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Ojewunmi OO, Adeyemo TA, Oyetunji AI, Inyang B, Akinrindoye A, Mkumbe BS, Gardner K, Rooks H, Brewin J, Patel H, Lee SH, Chung R, Rashkin S, Kang G, Chianumba R, Sangeda R, Mwita L, Isa H, Agumadu UN, Ekong R, Faruk JA, Jamoh BY, Adebiyi NM, Umar IA, Hassan A, Grace C, Goel A, Inusa BPD, Falchi M, Nkya S, Makani J, Ahmad HR, Nnodu O, Strouboulis J, Menzel S. The genetic dissection of fetal haemoglobin persistence in sickle cell disease in Nigeria. Hum Mol Genet 2024:ddae014. [PMID: 38339995 DOI: 10.1093/hmg/ddae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
The clinical severity of sickle cell disease (SCD) is strongly influenced by the level of fetal haemoglobin (HbF) persistent in each patient. Three major HbF loci (BCL11A, HBS1L-MYB, and Xmn1-HBG2) have been reported, but a considerable hidden heritability remains. We conducted a genome-wide association study for HbF levels in 1006 Nigerian patients with SCD (HbSS/HbSβ0), followed by a replication and meta-analysis exercise in four independent SCD cohorts (3,582 patients). To dissect association signals at the major loci, we performed stepwise conditional and haplotype association analyses and included public functional annotation datasets. Association signals were detected for BCL11A (lead SNP rs6706648, β = -0.39, P = 4.96 × 10-34) and HBS1L-MYB (lead SNP rs61028892, β = 0.73, P = 1.18 × 10-9), whereas the variant allele for Xmn1-HBG2 was found to be very rare. In addition, we detected three putative new trait-associated regions. Genetically, dissecting the two major loci BCL11A and HBS1L-MYB, we defined trait-increasing haplotypes (P < 0.0001) containing so far unidentified causal variants. At BCL11A, in addition to a haplotype harbouring the putative functional variant rs1427407-'T', we identified a second haplotype, tagged by the rs7565301-'A' allele, where a yet-to-be-discovered causal DNA variant may reside. Similarly, at HBS1L-MYB, one HbF-increasing haplotype contains the likely functional small indel rs66650371, and a second tagged by rs61028892-'C' is likely to harbour a presently unknown functional allele. Together, variants at BCL11A and HBS1L-MYB SNPs explained 24.1% of the trait variance. Our findings provide a path for further investigation of the causes of variable fetal haemoglobin persistence in sickle cell disease.
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Affiliation(s)
- Oyesola O Ojewunmi
- School of Cancer and Pharmaceutical Sciences, King's College London, 123 Coldharbour Lane, London SE5 9NU, United Kingdom
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Titilope A Adeyemo
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, P.M.B 12003, Lagos, Nigeria
| | - Ajoke I Oyetunji
- Sickle Cell Foundation Nigeria, Ishaga Road, Idi-Araba, P.O. Box 3463, Lagos, Nigeria
| | - Bassey Inyang
- Department of Medical Biochemistry, College of Health Sciences, University of Abuja, Mohammed Maccido Road, Airport Road, P.M.B 117, Abuja, Nigeria
| | - Afolashade Akinrindoye
- Sickle Cell Foundation Nigeria, Ishaga Road, Idi-Araba, P.O. Box 3463, Lagos, Nigeria
- School of Science, University of Greenwich, Central Avenue, Chatham Maritime, Kent ME4 4TB, United Kingdom
| | - Baraka S Mkumbe
- Department of Biochemistry and Molecular Biology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, United Nations Rd, Dar es Salaam, Tanzania
- Department of Artificial Intelligence and Innovative Medicine, Tohoku University Graduate School of Medicine, 980-8573, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Kate Gardner
- School of Cancer and Pharmaceutical Sciences, King's College London, 123 Coldharbour Lane, London SE5 9NU, United Kingdom
- Clinical Haematology, Haematology and Oncology Directorate, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Helen Rooks
- School of Cancer and Pharmaceutical Sciences, King's College London, 123 Coldharbour Lane, London SE5 9NU, United Kingdom
| | - John Brewin
- School of Cancer and Pharmaceutical Sciences, King's College London, 123 Coldharbour Lane, London SE5 9NU, United Kingdom
- Department of Haematological Medicine, King's College Hospital, London SE5 9RS, United Kingdom
| | - Hamel Patel
- NIHR BioResource Centre Maudsley, NIHR Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) and Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London SE5 8AB, United Kingdom
| | - Sang Hyuck Lee
- NIHR BioResource Centre Maudsley, NIHR Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) and Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London SE5 8AB, United Kingdom
| | - Raymond Chung
- NIHR BioResource Centre Maudsley, NIHR Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) and Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London SE5 8AB, United Kingdom
| | - Sara Rashkin
- St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, United States
| | - Guolian Kang
- St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, United States
| | - Reuben Chianumba
- Centre of Excellence for Sickle Cell Disease Research and Training (CESRTA), University of Abuja, Mohammed Maccido Road, Airport Road, P.M.B 117, Abuja, Nigeria
| | - Raphael Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Liberata Mwita
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Hezekiah Isa
- Centre of Excellence for Sickle Cell Disease Research and Training (CESRTA), University of Abuja, Mohammed Maccido Road, Airport Road, P.M.B 117, Abuja, Nigeria
- Department of Haematology and Blood Transfusion, University of Abuja Teaching Hospital, Gwagwalada, P.M.B. 228, Gwagwalada, FCT Abuja, Nigeria
| | - Uche-Nnebe Agumadu
- Department of Paediatrics, College of Health Sciences, University of Abuja, Mohammed Maccido Road, Airport Road, P.M.B 117, Abuja, Nigeria
| | - Rosemary Ekong
- Research Department of Genetics, Evolution and Environment, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Jamilu A Faruk
- Department of Paediatrics, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, P.M.B 006, Zaria, Nigeria
| | - Bello Y Jamoh
- Department of Internal Medicine, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, P.M.B 006, Zaria, Nigeria
| | - Niyi M Adebiyi
- Department of Paediatrics, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, P.M.B 006, Zaria, Nigeria
| | - Ismail A Umar
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Sokoto Road, Samaru, P.M.B 006, Zaria, Nigeria
| | - Abdulaziz Hassan
- Department of Haematology and Blood Transfusion, Ahmadu Bello University, Sokoto Road, Samaru, P.M.B 006, Zaria, Nigeria
| | - Christopher Grace
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Centre for Human Genetics, Roosevelt Drive, Oxford OX37BN, United Kingdom
| | - Anuj Goel
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Centre for Human Genetics, Roosevelt Drive, Oxford OX37BN, United Kingdom
| | - Baba P D Inusa
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London SE1 7EH, United Kingdom
| | - Mario Falchi
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Siana Nkya
- Department of Biochemistry and Molecular Biology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, United Nations Rd, Dar es Salaam, Tanzania
- Tanzania Human Genetics Organisation, Sickle Cell Centre, 1 Kipalapala Street, Dar es Salaam, Tanzania
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, United Nations Rd, Dar es Salaam, Tanzania
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Julie Makani
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, United Nations Rd, Dar es Salaam, Tanzania
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
- Centre for Haematology, Department of Immunology & Inflammation, Imperial College London, Commonwealth Building, Hammersmith Campus, Du Cane Rd, London W12 0NN, United Kingdom
| | - Hafsat R Ahmad
- Department of Paediatrics, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, P.M.B 006, Zaria, Nigeria
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training (CESRTA), University of Abuja, Mohammed Maccido Road, Airport Road, P.M.B 117, Abuja, Nigeria
- Department of Haematology and Blood Transfusion, University of Abuja Teaching Hospital, Gwagwalada, P.M.B. 228, Gwagwalada, FCT Abuja, Nigeria
| | - John Strouboulis
- School of Cancer and Pharmaceutical Sciences, King's College London, 123 Coldharbour Lane, London SE5 9NU, United Kingdom
| | - Stephan Menzel
- School of Cancer and Pharmaceutical Sciences, King's College London, 123 Coldharbour Lane, London SE5 9NU, United Kingdom
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Masamu U, Sangeda RZ, Mgaya J, Nkya S, Octavian B, Mtiiye FR, Nduguru J, Jonathan A, Kandonga D, Minja IK, Rugajo P, Balandya E, Makani J. Improved Biorepository to Support Sickle Cell Disease Genomics and Clinical Research: A Practical Approach to Link Patient Data and Biospecimens from Muhimbili Sickle Cell Program, Tanzania. Biopreserv Biobank 2023. [PMID: 37943607 DOI: 10.1089/bio.2023.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
In Africa, sickle cell disease phenotypes' genetic contributors remain understudied due to the dearth of databases that pair biospecimens with demographic and clinical details. The absence of biorepositories in these settings can exacerbate this issue. This article documents the physical verification process of biospecimens in the biorepository, connecting them to patient clinical and demographic data and aiding in the planning of future genomic and clinical research studies' experience from the Muhimbili Sickle Cell Program in Dar es Salaam, Tanzania. The biospecimen database was updated with the current biospecimen position following the physical verification and then mapping this information to its demographic and clinical data using demographic identifiers. The biorepository stored 74,079 biospecimens in three -80°C freezers, including 63,345 from 5159 patients enrolled in the cohort between 2004 and 2016. Patients were identified by a control (first visit), entry (when confirmed sickle cell homozygous), admission (when hospitalized), and follow-up numbers (subsequent visits). Of 63,345 biospecimens, follow-ups were 46,915 (74.06%), control 8067 (12.74%), admission 5517 (8.71%), and entry 2846 (4.49%). Of these registered patients, females were 2521 (48.87%) and males were 2638 (51.13%). The age distribution was 1-59 years, with those older than 18 years being 577 (11.18%) and children 4582 (88.82%) of registered patients. The notable findings during the process include a lack of automated biospecimen checks, laboratory information management system, and tubes with volume calibration; this caused the verification process to be tedious and manual. Biospecimens not linked to clinical and demographic data, date format inconsistencies, and lack of regular updating of a database on exhausted biospecimens and updates when biospecimens are moved between positions within freezers were other findings that were found. A well-organized biorepository plays a crucial role in answering future research questions. Enforcing standard operating procedures and quality control will ensure that laboratory users adhere to the best biospecimen management procedures.
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Affiliation(s)
- Upendo Masamu
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Raphael Z Sangeda
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Josephine Mgaya
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Siana Nkya
- Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice Octavian
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frank R Mtiiye
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joyce Nduguru
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Agnes Jonathan
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Daniel Kandonga
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Irene K Minja
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paschal Rugajo
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmanuel Balandya
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julie Makani
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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3
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Cornetta K, Kay S, Urio F, Minja IK, Mbugi E, Mgaya J, Mselle T, Nkya S, Alimohamed MZ, Ndaki K, Bonamino M, Koya RC, Shah LD, Mahlangu J, Drago D, Rangarajan S, Jayandharan GR. Implementation of a gene therapy education initiative by the ASGCT and Muhimbili University of Health and Allied Sciences. Mol Ther 2023; 31:2561-2565. [PMID: 37595584 PMCID: PMC10492022 DOI: 10.1016/j.ymthe.2023.07.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/04/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023] Open
Abstract
There has been rapid growth in gene therapy development with an expanding list of approved clinical products. Several therapies are particularly relevant to patients in low- and middle-income countries. Moreover, investing in research and manufacturing presents an opportunity for economic development. To increase awareness of gene therapy, the American Society of Gene and Cell Therapy partnered with the Muhimbili University of Health and Allied Sciences, Tanzania, to create a certificate-bearing course. The goal was to provide faculty teaching in graduate and medical schools with the tools needed to add gene therapy to the university curriculum. The first virtual course was held in October of 2022, and 45 individuals from 9 countries in Africa completed the training. The content was new to approximately two-thirds of participants, with the remaining third indicating that the course increased their knowledge base. The program was well received and will be adapted for other under-resourced regions.
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Affiliation(s)
- Kenneth Cornetta
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Samantha Kay
- American Society of Gene and Cell Therapy, Milwaukee, WI, USA
| | - Florence Urio
- Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, The Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS)
| | - Irene Kida Minja
- SPARCo-Clinical Coordinating Center - Haematology and Blood Transfusion Department, The Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS)
| | - Erasto Mbugi
- Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, The Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS)
| | - Josephine Mgaya
- SPARCo-Clinical Coordinating Center - Haematology and Blood Transfusion Department, The Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS)
| | - Teddy Mselle
- Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, The Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS)
| | - Siana Nkya
- Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, The Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS)
| | - Mohamed Zahir Alimohamed
- Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, The Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS)
| | - Kinuma Ndaki
- Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, The Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS)
| | - Martín Bonamino
- Cell and Gene Therapy Program, Research Coordination, National Cancer Institute (INCA), Rio de Janeiro, Brazil; Vice-Presidency of Research and Biological Collections (VPPCB), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Richard C Koya
- Department of Gynecology and Obstetrics, University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Lesha D Shah
- New York University Grossman School of Medicine, New York, NY, USA
| | - Johnny Mahlangu
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniela Drago
- Schools of Medicine and Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Savita Rangarajan
- Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK; KJ Somaiya Super Speciality Hospital and Research Centre, Mumbai, India
| | - Giridhara Rao Jayandharan
- Department of Biological Sciences and Bioengineering, and Gangwal School of Medical Sciences and Technology and Mehta Family Center for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur, UP, India
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Nyangasa S, Solomon D, Njiro B, Faisal A, Makani J, Nkya S. The rate and pattern of fetal hemoglobin decline adjusted to sickle cell status of newborns in Dar es Salaam, Tanzania: A prospective cohort study. Am J Hematol 2023; 98:E241-E243. [PMID: 37345514 DOI: 10.1002/ajh.27004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
Foetal haemoglobin (%) and foetal cell (%) according to sickle cell status.
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Affiliation(s)
- Salama Nyangasa
- Dar es Salaam University College of Education, Dar es salaam, Tanzania
| | - David Solomon
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Belinda Njiro
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Anab Faisal
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Siana Nkya
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
- Tanzania Human Genetics Organisation, Dar es Salaam, Tanzania
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Nkya S, Kaywanga F, Nzunda C, Karim S, Solomon D, Saukiwa E, Christopher H, Ngowi D, Johansen J, Urio F, Mgaya J, Chamba C, Hashim F, Ambroise E, Acquah SO, Makani J. Genomics of fetal haemoglobin: a targeted approach for reticulocyte transcriptome study. Res Sq 2023:rs.3.rs-3061395. [PMID: 37461456 PMCID: PMC10350219 DOI: 10.21203/rs.3.rs-3061395/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Background Fetal haemoglobin (HbF) remains a major sickle cell disease modifier. The mechanism of HbF synthesis has been studied for several decades with the intention of increasing interventions for sickle cell disease (SCD), including drugs. However, the complex mechanism of HbF synthesis is influenced by multiple genetic factors interacting with environmental factors. In order to capture useful genetic information, especially with limited resources, one has to carefully design the study. This includes choosing the relevant participants, the correct phenotyping, the choice of samples, and the right genomic assays. This paper describes the approach undertaken as part of preparations for a reticulocyte transcriptome study intended to discover genes associated with HbF decline in newborns in Tanzania. Results Of the 152 newborns enrolled in the larger study, 40 babies were selected for the reticulocyte transcriptome study based on their HbF levels at birth and later stage of life. Of these, 30 individuals were included under the category of high HbF levels ranging from 72.6-90% and the remaining 10 under the category of low HbF levels ranging from 5.9 - 10.3%. The reticulocyte enrichment recovery purity ranged from 85% - 97%. The total RNA concentrations obtained were >250 ng total RNA, with the average purity of 1.9 (A 260/280) respectively. The total concentration obtained was sufficient for the transcriptome and other downstream assays. Conclusion We have documented important steps and factors to consider in identifying the relevant participants and required laboratory sample processes prior to the final stage, which involves total reticulocyte RNA sequencing.
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Affiliation(s)
- Siana Nkya
- Muhimbili University of Health and Allied Sciences
| | | | | | | | | | | | | | - Doreen Ngowi
- Muhimbili University of Health and Allied Sciences
| | | | | | | | - Clara Chamba
- Muhimbili University of Health and Allied Sciences
| | | | | | | | - Julie Makani
- Muhimbili University of Health and Allied Sciences
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6
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Cato LD, Li R, Lu HY, Yu F, Wissman M, Mkumbe BS, Ekwattanakit S, Deelen P, Mwita L, Sangeda R, Suksangpleng T, Riolueang S, Bronson PG, Paul DS, Kawabata E, Astle WJ, Aguet F, Ardlie K, de Lapuente Portilla AL, Kang G, Zhang Y, Nouraie SM, Gordeuk VR, Gladwin MT, Garrett ME, Ashley-Koch A, Telen MJ, Custer B, Kelly S, Dinardo CL, Sabino EC, Loureiro P, Carneiro-Proietti AB, Maximo C, Méndez A, Hammerer-Lercher A, Sheehan VA, Weiss MJ, Franke L, Nilsson B, Butterworth AS, Viprakasit V, Nkya S, Sankaran VG. Genetic regulation of fetal hemoglobin across global populations. medRxiv 2023:2023.03.24.23287659. [PMID: 36993312 PMCID: PMC10055601 DOI: 10.1101/2023.03.24.23287659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Human genetic variation has enabled the identification of several key regulators of fetal-to-adult hemoglobin switching, including BCL11A, resulting in therapeutic advances. However, despite the progress made, limited further insights have been obtained to provide a fuller accounting of how genetic variation contributes to the global mechanisms of fetal hemoglobin (HbF) gene regulation. Here, we have conducted a multi-ancestry genome-wide association study of 28,279 individuals from several cohorts spanning 5 continents to define the architecture of human genetic variation impacting HbF. We have identified a total of 178 conditionally independent genome-wide significant or suggestive variants across 14 genomic windows. Importantly, these new data enable us to better define the mechanisms by which HbF switching occurs in vivo. We conduct targeted perturbations to define BACH2 as a new genetically-nominated regulator of hemoglobin switching. We define putative causal variants and underlying mechanisms at the well-studied BCL11A and HBS1L-MYB loci, illuminating the complex variant-driven regulation present at these loci. We additionally show how rare large-effect deletions in the HBB locus can interact with polygenic variation to influence HbF levels. Our study paves the way for the next generation of therapies to more effectively induce HbF in sickle cell disease and β-thalassemia.
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Affiliation(s)
- Liam D. Cato
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Rick Li
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Henry Y. Lu
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Fulong Yu
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Mariel Wissman
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Baraka S. Mkumbe
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Biochemistry, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
- Department of Artificial Intelligence and Innovative Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Supachai Ekwattanakit
- Siriraj Thalassemia Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patrick Deelen
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Oncode Institute, Amsterdam, the Netherlands
| | - Liberata Mwita
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Raphael Sangeda
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Thidarat Suksangpleng
- Siriraj Thalassemia Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suchada Riolueang
- Siriraj Thalassemia Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paola G. Bronson
- R&D Translational Biology, Biogen, Cambridge, Massachusetts, USA
| | - Dirk S. Paul
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
| | - Emily Kawabata
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - William J. Astle
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, Cambridge, UK
| | - Francois Aguet
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Kristin Ardlie
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | | | - Guolian Kang
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yingze Zhang
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seyed Mehdi Nouraie
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Victor R. Gordeuk
- Division of Hematology and Oncology, Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mark T. Gladwin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Melanie E. Garrett
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Allison Ashley-Koch
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Marilyn J. Telen
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, UCSF, San Francisco, California, USA
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, California, USA
- Division of Pediatric Hematology, UCSF Benioff Children's Hospital, Oakland, California, USA
| | - Carla Luana Dinardo
- Fundacao Pro-Sangue Hemocentro de Sao Paulo, Sao Paulo, Brazil
- Institute of Tropical Medicine, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ester C. Sabino
- Institute of Tropical Medicine, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | - Adriana Méndez
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, 5000 Aarau, Switzerland
| | | | - Vivien A. Sheehan
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta & Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Lude Franke
- Oncode Institute, Amsterdam, the Netherlands
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Björn Nilsson
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Lund Stem Cell Center, Lund University, 221 84 Lund, Sweden
- Department of Laboratory Medicine, Lund University, 221 84 Lund, Sweden
| | - Adam S. Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Vip Viprakasit
- Siriraj Thalassemia Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Siana Nkya
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Biochemistry, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
- Tanzania Human Genetics Organisation, Tanzania
| | - Vijay G. Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Harvard Stem Cell Institute, Cambridge, Massachusetts, USA
- Department of Biochemistry, Muhimbili University of Health and Allied Science
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7
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Urio F, Nkya S, Mgaya J, Rooks H, Ponsian P, El Hoss S, Mselle T, Makani J, Menzel S. Gender effect on production and enrichment of F cell numbers in Sickle Cell Disease patients in Tanzania. Am J Hematol 2023; 98:E139-E141. [PMID: 36929589 DOI: 10.1002/ajh.26914] [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: 06/22/2022] [Revised: 02/20/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Florence Urio
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Tanzania.,Department of Biochemistry, Muhimbili University of Health and Allied Sciences
| | - Siana Nkya
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Tanzania.,Department of Biochemistry, Muhimbili University of Health and Allied Sciences.,Tanzania Human Genetics Organization, Tanzania
| | - Josephine Mgaya
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Helen Rooks
- Comprehensive Cancer Centre, Kings College London, London, United Kingdom
| | - Peter Ponsian
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Sara El Hoss
- Comprehensive Cancer Centre, Kings College London, London, United Kingdom
| | - Teddy Mselle
- Department of Biochemistry, Muhimbili University of Health and Allied Sciences
| | - Julie Makani
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Tanzania.,Department of Biochemistry, Muhimbili University of Health and Allied Sciences.,Tanzania Human Genetics Organization, Tanzania.,Comprehensive Cancer Centre, Kings College London, London, United Kingdom.,Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, Tanzania.,Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Stephan Menzel
- Comprehensive Cancer Centre, Kings College London, London, United Kingdom
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8
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Nkya S, Njiro BJ, Ngowi D, Solomon D, Kaywanger F, Nyangasa S, Ndoje G, Marco E, Moses M, Makani J. Building research capacity for sickle cell disease in Africa: Lessons and challenges from establishing a birth cohort in Tanzania. Front Pediatr 2022; 10:826199. [PMID: 36160767 PMCID: PMC9500343 DOI: 10.3389/fped.2022.826199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Sickle Cell Disease (SCD) is a known public health burden in sub-Saharan Africa (SSA). The manifestation of SCD starts in early childhood and if not well-managed may lead to early death (before the age of 5 years). Understanding the underlying mechanisms that influence early SCD manifestation is of great importance for early disease and intervention management which will in turn, reduce both morbidity and mortality rates in children. One approach of achieving this is by establishing SCD birth cohorts that can be followed for a period of time (3-5 years) whilst documenting necessary information related to early childhood illnesses. To date, there are few SCD birth cohorts in Africa. To address this gap, we have established a birth cohort of babies with and without SCD (with sickle cell trait and healthy babies). These babies are followed up for 3 years with their study visits synchronized to the immunization schedule. During enrollment and follow-up visits, information on demographic, clinical, and laboratory parameters are collected. To date, we have enrolled a total of 341 babies with and without SCD. Out of these, a total of 311, 186, 133, 81, 44, and 16 babies have returned for their 1st, 2nd, 3rd, 4th, 5th, and 6th visits, respectively. We have collected both demographic and clinical information for these babies at enrollment and during follow-up. We have also utilized this platform to learn on the best approaches of establishing and maintaining a research birth cohort in an African context. We have analyzed the practical issues pertaining to the integration of the birth cohort with the immunization platform which seems to be the most effective and sustainable strategy for maintaining a birth cohort in our context.
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Affiliation(s)
- Siana Nkya
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Biological Sciences, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
- Tanzania Human Genetics Organization, Dar es Salaam, Tanzania
| | - Belinda J. Njiro
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Doreen Ngowi
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - David Solomon
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frida Kaywanger
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Salama Nyangasa
- Biological Sciences, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Godfrey Ndoje
- Biological Sciences, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Emmanuela Marco
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mazoea Moses
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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9
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Kaywanga F, Alimohamed MZ, David AB, Maeda D, Mbarak S, Mavura T, Nkya S, Ishengoma DS. Rare diseases in Tanzania: a National Call for Action to address policy and urgent needs of individuals with rare diseases. Orphanet J Rare Dis 2022; 17:343. [PMID: 36064429 PMCID: PMC9446714 DOI: 10.1186/s13023-022-02498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 08/18/2022] [Indexed: 11/30/2022] Open
Abstract
A rare disease is generally defined as a condition which affects about 1 among 2000 people and currently, there are approximately 5000–8000 rare diseases (RDs) affecting over 400 million people world-wide. Although RDs may arise from different causes such as infections and environmental factors, about 80% are caused by genetic abnormalities. In Tanzania, there are no reports of the types of RDs, their incidence, distribution and numbers of individuals affected. In addition, there have been no strategies to map RDs in the country and develop a definition that fits the local context. Public awareness and understanding of RDs are very limited, and these lead to poor management and stigmatisation of patients. To address the ongoing problems, Tanzania joined other countries world-wide and global partners to commemorate the rare diseases day (RDD) for the first time in 2016 and subsequently every year. Unlike previous years where the RDD was organised by Ali Kimara Rare Diseases Foundation (AKRDF) with few partners, in 2020, a bigger event was co-hosted by Ali AKRDF and Tanzania Human Genetics Organization together with government representatives and other multiple partners. The organisers, government representatives and participants proposed a national “Call for Action” with the overall goal of improving the lives of patients/individuals with RDs. The call focuses and aims to address 17 strategic issues that are broadly categorised into four areas. These include generating demographic data of individuals with RDs; advocating for policies and guidelines for diagnosis, care, treatment and health financing; developing policies supporting public education, awareness and advocacy; and strengthening research, innovation and public–private partnerships. If adopted and implemented, the potential impacts of these recommendations will include improved access to adequate and high-quality health and education services, and policies and guidelines to address the current and future challenges facing individuals with RDs and their families.
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Affiliation(s)
- Frida Kaywanga
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Tanzania Human Genetics Organization, Dar es Salaam, Tanzania
| | - Mohamed Zahir Alimohamed
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Tanzania Human Genetics Organization, Dar es Salaam, Tanzania.,Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania.,Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Aneth Bella David
- Tanzania Human Genetics Organization, Dar es Salaam, Tanzania.,Department of Molecular Biology and Biotechnology, University of Dar Es Salaam, Dar es Salaam, Tanzania.,Plant Protection Department, Swedish University of Agricultural Sciences, Alnarp, Sweden
| | - Daniel Maeda
- Tanzania Human Genetics Organization, Dar es Salaam, Tanzania.,Department of Molecular Biology and Biotechnology, University of Dar Es Salaam, Dar es Salaam, Tanzania
| | - Sharifa Mbarak
- Ali Kimara Rare Diseases Foundation, Dar es Salaam, Tanzania
| | - Togolani Mavura
- Ali Kimara Rare Diseases Foundation, Dar es Salaam, Tanzania.,Jakaya Mrisho Kikwete Foundation, Dar es Salaam, Tanzania
| | - Siana Nkya
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Tanzania Human Genetics Organization, Dar es Salaam, Tanzania.,Dar es Salaam University College of Education, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Deus S Ishengoma
- Tanzania Human Genetics Organization, Dar es Salaam, Tanzania. .,National Institute for Medical Research, 3 Baraka Obama Drive, P. O Box 9653, 11101, Dar es Salaam, Tanzania. .,Faculty of Pharmaceutical Sciences, Monash University, Melbourne, Australia. .,Harvard T.H Chan School of Public Health, Boston, MA, USA.
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10
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Christopher H, Josephat E, Kaywanga F, Saul S, Mshana I, Kunambi P, Nasser A, Chamba C, Makani J, Nkya S. Potential of point of care tests for newborn screening for sickle cell disease: Evaluation of HemotypeSC™ and sickle SCAN® in Tanzania. Int J Lab Hematol 2022; 44:959-965. [PMID: 35775883 DOI: 10.1111/ijlh.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is an important cause of <5 mortality. In Tanzania, it is estimated up to 11 000 children are born with SCD annually, making this the fifth country with the highest SCD annual births worldwide. The biggest challenge of expanding the service of newborn screening for SCD as the national health intervention in Tanzania is due to the high cost of the currently used assays and lack of rapid screening methods. Therefore, in this study, we assessed the diagnostic accuracy of point-of-care tests for SCD diagnosis in newborns. AIM To evaluate the sensitivity and specificity of HemotypeSC™ and sickle SCAN® in diagnosing SCD in newborns. METHODS Diagnostic accuracy of HemotypeSC™ and sickle SCAN® were evaluated in comparison to isoelectric focusing as a confirmatory method. RESULTS A total of 706 newborns were enrolled in the study. The sensitivity and specificity of HemotypeSC in detecting Hb SS, Hb AS and Hb AA phonotypes was 100%. The sensitivity and specificity of sickle SCAN® in detecting Hb SS, Hb AS and Hb AA phenotypes were 100%, 97% and 100% respectively. CONCLUSION Both POC tests displayed high accuracy in detecting SCD, we believe the introduction of either of these tests in health facilities will help in the early detection and management of SCD. In addition, the margin of cost per test is relatively affordable (1.4$ per test for HemotypeSC™ and 4.75$ for sickle SCAN®).
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Affiliation(s)
- Heavenlight Christopher
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Emmanuel Josephat
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Frida Kaywanga
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Sephord Saul
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Irene Mshana
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Peter Kunambi
- Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Ahlam Nasser
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Clara Chamba
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Siana Nkya
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania.,Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania.,Tanzania Human Genetics Organization, Dar es salaam, Tanzania
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11
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Affiliation(s)
- Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania. .,Sickle Cell Programme, Department of Haematology and Blood Transfusion, School of Medicine, MUHAS, Dar-es-Salaam, Tanzania. .,Sickle Pan-African Consortium (SPARCO) Clinical Coordinating Centre, SickleInAfrica, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania.
| | - Siana Nkya
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, School of Medicine, MUHAS, Dar-es-Salaam, Tanzania.,Sickle Pan-African Consortium (SPARCO) Clinical Coordinating Centre, SickleInAfrica, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania.,Department of Biochemistry, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania.,Tanzania Society of Human Genetics, Dar-es-Salaam, Tanzania
| | - Francis Collins
- National Human Genome Research Institute (NHGRI), National Institutes of Health (NIH), Bethesda, USA
| | - Lucio Luzzatto
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania.,Sickle Cell Programme, Department of Haematology and Blood Transfusion, School of Medicine, MUHAS, Dar-es-Salaam, Tanzania.,University of Florence, Firenze, Italy
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12
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Archer NM, Inusa B, Makani J, Nkya S, Tshilolo L, Tubman VN, McGann PT, Ambrose EE, Henrich N, Spector J, Ohene-Frempong K. Enablers and barriers to newborn screening for sickle cell disease in Africa: results from a qualitative study involving programmes in six countries. BMJ Open 2022; 12:e057623. [PMID: 35264367 PMCID: PMC8915265 DOI: 10.1136/bmjopen-2021-057623] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Given the fundamental role of newborn bloodspot screening (NBS) to enable prompt diagnosis and optimal clinical management of individuals with sickle cell disease (SCD), we sought to systematically assess enablers and barriers to implementation of NBS programmes for SCD in Africa using established qualitative research methods. SETTING Childbirth centres and NBS laboratories from six countries in East, West and Southern Africa. PARTICIPANTS Eight programme leaders involved with establishing and operating NBS programmes for SCD in Angola, Democratic Republic of Congo, Ghana, Liberia, Nigeria and Tanzania. PRIMARY AND SECONDARY OUTCOME MEASURES Data obtained through a structured, phased interview approach were analysed using a combination of inductive and deductive codes and used to determine primary themes related to the implementation and sustainability of SCD NBS programmes. RESULTS Four primary themes emerged from the analysis relating to governance (eg, pragmatic considerations when deploying overcommitted clinical staff to perform NBS), technical (eg, design and execution of operational processes), cultural (eg, variability of knowledge and perceptions of community-based staff) and financial (eg, issues that can arise when external funding may effectively preclude government inputs) aspects. Key learnings included perceived factors that contribute to long-term NBS programme sustainability. CONCLUSIONS The establishment of enduring NBS programmes is a proven approach to improving the health of populations with SCD. Organising such programmes in Africa is feasible, but initial implementation does not assure sustainability. Our analysis suggests that future programmes should prioritise government partner participation and funding from the earliest stages of programme development.
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Affiliation(s)
- Natasha M Archer
- Division of Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Baba Inusa
- Evelina London Children's Hospital, London, UK
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Siana Nkya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Léon Tshilolo
- Institut de Recherche Biomédicale/CEFA and Centre Hospitalier Mère-Enfant Monkole, Kinshasa, Congo
| | - Venee N Tubman
- Texas Children's Cancer and Hematology Centers, Houston, Texas, USA
| | - Patrick T McGann
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Natalie Henrich
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jonathan Spector
- Department of Global Health, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA
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13
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Christopher H, Burns A, Josephat E, Makani J, Schuh A, Nkya S. Using DNA testing for the precise, definite, and low-cost diagnosis of sickle cell disease and other Haemoglobinopathies: findings from Tanzania. BMC Genomics 2021; 22:902. [PMID: 34915846 PMCID: PMC8679995 DOI: 10.1186/s12864-021-08220-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Sickle cell disease (SCD) is an important cause of under-five mortality. Tanzania is the 5th country in the world with the highest births prevalence of SCD individuals. Significant advances in the neonatal diagnosis of SCD using rapid point-of-care testing have been made. However genetic confirmation is still required for positive cases, in uncertain cases, in multiply transfused patients, to resolve compound heterozygosity (Hb S/ β0 Thal or Hb S/ β+ thal) not uncommon in the coastal regions of East Africa and increasingly also for pre-marital counselling and potentially for future curative approaches such as gene therapy. The currently available DNA tests are prohibitively expensive. Here, we describe an easy-to-use, affordable and accurate β-globin sequencing approach that can be easily integrated within existing NBS for SCD and other haemoglobinopathies especially in Low- and Middle-income Countries. Aim To evaluate an affordable DNA technology for the diagnosis of Sickle cell disease and other haemoglobinopathies in a resource-limited setting. Methods Laboratory-based validation study was conducted by Muhimbili University of Health and Allied Sciences and the University of Oxford involving sequencing of the entire β -haemoglobin locus using the Oxford Nanopore MinION platform. A total number of 36 Dried blood spots and whole blood samples were subjected to conventional protein-based methods (isoelectric focusing, HPLC), and/or sequenced by the Sanger method as comparators. Results Sequencing results for SCD using the MinION were 100% concordant with those from the Sanger method. In addition, the long-read DNA sequencing method enabled the resolution of cases with unusual phenotypes which make up 1% of all children in Tanzania. The cost is £11/ sample for consumables, which is cheaper compared to other sequencing platforms. Conclusions This is the first report of a comprehensive single DNA assay as a definitive diagnostic test for SCD and other haemoglobinopathies. The test is fast, precise, accurate and affordable.
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Affiliation(s)
- Heavenlight Christopher
- Sickle cell programme, Department of haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Adam Burns
- Oxford Molecular Diagnostics Centre, University of Oxford, Oxford, UK
| | - Emmanuel Josephat
- Sickle cell programme, Department of haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julie Makani
- Sickle cell programme, Department of haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna Schuh
- Sickle cell programme, Department of haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Oxford Molecular Diagnostics Centre, University of Oxford, Oxford, UK
| | - Siana Nkya
- Sickle cell programme, Department of haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Biological Sciences, Dar es Salaam University College of Education (DUCE), Dar es Salaam, Tanzania
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14
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Kountouris P, Stephanou C, Archer N, Bonifazi F, Giannuzzi V, Kuo KHM, Maggio A, Makani J, Mañú-Pereira MDM, Michailidou K, Nkya S, Nnodu OE, Trompeter S, Tshilolo L, Wonkam A, Zilfalil BA, Inusa BPD, Kleanthous M. The International Hemoglobinopathy Research Network (INHERENT): An international initiative to study the role of genetic modifiers in hemoglobinopathies. Am J Hematol 2021; 96:E416-E420. [PMID: 34406671 PMCID: PMC10390849 DOI: 10.1002/ajh.26323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Petros Kountouris
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | | | - Natasha Archer
- Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Kevin H M Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - María Del Mar Mañú-Pereira
- Translational Research in Child and Adolescent Cancer. Vall d'Hebron Institut de recerca, Barcelona, Spain
| | - Kyriaki Michailidou
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Siana Nkya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Obiageli E Nnodu
- Department of Haematology and Blood Transfusion, University of Abuja, Abuja, Nigeria
| | - Sara Trompeter
- University College London Hospitals NHS Trust, London, UK.,NHS Blood and Transplant, London, UK
| | - Léon Tshilolo
- Centre Hospitalier Monkole and CEFA-Institut de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | | | - Baba P D Inusa
- Paediatric Haematology, Evelina London Children's Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Marina Kleanthous
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, Nicosia, Cyprus
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15
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Brown BJ, Madu A, Sangeda RZ, Nkya S, Peprah E, Paintsil V, Mmbando BP, Gyamfi J, Okocha CE, Asala SA, Nembaware V, Jonas M, Kengne AP, Chimusa ER, Nguweneza A, Isa HA, Nnebe-Agumadu U, Adekile AD, Osei-Akoto A, Ohene-Frempong K, Balandya E, Nnodu OE, Wonkam A. Utilization of Pneumococcal Vaccine and Penicillin Prophylaxis in Sickle Cell Disease in Three African Countries: Assessment among Healthcare Providers in SickleInAfrica. Hemoglobin 2021; 45:163-170. [PMID: 34355623 PMCID: PMC10022452 DOI: 10.1080/03630269.2021.1954943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
Sickle cell disease is a genetic disease with a predisposition to infections caused by encapsulated organisms, especially Streptococcus pneumoniae. Pneumococcal vaccines and prophylactic penicillin have reduced the rate of this infection and mortality in sickle cell disease. However, implementation of these interventions is limited in Africa. The objectives of the study were to assess health care providers' behaviors with the implementation of pneumococcal vaccination and penicillin prophylaxis and to identify barriers to their use. A 25-item online questionnaire was administered through SickleinAfrica: a network of researchers, and healthcare providers, in Ghana, Nigeria, and Tanzania, working to improve health outcomes of sickle cell disease in Africa. Data was collected and managed using the Research Electronic Data Capture (REDCap), tools and data analysis was done using STATA version 13 and R statistical software. Eighty-two medical practitioners responded to the questionnaire. Only 54.0 and 48.7% of respondents indicated the availability of published guidelines on sickle cell disease management and pneumococcal vaccine use, respectively, at their facilities. The majority (54.0%) perceived that the vaccines are effective but over 20.0% were uncertain of their usefulness. All respondents from Ghana and Tanzania affirmed the availability of guidelines for penicillin prophylaxis in contrast to 44.1% in Nigeria. Eighty-five percent of respondents affirmed the need for penicillin prophylaxis but 15.0% had a contrary opinion for reasons including the rarity of isolation of Streptococcus pneumoniae in African studies, and therefore, the uncertainty of its benefit. Lack of published guidelines on the management of sickle cell disease and doubts about the necessity of prophylactic measures are potential barriers to the implementation of effective interventions.
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Affiliation(s)
- Biobele J. Brown
- Department of Paediatrics, Haematology & Oncology Unit, College of Medicine, University of Ibadan & University College Hospital, Ibadan, Nigeria
| | - Anazoeze Madu
- Department of Haematology, University of Nigeria, Nsukka, Nigeria
| | - Raphael Z. Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Siana Nkya
- Department of Biological Sciences, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Emmanuel Peprah
- Department of Social & Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Vivian Paintsil
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruno P. Mmbando
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | - Joyce Gyamfi
- Department of Social & Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Chide E. Okocha
- Department of Haematology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Samuel A. Asala
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Victoria Nembaware
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Mario Jonas
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council & Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emile R. Chimusa
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Arthemon Nguweneza
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Hezekiah A. Isa
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Uche Nnebe-Agumadu
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Adekunle D. Adekile
- Faculty of Medicine, Department of Paediatrics, Kuwait University, Jabriya, Kuwait
| | - Alex Osei-Akoto
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Emmanuel Balandya
- Department of Physiology, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Obiageli E. Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Ambroise Wonkam
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - The SickleInAfrica Consortium
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Bukini D, Nkya S, McCurdy S, Mbekenga C, Manji K, Parker M, Makani J. Perspectives on Building Sustainable Newborn Screening Programs for Sickle Cell Disease: Experience from Tanzania. Int J Neonatal Screen 2021; 7:ijns7010012. [PMID: 33652550 PMCID: PMC7930989 DOI: 10.3390/ijns7010012] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022] Open
Abstract
The prevalence of sickle cell disease is high in Africa, with significant public health effects on the affected countries. Many of the countries with the highest prevalence of the disease also have poor health care systems and a high burden of infectious diseases with many other competing health care priorities. Although considerable efforts have been made to implement newborn screening for sickle cell disease programs in Africa, coverage is still low. Tanzania has one of the highest birth prevalence of children with sickle cell disease in Africa. In 2015, the country implemented a pilot project for Newborn Screening for Sickle Cell Disease to assess feasibility. Several efforts have been made afterwards to continue providing the screening services as well as related comprehensive care services. Using qualitative methods, we conducted in-depth interviews and focus group discussions with policy makers (n = 4), health care providers (n = 21) and families (n = 15) to provide an analysis of their experiences and perspectives on efforts to expand and sustain newborn screening for sickle cell disease and related comprehensive care services in the country. Thematic content analysis was used to analyze the data through the framework analysis method. The findings have demonstrated both the opportunities and areas that need addressing in the implementation and sustainability of the services in low resource settings. A key area of strengthening is full integration of the services in countries' health care systems to facilitate the coverage, accessibility and affordability of the services. Although the coverage of newborn screening services for sickle cell disease is still low, efforts at the local level to sustain the implementation of the programs and related comprehensive care services are encouraging and can be used as a model for other programs implemented in low resources settings.
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Affiliation(s)
- Daima Bukini
- Sickle Cell Programme, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, P.O. Box 65001 Dar es Salaam, Tanzania; (S.N.); (J.M.)
- Correspondence: or
| | - Siana Nkya
- Sickle Cell Programme, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, P.O. Box 65001 Dar es Salaam, Tanzania; (S.N.); (J.M.)
- Department of Biological Sciences, Dar es Salaam University College of Education, P.O. Box 2329 Dar es Salaam, Tanzania
| | - Sheryl McCurdy
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Centre at Houston, School of Public Health, Houston, TX 77030, USA;
| | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, P.O. Box 38129 Dar es Salaam, Tanzania;
| | - Karim Manji
- Department of Pediatrics & Child health, Muhimbili University of Health and Allied Sciences, P.O. Box 65001 Dar es Salaam, Tanzania;
| | - Michael Parker
- Welcome Centre for Ethics and Humanities, University of Oxford, Oxford OX3 7LF, UK;
| | - Julie Makani
- Sickle Cell Programme, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, P.O. Box 65001 Dar es Salaam, Tanzania; (S.N.); (J.M.)
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Alimohamed MZ, Mwakilili AD, Mbwanji K, Manji ZK, Kaywang F, Mwaikono KS, Adolf I, Makani J, Hamel B, Masimirembwa C, Ishengoma DS, Nkya S. Inauguration of the Tanzania Society of Human Genetics: Biomedical Research in Tanzania with Emphasis on Human Genetics and Genomics. Am J Trop Med Hyg 2020; 104:474-477. [PMID: 33350369 DOI: 10.4269/ajtmh.20-0861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 11/07/2022] Open
Abstract
Human genetics research and applications are rapidly growing areas in health innovations and services. African populations are reported to be highly diverse and carry the greatest number of variants per genome. Exploring these variants is key to realize the genomic medicine initiative. However, African populations are grossly underrepresented in various genomic databases, which has alerted scientists to address this issue with urgency. In Tanzania, human genetics research and services are conducted in different institutions on both communicable and noncommunicable diseases. However, there is poor coordination of the research activities, often leading to limited application of the research findings and poor utilization of available resources. In addition, contributions from Tanzanian human genetics research and services are not fully communicated to the government, national, and international communities. To address this scientific gap, the Tanzania Society of Human Genetics (TSHG) has been formed to bring together all stakeholders of human genetics activities in Tanzania and to formally bring Tanzania as a member to the African Society of Human Genetics. This article describes the inauguration event of the TSHG, which took place in November 2019. It provides a justification for its establishment and discusses presentations from invited speakers who took part in the inauguration of the TSHG.
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Affiliation(s)
- Mohamed Zahir Alimohamed
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Aneth David Mwakilili
- Plant Protection Department, Swedish University of Agricultural Sciences, Alnarp, Sweden.,Department of Molecular Biology and Biotechnology, University of Dar es Salaam, Dar es Salaam, Tanzania
| | | | - Zainab Karim Manji
- Department of Clinical Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frida Kaywang
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kilaza Samson Mwaikono
- Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, Dar es Salaam, Tanzania
| | - Ismael Adolf
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Julie Makani
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Ben Hamel
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Collen Masimirembwa
- African Institute of Biomedical Science and Technology, Wilkins Hospital, Harare, Zimbabwe
| | - Deus Simon Ishengoma
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Faculty of Pharmaceutical Sciences, Monash University, Melbourne, Australia.,National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Siana Nkya
- Dar es Salaam University College of Education, UDSM, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
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18
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Masamu U, Sangeda RZ, Kandonga D, Ondengo J, Ndobho F, Mmbando B, Nkya S, Msami K, Makani J. Patterns and patient factors associated with loss to follow-up in the Muhimbili sickle cell cohort, Tanzania. BMC Health Serv Res 2020; 20:1141. [PMID: 33317526 PMCID: PMC7737273 DOI: 10.1186/s12913-020-05998-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 12/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring patient's clinical attendance is a crucial means of improving retention in care and treatment programmes. Sickle cell patients' outcomes are improved by participation in comprehensive care programmes, but these benefits cannot be achieved when patients are lost from clinical care. In this study, patients are defined as loss to follow-up when they did not attend clinic for more than 9 months. Precise information on the retention rate and characteristics of those who are not following their clinic appointments is needed to enable the implementation of interventions that will be effective in increasing the retention to care. METHOD This was a retrospective study involving sickle cell patients registered in the Muhimbili Sickle Cohort in Tanzania. Descriptive and survival analysis techniques both non-parametric methods (Kaplan-Meier estimator and Log-rank test) and semi-parametric method (Cox's proportional hazard model), were used. A p-value of 0.05 was considered significant to make an inference from the analysis. RESULTS A total of 5476 patients were registered in the cohort from 2004 to 2016. Of these, 3350 (58.13%) were actively participating in clinics, while 2126 (41.87%) were inactive, of which 1927 (35.19%) were loss to follow-up. We used data from 2004 to 2014 because between 2015 and 2016, patients were referred to other government hospitals. From the survival analysis results, pediatric (HR: 14.29,95% CI: 11.0071-18.5768, p < 0.001) and children between 5 and 17 years [HR:2.61,95% CI:2.2324-3.0705, p < 0.001] patients were more likely to be loss to follow-up than the adult (18 and above years) patients. It was found that patients with above averages for hematocrit (HR: 2.38, 95% CI: 1.0076-1.0404, p = 0.0039) or mean cell volume (HR: 4.28, (95% CI: 1.0260-1.0598, p < 0.001) were more likely to be loss to follow-up than their counterparts. CONCLUSION Loss to follow-up is evident in the cohort of patients in long term comprehensive care. It is, therefore, necessary to design interventions that improve patients' retention. Suggested solutions include refresher training for health care workers and those responsible for patient follow-up on techniques for retaining patients and comprehensive transition programs to prepare patients who are moving from pediatric to adult clinics.
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Affiliation(s)
- Upendo Masamu
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania.
| | - Raphael Z Sangeda
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania.,Department of Pharmaceutical Microbiology, Muhimbili University of Healthy and Allied Sciences, Dar es Salaam, Tanzania
| | - Daniel Kandonga
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania
| | - Jesca Ondengo
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania
| | - Flora Ndobho
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Bruno Mmbando
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania.,National Institute for Medical Research, Tanga, Tanzania
| | - Siana Nkya
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania.,Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Khadija Msami
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania
| | - Julie Makani
- Muhimbili University of Healthy and Allied Sciences Sickle Cell Program, Dar es Salaam, Tanzania.,Department of Hematology and Blood Transfusion, Muhimbili University of Healthy and Allied Sciences, Dar es Salaam, Tanzania
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19
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Urio F, Nkya S, Rooks H, Mgaya JA, Masamu U, Zozimus Sangeda R, Mmbando BP, Brumat M, Mselle T, Menzel S, Luzzatto L, Makani J. F cell numbers are associated with an X-linked genetic polymorphism and correlate with haematological parameters in patients with sickle cell disease. Br J Haematol 2020; 191:888-896. [PMID: 33073380 DOI: 10.1111/bjh.17102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/11/2020] [Indexed: 01/18/2023]
Abstract
Patients with sickle cell disease (SCD) with high fetal haemoglobin (HbF) tend to have a lower incidence of complications and longer survival due to inhibition of deoxyhaemoglobin S (HbS) polymerisation by HbF. HbF-containing cells, namely F cells, are strongly influenced by genetic factors. We measured the percentage of F cells (Fcells%) in 222 patients with SCD to evaluate the association of (i) Fcells% with genetic HbF-modifier variants and (ii) Fcells% with haematological parameters. There was a different distribution of Fcells% in females compared to males. The association of the B-cell lymphoma/leukaemia 11A (BCL11A) locus with Fcells% (β = 8·238; P < 0·001) and with HbF% (β = 2·490; P < 0·001) was significant. All red cell parameters except for Hb and mean corpuscular Hb concentration levels in males and females were significantly different. The Fcells% was positively associated with mean cell Hb, mean cell volume and reticulocytes. To explain the significant gender difference in Fcells%, we tested for associations with single nucleotide polymorphisms on the X chromosomal region Xp22.2, where a genetic determinant of HbF had been previously hypothesised. We found in males a significant association with a SNP in FERM and PDZ domain-containing protein 4 (FRMPD4) and adjacent to male-specific lethal complex subunit 3 (MSL3). Thus, we have identified an X-linked locus that could account for a significant fraction of the Fcells% variation in patients with SCD.
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Affiliation(s)
- Florence Urio
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Siana Nkya
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Biological Sciences, Dar es salaam University College of Education, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Helen Rooks
- Comprehensive Cancer Centre, Kings College London, London, UK
| | - Josephine A Mgaya
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Upendo Masamu
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Raphael Zozimus Sangeda
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno P Mmbando
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- National Institute for Medical Research, Tanga, Tanzania
| | - Marco Brumat
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Ted Mselle
- Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stephan Menzel
- Comprehensive Cancer Centre, Kings College London, London, UK
| | - Lucio Luzzatto
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julie Makani
- Muhimbili Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Bukini D, Mbekenga C, Nkya S, Purvis L, McCurdy S, Parker M, Makani J. A qualitative study on aspects of consent for genomic research in communities with low literacy. BMC Med Ethics 2020; 21:48. [PMID: 32532327 PMCID: PMC7291634 DOI: 10.1186/s12910-020-00488-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low literacy of study participants in Sub - Saharan Africa has been associated with poor comprehension during the consenting process in research participation. The concerns in comprehension are far greater when consenting to participate in genomic studies due to the complexity of the science involved. While efforts are made to explore possibilities of applying genomic technologies in diseases prevalent in Sub Saharan Africa, we ought to develop methods to improve participants' comprehension for genomic studies. The purpose of this study was to understand different approaches that can be used to seek consent from individuals with low literacy in Sub-Saharan African countries in genomic research to improve comprehension. METHODS Using qualitative study design, we conducted focus-group discussions, in-depth interviews and participant observations as data collection methods. This study was embedded in a hospital based genomic study on Sickle Cell Disease at Muhimbili National Hospital in Tanzania. Thematic content analysis was used to analyse the transcripts and field notes. RESULTS Findings from this study show that literacy level has little influence on understanding the research details. According to the participants of this study, the methods used to provide information, the language, and time spent with the study participants were the key factors influencing understanding. The availability of group sessions held before individual consent to allow for a detailed questions and answers format was agreed to be the best method to facilitate the comprehension. CONCLUSION The quality of the consenting process of participants will be influence by a number of factors. The type of research consented for, where the research will be implemented and who are the potential study participants are amongst the factors that need to be assessed during the consenting. Measures to improve participants' comprehension need to be developed when consenting participants with low literacy level in genomic studies.
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Affiliation(s)
- Daima Bukini
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania.
| | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Siana Nkya
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania
| | - Lisa Purvis
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Centre, Hanover, NH, USA
| | - Sheryl McCurdy
- University of Texas Health Science Centre at Houston, School of Public Health, Houston, TX, USA
| | - Michael Parker
- Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Julie Makani
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania
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21
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Nkya S, Mwita L, Mgaya J, Kumburu H, van Zwetselaar M, Menzel S, Mazandu GK, Sangeda R, Chimusa E, Makani J. Identifying genetic variants and pathways associated with extreme levels of fetal hemoglobin in sickle cell disease in Tanzania. BMC Med Genet 2020; 21:125. [PMID: 32503527 PMCID: PMC7275552 DOI: 10.1186/s12881-020-01059-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a blood disorder caused by a point mutation on the beta globin gene resulting in the synthesis of abnormal hemoglobin. Fetal hemoglobin (HbF) reduces disease severity, but the levels vary from one individual to another. Most research has focused on common genetic variants which differ across populations and hence do not fully account for HbF variation. METHODS We investigated rare and common genetic variants that influence HbF levels in 14 SCD patients to elucidate variants and pathways in SCD patients with extreme HbF levels (≥7.7% for high HbF) and (≤2.5% for low HbF) in Tanzania. We performed targeted next generation sequencing (Illumina_Miseq) covering exonic and other significant fetal hemoglobin-associated loci, including BCL11A, MYB, HOXA9, HBB, HBG1, HBG2, CHD4, KLF1, MBD3, ZBTB7A and PGLYRP1. RESULTS Results revealed a range of genetic variants, including bi-allelic and multi-allelic SNPs, frameshift insertions and deletions, some of which have functional importance. Notably, there were significantly more deletions in individuals with high HbF levels (11% vs 0.9%). We identified frameshift deletions in individuals with high HbF levels and frameshift insertions in individuals with low HbF. CHD4 and MBD3 genes, interacting in the same sub-network, were identified to have a significant number of pathogenic or non-synonymous mutations in individuals with low HbF levels, suggesting an important role of epigenetic pathways in the regulation of HbF synthesis. CONCLUSIONS This study provides new insights in selecting essential variants and identifying potential biological pathways associated with extreme HbF levels in SCD interrogating multiple genomic variants associated with HbF in SCD.
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Affiliation(s)
- Siana Nkya
- Department of Biological Sciences, Dar es Salaam University College of Education, Dar es Salaam, Tanzania. .,Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Liberata Mwita
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Josephine Mgaya
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Happiness Kumburu
- Department of Biotechnology Laboratory, Kilimanjaro Clinical Research Institute, Kilimanjaro, Tanzania
| | - Marco van Zwetselaar
- Department of Biotechnology Laboratory, Kilimanjaro Clinical Research Institute, Kilimanjaro, Tanzania
| | - Stephan Menzel
- Department of Molecular Hematology, King's College of London, London, UK
| | - Gaston Kuzamunu Mazandu
- Department of Pathology, Division of Human Genetics, University of Cape Town, IDM, Cape Town, South Africa. .,Department of Integrative Biomedical Sciences, Computational Biology Division, University of Cape Town, Observatory, 7925, South Africa. .,African Institute for Mathematical Sciences, Muizenberg, Cape Town, 7945, South Africa.
| | - Raphael Sangeda
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emile Chimusa
- Department of Pathology, Division of Human Genetics, University of Cape Town, IDM, Cape Town, South Africa
| | - Julie Makani
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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22
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Nkya S, Mtei L, Soka D, Mdai V, Mwakale PB, Mrosso P, Mchoropa I, Rwezaula S, Azayo M, Ulenga N, Ngido M, Cox SE, D'Mello BS, Masanja H, Kabadi GS, Mbuya F, Mmbando B, Daniel Y, Streetly A, Killewo J, Tluway F, Lyimo M, Makani J. Newborn screening for sickle cell disease: an innovative pilot program to improve child survival in Dar es Salaam, Tanzania. Int Health 2020; 11:589-595. [PMID: 31145786 DOI: 10.1093/inthealth/ihz028] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 02/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a recognized cause of childhood mortality. Tanzania has the fifth highest incidence of SCD (with an estimated 11 000 SCD annual births) worldwide. Although newborn screening (NBS) for SCD and comprehensive healthcare have been shown to reduce under-5 mortality by up to 94% in high-income countries such as the USA, no country in Africa has maintained NBS for SCD as a national health program. The aims of this program were to establish and evaluate NBS-SCD as a health intervention in Tanzania and to determine the birth prevalence of SCD. METHODS Muhimbili University of Health and Allied Sciences conducted NBS for SCD from January 2015 to November 2016. Dried blood spot samples were collected and tested for SCD using isoelectric focusing. RESULTS Screening was conducted on 3981 newborns. Thirty-one (0.8%) babies had SCD, 505 (12.6%) had sickle cell trait and 26 (0.7%) had other hemoglobinopathies. Twenty-eight (90.3%) of the 31 newborns with SCD were enrolled for comprehensive healthcare. CONCLUSIONS This is the first report on NBS as a health program for SCD in Tanzania. The SCD birth prevalence of 8 per 1000 births is of public health significance. It is therefore important to conduct NBS for SCD with enrollment into a comprehensive care program.
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Affiliation(s)
- Siana Nkya
- Dar es Salaam University College of Education, Dar es Salaam, Tanzania.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lillian Mtei
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deogratias Soka
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Vera Mdai
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Promise B Mwakale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Mrosso
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Issa Mchoropa
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Delloite and Touche, Dar es Salaam, Tanzania
| | - Stella Rwezaula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Mary Azayo
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Melkiory Ngido
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Delloite and Touche, Dar es Salaam, Tanzania
| | - Sharon E Cox
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Graduate School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan.,Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Brenda S D'Mello
- Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), Dar es Salaam, Tanzania
| | | | - Gregory S Kabadi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Frederick Mbuya
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Mmbando
- Dar es Salaam University College of Education, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Yvonne Daniel
- Public Health England, NHS Sickle Cell and Thalassemia Screening Programme and National Healthcare Public Health Division, London, UK
| | - Allison Streetly
- Public Health England, NHS Sickle Cell and Thalassemia Screening Programme and National Healthcare Public Health Division, London, UK
| | - Japhet Killewo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Furahini Tluway
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Magdalena Lyimo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,National Blood Transfusion service, Dar es Salaam, Tanzania
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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23
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Jacob M, Saunders DE, Kawadler JM, Mussa B, Murdoch R, Lapidaire W, Tluway F, Kazema RR, Nkya S, Ahmed M, Kija E, Fundikira L, Kussaga F, Darekar A, Tutuba H, Shmueli K, Clark CA, Makani J, Kirkham FJ. Neuroimaging in patients with sickle cell anemia: capacity building in Africa. Blood Adv 2018; 2:26-29. [PMID: 30504194 PMCID: PMC6438286 DOI: 10.1182/bloodadvances.2018gs112714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/20/2022] Open
Affiliation(s)
- Mboka Jacob
- Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences
- Developmental Neurosciences, Section and Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, Section and Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences, Section and Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Balowa Mussa
- Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences
| | - Russell Murdoch
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Winok Lapidaire
- Developmental Neurosciences, Section and Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - Ramadhan R Kazema
- Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences
| | | | - Magda Ahmed
- Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences
| | | | - Lulu Fundikira
- Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences
| | | | - Angela Darekar
- University Hospital Southampton, Southampton, United Kingdom; and
| | | | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Christopher A Clark
- Developmental Neurosciences, Section and Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Julie Makani
- Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences
| | - Fenella J Kirkham
- Developmental Neurosciences, Section and Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
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24
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Makani J, Tluway F, Makubi A, Soka D, Nkya S, Sangeda R, Mgaya J, Rwezaula S, Kirkham FJ, Kindole C, Osati E, Meda E, Snow RW, Newton CR, Roberts D, Aboud M, Thein SL, Cox SE, Luzzatto L, Mmbando BP. A ten year review of the sickle cell program in Muhimbili National Hospital, Tanzania. BMC Hematol 2018; 18:33. [PMID: 30459954 PMCID: PMC6236876 DOI: 10.1186/s12878-018-0125-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022]
Abstract
Background Africa has the highest burden of Sickle cell disease (SCD) but there are few large, systematic studies providing reliable descriptions of the disease spectrum. Tanzania, with 11,000 SCD births annually, established the Muhimbili Sickle Cell program aiming to improve understanding of SCD in Africa. We report the profile of SCD seen in the first 10 years at Muhimbili National Hospital (MNH). Methods Individuals seen at MNH known or suspected to have SCD were enrolled at clinic and laboratory testing for SCD, haematological and biochemical analyses done. Ethnicity was self-reported. Clinical and laboratory features of SCD were documented. Comparison was made with non-SCD population as well as within 3 different age groups (< 5, 5–17 and ≥ 18 years) within the SCD population. Results From 2004 to 2013, 6397 individuals, 3751 (58.6%) SCD patients, were enrolled, the majority (47.4%) in age group 5–17 years. There was variation in the geographical distribution of SCD. Individuals with SCD compared to non-SCD, had significantly lower blood pressure and peripheral oxygen saturation (SpO2). SCD patients had higher prevalence of severe anemia, jaundice and desaturation (SpO2 < 95%) as well as higher levels of reticulocytes, white blood cells, platelets and fetal hemoglobin. The main causes of hospitalization for SCD within a 12-month period preceding enrolment were pain (adults), and fever and severe anemia (children). When clinical and laboratory features were compared in SCD within 3 age groups, there was a progressive decrease in the prevalence of splenic enlargement and an increase in prevalence of jaundice. Furthermore, there were significant differences with monotonic trends across age groups in SpO2, hematological and biochemical parameters. Conclusion This report confirms that the wide spectrum of clinical expression of SCD observed elsewhere is also present in Tanzania, with non-uniform geographical distribution across the country. Age-specific analysis is consistent with different disease-patterns across the lifespan.
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Affiliation(s)
- Julie Makani
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,2University of Oxford, Oxford, UK.,3Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Furahini Tluway
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Abel Makubi
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Deogratius Soka
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Siana Nkya
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,4Dar-es-Salaam University College of Education, Dar-es-Salaam, Tanzania
| | - Raphael Sangeda
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Josephine Mgaya
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Stella Rwezaula
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,3Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | | | - Christina Kindole
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,3Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Elisha Osati
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,3Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Elineema Meda
- 3Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Robert W Snow
- 2University of Oxford, Oxford, UK.,6Centre for Geographic Medicine Research, Kenya Medical Research Institute, Kilifi, Kenya
| | - Charles R Newton
- 2University of Oxford, Oxford, UK.,6Centre for Geographic Medicine Research, Kenya Medical Research Institute, Kilifi, Kenya
| | | | - Muhsin Aboud
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | | | - Sharon E Cox
- 8London School of Hygiene & Tropical Medicine, London, UK
| | - Lucio Luzzatto
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Bruno P Mmbando
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,National Institute for Medical Research Tanga Centre, Tanga, Tanzania
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25
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Ben Hamda C, Sangeda R, Mwita L, Meintjes A, Nkya S, Panji S, Mulder N, Guizani-Tabbane L, Benkahla A, Makani J, Ghedira K. A common molecular signature of patients with sickle cell disease revealed by microarray meta-analysis and a genome-wide association study. PLoS One 2018; 13:e0199461. [PMID: 29979707 PMCID: PMC6034806 DOI: 10.1371/journal.pone.0199461] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022] Open
Abstract
A chronic inflammatory state to a large extent explains sickle cell disease (SCD) pathophysiology. Nonetheless, the principal dysregulated factors affecting this major pathway and their mechanisms of action still have to be fully identified and elucidated. Integrating gene expression and genome-wide association study (GWAS) data analysis represents a novel approach to refining the identification of key mediators and functions in complex diseases. Here, we performed gene expression meta-analysis of five independent publicly available microarray datasets related to homozygous SS patients with SCD to identify a consensus SCD transcriptomic profile. The meta-analysis conducted using the MetaDE R package based on combining p values (maxP approach) identified 335 differentially expressed genes (DEGs; 224 upregulated and 111 downregulated). Functional gene set enrichment revealed the importance of several metabolic pathways, of innate immune responses, erythrocyte development, and hemostasis pathways. Advanced analyses of GWAS data generated within the framework of this study by means of the atSNP R package and SIFT tool identified 60 regulatory single-nucleotide polymorphisms (rSNPs) occurring in the promoter of 20 DEGs and a deleterious SNP, affecting CAMKK2 protein function. This novel database of candidate genes, transcription factors, and rSNPs associated with SCD provides new markers that may help to identify new therapeutic targets.
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Affiliation(s)
- Cherif Ben Hamda
- Laboratory of Bioinformatics, Biomathematics and Biostatistics, Institute Pasteur of Tunis, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
- Faculty of Science of Bizerte, Jarzouna, University of Carthage, Tunisia
- * E-mail: (KG); (CBH)
| | - Raphael Sangeda
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Liberata Mwita
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Siana Nkya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sumir Panji
- University of Cape Town, Cape Town, South Africa
| | | | - Lamia Guizani-Tabbane
- University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Medical Parasitology, Biotechnology and Biomolecules, Institute Pasteur of Tunis, Tunis, Tunisia
| | - Alia Benkahla
- Laboratory of Bioinformatics, Biomathematics and Biostatistics, Institute Pasteur of Tunis, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Julie Makani
- Faculty of Science of Bizerte, Jarzouna, University of Carthage, Tunisia
| | - Kais Ghedira
- Laboratory of Bioinformatics, Biomathematics and Biostatistics, Institute Pasteur of Tunis, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
- * E-mail: (KG); (CBH)
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26
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Nkya S, Mgaya J, Urio F, Makubi A, Thein SL, Menzel S, Cox SE, Newton CR, Kirkham FJ, Mmbando BP, Makani J. Fetal Hemoglobin is Associated with Peripheral Oxygen Saturation in Sickle Cell Disease in Tanzania. EBioMedicine 2017; 23:146-149. [PMID: 28844412 PMCID: PMC5605324 DOI: 10.1016/j.ebiom.2017.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/31/2017] [Accepted: 08/05/2017] [Indexed: 11/10/2022] Open
Abstract
Fetal hemoglobin (HbF) and peripheral hemoglobin oxygen saturation (SpO2) both predict clinical severity in sickle cell disease (SCD), while reticulocytosis is associated with vasculopathy, but there are few data on mechanisms. HbF, SpO2 and routine clinical and laboratory measures were available in a Tanzanian cohort of 1175 SCD individuals aged ≥ 5 years and the association with SpO2 (as response variable transformed to a Poisson distribution) was assessed by negative binomial model with age and sex as covariates. Increase in HbF was associated with increased SpO2 (rate ratio, RR = 1.19; 95% confidence intervals [CI] 1.04, 1.37 per natural log unit of HbF; p = 0.0004). In univariable analysis, SpO2 was inversely associated with age, reticulocyte count, and log (total bilirubin) and directly with pulse, SBP, hemoglobin, and log(HbF). In multivariable regression log(HbF) (RR 1.191; 95%CI 1.04, 1.37; p = 0.013), pulse (RR 1.01; 95%CI 1.00, 1.01; p = 0.026), SBP (RR 1.008; 95%CI 1.00, 1.02; p = 0.014), and hemoglobin (1.120; 95%CI 1.05, 1.19; p = 0.001) were positively and independently associated with SpO2 while reticulocyte count (RR 0.985; 95%CI 0.97, 0.99; p = 0.019) was independently inversely associated with SpO2. In SCD, improving SpO2, in part through cardiovascular compensation and associated with reduced reticulocytosis, may be a mechanism by which HbF reduces disease severity. Fetal hemoglobin may moderate sickle cell disease through increased oxygen saturation. Low oxygen saturation is associated with reticulocytosis which might moderate cerebral vasculopathy and stroke risk. Higher pulse rate and systolic blood pressure in those with higher SpO2 suggests cardiovascular compensation for low SpO2.
Fetal hemoglobin (HbF) is normally synthesized during intrauterine life and it starts to decline before birth being replaced by adult hemoglobin (HbA). However some individuals continue to synthesize HbF to adulthood and are relatively protected from severe sickle cell disease. The mechanism of HbF protection in SCD has not been entirely established. This study reports a positive association between HbF and oxygen saturation (SpO2). Higher SpO2 is associated with decreased reticulocytes but increased pulse rate and systolic blood pressure, suggesting SpO2 is maintained in part through cardiovascular compensation. Increasing HbF may reduce disease severity partly through increasing SpO2.
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Affiliation(s)
- Siana Nkya
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania; Dar-es-Salaam University College of Education, Dar-es-Salaam, Tanzania.
| | - Josephine Mgaya
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Florence Urio
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Abel Makubi
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Swee Lay Thein
- King's College London, Molecular Haematology, Division of Cancer Studies, UK; Sickle Cell Branch, National Heart, Lung and Blood Institute, The National Institutes of Health, USA
| | - Stephan Menzel
- King's College London, Molecular Haematology, Division of Cancer Studies, UK
| | - Sharon E Cox
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania; Graduate School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan; Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Charles R Newton
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania; Nuffield Department of Medicine, University of Oxford, UK
| | - Fenella J Kirkham
- UCL Great Oromnd Street Institute of Child Health, London, UK; Clinical and Experimental Sciences, University of Southampton, UK; Southampton Children's Hospital, UK
| | - Bruno P Mmbando
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania; National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Julie Makani
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania; Nuffield Department of Medicine, University of Oxford, UK
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27
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Ochola LB, Siddondo BR, Ocholla H, Nkya S, Kimani EN, Williams TN, Makale JO, Liljander A, Urban BC, Bull PC, Szestak T, Marsh K, Craig AG. Specific receptor usage in Plasmodium falciparum cytoadherence is associated with disease outcome. PLoS One 2011; 6:e14741. [PMID: 21390226 PMCID: PMC3048392 DOI: 10.1371/journal.pone.0014741] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 01/07/2011] [Indexed: 12/22/2022] Open
Abstract
Our understanding of the basis of severe disease in malaria is incomplete. It is clear that pathology is in part related to the pro-inflammatory nature of the host response but a number of other factors are also thought to be involved, including the interaction between infected erythrocytes and endothelium. This is a complex system involving several host receptors and a major parasite-derived variant antigen (PfEMP1) expressed on the surface of the infected erythrocyte membrane. Previous studies have suggested a role for ICAM-1 in the pathology of cerebral malaria, although these have been inconclusive. In this study we have examined the cytoadherence patterns of 101 patient isolates from varying clinical syndromes to CD36 and ICAM-1, and have used variant ICAM-1 proteins to further characterise this adhesive phenotype. Our results show that increased binding to CD36 is associated with uncomplicated malaria while ICAM-1 adhesion is raised in parasites from cerebral malaria cases.
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Affiliation(s)
- Lucy B Ochola
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya.
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28
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Mlingi N, Nkya S, Tatala S, Rashid S, Bradbury J. Recurrence of konzo in southern Tanzania: Rehabilitation and prevention using the wetting method. Food Chem Toxicol 2011; 49:673-7. [DOI: 10.1016/j.fct.2010.09.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 09/13/2010] [Accepted: 09/14/2010] [Indexed: 11/26/2022]
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