 19:57-63. [PMID: 10487389 DOI: 10.1016/s0741-8329(99)00018-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 10/18/2022]
Abstract
Alcoholics have increased susceptibility to infections including tuberculosis. Chronic alcohol treatment impairs host response to bovine mycobacterium infection from BCG. This study assesses the role of four cytokines (TNFalpha, IFNgamma, IL-4, and IL-10) in this impaired response. Twenty male C57BL/6 mice were pair-fed on the Lieber DiCarli control (LCD) or ethanol (LED) diets for 28 days. The LED treated subjects ate ad lib and consumed a mean of 13 g/kg/d of ethanol. After 14 days, based on body weight, subjects were randomly divided into four treatment groups of five each. Ten infected with 2x10(6) colony-forming units (CFU) of BCG by tail-vein. On day 28, the mice were sacrificed. Liver was cultured to determine the mycobacteria CFU/g tissue. Spleens were assayed for the levels of TNFalpha, IFNgamma, IL-4, and IL-10 mRNA relative to mRNA levels for a housekeeping gene using a quantitative reverse transcriptase PCR. Without BCG infection, only the mRNA for IFNgamma was increased by LED treatment, 51% (p = 0.0001). BCG infection significantly increased TNFalpha, IFNgamma, and IL-10 mRNA (p<0.0001). IL-4 mRNA decreased (p = 0.0006). Chronic LED plus BCG infection further increased TNFalpha (p = 0.002) and IFN-gamma (p = 0.04); IL-10 was unchanged, whereas IL-4 was marginally further decreased (p = 0.06). CFU/liver increased with LED (mean +/- SD, 72+/-33x10(5) vs. 39+/-17x10(5); p = 0.004). A significant direct correlation was observed between CFU and TNFalpha, r = 0.70, p = 0.03. In conclusion, BCG infection increases TNFalpha, IFNgamma, & IL-10 and decreases IL-4. CFU numbers correlate with mRNA for TNFalpha, and LED inhibits host containment of BCG infection as measured by liver CFU. This study could not identify cytokine alterations in either Th1- or Th2-type immune responses that might contribute to the impaired host response to the BCG infection.
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Affiliation(s)
- C L Mendenhall
- Department of Veteran Affairs and Department of Medicine, University of Cincinnati Medical Center, OH 45220, USA
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Means RT. Advances in the anemia of chronic disease. Int J Hematol 1999; 70:7-12. [PMID: 10446488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The anemia found in patients with chronic infectious, inflammatory, and neoplastic disorders, known as the anemia of chronic disease (ACD), is one of the most common syndromes in medicine. A characteristic finding of the disorders associated with ACD is increased production of the cytokines that mediate the immune or inflammatory response, such as tumor necrosis factor, interleukin-1, and the interferons. All the processes involved in the development of ACD can be attributed to these cytokines, including shortened red cell survival, blunted erythropoietin response to anemia, impaired erythroid colony formation in response to erythropoietin, and abnormal mobilization of reticuloendothelial iron stores. In this review, advances in the understanding of the diagnostic, pathophysiologic, and therapeutic aspects of this syndrome are summarized.
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Affiliation(s)
- R T Means
- Hematology/Oncology Division, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA.
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Abstract
In previous studies, we have demonstrated that the inhibitory effects of tumor necrosis factor (TNF) and interleukin (IL)-1 on human erythroid colony formation are indirect and mediated by beta and gamma interferon (IFN), respectively, which act directly upon erythroid colony forming units (CFU-E). The in vitro inhibitory effect of gammaIFN but not betaIFN is reversed by exposure to high concentrations of recombinant human (rh) erythropoietin (EPO). Ceramide, a product of sphingomyelin hydrolysis, is a known mediator of apoptotic effects of TNF, IL-1, and gammaIFN. In this report, the effects of ceramide on CFU-E colony formation and its implication in the model described above are evaluated. Endogenous ceramide produced by exposure to bacterial sphingomyelinase (0.2-2.0 U/mL) and exogenous cell-permeable ceramide (C2-ceramide; 5 and 10 mM) significantly inhibited bone marrow CFU-E colony formation. This effect was reversed by the ceramide antagonist sphingosine-1-phosphate (S-1-P). Inhibition of CFU-E by rhgammaIFN, but not rhbetaIFN, was significantly reversed by S-1-P. rhEPO 10 U/mL reversed CFU-E inhibition by C2-ceramide 10 mM. Exposure of marrow cells to rhgammaIFN led to a 57% increase in ceramide content. The present study demonstrates that colony formation by human CFU-E is inhibited by endogenous and exogenous ceramide, and that inhibition by rhgammaIFN can be reversed by the ceramide antagonist S-1-P. Inhibition of CFU-E colony formation by ceramide and by are both reversed by high concentrations of rhEPO. These findings strongly suggest that ceramide mediates inhibition of human CFU-E colony formation by gammaIFN.
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Affiliation(s)
- G Dallalio
- Department of Internal Medicine, Department of Veterans Affairs Medical Center and the University of Cincinnati College of Medicine, OH, USA
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Means RT, Allen J, Sears DA, Schuster SJ. Serum soluble transferrin receptor and the prediction of marrow aspirate iron results in a heterogeneous group of patients. Clin Lab Haematol 1999; 21:161-7. [PMID: 10448597 DOI: 10.1046/j.1365-2257.1999.00224.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Serum soluble transferrin receptor (sTfR) concentration has been evaluated in the diagnosis of iron deficiency in otherwise healthy individuals and in patients with rheumatoid arthritis, but has not been studied in a general population of patients with complicated clinical presentations. In this study, 145 anaemic patients with a variety of medical conditions undergoing diagnostic bone marrow aspiration for any reason were tested by a complete blood count, a panel of biochemical tests to evaluate iron status, bone-marrow aspirate iron stain, and serum sTfR concentration. Sixteen per cent lacked stainable iron in the marrow aspirate. All biochemical parameters differed significantly between patients with or without stainable marrow iron. The sTfR assay was significantly more sensitive but less specific than other iron status assays in identifying the absence of stainable iron. Logistic regression analysis demonstrated that only sTfR and ferritin contributed independently to the prediction of marrow iron status. Serum ferritin alone was highly specific but insensitive. A decision algorithm combining serum ferritin and sTfR was as sensitive as TfR and as specific as serum ferritin. The measurement of serum sTfR, especially in conjunction with serum ferritin, is a valuable addition to the existing methods for predicting the results of marrow aspirate iron stains.
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Affiliation(s)
- R T Means
- Hematology/Oncology Division, Medical University of South Carolina, Charleston, USA
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Means RT. Commentary: an anemia of chronic disease, after all? J Investig Med 1999; 47:203. [PMID: 10361378] [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: 02/12/2023]
Affiliation(s)
- R T Means
- Hematology/Oncology Division, Ralph H. Johnson VA Medical Center, SC, USA
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Abstract
Lung Kruppel-like factor (LKLF) is a member of the Kruppel-like family of zinc finger transcription factors and is closely related to erythroid kruppel-like factor (EKLF), which is necessary for beta-globin gene expression. While EKLF is expressed exclusively in erythroid cells, LKLF is expressed temporally during early embryonic development and predominantly in the adult mouse lung. To understand the role this novel transcription factor plays in development as well as tissue differentiation and function, animals lacking LKLF were produced using gene targeting technology. Mice lacking LKLF die in utero between day 11.5 and 13.5 of embryonic life and exhibit retarded growth, craniofacial abnormalities, abdominal bleeding and signs of anaemia. Although the yolk sac erythropoiesis is normal in mutant embryos, in vitro fetal liver cultures of these embryos fail to give rise to erythroid cells. Expression of other erythroid specific genes such as EKLF, GATA1 and GATA3 is unaltered in these animals. These findings demonstrate the LKLF function is indispensable during normal embryonic development, and although both LKLF and EKLF recognize common DNA motifs, they do not substitute for each other.
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Affiliation(s)
- M A Wani
- Department of Molecular Genetics, Biochemistry and Microbiology, College of Medicine, University of Cincinnati, Ohio 45267-0524, USA
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Allen J, Backstrom KR, Cooper JA, Cooper MC, Detwiler TC, Essex DW, Fritz RP, Means RT, Meier PB, Pearlman SR, Roitman-Johnson B, Seligman PA. Measurement of soluble transferrin receptor in serum of healthy adults. Clin Chem 1998. [DOI: 10.1093/clinchem/44.1.35] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AbstractThe concentration of soluble transferrin receptor (sTfR) in serum is reported to be useful in the diagnosis of iron deficiency, especially for patients with concurrent chronic disease, where routine tests of iron status are compromised by the inflammatory condition. A new diagnostic assay for sTfR is calibrated against natural plasma sTfR, thus minimizing calibration discrepancies that result from differences between the analyte and the cellular transferrin receptor used in other assays. Use of the new assay to measure sTfR concentrations in 225 healthy, hematologically normal adults provided a reference interval against which pathological samples could be compared. There was no difference in the reference intervals for men and women and no correlation of [sTfR] with the age of the subject. Black subjects had significantly higher concentrations than nonblacks, and people living at high altitude had higher concentrations than those living closer to sea level. These differences were additive.
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Affiliation(s)
- Jean Allen
- R&D Systems, Inc., 614 McKinley Place NE, Minneapolis, MN 55413
| | | | | | | | | | - David W Essex
- State University of New York Health Science Center at Brooklyn, Brooklyn, NY
| | - Rose P Fritz
- R&D Systems, Inc., 614 McKinley Place NE, Minneapolis, MN 55413
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Allen J, Backstrom KR, Cooper JA, Cooper MC, Detwiler TC, Essex DW, Fritz RP, Means RT, Meier PB, Pearlman SR, Roitman-Johnson B, Seligman PA. Measurement of soluble transferrin receptor in serum of healthy adults. Clin Chem 1998; 44:35-9. [PMID: 9550555] [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] [Indexed: 02/07/2023]
Abstract
The concentration of soluble transferrin receptor (sTfR) in serum is reported to be useful in the diagnosis of iron deficiency, especially for patients with concurrent chronic disease, where routine tests of iron status are compromised by the inflammatory condition. A new diagnostic assay for sTfR is calibrated against natural plasma sTfR, thus minimizing calibration discrepancies that result from differences between the analyte and the cellular transferrin receptor used in other assays. Use of the new assay to measure sTfR concentrations in 225 healthy, hematologically normal adults provided a reference interval against which pathological samples could be compared. There was no difference in the reference intervals for men and women and no correlation of [sTfR] with the age of the subject. Black subjects had significantly higher concentrations than nonblacks, and people living at high altitude had higher concentrations than those living closer to sea level. These differences were additive.
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Affiliation(s)
- J Allen
- R&D Systems, Inc., Minneapolis, MN 55413, USA
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47
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Means RT. Cytokines and anaemia in human immunodeficiency virus infection. Cytokines Cell Mol Ther 1997; 3:179-86. [PMID: 9426976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The anaemia that is a common complication of human immunodeficiency virus (HIV) infection bears many similarities to the anaemia of chronic disease. These similarities include an impaired erythropoietin (EPO) response to anaemia, reduced concentrations of marrow progenitors giving rise to erythroid colonies, abnormalities of reticuloendothelial iron metabolism, and correction of anaemia with recombinant human EPO. A model has been developed in which the pathophysiologic processes producing the anaemia of chronic disease may be attributed to actions of the cytokines that mediate the immune response, such as interleukin-1, tumor necrosis factor and the interferons. These cytokines are also implicated in HIV-related anaemia. In this review, the applicability of this cytokine-mediated anaemia model to the anaemia of HIV infection is explored.
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Affiliation(s)
- R T Means
- Hematology/Oncology Division, University of Cincinnati College of Medicine, OH, USA.
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North M, Dallalio G, Donath AS, Melink R, Means RT. Serum transferrin receptor levels in patients undergoing evaluation of iron stores: correlation with other parameters and observed versus predicted results. Clin Lab Haematol 1997; 19:93-7. [PMID: 9218147 DOI: 10.1046/j.1365-2257.1997.00041.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Serum transferrin receptor (sTfR) concentrations were measured in specimens from 77 patients undergoing serum ferritin determination, and the results correlated with serum ferritin, serum iron, serum total iron-binding capacity (TIBC) saturation, erythrocyte mean corpuscular volume (MCV), and mean corpuscular haemoglobin (MCH). All parameters exhibited the expected inverse correlation with sTfR; this correlation was statistically significant for all parameters except serum iron concentration. The frequency with which iron deficiency (defined as absence of stainable marrow iron) is observed in patients with particular ferritin values in this centre was determined and used to estimate the expected number of iron deficient patients in the present study. In no setting were significantly fewer sTfR levels > 3.05 micrograms/ml observed than expected. However, significantly greater than expected numbers of elevated sTfR values were observed in patients with serum ferritin > 220 micrograms/l (P = 0.002). The results suggest that the sTfR level is probably not useful as a single test for identification of iron deficiency in unselected patients.
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Affiliation(s)
- M North
- Erythropoiesis Research and Diagnostic Haematology Laboratories, University of Cincinnati College of Medicine, Ohio, USA
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McKenzie SW, Means RT. Extreme hyperferritinemia in patients infected with human immunodeficiency virus is not a highly specific marker for disseminated histoplasmosis. Clin Infect Dis 1997; 24:519-20. [PMID: 9114215 DOI: 10.1093/clinids/24.3.519] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- S W McKenzie
- Division of Infectious Diseases, University of Cincinnati College of Medicine, and Department of Veterans Affairs Medical Center, Ohio 54220, USA
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Abstract
Increased production of cytokines such as beta-interferon (IFN) and gamma-IFN may contribute to the anemia frequently observed in patients with human immunodeficiency virus (HIV) infection. The hypothesis that HIV infection might enhance the susceptibility of erythroid progenitors to cytokine-mediated inhibition was evaluated by comparing the effects of beta- and gamma-IFN on in vitro colony formation by marrow erythroid colony-forming units (CFU-E) from HIV patients, normal volunteers, and anemic non-HIV-infected individuals. CFU-E colony formation from HIV patients was not significantly different from controls, and the degree of inhibition by IFN did not differ among patient subsets. HIV infection does not appear to impair baseline CFU-E colony formation, nor does it appear to enhance the susceptibility of CFU-E to suppression by cytokines.
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Affiliation(s)
- G Dallalio
- Hematology/Oncology Division, University of Cincinnati College of Medicine, Ohio, USA
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