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Kaminski TW, Katoch O, Li Z, Hanway CB, Dubey RK, Alagbe A, Brzoska T, Zhang H, Sundd P, Kato GJ, Novelli EM, Pradhan-Sundd T. Impaired hemoglobin clearance by sinusoidal endothelium promotes vaso-occlusion and liver injury in sickle cell disease. Haematologica 2024; 109:1535-1550. [PMID: 37941440 PMCID: PMC11063870 DOI: 10.3324/haematol.2023.283792] [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: 06/21/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023] Open
Abstract
Sickle cell disease (SCD) is a monogenic disorder that affects 100,000 African-Americans and millions of people worldwide. Intra-erythrocytic polymerization of sickle hemoglobin (HbS) promotes erythrocyte sickling, impaired rheology, ischemia and hemolysis, leading to the development of progressive liver injury in SCD. Liver-resident macrophages and monocytes are known to enable the clearance of HbS; however, the role of liver sinusoidal endothelial cells (LSEC) in HbS clearance and liver injury in SCD remains unknown. Using real-time intravital (in vivo) imaging in mice liver as well as flow cytometric analysis and confocal imaging of primary human LSEC, we show for the first time that liver injury in SCD is associated with accumulation of HbS and iron in the LSEC, leading to senescence of these cells. Hemoglobin uptake by LSEC was mediated by micropinocytosis. Hepatic monocytes were observed to attenuate LSEC senescence by accelerating HbS clearance in the liver of SCD mice; however, this protection was impaired in P-selectin-deficient SCD mice secondary to reduced monocyte recruitment in the liver. These findings are the first to suggest that LSEC contribute to HbS clearance and HbS-induced LSEC senescence promotes progressive liver injury in SCD mice. Our results provide a novel insight into the pathogenesis of hemolysis-induced chronic liver injury in SCD caused by LSEC senescence. Identifying the regulators of LSEC-mediated HbS clearance may lead to new therapies to prevent the progression of liver injury in SCD.
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Affiliation(s)
- Tomasz W Kaminski
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Omika Katoch
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ziming Li
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Corrine B Hanway
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rikesh K Dubey
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Adekunle Alagbe
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Tomasz Brzoska
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Prithu Sundd
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Enrico M Novelli
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Tirthadipa Pradhan-Sundd
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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2
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Habibzadeh F. On the feasibility of malaria hypothesis. Sci Rep 2024; 14:5800. [PMID: 38461305 PMCID: PMC10924941 DOI: 10.1038/s41598-024-56515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/07/2024] [Indexed: 03/11/2024] Open
Abstract
In 1954, Allison proposed that hemoglobin S (HbS) gene causes protection against fatal malaria. This would explain the high HbS gene frequency observed in certain regions hyperendemic for malaria, so-called "malaria hypothesis". This in silico study was conducted to examine the feasibility of the hypothesis under more realistic initial conditions, where a mutant gene with heterozygous advantage against malaria (e.g., HbS) was introduced in a group of Neolithic hunter-gatherers who decided to start agriculture nearby water where malaria killed a proportion of population. The tribe population size, number of children born to each woman in each generation, mortality from malaria and sickle cell disease, the protection factor provided by the gene carriers against malaria, the probability of mating between the members of the parent and offspring populations, population growth, and increased fertility in women heterozygous for HbS, were also considered. For effectively confer protection against malaria within the shortest possible period, the mutation needs to be happened in a small population. For a large population, the process would take around 100 generations (~ 2500 years) or more to provide an effective protection. Even then, the probability that the new gene could survive and propagate to future generations is about 35%. Conventional population genetics equations with differential or difference equations, give totally incorrect estimates of the gene frequency in small populations; discrete mathematics should be used, instead. After introduction of the advantageous mutation, the gene frequency increased until a steady state value. This value is far less than the gene frequency reported in certain tribes of Africa. It seems that the malaria hypothesis, per se, could not explain such a high observed gene frequency, unless HbS is associated with lower mortality from other causes too.
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3
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Waye JS, Hanna M, Nakamura L, Walker L, Eng B, Nfonsam LE. Splice Acceptor Mutation [ HBB:c.93-2A > T] in a Patient with Hb S/β 0-Thalassemia. Hemoglobin 2024; 48:116-117. [PMID: 38360540 DOI: 10.1080/03630269.2024.2314075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
We report a case of Hb S/β0-thalassemia (Hb S/β0-thal) in a patient who is a compound heterozygote for the Hb Sickle mutation (HBB:c.20A > T) and a mutation of the canonical splice acceptor sequence of IVS1 (AG > TG, HBB:c.93-2A > T). This is the fifth mutation involving the AG splice acceptor site of IVS1, all of which prevent normal splicing and cause β0-thal.
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Affiliation(s)
- John S Waye
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Meredith Hanna
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
| | - Lisa Nakamura
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
| | - Lynda Walker
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
| | - Barry Eng
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Landry E Nfonsam
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
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4
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Kuczynski CE, Porada CD, Atala A, Cho SS, Almeida-Porada G. Evaluating sheep hemoglobins with MD simulations as an animal model for sickle cell disease. Sci Rep 2024; 14:276. [PMID: 38168584 PMCID: PMC10761887 DOI: 10.1038/s41598-023-50707-y] [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: 09/14/2022] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
Sickle cell disease (SCD) affects millions worldwide, yet there are few therapeutic options. To develop effective treatments, preclinical models that recapitulate human physiology and SCD pathophysiology are needed. SCD arises from a single Glu-to-Val substitution at position 6 in the β subunit of hemoglobin (Hb), promoting Hb polymerization and subsequent disease. Sheep share important physiological and developmental characteristics with humans, including the same developmental pattern of fetal to adult Hb switching. Herein, we investigated whether introducing the SCD mutation into the sheep β-globin locus would recapitulate SCD's complex pathophysiology by generating high quality SWISS-MODEL sheep Hb structures and performing MD simulations of normal/sickle human (huHbA/huHbS) and sheep (shHbB/shHbS) Hb, establishing how accurately shHbS mimics huHbS behavior. shHbS, like huHbS, remained stable with low RMSD, while huHbA and shHbB had higher and fluctuating RMSD. shHbB and shHbS also behaved identically to huHbA and huHbS with respect to β2-Glu6 and β1-Asp73 (β1-Asn72 in sheep) solvent interactions. These data demonstrate that introducing the single SCD-causing Glu-to-Val substitution into sheep β-globin causes alterations consistent with the Hb polymerization that drives RBC sickling, supporting the development of a SCD sheep model to pave the way for alternative cures for this debilitating, globally impactful disease.
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Affiliation(s)
| | | | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, 27101, USA
| | - Samuel S Cho
- Department of Physics, Wake Forest University, Winston-Salem, NC, 27109, USA.
- Department of Computer Science, Wake Forest University, Winston-Salem, NC, 27109, USA.
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5
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Almeida LEF, Smith ML, Kamimura S, Vogel S, Quezado ZMN. Calcium flux alterations in erythrocytes from sickle cell mice: The relevance of mean corpuscular volume. Blood Cells Mol Dis 2024; 104:102800. [PMID: 37951090 PMCID: PMC10842784 DOI: 10.1016/j.bcmd.2023.102800] [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: 10/23/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023]
Abstract
Red blood cells (RBC) from patients with sickle cell disease (SCD) have elevated calcium levels at baseline, which are further elevated upon deoxygenation. Here we examined baseline calcium levels and calcium flux in RBCs from a mouse model of SCD mice. We found that akin to humans with SCD, sickle (HbSS) Townes mice, have higher baseline levels and increased calcium flux in RBCs compared to control (HbAA) animals. As HbSS mice, unlike humans with SCD, have high mean corpuscular volume compared with HbAA, we highlight the importance of adjusting biochemical results to number of RBCs rather than hematocrit during the analysis and interpretation of the results. Our findings add to the face validity of humanized sickle cell mice and support its use for studies of RBC calcium flux in SCD.
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Affiliation(s)
- Luis E F Almeida
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Meghann L Smith
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sayuri Kamimura
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sebastian Vogel
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Zenaide M N Quezado
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
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6
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Palani CD, Zhu X, Alagar M, Attucks OC, Pace BS. Bach1 inhibitor HPP-D mediates γ-globin gene activation in sickle erythroid progenitors. Blood Cells Mol Dis 2024; 104:102792. [PMID: 37633023 DOI: 10.1016/j.bcmd.2023.102792] [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: 02/07/2023] [Revised: 07/14/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
Sickle cell disease (SCD) is the most common β-hemoglobinopathy caused by various mutations in the adult β-globin gene resulting in sickle hemoglobin production, chronic hemolytic anemia, pain, and progressive organ damage. The best therapeutic strategies to manage the clinical symptoms of SCD is the induction of fetal hemoglobin (HbF) using chemical agents. At present, among the Food and Drug Administration-approved drugs to treat SCD, hydroxyurea is the only one proven to induce HbF protein synthesis, however, it is not effective in all people. Therefore, we evaluated the ability of the novel Bach1 inhibitor, HPP-D to induce HbF in KU812 cells and primary sickle erythroid progenitors. HPP-D increased HbF and decreased Bach1 protein levels in both cell types. Furthermore, chromatin immunoprecipitation assay showed reduced Bach1 and increased NRF2 binding to the γ-globin promoter antioxidant response elements. We also observed increased levels of the active histone marks H3K4Me1 and H3K4Me3 supporting an open chromatin configuration. In primary sickle erythroid progenitors, HPP-D increased γ-globin transcription and HbF positive cells and reduced sickled erythroid progenitors under hypoxia conditions. Collectively, our data demonstrate that HPP-D induces γ-globin gene transcription through Bach1 inhibition and enhanced NRF2 binding in the γ-globin promoter antioxidant response elements.
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Affiliation(s)
- Chithra D Palani
- Division of Hematology/Oncology, Department of Pediatrics, Augusta University, Augusta, GA 30912, USA; Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Xingguo Zhu
- Division of Hematology/Oncology, Department of Pediatrics, Augusta University, Augusta, GA 30912, USA; Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Manickam Alagar
- Division of Hematology/Oncology, Department of Pediatrics, Augusta University, Augusta, GA 30912, USA; Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | | | - Betty S Pace
- Division of Hematology/Oncology, Department of Pediatrics, Augusta University, Augusta, GA 30912, USA; Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA.
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7
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Worth EH, Fugate MK, Grasty KC, Loll PJ, Bishop MF, Ferrone FA. An α-chain modification rivals the effect of fetal hemoglobin in retarding the rate of sickle cell fiber formation. Sci Rep 2023; 13:21997. [PMID: 38081985 PMCID: PMC10713580 DOI: 10.1038/s41598-023-48919-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
Adults with sickle cell disease bear a mutation in the β-globin gene, leading to the expression of sickle hemoglobin (HbS; α2βS2). Adults also possess the gene for γ-globin, which is a component of fetal hemoglobin (HbF, α2γ2); however, γ-chain expression normally ceases after birth. As HbF does not form the fibers that cause the disease, pharmacological and gene-modifying interventions have attempted to either reactivate expression of the γ chain or introduce a gene encoding a modified β chain having γ-like character. Here, we show that a single-site modification on the α chain, αPro114Arg, retards fiber formation as effectively as HbF. Because this addition to the repertoire of anti-sickling approaches acts independently of other modifications, it could be coupled with other therapies to significantly enhance their effectiveness.
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Affiliation(s)
- Eli H Worth
- Department of Physics, Drexel University, Philadelphia, PA, 19104, USA
| | - Mark K Fugate
- Department of Physics, Drexel University, Philadelphia, PA, 19104, USA
| | - Kimberly C Grasty
- Department of Biochemistry and Molecular Biology, Drexel University, Philadelphia, PA, 19102, USA
| | - Patrick J Loll
- Department of Biochemistry and Molecular Biology, Drexel University, Philadelphia, PA, 19102, USA
| | - Marilyn F Bishop
- Deparment of Physics, Virginia Commonwealth University, Richmond, VA, 23284-2000, USA
| | - Frank A Ferrone
- Department of Physics, Drexel University, Philadelphia, PA, 19104, USA.
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8
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Janda J, Hegert S, Bzdok J, Tesorero R, Holtkamp U, Burggraf S, Schuhmann E, Hörster F, Hoffmann GF, Janzen N, Okun JG, Becker M, Durner J. High Throughput Newborn Screening for Sickle Cell Disease - Application of Two-Tiered Testing with a qPCR-Based Primary screen. Klin Padiatr 2023; 235:366-372. [PMID: 37748509 PMCID: PMC10635756 DOI: 10.1055/a-2153-7789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a group of hemoglobinopathies with a common point mutation causing the production of sickle cell hemoglobin (HbS). In high-throughput newborn screening (NBS) for SCD, a two-step procedure is suitable, in which qPCR first pre-selects relevant samples that are differentiated by a second method. METHODS Three NBS centers using qPCR-based primary screening for SCD performed a laboratory comparison. Methods using tandem MS or HPLC were used for differentiation. RESULTS In a benchmarking test, 450 dried blood samples were analyzed. Samples containing HbS were detected as reliably by qPCR as by methods established for hemoglobinopathy testing. In a two-step screening approach, the 2nd-tier-analyses have to distinguish the carrier status from pathological variants. In nine months of regular screening, a total of 353,219 samples were analyzed using two-stage NBS procedures. The 1st-tier screening by qPCR reduced the number of samples for subsequent differentiation by>99.5%. Cases with carrier status or other variants were identified as inconspicuous while 78 cases with SCD were revealed. The derived incidence of 1:4,773, is in good agreement with previously published incidences. CONCLUSION In high-throughput NBS for SCD, qPCR is suitable to focus 2nd-tier analyses on samples containing HbS, while being unaffected by factors such as prematurity or transfusions. The substantial reduction of samples numbers positively impacts resource conservation, sustainability, and cost-effectiveness. No false negative cases came to attention.
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Affiliation(s)
- Joachim Janda
- Department of General Pediatrics, Division of Neuropediatrics and
Metabolic Medicine, University Hospital Heidelberg Center of Paediatric and
Adolescent Medicine, Heidelberg, Germany
| | | | | | - Rafael Tesorero
- Department of General Pediatrics, Division of Neuropediatrics and
Metabolic Medicine, University Hospital Heidelberg Center of Paediatric and
Adolescent Medicine, Heidelberg, Germany
| | - Ute Holtkamp
- Screening-Laboratory Hannover, Hannover, Germany
| | | | | | - Friedrike Hörster
- Department of General Pediatrics, Division of Neuropediatrics and
Metabolic Medicine, University Hospital Heidelberg Center of Paediatric and
Adolescent Medicine, Heidelberg, Germany
| | - Georg F. Hoffmann
- Department of General Pediatrics, Division of Neuropediatrics and
Metabolic Medicine, University Hospital Heidelberg Center of Paediatric and
Adolescent Medicine, Heidelberg, Germany
| | - Nils Janzen
- Screening-Laboratory Hannover, Hannover, Germany
- Dept. of Clinical Chemistry, Hannover Medical School, Hannover,
Germany
- Division of Laboratory Medicine, Kinderkrankenhaus auf der Bult,
Hannover, Germany
| | - Jürgen G Okun
- Department of General Pediatrics, Division of Neuropediatrics and
Metabolic Medicine, University Hospital Heidelberg Center of Paediatric and
Adolescent Medicine, Heidelberg, Germany
| | - Marc Becker
- Laboratory Becker & Colleagues, Munich, Germany
- Department of Conservative Dentistry and Periodontology, Ludwig
Maximilians University Munich, Munich, Germany
| | - Jürgen Durner
- Laboratory Becker & Colleagues, Munich, Germany
- Department of Conservative Dentistry and Periodontology, Ludwig
Maximilians University Munich, Munich, Germany
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Ilerhunmwuwa NP, Inyang L, Wasifuddin M, Aiwuyo H, Tahir M, Hakobyan N, Ankah P, Torere BE, Amaechi UM, Rayapureddy AK, Wang JC. Demographics and outcomes of hemoglobin genotype in hospitalized patients with COVID-19 and sickle cell disease in the United States. Eur J Haematol 2023; 111:611-619. [PMID: 37477175 DOI: 10.1111/ejh.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is associated with poor outcomes in sickle cell disease (SCD) patients. However, there is a paucity of data comparing hemoglobin (Hb) genotypes in SCD and infection outcomes. METHODS The National Inpatient Sample was used to identify the record of hospitalizations with COVID-19 and SCD in 2020 using the International Classification of Disease, Tenth Revision codes. Study outcomes (invasive mechanical ventilation, extracorporeal membrane oxygenation, shock, vasopressor use, measures of resource utilization, and in-hospital mortality) were compared between hemoglobin SS, SC, and S-beta thalassemia (Sβ). RESULTS Of the 102 975 COVID-19 hospitalizations with SCD, 87.26% had HbSS, 7.16% had HbSC, and 5.58% had HbSβ. Younger patients were more likely to have HbSS, while older patients were likely to have HbSC and HbSβ. HbSS was more frequent with Blacks, while HbSβ was more prevalent with Whites and Hispanics. Though measures of resource utilization were higher in HbSS, there was no significant difference in in-hospital outcomes between the three genotypes. CONCLUSION There is no difference in COVID-19 outcomes among Hb genotypes in SCD. Further studies are needed to explore the reasons for this observation.
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Affiliation(s)
- Nosakhare Paul Ilerhunmwuwa
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Lawrence Inyang
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Mustafa Wasifuddin
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Henry Aiwuyo
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Muhammad Tahir
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Narek Hakobyan
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Paul Ankah
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Beatrice E Torere
- Department of Internal Medicine, North Mississippi Medical Center, Tupelo, Mississippi, USA
| | - Uchenna M Amaechi
- Department of Internal Medicine, Lagos University Teaching Hospital, Surulere, Nigeria
| | | | - Jen Chin Wang
- Department of Hematology and Oncology, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
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10
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Li C, Georgakopoulou A, Newby GA, Chen PJ, Everette KA, Paschoudi K, Vlachaki E, Gil S, Anderson AK, Koob T, Huang L, Wang H, Kiem HP, Liu DR, Yannaki E, Lieber A. In vivo HSC prime editing rescues sickle cell disease in a mouse model. Blood 2023; 141:2085-2099. [PMID: 36800642 PMCID: PMC10163316 DOI: 10.1182/blood.2022018252] [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: 08/29/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Abstract
Sickle cell disease (SCD) is a monogenic disease caused by a nucleotide mutation in the β-globin gene. Current gene therapy studies are mainly focused on lentiviral vector-mediated gene addition or CRISPR/Cas9-mediated fetal globin reactivation, leaving the root cause unfixed. We developed a vectorized prime editing system that can directly repair the SCD mutation in hematopoietic stem cells (HSCs) in vivo in a SCD mouse model (CD46/Townes mice). Our approach involved a single intravenous injection of a nonintegrating, prime editor-expressing viral vector into mobilized CD46/Townes mice and low-dose drug selection in vivo. This procedure resulted in the correction of ∼40% of βS alleles in HSCs. On average, 43% of sickle hemoglobin was replaced by adult hemoglobin, thereby greatly mitigating the SCD phenotypes. Transplantation in secondary recipients demonstrated that long-term repopulating HSCs were edited. Highly efficient target site editing was achieved with minimal generation of insertions and deletions and no detectable off-target editing. Because of its simplicity and portability, our in vivo prime editing approach has the potential for application in resource-poor countries where SCD is prevalent.
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Affiliation(s)
- Chang Li
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
| | - Aphrodite Georgakopoulou
- Gene and Cell Therapy Center, Hematology Department, George Papanicolaou Hospital, Thessaloniki, Greece
| | - Gregory A. Newby
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA
| | - Peter J. Chen
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA
| | - Kelcee A. Everette
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA
| | - Kiriaki Paschoudi
- Gene and Cell Therapy Center, Hematology Department, George Papanicolaou Hospital, Thessaloniki, Greece
- School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Vlachaki
- Hematological Laboratory, Second Department of Internal Medicine, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Sucheol Gil
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
| | - Anna K. Anderson
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
| | - Theodore Koob
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
| | - Lishan Huang
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
| | - Hongjie Wang
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
| | - Hans-Peter Kiem
- Stem and Gene Therapy Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - David R. Liu
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA
| | - Evangelia Yannaki
- Gene and Cell Therapy Center, Hematology Department, George Papanicolaou Hospital, Thessaloniki, Greece
| | - André Lieber
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
- Department of Pathology, University of Washington, Seattle, WA
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11
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Ghaju S, Khadayat K, Shrestha R, Ghaju S, Manandhar T, Marasini BP. Knowledge and DdeI Based Confirmation of Sickle Cell Anemia Among the Tharu Community. J Nepal Health Res Counc 2022; 20:454-459. [PMID: 36550728 DOI: 10.33314/jnhrc.v20i02.4158] [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] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/03/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Sickle cell anemia is an inherited blood disorder caused due to a point mutation at the sixth codon of the ?-globin gene of both alleles. Sickle cell traits occur when the mutation is in one of the two alleles of the ?-globin genes. This study was carried out in the Tharu community, which is an indigenous and minority group mostly residing in the Terai region of Nepal. They are also considered as the most vulnerable group for inheriting Sickle cell anemia. METHODS Purposive sampling, which included 130 Tharu individuals of Kanchanpur district of Nepal, was considered for the study. The survey was conducted using a descriptive questionnaire that contained relevant information including the family history of Sickle cell anemia. This was followed by the analysis of blood samples to determine the prevalence of Sickle cell anemia and Sickle cell traits. Primer-mediated enzymatic amplification of target sequences in genomic DNA followed by restriction endonuclease assay with an enzyme DdeI was carried out for the confirmation. RESULTS Among 130 individuals, only 55.4% had basic knowledge about Sickle cell anemia. After screening for sickle cell anemia from 60 participants, 27 (45%) of them were found to be in the heterozygous state (carrier, Hb AS) and 28 (46.7%) were in the homozygous (normal, AA Hb) state with 5 (8.3%) having the diseased hemoglobin (Hb SS) variant of Sickle cell anemia. CONCLUSIONS This study demonstrated a high prevalence of Sickle cell anemia and Sickle cell traits in the Tharu community. This study may be beneficial for concerned personnel policymakers to reduce sickle cell cases by improving genetic literacy among the Tharu community.
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Affiliation(s)
- Sajani Ghaju
- Department of Biotechnology, National College, Tribhuvan University, Kathmandu, Nepal
| | - Karan Khadayat
- Department of Biotechnology, National College, Tribhuvan University, Kathmandu, Nepal
| | - Raju Shrestha
- Department of Microbiology, National College, Tribhuvan University, Kathmandu, Nepal
| | - Salan Ghaju
- Department of Biomedical Sciences, Kent State University, Ohio, USA
| | - Trishna Manandhar
- Department of Biotechnology, National College, Tribhuvan University, Kathmandu, Nepal
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12
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Gil GP, Ananina G, Maschietto M, Lima SCS, da Silva Costa SM, Baptista LDC, Ito MT, Costa FF, Costa ML, de Melo MB. Epigenetic analysis in placentas from sickle cell disease patients reveals a hypermethylation profile. PLoS One 2022; 17:e0274762. [PMID: 36129958 PMCID: PMC9491616 DOI: 10.1371/journal.pone.0274762] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
Pregnancy in Sickle Cell Disease (SCD) women is associated to increased risk of clinical and obstetrical complications. Placentas from SCD pregnancies can present increased abnormal findings, which may lead to placental insufficiency, favoring adverse perinatal outcome. These placental abnormalities are well known and reported, however little is known about the molecular mechanisms, such as epigenetics. Thus, our aim was to evaluate the DNA methylation profile in placentas from women with SCD (HbSS and HbSC genotypes), compared to uncomplicated controls (HbAA). We included in this study 11 pregnant women with HbSS, 11 with HbSC and 21 with HbAA genotypes. Illumina Methylation EPIC BeadChip was used to assess the whole placental DNA methylation. Pyrosequencing was used for array data validation and qRT-PCR was applied for gene expression analysis. Our results showed high frequency of hypermethylated CpGs sites in HbSS and HbSC groups with 73.5% and 76.2% respectively, when compared with the control group. Differentially methylated regions (DMRs) also showed an increased hypermethylation status for the HbSS (89%) and HbSC (86%) groups, when compared with the control group methylation data. DMRs were selected for methylation validation (4 DMRs-HbSS and 3 DMRs the HbSC groups) and after analyses three were validated in the HbSS group, and none in the HbSC group. The gene expression analysis showed differential expression for the PTGFR (-2.97-fold) and GPR56 (3.0-fold) genes in the HbSS group, and for the SPOCK1 (-2.40-fold) and ADCY4 (1.80-fold) genes in the HbSC group. Taken together, these data strongly suggest that SCD (HbSS and HbSC genotypes) can alter placental DNA methylation and lead to gene expression changes. These changes possibly contribute to abnormal placental development and could impact in the clinical course, especially for the fetus, possibly leading to increased risk of abortion, fetal growth restriction (FGR), stillbirth, small for gestational age newborns and prematurity.
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Affiliation(s)
- Gislene Pereira Gil
- Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
| | - Galina Ananina
- Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
| | | | | | - Sueli Matilde da Silva Costa
- Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
| | - Leticia de Carvalho Baptista
- Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
| | - Mirta Tomie Ito
- Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
| | | | - Maria Laura Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Mônica Barbosa de Melo
- Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
- * E-mail:
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Abstract
The landscape of sickle cell disease (SCD) treatment continues to evolve rapidly, with new disease-modifying therapies in development and potentially curative options on the horizon. Until recently, allogeneic stem cell transplant has been the only proven cure for SCD. Gene therapy is rising to the forefront of the discussion as a potentially curative or highly disease- modifying option for abating the complications of the disease. Understanding the different types of gene therapy in use, the differences in their end points, and their potential risks and benefits will be key to optimizing the long-term use of this therapy.
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Affiliation(s)
- Julie Kanter
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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14
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Masese RV, Bulgin D, Knisely MR, Preiss L, Stevenson E, Hankins JS, Treadwell MJ, King AA, Gordeuk VR, Kanter J, Gibson R, Glassberg JA, Tanabe P, Shah N. Sex-based differences in the manifestations and complications of sickle cell disease: Report from the Sickle Cell Disease Implementation Consortium. PLoS One 2021; 16:e0258638. [PMID: 34714833 PMCID: PMC8555833 DOI: 10.1371/journal.pone.0258638] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sex-based clinical outcome differences in sickle cell disease (SCD) remain largely unknown despite evidence that female sex is associated with an increased lifespan. To better characterize sex-based differences in SCD, we assessed pain, treatment characteristics, laboratory measures and complications among males and females currently enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. METHODS The SCDIC consists of eight comprehensive SCD centers and one data coordinating center that received funding from the National Heart Lung and Blood Institute to improve outcomes for individuals with SCD. Eligibility criteria included: 15 to 45 years of age and a confirmed diagnosis of SCD. Self-report surveys were completed and data were also abstracted from the participants' medical records. RESULTS A total of 2,124 participants were included (mean age: 27.8 years; 56% female). The majority had hemoglobin SS SCD genotype. Females had worse reports of pain severity (mean (SD) T-score 51.6 (9.6) vs 49.3 (10), p<0.001), more vaso-occlusive episodes (p = 0.01) and a higher occurrence of 3 or more hospital admissions in the past year (30.9% vs. 25.5, p = 0.03). On multivariable analysis, males had higher odds of acute chest syndrome (odds ratio (OR) 1.4, p = 0.002), cardiovascular (OR 1.70, p<0.001) and musculoskeletal (OR 1.33, p = 0.0034) complications and lower odds of depression (OR 0.77, p = 0.0381). Females had higher fetal hemoglobin levels with and without hydroxyurea use (9.6% vs 8.5%, p = 0.03 and 3% vs 2.2%, p = 0.0005, respectively). CONCLUSION Our data suggests that sex differences in clinical outcomes do occur among individuals with SCD. Future research needs to explore the mechanisms underlying these differences.
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Affiliation(s)
- Rita V. Masese
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Dominique Bulgin
- College of Nursing, University of Tennessee Knoxville, Knoxville, Tennessee, United States of America
| | - Mitchell R. Knisely
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Liliana Preiss
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Eleanor Stevenson
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Marsha J. Treadwell
- Department of Pediatrics, University of California San Francisco Benioff Children’s Hospital, Oakland, California, United States of America
| | - Allison A. King
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Victor R. Gordeuk
- University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Julie Kanter
- University of Alabama, Birmingham, Alabama, United States of America
| | - Robert Gibson
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, United States of America
| | - Jeffrey A. Glassberg
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Paula Tanabe
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Nirmish Shah
- School of Nursing, Duke University, Durham, North Carolina, United States of America
- School of Medicine, Duke University, Durham, North Carolina, United States of America
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Ebel ER, Kuypers FA, Lin C, Petrov DA, Egan ES. Common host variation drives malaria parasite fitness in healthy human red cells. eLife 2021; 10:e69808. [PMID: 34553687 PMCID: PMC8497061 DOI: 10.7554/elife.69808] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022] Open
Abstract
The replication of Plasmodium falciparum parasites within red blood cells (RBCs) causes severe disease in humans, especially in Africa. Deleterious alleles like hemoglobin S are well-known to confer strong resistance to malaria, but the effects of common RBC variation are largely undetermined. Here, we collected fresh blood samples from 121 healthy donors, most with African ancestry, and performed exome sequencing, detailed RBC phenotyping, and parasite fitness assays. Over one-third of healthy donors unknowingly carried alleles for G6PD deficiency or hemoglobinopathies, which were associated with characteristic RBC phenotypes. Among non-carriers alone, variation in RBC hydration, membrane deformability, and volume was strongly associated with P. falciparum growth rate. Common genetic variants in PIEZO1, SPTA1/SPTB, and several P. falciparum invasion receptors were also associated with parasite growth rate. Interestingly, we observed little or negative evidence for divergent selection on non-pathogenic RBC variation between Africans and Europeans. These findings suggest a model in which globally widespread variation in a moderate number of genes and phenotypes modulates P. falciparum fitness in RBCs.
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Affiliation(s)
- Emily R Ebel
- Department of Biology, Stanford UniversityStanfordUnited States
- Department of Pediatrics, Stanford University School of MedicineStanfordUnited States
| | - Frans A Kuypers
- Children's Hospital Oakland Research InstituteOaklandUnited States
| | - Carrie Lin
- Department of Pediatrics, Stanford University School of MedicineStanfordUnited States
| | - Dmitri A Petrov
- Department of Biology, Stanford UniversityStanfordUnited States
| | - Elizabeth S Egan
- Department of Pediatrics, Stanford University School of MedicineStanfordUnited States
- Department of Microbiology & Immunology, Stanford University School of MedicineStanfordUnited States
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16
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Akhter MS, Mobarki AA, Hamali HA, Saboor M, Madkhali AM, Dobie G, Hobani YH, Eisa ZM. Prevalence of β-S Globin Haplotypes in Jazan Region of Saudi Arabia. Clin Lab 2021; 67. [PMID: 34383420 DOI: 10.7754/clin.lab.2020.201205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a common hematological genetic disorder in Saudi Arabia, Africa, the Mediterranean region, and India. The present study aimed to characterize βS haplotypes found in the Jazan region, Saudi Arabia. METHODS One hundred sickle cell trait (SCT) individuals, diagnosed during their visit to the premarital screening clinic at King Fahad Central Hospital, were included in the study. Molecular analysis was carried out by polymerase chain reaction (PCR) and six polymorphic sites of the β-globin gene were analyzed using restriction endonucleases Hind II, Xmn-I, Hind III, and Ava II. RESULTS The results of the current study revealed the presence of five typical haplotypes in which Benin, Bantu, and Senegal were found in homozygous state with 29%, 3% and 1% frequencies, respectively. Interestingly, 29% of the studied population showed atypical haplotypes in heterozygous state and 2% in homozygous state for the first time in Jazan region. CONCLUSIONS In addition to the typical haplotypes, high frequency of atypical haplotypes in this study indicates a diverse genetic mechanism that might have a crucial effect on the severity of SCD in this region. Therefore, considering this study in a cohort population with SCD in Jazan region may provide more indepth details about the correlation between haplotypes and the clinical manifestation of the disease.
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17
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Khamees I, Ata F, Choudry H, Soliman AT, De Sanctis V, Yassin MA. Manifestations of HbSE sickle cell disease: a systematic review. J Transl Med 2021; 19:262. [PMID: 34134694 PMCID: PMC8207785 DOI: 10.1186/s12967-021-02931-1] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is commonly encountered in Africa and Middle Eastern countries. The causative mutation in the gene encoding the hemoglobin subunit β (HBB) leads to various genotypic variants of the disease. This results in varied phenotypes, with a spectrum of complications, from benign to fatal. Hemoglobin SS (HBSS) genotype is associated with most of these complications; hence, it is a severe form of SCD. On the other hand, rare genotypes such as hemoglobin SE (HBSE) are considered benign. There is limited literature about the clinical manifestations and characteristics of patients with HBSE. We pooled all available data describing the phenotypic manifestations of HBSE heterozygote worldwide to perform a systematic review. METHODS We performed a systematic review according to PRISMA guidelines using PubMed, SCOPUS, and Google Scholar databases. Two independent reviewers (FA and IK) evaluated studies for eligibility and extracted data. We synthesized data on demographics, manifestations, and management of HBSE disease. PROSPERO Registration Number: CRD42021229877. RESULTS We found 68 HBSE patients reported in the literature. 24 cases were extracted from case reports whereas 44 cases from case series and retrospective studies. Turkey reported the highest number of patients (n = 22). 32 (47%) of the patients were males. The mean age was 20.9 ± 18.26 years. The mean HBS and HBE percentages were 61.1% ± 7.25% and 32.3% ± 5.06%, respectively, whereas the mean hemoglobin was 11.64 ± 1.73 g/dl. Reported manifestations of HBSE disease included acute vaso-occlusive pain crisis (n = 22, 32.3%), splenomegaly (n = 11, 16.1%), hemolytic anemia (n = 10, 14.7%), infections (n = 8. 11.7%), bone infarction (n = 4, 5.8%), gallstones (n = 3, 4.4%), venous thromboembolism (VTE) (n = 2, 2.9%) and stroke (n = 2, 2.9%), and hematuria (n = 2, 2.9%). Death due to HBSE complications was reported in three patients. CONCLUSION HBSE is a rare genotypic variant of SCD. It has been considered a benign form; however, there are multiple reports of severe complications. Severe complications observed in HBSE disease include vaso-occlusive crisis, acute chest syndrome, stroke, bone marrow embolism, and death.
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Affiliation(s)
- Ibrahim Khamees
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, PO BOX 3050, Doha, Qatar
| | - Fateen Ata
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, PO BOX 3050, Doha, Qatar.
| | - Hassan Choudry
- Department of Internal Medicine, Faisalabad Medical University, Faisalabad, Pakistan
| | - Ashraf T Soliman
- Department of Paediatrics, University of Alexandria, Alexandria, Egypt
| | - Vincenzo De Sanctis
- Paediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Mohamed A Yassin
- Department of Medical Oncology/Hematology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Petersen JEV, Saelens JW, Freedman E, Turner L, Lavstsen T, Fairhurst RM, Diakité M, Taylor SM. Sickle-trait hemoglobin reduces adhesion to both CD36 and EPCR by Plasmodium falciparum-infected erythrocytes. PLoS Pathog 2021; 17:e1009659. [PMID: 34115805 PMCID: PMC8221791 DOI: 10.1371/journal.ppat.1009659] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/23/2021] [Accepted: 05/20/2021] [Indexed: 01/01/2023] Open
Abstract
Sickle-trait hemoglobin protects against severe Plasmodium falciparum malaria. Severe malaria is governed in part by the expression of the Plasmodium falciparum Erythrocyte Membrane Protein 1 (PfEMP1) that are encoded by var genes, specifically those variants that bind Endothelial Protein C Receptor (EPCR). In this study, we investigate the effect of sickle-trait on parasite var gene expression and function in vitro and in field-collected parasites. We mapped var gene reads generated from RNA sequencing in parasite cultures in normal and sickle-cell trait blood throughout the asexual lifecycle. We investigated sickle-trait effect on PfEMP1 interactions with host receptors CD36 and EPCR using static adhesion assays and flow cytometry. Var expression in vivo was compared by assembling var domains sequenced from total RNA in parasites infecting Malian children with HbAA and HbAS. Sickle-trait did not alter the abundance or type of var gene transcripts in vitro, nor the abundance of overall transcripts or of var functional domains in vivo. In adhesion assays using recombinant host receptors, sickle-trait reduced adhesion by 73-86% to CD36 and 83% to EPCR. Similarly, sickle-trait reduced the surface expression of EPCR-binding PfEMP1. In conclusion, Sickle-cell trait does not directly affect var gene transcription but does reduce the surface expression and function of PfEMP1. This provides a direct mechanism for protection against severe malaria conferred by sickle-trait hemoglobin. Trial Registration: ClinicalTrials.gov Identifier: NCT02645604.
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Affiliation(s)
- Jens E. V. Petersen
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
- * E-mail:
| | - Joseph W. Saelens
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Elizabeth Freedman
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Louise Turner
- Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Lavstsen
- Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Rick M. Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mahamadou Diakité
- Malaria Research and Training Center, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Steve M. Taylor
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Brewin JN, Rooks H, Gardner K, Senior H, Morje M, Patel H, Calvet D, Bartolucci P, Thein SL, Menzel S, Rees DC. Genome wide association study of silent cerebral infarction in sickle cell disease (HbSS and HbSC). Haematologica 2021; 106:1770-1773. [PMID: 33353285 PMCID: PMC8168512 DOI: 10.3324/haematol.2020.265827] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Indexed: 11/09/2022] Open
Abstract
Not available.
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Affiliation(s)
- John N Brewin
- Kings College London, UK; Kings College Hospital, London.
| | | | - Kate Gardner
- Kings College London, UK; Guys and St Thomas Hospital, London
| | | | | | | | | | | | | | | | - David C Rees
- Kings College London, UK; Kings College Hospital, London
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20
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Uchida N, Li L, Nassehi T, Drysdale CM, Yapundich M, Gamer J, Haro-Mora JJ, Demirci S, Leonard A, Bonifacino AC, Krouse AE, Linde NS, Allen C, Peshwa MV, De Ravin SS, Donahue RE, Malech HL, Tisdale JF. Preclinical evaluation for engraftment of CD34 + cells gene-edited at the sickle cell disease locus in xenograft mouse and non-human primate models. Cell Rep Med 2021; 2:100247. [PMID: 33948577 PMCID: PMC8080237 DOI: 10.1016/j.xcrm.2021.100247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/27/2020] [Accepted: 03/19/2021] [Indexed: 12/15/2022]
Abstract
Sickle cell disease (SCD) is caused by a 20A > T mutation in the β-globin gene. Genome-editing technologies have the potential to correct the SCD mutation in hematopoietic stem cells (HSCs), producing adult hemoglobin while simultaneously eliminating sickle hemoglobin. Here, we developed high-efficiency viral vector-free non-footprint gene correction in SCD CD34+ cells with electroporation to deliver SCD mutation-targeting guide RNA, Cas9 endonuclease, and 100-mer single-strand donor DNA encoding intact β-globin sequence, achieving therapeutic-level gene correction at DNA (∼30%) and protein (∼80%) levels. Gene-edited SCD CD34+ cells contributed corrected cells 6 months post-xenograft mouse transplant without off-target δ-globin editing. We then developed a rhesus β-to-βs-globin gene conversion strategy to model HSC-targeted genome editing for SCD and demonstrate the engraftment of gene-edited CD34+ cells 10-12 months post-transplant in rhesus macaques. In summary, gene-corrected CD34+ HSCs are engraftable in xenograft mice and non-human primates. These findings are helpful in designing HSC-targeted gene correction trials.
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Affiliation(s)
- Naoya Uchida
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
- Division of Molecular and Medical Genetics, Center for Gene and Cell Therapy, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | | | - Tina Nassehi
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Claire M. Drysdale
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Morgan Yapundich
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jackson Gamer
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Juan J. Haro-Mora
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Selami Demirci
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Alexis Leonard
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Allen E. Krouse
- Translational Stem Cell Biology Branch, NHLBI, NIH, Bethesda, MD, USA
| | - N. Seth Linde
- Translational Stem Cell Biology Branch, NHLBI, NIH, Bethesda, MD, USA
| | | | | | - Suk See De Ravin
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD, USA
| | - Robert E. Donahue
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Harry L. Malech
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD, USA
| | - John F. Tisdale
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institutes (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
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21
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Fares S, Hajjar S, Romana M, Connes P, Acomat M, Zorobabel C, Zuber K, Boulanger-Scemama E, Etienne-Julan M, David T, Beral L. Sickle Cell Maculopathy: Microstructural Analysis Using OCTA and Identification of Genetic, Systemic, and Biological Risk Factors. Am J Ophthalmol 2021; 224:7-17. [PMID: 33412123 DOI: 10.1016/j.ajo.2020.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE To identify genetic, systemic, and biological factors associated with the occurrence of sickle cell maculopathy (SCM). To evaluate microvascular macular alterations using optical coherence tomography angiography (OCTA) in sickle cell disease (SCD). DESIGN Cross-sectional study. METHODS One hundred fifty-one eyes of 78 adult SCD patients (43 HbSS, 30 HbSC, 4 S/β+, and 1 HbS Lepore) and 40 eyes of 20 healthy controls underwent spectral-domain optical coherence tomography (SDOCT) and OCTA using Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany). We analyzed the occurrence of SCM, the foveal avascular zone (FAZ) area, and the severity of macular ischemia and studied their relationships with genetic, systemic, and biological parameters using multivariate logistic regression analysis. RESULTS Maculopathy occurred in 66 eyes (44%), and more frequently in HbSS patients (71%, P = .004). Multivariate analysis identified HbSS genotype and lower prothrombin ratio (PR) as independently associated with SCM (P = .01). Proliferative sickle cell retinopathy was also associated with SCM (P = .02). FAZ enlargement was associated with higher lactate dehydrogenase level (P = .02). Macular ischemia was more severe in patients with lower hemoglobin level (P = .004) and lower PR (P = .01). No flow areas were identified with OCTA even in eyes with no macular thinning (36 eyes, 42%) and appeared more frequently in the temporal superior subfield (36%). CONCLUSIONS HbSS genotype, abnormal coagulation and hemolysis increase the risk of SCM. OCTA provides valuable criteria to identify potential risk factors of SCM. OCTA also improves detection of early microvascular changes before the onset of macular thinning.
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Affiliation(s)
- Selim Fares
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France.
| | - Sophie Hajjar
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Marc Romana
- Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France; Université des Antilles, UMR_S1134, BIGR, Pointe-à-Pitre, Guadeloupe, France; Laboratoire d'Excellence GR-Ex, Paris, France
| | - Philippe Connes
- Laboratoire d'Excellence GR-Ex, Paris, France; Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Université de Lyon, France
| | - Malik Acomat
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Coralie Zorobabel
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Kevin Zuber
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - Maryse Etienne-Julan
- Unité Transversale de la Drépanocytose, CHU de Pointe-à- Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Thierry David
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France; Université des Antilles, Guadeloupe (FWI), France
| | - Laurence Beral
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France; Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France; Université des Antilles, UMR_S1134, BIGR, Pointe-à-Pitre, Guadeloupe, France; Université des Antilles, Guadeloupe (FWI), France
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22
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Vats R, Liu S, Zhu J, Mukhi D, Tutuncuoglu E, Cardenes N, Singh S, Brzoska T, Kosar K, Bamne M, Jonassaint J, Michael AA, Watkins SC, Hillery C, Ma X, Nejak-Bowen K, Rojas M, Gladwin MT, Kato GJ, Ramakrishnan S, Sundd P, Monga SP, Pradhan-Sundd T. Impaired Bile Secretion Promotes Hepatobiliary Injury in Sickle Cell Disease. Hepatology 2020; 72:2165-2181. [PMID: 32190913 PMCID: PMC7923682 DOI: 10.1002/hep.31239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/22/2020] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Hepatic crisis is an emergent complication affecting patients with sickle cell disease (SCD); however, the molecular mechanism of sickle cell hepatobiliary injury remains poorly understood. Using the knock-in humanized mouse model of SCD and SCD patient blood, we sought to mechanistically characterize SCD-associated hepato-pathophysiology applying our recently developed quantitative liver intravital imaging, RNA sequence analysis, and biochemical approaches. APPROACH AND RESULTS SCD mice manifested sinusoidal ischemia, progressive hepatomegaly, liver injury, hyperbilirubinemia, and increased ductular reaction under basal conditions. Nuclear factor kappa B (NF-κB) activation in the liver of SCD mice inhibited farnesoid X receptor (FXR) signaling and its downstream targets, leading to loss of canalicular bile transport and altered bile acid pool. Intravital imaging revealed impaired bile secretion into the bile canaliculi, which was secondary to loss of canalicular bile transport and bile acid metabolism, leading to intrahepatic bile accumulation in SCD mouse liver. Blocking NF-κB activation rescued FXR signaling and partially ameliorated liver injury and sinusoidal ischemia in SCD mice. CONCLUSIONS These findings identify that NF-κB/FXR-dependent impaired bile secretion promotes intrahepatic bile accumulation, which contributes to hepatobiliary injury of SCD. Improved understanding of these processes could potentially benefit the development of therapies to treat sickle cell hepatic crisis.
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Affiliation(s)
- Ravi Vats
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Silvia Liu
- Dept. of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Junjie Zhu
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
| | - Dhanunjay Mukhi
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Egemen Tutuncuoglu
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nayra Cardenes
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sucha Singh
- Dept. of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Tomasz Brzoska
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Karis Kosar
- Dept. of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mikhil Bamne
- Sickle Cell Center for Excellence, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jude Jonassaint
- Sickle Cell Center for Excellence, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Simon C. Watkins
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Cheryl Hillery
- Sickle Cell Center for Excellence, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Xiaochao Ma
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kari Nejak-Bowen
- Dept. of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mauricio Rojas
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mark T Gladwin
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Sickle Cell Center for Excellence, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Gregory J Kato
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Sickle Cell Center for Excellence, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sadeesh Ramakrishnan
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Prithu Sundd
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Sickle Cell Center for Excellence, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Satdarshan Pal Monga
- Dept. of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Tirthadipa Pradhan-Sundd
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Sickle Cell Center for Excellence, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA
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Omar AM, Abdulmalik O, Ghatge MS, Muhammad YA, Paredes SD, El-Araby ME, Safo MK. An Investigation of Structure-Activity Relationships of Azolylacryloyl Derivatives Yielded Potent and Long-Acting Hemoglobin Modulators for Reversing Erythrocyte Sickling. Biomolecules 2020; 10:E1508. [PMID: 33147875 PMCID: PMC7693414 DOI: 10.3390/biom10111508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/25/2020] [Accepted: 10/30/2020] [Indexed: 12/27/2022] Open
Abstract
Aromatic aldehydes that bind to sickle hemoglobin (HbS) to increase the protein oxygen affinity and/or directly inhibit HbS polymer formation to prevent the pathological hypoxia-induced HbS polymerization and the subsequent erythrocyte sickling have for several years been studied for the treatment of sickle cell disease (SCD). With the exception of Voxelotor, which was recently approved by the U.S. Food and Drug Administration (FDA) to treat the disease, several other promising antisickling aromatic aldehydes have not fared well in the clinic because of metabolic instability of the aldehyde moiety, which is critical for the pharmacologic activity of these compounds. Over the years, our group has rationally developed analogs of aromatic aldehydes that incorporate a stable Michael addition reactive center that we hypothesized would form covalent interactions with Hb to increase the protein affinity for oxygen and prevent erythrocyte sickling. Although, these compounds have proven to be metabolically stable, unfortunately they showed weak to no antisickling activity. In this study, through additional targeted modifications of our lead Michael addition compounds, we have discovered other novel antisickling agents. These compounds, designated MMA, bind to the α-globin and/or β-globin to increase Hb affinity for oxygen and concomitantly inhibit erythrocyte sickling with significantly enhanced and sustained pharmacologic activities in vitro.
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Affiliation(s)
- Abdelsattar M. Omar
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, King Abdulaziz University, Alsulaymanyah, Jeddah 21589, Saudi Arabia; (Y.A.M.); (M.E.E.-A.)
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Al-Azhar University, Cairo 11884, Egypt
| | - Osheiza Abdulmalik
- Division of Hematology, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Mohini S. Ghatge
- Department of Medicinal Chemistry, School of Pharmacy and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, VA 23219, USA; (M.S.G.); (S.D.P.)
| | - Yosra A. Muhammad
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, King Abdulaziz University, Alsulaymanyah, Jeddah 21589, Saudi Arabia; (Y.A.M.); (M.E.E.-A.)
| | - Steven D. Paredes
- Department of Medicinal Chemistry, School of Pharmacy and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, VA 23219, USA; (M.S.G.); (S.D.P.)
| | - Moustafa E. El-Araby
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, King Abdulaziz University, Alsulaymanyah, Jeddah 21589, Saudi Arabia; (Y.A.M.); (M.E.E.-A.)
| | - Martin K. Safo
- Department of Medicinal Chemistry, School of Pharmacy and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, VA 23219, USA; (M.S.G.); (S.D.P.)
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24
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Barbanera Y, Arcioni F, Lancioni H, La Starza R, Cardinali I, Matteucci C, Nofrini V, Roetto A, Piga A, Grammatico P, Caniglia M, Mecucci C, Gorello P. Comprehensive analysis of mitochondrial and nuclear DNA variations in patients affected by hemoglobinopathies: A pilot study. PLoS One 2020; 15:e0240632. [PMID: 33091040 PMCID: PMC7581000 DOI: 10.1371/journal.pone.0240632] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022] Open
Abstract
The hemoglobin disorders are the most common single gene disorders in the world. Previous studies have suggested that they are deeply geographically structured and a variety of genetic determinants influences different clinical phenotypes between patients inheriting identical β-globin gene mutations. In order to get new insights into the heterogeneity of hemoglobin disorders, we investigated the molecular variations on nuclear genes (i.e. HBB, HBG2, BCL11A, HBS1L and MYB) and mitochondrial DNA control region. This pilot study was carried out on 53 patients belonging to different continents and molecularly classified in 4 subgroup: β-thalassemia (β+/β+, β0/β0 and β+/β0)(15), sickle cell disease (HbS/HbS)(20), sickle cell/β-thalassemia (HbS/β+ or HBS/β0)(10), and non-thalassemic compound heterozygous (HbS/HbC, HbO-Arab/HbC)(8). This comprehensive phylogenetic analysis provided a clear separation between African and European patients either in nuclear or mitochondrial variations. Notably, informing on the phylogeographic structure of affected individuals, this accurate genetic stratification, could help to optimize the diagnostic algorithm for patients with uncertain or unknown origin.
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Affiliation(s)
- Ylenia Barbanera
- Department of Medicine, Hematology, University of Perugia, Perugia, Italy
| | - Francesco Arcioni
- Pediatric Oncohematology, Hospital Santa Maria della Misericordia, Perugia, Italy
| | - Hovirag Lancioni
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - Roberta La Starza
- Department of Medicine, Hematology, University of Perugia, Perugia, Italy
| | - Irene Cardinali
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - Caterina Matteucci
- Department of Medicine, Hematology, University of Perugia, Perugia, Italy
| | - Valeria Nofrini
- Department of Medicine, Hematology, University of Perugia, Perugia, Italy
| | - Antonella Roetto
- Department of Clinical and Biological Sciences, University of Turin, Hospital San Luigi Gonzaga, Turin, Italy
| | - Antonio Piga
- Department of Clinical and Biological Sciences, University of Turin, Hospital San Luigi Gonzaga, Turin, Italy
| | - Paola Grammatico
- Department of Molecular Medicine, Laboratory of Medical Genetics, San Camillo-Forlanini Hospital, Sapienza University, Rome, Italy
| | - Maurizio Caniglia
- Pediatric Oncohematology, Hospital Santa Maria della Misericordia, Perugia, Italy
| | - Cristina Mecucci
- Department of Medicine, Hematology, University of Perugia, Perugia, Italy
| | - Paolo Gorello
- Department of Medicine, Hematology, University of Perugia, Perugia, Italy
- * E-mail:
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25
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Wang X, Xu JZ, Conrey A, Mendelsohn L, Shriner D, Pirooznia M, Thein SL. Whole genome sequence-based haplotypes reveal a single origin of the 1393 bp HBB deletion. J Med Genet 2020; 57:567-570. [PMID: 32001505 PMCID: PMC10692763 DOI: 10.1136/jmedgenet-2019-106698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/27/2019] [Accepted: 01/09/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Mutations of HBB give rise to two prevalent haemoglobin disorders-sickle cell disease (SCD) and β-thalassaemia. While SCD is caused by a single base substitution, nearly 300 mutations that downregulate expression of HBB have been described. The vast majority of β-thalassaemia alleles are point mutations or small insertion/deletions within the HBB gene; deletions causing β-thalassaemia are very rare. We have identified three individuals with haemoglobin Sβ0-thalassaemia in which the β0-thalassaemia mutation is caused by a large deletion. OBJECTIVE To use whole genome sequence data to determine whether these deletions arose from a single origin. METHODS We used two approaches to confirm unrelatedness: pairwise comparison of SNPs and identity by descent analysis. Eagle, V.2.4, was used to generate phased haplotypes for the 683 individuals. The Neighbor-Net method implemented in SplitsTree V.4.13.1 was used to construct the network of haplotypes. RESULTS All three deletions involved 1393 bp, encompassing the β-promoter, exons 1 and 2, and part of intron 2, with identical breakpoints. The cases were confirmed to be unrelated. Haplotypes based on 29 SNPs in the HBB cluster showed that the three individuals harboured different βS haplotypes. In contrast, the haplotype harbouring the 1393 bp deletion was the same in all three individuals. CONCLUSION We suggest that all the reported cases of the 1393 bp HBB deletion, including the three cases here, are likely to be of the same ancestral origin.
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Affiliation(s)
- Xunde Wang
- Sickle Cell Branch, NIH, Bethesda, Maryland, USA
| | - Julia Z Xu
- Sickle Cell Branch, NIH, Bethesda, Maryland, USA
| | - Anna Conrey
- Sickle Cell Branch, NIH, Bethesda, Maryland, USA
| | | | - Daniel Shriner
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Mehdi Pirooznia
- Bioinformatics and Computational Biology, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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26
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Sparkenbaugh EM, Chen C, Brzoska T, Nguyen J, Wang S, Vercellotti GM, Key NS, Sundd P, Belcher JD, Pawlinski R. Thrombin activation of PAR-1 contributes to microvascular stasis in mouse models of sickle cell disease. Blood 2020; 135:1783-1787. [PMID: 31977004 PMCID: PMC7225686 DOI: 10.1182/blood.2019003543] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 09/30/2019] [Accepted: 01/08/2020] [Indexed: 12/30/2022] Open
Abstract
Vaso-occlusive crisis (VOC) is the primary cause of morbidity and hospitalization in sickle cell disease (SCD); however, only 4 therapies (hydroxyurea, l-glutamine, crizanlizumab, and voxeletor) are currently approved in SCD. These agents limit the duration, severity, and frequency of crises. Activation of coagulation is a hallmark of SCD. Studies in animal models of SCD have shown that coagulation contributes to the chronic inflammation and end-organ damage associated with the disease; however, it is unknown whether coagulation directly contributes to the microvascular stasis that causes VOC. Herein, we demonstrate that inhibition of tissue factor (TF) and the downstream coagulation proteases factor Xa and thrombin significantly attenuates heme-induced microvascular stasis in mouse models of VOC. Pharmacologic inhibition of the principal thrombin receptor, protease activated receptor-1 (PAR-1), as well as deficiency of PAR-1 in all nonhematopoietic cells, also reduces stasis in sickle mice. PAR-1 deficiency was associated with reduced endothelial von Willebrand factor expression, which has been shown to mediate microvascular stasis. In addition, TF inhibition reduces lung vaso-occlusion in sickle mice mediated by arteriolar neutrophil-platelet microemboli. In sum, these results suggest that prophylactic anticoagulation might attenuate the incidence of VOC.
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MESH Headings
- Anemia, Sickle Cell/complications
- Anemia, Sickle Cell/genetics
- Anemia, Sickle Cell/metabolism
- Anemia, Sickle Cell/pathology
- Animals
- Blood Coagulation Disorders/etiology
- Blood Coagulation Disorders/genetics
- Blood Coagulation Disorders/metabolism
- Blood Platelets/metabolism
- Constriction, Pathologic/genetics
- Constriction, Pathologic/metabolism
- Disease Models, Animal
- Female
- Hemoglobin, Sickle/genetics
- Humans
- Male
- Mice
- Mice, Transgenic
- Microvessels/metabolism
- Microvessels/pathology
- Receptor, PAR-1/genetics
- Receptor, PAR-1/metabolism
- Thrombin/metabolism
- Vascular Diseases/etiology
- Vascular Diseases/metabolism
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Affiliation(s)
- Erica M Sparkenbaugh
- UNC Blood Research Center, Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Chunsheng Chen
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN; and
| | - Tomasz Brzoska
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute and
| | - Julia Nguyen
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN; and
| | - Shaobin Wang
- UNC Blood Research Center, Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gregory M Vercellotti
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN; and
| | - Nigel S Key
- UNC Blood Research Center, Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Prithu Sundd
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute and
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - John D Belcher
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN; and
| | - Rafal Pawlinski
- UNC Blood Research Center, Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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27
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Ataga KI, Gordeuk VR, Agodoa I, Colby JA, Gittings K, Allen IE. Low hemoglobin increases risk for cerebrovascular disease, kidney disease, pulmonary vasculopathy, and mortality in sickle cell disease: A systematic literature review and meta-analysis. PLoS One 2020; 15:e0229959. [PMID: 32243480 PMCID: PMC7122773 DOI: 10.1371/journal.pone.0229959] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/17/2020] [Indexed: 12/20/2022] Open
Abstract
Sickle cell disease (SCD) is characterized by deoxygenation-induced polymerization of hemoglobin in red blood cells, leading to hemolytic anemia, vaso-occlusion, and the development of multiple clinical complications. To characterize the clinical burden associated with differences in hemoglobin concentration and hemolysis measures, a systematic literature review of MEDLINE, EMBASE, and related meta-analyses was undertaken. For quantitative analyses related to hemoglobin concentration, pooled results were analyzed using random effects models to control for within-and between-study variability. To derive risk ratios associated with hemoglobin concentration change, we combined ratios of means from select studies, which reported hazard and odds ratios in meta-analyses for hemoglobin concentration-related outcomes and changes between groups. Forty-one studies were identified for inclusion based on relating hemoglobin concentration to clinical outcomes. Meta-analyses demonstrated that mean hemoglobin concentration was significantly lower in patients with cerebrovascular disease (0.4 g/dL), increased transcranial Doppler velocity in cerebral arteries (0.6 g/dL), albuminuria (0.6 g/dL), elevated estimated pulmonary artery systolic pressure (0.9 g/dL), and in patients that subsequently died (0.6 g/dL). In a risk reduction meta-analysis, modeled increased hemoglobin concentrations of 1 g/dL or greater resulted in decreased risk of negative clinical outcomes of 41% to 64%. In conclusion, chronic anemia is associated with worse clinical outcomes in individuals with SCD and even modest increases in hemoglobin concentration may be beneficial in this patient population. This systematic review has been registered on Prospero (Registration number CRD42018096860; https://www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- Kenneth I. Ataga
- University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Victor R. Gordeuk
- University of Illinois at Chicago College of Medicine, Chicago, IL, United States of America
| | - Irene Agodoa
- GBT, South San Francisco, CA, United States of America
| | | | | | - Isabel E. Allen
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
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28
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da Guarda CC, Yahouédéhou SCMA, Santiago RP, Neres JSDS, Fernandes CFDL, Aleluia MM, Figueiredo CVB, Fiuza LM, Carvalho SP, de Oliveira RM, Fonseca CA, Ndidi US, Nascimento VML, Rocha LC, Goncalves MS. Sickle cell disease: A distinction of two most frequent genotypes (HbSS and HbSC). PLoS One 2020; 15:e0228399. [PMID: 31995624 PMCID: PMC6988974 DOI: 10.1371/journal.pone.0228399] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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: 10/21/2019] [Accepted: 01/14/2020] [Indexed: 01/08/2023] Open
Abstract
Sickle cell disease (SCD) consists of a group of hemoglobinopathies in which individuals present highly variable clinical manifestations. Sickle cell anemia (SCA) is the most severe form, while SC hemoglobinopathy (HbSC) is thought to be milder. Thus, we investigated the clinical manifestations and laboratory parameters by comparing each SCD genotype. We designed a cross-sectional study including 126 SCA individuals and 55 HbSC individuals in steady-state. Hematological, biochemical and inflammatory characterization was performed as well as investigation of previous history of clinical events. SCA patients exhibited most prominent anemia, hemolysis, leukocytosis and inflammation, whereas HbSC patients had increased lipid determinations. The main cause of hospitalization was pain crises on both genotypes. Vaso-occlusive events and pain crises were associated with hematological, inflammatory and anemia biomarkers on both groups. Cluster analysis reveals hematological, inflammatory, hemolytic, endothelial dysfunction and anemia biomarkers in HbSC disease as well as SCA. The results found herein corroborate with previous studies suggesting that SCA and HbSC, although may be similar from the genetic point of view, exhibit different clinical manifestations and laboratory alterations which are useful to monitor the clinical course of each genotype.
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Affiliation(s)
- Caroline Conceição da Guarda
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brasil
| | | | - Rayra Pereira Santiago
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brasil
| | - Joelma Santana dos Santos Neres
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brasil
| | - Camila Felix de Lima Fernandes
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brasil
| | | | - Camylla Vilas Boas Figueiredo
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brasil
| | - Luciana Magalhães Fiuza
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brasil
| | - Suellen Pinheiro Carvalho
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brasil
| | - Rodrigo Mota de Oliveira
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brasil
| | - Cleverson Alves Fonseca
- Laboratório de Pesquisa em Anemias, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| | - Uche Samuel Ndidi
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brasil
| | | | - Larissa Carneiro Rocha
- Fundação de Hematologia e Hemoterapia do Estado da Bahia, HEMOBA, Salvador, Bahia, Brasil
| | - Marilda Souza Goncalves
- Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brasil
- * E-mail:
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Ortega DC, Cárdenas H, Barreto G. Joint selection for two malaria resistance mutations in a south-west Colombian population. Infect Genet Evol 2020; 80:104188. [PMID: 31927074 DOI: 10.1016/j.meegid.2020.104188] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 11/19/2022]
Abstract
In regions with an Afro-descendant population and where malaria is endemic, high frequencies of polymorphisms have been found that confer resistance to this disease, such as the haemoglobin S (HbS) and Duffy genes, which provide resistance to P. falciparum and P. vivax infection, respectively. The objective of this study was to evaluate the individual and joint selection actions of these two genes in an Afro-descendant Colombian population. A total of 819 individuals were analysed using stratified random sampling. PCR-RFLP and Hardy-Weinberg equilibrium deviation analysis (H-W eq.), linkage disequilibrium (LD), D'IS2 and D'ST2 indexes, neutrality tests, correlations and fitness were performed using Arlequin 3.5.2.2 and R 3.4.1 software. In general, the population showed neutrality and H-W eq. for the HbS gene but not for the Duffy gene (FYA/FYB, FYA/FYBES and FYB/FYBES genotypes were responsible for this deviation). LD between the HbS locus and the promoter region of the Duffy gene, a value D'IS2 = 0.001 and D'ST2 = 0.020 was found, an increase in fitness of the AS*FYBES/FYBES genotype combination (marked in adolescents and adults), and a strong correlation between these genotypes (Rho = 90%, p = .001) were found, evidencing a possible joint selection action for these two alleles. This work presents evidence of the action of natural selection, both individually and jointly, on malaria resistance genes, HbS and Duffy, in the Buenaventura population.
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Affiliation(s)
- Diana Carolina Ortega
- Human Molecular Genetics Group, Department of Biology, Universidad del Valle, Cali, Colombia
| | - Heiber Cárdenas
- Human Molecular Genetics Group, Department of Biology, Universidad del Valle, Cali, Colombia
| | - Guillermo Barreto
- Human Molecular Genetics Group, Department of Biology, Universidad del Valle, Cali, Colombia.
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de Martino CC, Alencar CS, Loureiro P, Carneiro-Proietti ABDF, Máximo CDA, Mota RA, Rodrigues DOW, Gaburo Junior N, Kelly S, Sabino EC. Use of an automated pyrosequencing technique for confirmation of sickle cell disease. PLoS One 2019; 14:e0216020. [PMID: 31830127 PMCID: PMC6907837 DOI: 10.1371/journal.pone.0216020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/26/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The diagnosis of sickle cell disease (SCD) is made by hemoglobin assays such as high-performance liquid chromatography (HPLC), isoelectric focusing and cellulose acetate or citrate agar electrophoresis. These assays are easy to perform and used in large-scale newborn screening in many countries. These tests however may not easily differentiate Sβ0 thalassemia from SS or identify other hemoglobin variants, and in this case, hemoglobin (HBB) gene sequencing may be necessary. OBJECTIVES To develop a high throughput DNA based confirmatory assay for SCD and to detect mutations in the HBB gene. METHODS We developed an automated pyrosequencing technique (PyS) based on QIAGEN technology (Hilden, Germany) to detect homozygous or heterozygous hemoglobin S mutations as well as hemoglobin C mutations. The technique was tested on 2,748 samples from patients enrolled in a multi-center SCD cohort in Brazil. Patients were previously tested using HPLC to diagnose SCD as part of routine clinical care. Any subjects with discrepant results between HPLC and PyS or with heterozygous hemoglobin S detected had Sanger sequencing of the HBB gene. RESULTS We identified 168 samples with discrepant results between HPLC and PyS and 100 with concordant PyS = heterozygous S and HPLC, which would suggest SB-thalassemia or other heterozygous S variants. The PyS assay correctly identified 1906 (98.7%) of the 1930 HbSS and 628 (98.7%) of the 636 HbSC samples. Of the 179 remaining samples, PyS correctly indicated S heterozygosis in 165 (92.2%). Of the 165 heterozygous S samples confirmed by Sanger as consistent with Sβ thalassemia genotype, 84 samples were classified as Sβ0 thalassemia and 81 as Sβ+ thalassemia. The most frequent beta thalassemia mutations of Sβ0 and Sβ+ were HBB: c.118C>T (Gln40Stop) and HBB c.92 + 6T> C, respectively. DISCUSSION The PyS proved to be satisfactory for large-scale confirmatory testing of hemoglobin mutation. Moreover, with this study we were able to describe the most common β+ and β0 mutations in SCD patients with Sβ-thalassemia in a large multi-institutional SCD cohort in Brazil.
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Affiliation(s)
- Camila Cruz de Martino
- Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, LIM 46, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cecilia Salete Alencar
- Laboratório de Investigacao Medica, LIM 03, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Nelson Gaburo Junior
- Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, LIM 46, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, California, United States of America
- UCSF Benioff Children’s Hospital Oakland, Oakland, California, United States of America
| | - Ester Cerdeira Sabino
- Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, LIM 46, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- * E-mail:
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Caughey MC, Derebail VK, Key NS, Reiner AP, Gottesman RF, Kshirsagar AV, Heiss G. Thirty-year risk of ischemic stroke in individuals with sickle cell trait and modification by chronic kidney disease: The atherosclerosis risk in communities (ARIC) study. Am J Hematol 2019; 94:1306-1313. [PMID: 31429114 PMCID: PMC6858511 DOI: 10.1002/ajh.25615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/29/2019] [Accepted: 08/08/2019] [Indexed: 12/20/2022]
Abstract
Sickle cell trait (SCT) has been associated with hypercoagulability, chronic kidney disease (CKD), and ischemic stroke. Whether concomitant CKD modifies long-term ischemic stroke risk in individuals with SCT is uncertain. We analyzed data from 3602 genotyped black adults (female = 62%, mean baseline age = 54 years) who were followed for a median 26 years by the Atherosclerosis Risk in Communities Study. Ischemic stroke was verified by physician review. Associations between SCT and ischemic stroke were analyzed using repeat-events Cox regression, adjusted for potential confounders. SCT was identified in 236 (7%) participants, who more often had CKD at baseline than noncarriers (18% vs 13%, P = .02). Among those with CKD, elevated factor VII activity was more prevalent with SCT genotype (36% vs 22%; P = .05). From 1987-2017, 555 ischemic strokes occurred in 436 individuals. The overall hazard ratio of ischemic stroke associated with SCT was 1.31 (95% CI: 0.95-1.80) and was stronger in participants with concomitant CKD (HR = 2.18; 95% CI: 1.16-4.12) than those without CKD (HR = 1.09; 95% CI: 0.74-1.61); P for interaction = .04. The hazard ratio of composite ischemic stroke and/or death associated with SCT was 1.20 (95% CI: 1.01-1.42) overall, 1.44 (95% CI: 1.002-2.07) among those with CKD, and 1.15 (95% CI: 0.94-1.39) among those without CKD; P for interaction = .18. The long-term risk of ischemic stroke associated with SCT relative to noncarrier genotype appears to be modified by concomitant CKD.
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Affiliation(s)
- Melissa C. Caughey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vimal K. Derebail
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nigel S. Key
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Abhijit V. Kshirsagar
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Detterich JA, Liu H, Suriany S, Kato RM, Chalacheva P, Tedla B, Shah PM, Khoo MC, Wood JC, Coates TD, Milne GL, Oh JY, Patel RP, Forman HJ. Erythrocyte and plasma oxidative stress appears to be compensated in patients with sickle cell disease during a period of relative health, despite the presence of known oxidative agents. Free Radic Biol Med 2019; 141:408-415. [PMID: 31279092 PMCID: PMC6750280 DOI: 10.1016/j.freeradbiomed.2019.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/03/2019] [Accepted: 07/03/2019] [Indexed: 01/17/2023]
Abstract
Sickle cell disease (SCD) is a monogenetic disease that results in the formation of hemoglobin S. Due to more rapid oxidation of hemoglobin S due to intracellular heme and adventitious iron in SCD, it has been thought that an inherent property of SCD red cells would be an imbalance in antioxidant defenses and oxidant production. Less deformable and fragile RBC in SCD results in intravascular hemolysis and release of free hemoglobin (PFHb) in the plasma, which might be expected to produce oxidative stress in the plasma. Thus, we aimed to characterize intracellular and vascular oxidative stress in whole blood and plasma samples from adult SCD patients and controls recruited into a large study of SCD at Children's Hospital of Los Angeles. We evaluated the cellular content of metHb and several components of the antioxidant system in RBC as well as oxidation of GSH and Prx-2 oxidation in RBC after challenge with hydroperoxides. Plasma markers included PFHb, low molecular weight protein bound heme (freed heme), hemopexin, isoprostanes, and protein carbonyls. While GSH was slightly lower in SCD RBC, protein carbonyls, NADH, NAD+ and total NADP+ + NADPH were not different. Furthermore, GSH or Prx-2 oxidation was not different after oxidative challenge in SCD vs. Control. Elevated freed heme and PFHb had a significant negative, non-linear association with hemopexin. There appeared to be a threshold effect for hemopexin (200 μg/ml), under which the freed heme rose acutely. Plasma F2-isoprostanes were not significantly elevated in SCD. Despite significant release of Hb and elevation of freed heme in SCD when hemopexin was apparently saturated, there was no clear indication of uncompensated vascular oxidative stress. This somewhat surprising result, suggests that oxidative stress is well compensated in RBCs and plasma during a period of relative health.
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Affiliation(s)
- Jon A Detterich
- Division of Cardiology, Children's Hospital of Los Angeles, USA.
| | - Honglei Liu
- Division of Cardiology, Children's Hospital of Los Angeles, USA
| | - Silvie Suriany
- Division of Cardiology, Children's Hospital of Los Angeles, USA; Division of Hematology, Children's Hospital of Los Angeles, USA
| | | | | | - Bruke Tedla
- Division of Cardiology, Children's Hospital of Los Angeles, USA
| | - Payal M Shah
- Division of Hematology, Children's Hospital of Los Angeles, USA
| | - Michael C Khoo
- Viterbi School of Engineering, University of Southern California, USA
| | - John C Wood
- Division of Cardiology, Children's Hospital of Los Angeles, USA; Viterbi School of Engineering, University of Southern California, USA
| | - Thomas D Coates
- Division of Hematology, Children's Hospital of Los Angeles, USA
| | - Ginger L Milne
- Division of Clinical Pharmacology, Vanderbilt University, USA
| | - Joo-Yeun Oh
- Department of Pathology and Center for Free Radical Biology, University of Alabama School of Medicine, USA
| | - Rakesh P Patel
- Department of Pathology and Center for Free Radical Biology, University of Alabama School of Medicine, USA
| | - Henry Jay Forman
- Leonard Davis School of Gerontology, University of Southern California, USA
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Leong A, Chen J, Wheeler E, Hivert MF, Liu CT, Merino J, Dupuis J, Tai ES, Rotter JI, Florez JC, Barroso I, Meigs JB. Mendelian Randomization Analysis of Hemoglobin A 1c as a Risk Factor for Coronary Artery Disease. Diabetes Care 2019; 42:1202-1208. [PMID: 30659074 PMCID: PMC6609962 DOI: 10.2337/dc18-1712] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/18/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Observational studies show that higher hemoglobin A1c (A1C) predicts coronary artery disease (CAD). It remains unclear whether this association is driven entirely by glycemia. We used Mendelian randomization (MR) to test whether A1C is causally associated with CAD through glycemic and/or nonglycemic factors. RESEARCH DESIGN AND METHODS To examine the association of A1C with CAD, we selected 50 A1C-associated variants (log10 Bayes factor ≥6) from an A1C genome-wide association study (GWAS; n = 159,940) and performed an inverse-variance weighted average of variant-specific causal estimates from CAD GWAS data (CARDIoGRAMplusC4D; 60,801 CAD case subjects/123,504 control subjects). We then replicated results in UK Biobank (18,915 CAD case subjects/455,971 control subjects) and meta-analyzed all results. Next, we conducted analyses using two subsets of variants, 16 variants associated with glycemic measures (fasting or 2-h glucose) and 20 variants associated with erythrocyte indices (e.g., hemoglobin [Hb]) but not glycemic measures. In additional MR analyses, we tested the association of Hb with A1C and CAD. RESULTS Genetically increased A1C was associated with higher CAD risk (odds ratio [OR] 1.61 [95% CI 1.40, 1.84] per %-unit, P = 6.9 × 10-12). Higher A1C was associated with increased CAD risk when using only glycemic variants (OR 2.23 [1.73, 2.89], P = 1.0 × 10-9) and when using only erythrocytic variants (OR 1.30 [1.08, 1.57], P = 0.006). Genetically decreased Hb, with concomitantly decreased mean corpuscular volume, was associated with higher A1C (0.30 [0.27, 0.33] %-unit, P = 2.9 × 10-6) per g/dL and higher CAD risk (OR 1.19 [1.04, 1.37], P = 0.02). CONCLUSIONS Genetic evidence supports a causal link between higher A1C and higher CAD risk. This relationship is driven not only by glycemic but also by erythrocytic, glycemia-independent factors.
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Affiliation(s)
- Aaron Leong
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Ji Chen
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, U.K
| | - Eleanor Wheeler
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, U.K
| | - Marie-France Hivert
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Jordi Merino
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Jose C Florez
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Inês Barroso
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, U.K
| | - James B Meigs
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
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Uyoga S, Macharia AW, Ndila CM, Nyutu G, Shebe M, Awuondo KO, Mturi N, Peshu N, Tsofa B, Scott JAG, Maitland K, Williams TN. The indirect health effects of malaria estimated from health advantages of the sickle cell trait. Nat Commun 2019; 10:856. [PMID: 30787300 PMCID: PMC6382840 DOI: 10.1038/s41467-019-08775-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 09/06/2018] [Accepted: 01/29/2019] [Indexed: 12/01/2022] Open
Abstract
Most estimates of the burden of malaria are based on its direct impacts; however, its true burden is likely to be greater because of its wider effects on overall health. Here we estimate the indirect impact of malaria on children's health in a case-control study, using the sickle cell trait (HbAS), a condition associated with a high degree of specific malaria resistance, as a proxy indicator for an effective intervention. We estimate the odds ratios for HbAS among cases (all children admitted to Kilifi County Hospital during 2000-2004) versus community controls. As expected, HbAS protects strongly against malaria admissions (aOR 0.26; 95%CI 0.22-0.31), but it also protects against other syndromes, including neonatal conditions (aOR 0.79; 0.67-0.93), bacteraemia (aOR 0.69; 0.54-0.88) and severe malnutrition (aOR 0.67; 0.55-0.83). The wider health impacts of malaria should be considered when estimating the potential added benefits of effective malaria interventions.
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Affiliation(s)
- Sophie Uyoga
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
| | - Alex W Macharia
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
| | - Carolyne M Ndila
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
| | - Gideon Nyutu
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
| | - Mohammed Shebe
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
| | - Kennedy O Awuondo
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
| | - Neema Mturi
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
| | - Norbert Peshu
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
| | - Benjamin Tsofa
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
| | - J Anthony G Scott
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Kathryn Maitland
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya
- Department of Medicine, Imperial College, St Mary's Hospital, London, W21NY, UK
| | - Thomas N Williams
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, 80108, Kenya.
- Department of Medicine, Imperial College, St Mary's Hospital, London, W21NY, UK.
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Grignard L, Mair C, Curry J, Mahey L, Bastiaens GJH, Tiono AB, Okebe J, Coulibaly SA, Gonçalves BP, Affara M, Ouédraogo A, Bougouma EC, Sanou GS, Nébié I, Lanke KHW, Sirima SB, d'Alessandro U, Clark TG, Campino S, Bousema T, Drakeley C. Bead-based assays to simultaneously detect multiple human inherited blood disorders associated with malaria. Malar J 2019; 18:14. [PMID: 30665411 PMCID: PMC6341711 DOI: 10.1186/s12936-019-2648-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase deficiency (G6PDd), haemoglobin C (HbC) and S (HbS) are inherited blood disorders (IBD) common in populations in malaria endemic areas. All are associated to some degree with protection against clinical malaria whilst additionally G6PDd is associated with haemolysis following treatment with 8-aminoquinolines. Measuring the prevalence of these inherited blood disorders in affected populations can improve understanding of disease epidemiology. Current methodologies in epidemiological studies commonly rely on individual target amplification and visualization; here a method is presented to simultaneously detect the polymorphisms and that can be expanded to include other single nucleotide polymorphisms (SNPs) of interest. METHODS Human DNA from whole blood samples was amplified in a novel, multiplex PCR reaction and extended with SNP-specific probes in an allele specific primer extension (ASPE) to simultaneously detect four epidemiologically important human markers including G6PD SNPs (G202A and A376G) and common haemoglobin mutations (HbS and HbC). The products were hybridized to magnetic beads and the median fluorescence intensity (MFI) was read on MAGPIX® (Luminex corp.). Genotyping data was compared to phenotypical data generated by flow cytometry and to established genotyping methods. RESULTS Seventy-five samples from Burkina Faso (n = 75/78, 96.2%) and 58 samples from The Gambia (n = 58/61, 95.1%) had a G6PD and a HBB genotype successfully assigned by the bead-based assay. Flow cytometry data available for n = 61 samples further supported the concordance between % G6PD normal/deficient cells and genotype. CONCLUSIONS The bead based assay compares well to alternative measures of genotyping and phenotyping for G6PD. The screening is high throughput, adaptable to inclusion of multiple targets of interest and easily standardized.
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Affiliation(s)
- Lynn Grignard
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.
| | - Catherine Mair
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Guide J H Bastiaens
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alfred B Tiono
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Joseph Okebe
- Disease Control & Elimination Theme, Medical Research Council Unit at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Sam A Coulibaly
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Bronner P Gonçalves
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Muna Affara
- Disease Control & Elimination Theme, Medical Research Council Unit at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Alphonse Ouédraogo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Edith C Bougouma
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Guillaume S Sanou
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issa Nébié
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Kjerstin H W Lanke
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sodiomon B Sirima
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Umberto d'Alessandro
- Disease Control & Elimination Theme, Medical Research Council Unit at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Taane G Clark
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Susana Campino
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
Objectives: To examine the association between beta-globin sequence variations and phenotypes of sickle-cell disease (SCD) complications among Palestinian refugees in Lebanon correlating them with chromatographic readings and co-inheritance with β-thalassemia traits. Methods: This cross-sectional study included 47 Palestinian refugees aged 4 to 54 living in different regions in Lebanon during the year 2015. Participant filled a well-designed questionnaire. Deoxyribonucleic acid (DNA) was purified from the blood collected from all participants, followed by polymerase chain reaction (PCR) amplification of exon 1, exon 2, and IVS 1 of hemoglobin beta. Multiple sequence alignment for comparative analysis was performed against normal hemoglobin sequences. Results: In addition to well-known SCD mutations, rare beta globin variations were identified. Participants with these variations have phenotypic thalassemia despite the absence of known β-thalassemia mutations. Conclusion: The genetic variation seen among our study population is correlated with reduced beta globin transcription, and phenotypic β-thalassemia complications among SCD patients under study.
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Affiliation(s)
- Esraa Y Moussa
- Department of Biological Sciences, Beirut Arab University, Beirut, Lebanon. E-mail.
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Waitumbi JN, Kifude CM, Hunja CW, Ogutu BR. Females of HbAS genotype have reduced concentration of the malaria protective deoxyhemoglobin S than males. PLoS One 2018; 13:e0203455. [PMID: 30204801 PMCID: PMC6133351 DOI: 10.1371/journal.pone.0203455] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 08/21/2018] [Indexed: 11/18/2022] Open
Abstract
The quantity of the intra-erythrocytic deoxyhemoglobin S (Hb S) affects the level of protection against malaria and also the sickling phenomenon. This study reports on significantly lower concentration of Hb S in females than males. Data came from 350 children, aged 12-47 months who participated in a phase 2b malaria vaccine trial. Hemoglobinopathy and G6PD deficiency typing was necessary to ascertain equal representation of these malaria protective traits across the vaccine cohorts. Hemoglobin types (HbAA, HbAS) and % Hb S were evaluated by HPLC. Alpha thalassemia (alpha-thal) and G6PD genotypes were evaluated by PCR. The overall prevalence for HbAS was 20%, 46% for 3 alpha genes and 10% for 2 alpha genes and 14% for G6PD A-. More females of HbAS/αα/αα genotype had low Hb S than males and had mean % Hb S of 37.5% ± 5.4 SD, compared to 42.0% ± 2.5 SD in males of same genotype (P = 0.018). Consistent with reduction of the malaria protective Hb S in females, parasite load in females was nearly twice that of males but the difference was not statistically significant. The X-chromosome linked G6PD deficiency did not influence the level of Hb S. We conclude that, the low Hb S in these females explains the resultant higher malaria parasite load. We speculate that the low Hb S in females could also explain observations suggesting that the sickling phenomenon tends to be less severe in females than males.
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Affiliation(s)
- John N. Waitumbi
- Walter Reed Project, Kenya Medical Research Institute, Kisumu, Kenya
- * E-mail:
| | | | - Carol W. Hunja
- South Eastern Kenya University, School of Pure and Applied Sciences, Department of Biology, Kitui, Kenya
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Sadhu N, Jhun EH, Yao Y, He Y, Molokie RE, Wilkie DJ, Wang ZJ. Genetic variants of GCH1 associate with chronic and acute crisis pain in African Americans with sickle cell disease. Exp Hematol 2018; 66:42-49. [PMID: 30031848 DOI: 10.1016/j.exphem.2018.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/20/2018] [Accepted: 07/15/2018] [Indexed: 01/29/2023]
Abstract
The multidimensional nature of pain in sickle cell disease (SCD) has rendered its therapeutic management extremely challenging. In this study, we explored the role of five single nucleotide polymorphisms (SNPs) of candidate gene GCH1 in SCD pain. Composite pain index (CPI) scores and acute care utilization rates were used as phenotype markers. Rs8007267 was associated with chronic pain (additive model: B = -3.76, p = 0.037; dominant model: B = -5.61, p = 0.021) and rs3783641 (additive model: incident rate ratio [IRR] = 1.37, p = 0.024; recessive model: IRR = 1.81, p = 0.018) with utilization rate. These associations persisted when subjects with HbSS and HbSβ° genotype only were analyzed. We also identified two haploblocks (rs10483639[G>C]-rs752688[C>T]-rs4411417[T>C] and rs3783641[T>A]-rs8007267[T>C]) with SNPs in high linkage disequilibrium. Of these, haplotype T-C of haploblock rs3783641-rs8007267 showed significant association with rate of utilization (odds ratio [OR] = 0.31, p = 0.001). Our study indicates potential contribution of GCH1 polymorphisms to the variability of pain in African Americans with SCD.
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Affiliation(s)
- Nilanjana Sadhu
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Ellie H Jhun
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Ying He
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA; Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert E Molokie
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA; Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA; Jesse Brown Veteran's Administration Medical Center, Chicago, IL, USA; Division of Hematology/Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA; Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA; Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA.
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Raffield LM, Ulirsch JC, Naik RP, Lessard S, Handsaker RE, Jain D, Kang HM, Pankratz N, Auer PL, Bao EL, Smith JD, Lange LA, Lange EM, Li Y, Thornton TA, Young BA, Abecasis GR, Laurie CC, Nickerson DA, McCarroll SA, Correa A, Wilson JG, Lettre G, Sankaran VG, Reiner AP. Common α-globin variants modify hematologic and other clinical phenotypes in sickle cell trait and disease. PLoS Genet 2018; 14:e1007293. [PMID: 29590102 PMCID: PMC5891078 DOI: 10.1371/journal.pgen.1007293] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 01/29/2018] [Revised: 04/09/2018] [Accepted: 03/06/2018] [Indexed: 11/18/2022] Open
Abstract
Co-inheritance of α-thalassemia has a significant protective effect on the severity of complications of sickle cell disease (SCD), including stroke. However, little information exists on the association and interactions for the common African ancestral α-thalassemia mutation (-α3.7 deletion) and β-globin traits (HbS trait [SCT] and HbC trait) on important clinical phenotypes such as red blood cell parameters, anemia, and chronic kidney disease (CKD). In a community-based cohort of 2,916 African Americans from the Jackson Heart Study, we confirmed the expected associations between SCT, HbC trait, and the -α3.7 deletion with lower mean corpuscular volume/mean corpuscular hemoglobin and higher red blood cell count and red cell distribution width. In addition to the recently recognized association of SCT with lower estimated glomerular filtration rate and glycated hemoglobin (HbA1c), we observed a novel association of the -α3.7 deletion with higher HbA1c levels. Co-inheritance of each additional copy of the -α3.7 deletion significantly lowered the risk of anemia and chronic kidney disease among individuals with SCT (P-interaction = 0.031 and 0.019, respectively). Furthermore, co-inheritance of a novel α-globin regulatory variant was associated with normalization of red cell parameters in individuals with the -α3.7 deletion and significantly negated the protective effect of α-thalassemia on stroke in 1,139 patients with sickle cell anemia from the Cooperative Study of Sickle Cell Disease (CSSCD) (P-interaction = 0.0049). Functional assays determined that rs11865131, located in the major alpha-globin enhancer MCS-R2, was the most likely causal variant. These findings suggest that common α- and β-globin variants interact to influence hematologic and clinical phenotypes in African Americans, with potential implications for risk-stratification and counseling of individuals with SCD and SCT.
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Affiliation(s)
- Laura M. Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jacob C. Ulirsch
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Rakhi P. Naik
- Hematology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Samuel Lessard
- Department of Medicine, Université de Montréal, Montréal, Quebec, Canada
- Montreal Heart Institute, Montréal, Quebec, Canada
| | - Robert E. Handsaker
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Deepti Jain
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Hyun M. Kang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Nathan Pankratz
- Department of Laboratory Medicine & Pathology, School of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Paul L. Auer
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
| | - Erik L. Bao
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Joshua D. Smith
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Leslie A. Lange
- Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Ethan M. Lange
- Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Yun Li
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Timothy A. Thornton
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Bessie A. Young
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
| | - Goncalo R. Abecasis
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Cathy C. Laurie
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Deborah A. Nickerson
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Steven A. McCarroll
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - James G. Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | | | - Guillaume Lettre
- Department of Medicine, Université de Montréal, Montréal, Quebec, Canada
- Montreal Heart Institute, Montréal, Quebec, Canada
| | - Vijay G. Sankaran
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- * E-mail: (APR); (VGS)
| | - Alex P. Reiner
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- * E-mail: (APR); (VGS)
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Rahman MM, Fatema K, Hossain MM. Double Heterozygous For Haemoglobin S and Haemoglobin E. Mymensingh Med J 2018; 27:205-208. [PMID: 29459615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Here we present a Bangladeshi family where out of four family members two (mother and son) inherited both haemoglobin (HbS) S and haemoglobin (HbE) E gene confirming the diagnosis of double heterozygous state for HbS and HbE, presented in the Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka, Bangladesh on the month of July 2016. Among other two members, one (daughter) inherited HbS and other (father) HbE. Double heterozygous state for HbS and HbE is a rare condition in this subcontinent especially in Bangladesh. HbS is rare but HbE is prevalent in Bangladesh. Co-inheritance of both HbS and HbE is therefore uncommon in this country in comparison to HbE/β - thalassaemia. Though the double heterozygous state for HbS and HbE is rare and the patients are usually asymptomatic but their documentation is important for genetic counseling and to determine the reproductive risk of the family.
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Affiliation(s)
- M M Rahman
- Colonel (Dr) Mohammad Mizanur Rahman, Classified Specialist in Pathology, Department of Haematology, Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka, Bangladesh; E-mail:
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Lim WS, Magan T, Mahroo OA, Hysi PG, Helou J, Mohamed MD. Retinal thickness measurements in sickle cell patients with HbSS and HbSC genotype. Can J Ophthalmol 2017; 53:420-424. [PMID: 30119799 PMCID: PMC6117475 DOI: 10.1016/j.jcjo.2017.10.006] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Temporal macula thinning has been reported in sickle cell patients, but it remains unclear if there is a difference between HbSS and HbSC genotypes. We aimed to quantitatively compare macular thickness between eyes with HbSS and HbSC genotype. DESIGN Retrospective descriptive study. METHODS Consecutive patients seen over a 5.5-year period in the Ophthalmology Department at St Thomas' Hospital, London, were identified. Macular optical coherence tomography images were retrospectively analyzed. The retinal thickness in all 9 subfields of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid was compared between HbSS and HbSC eyes. Right eyes and left eyes were analyzed independently, as well as averaged measurements from both eyes. Comparison was made between the 2 genotypes, adjusting for age and sex, and for multiple testing. Scans were excluded in cases of poor fixation or ocular comorbidity affecting retinal thickness. RESULTS 132 HbSC and 120 HbSS patients were identified. Scans from 166 right and 153 left eyes were included (with approximately equal numbers of HbSS and HbSC genotypes). Mean retinal thickness was lower in HbSS eyes compared with HbSC eyes in all subfields of the ETDRS grid, but in most subfields the difference was <10 microns. Differences reached statistical significance for outer superior, inferior, and temporal subfields and the inner temporal subfield (p < 0.05). CONCLUSION Although the HbSC genotype is more strongly associated with proliferative retinopathy, HbSS patients had on average more macular thinning.
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Affiliation(s)
- Wei S Lim
- Ophthalmology Department, St Thomas' Hospital, London, United Kingdom.
| | - Tejal Magan
- Ophthalmology Department, St Thomas' Hospital, London, United Kingdom
| | - Omar A Mahroo
- Ophthalmology Department, St Thomas' Hospital, London, United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London; Section of Academic Ophthalmology, School of Life Course Sciences(,) Faculty of Life Course Sciences and Medicine, King's College London, St Thomas' Hospital Campus, London, United Kingdom
| | - Pirro G Hysi
- Section of Academic Ophthalmology, School of Life Course Sciences(,) Faculty of Life Course Sciences and Medicine, King's College London, St Thomas' Hospital Campus, London, United Kingdom
| | - Juliana Helou
- Ophthalmology Department, St Thomas' Hospital, London, United Kingdom
| | - Moin D Mohamed
- Ophthalmology Department, St Thomas' Hospital, London, United Kingdom
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Habara AH, Shaikho EM, Steinberg MH. Fetal hemoglobin in sickle cell anemia: The Arab-Indian haplotype and new therapeutic agents. Am J Hematol 2017; 92:1233-1242. [PMID: 28736939 PMCID: PMC5647233 DOI: 10.1002/ajh.24872] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 12/28/2022]
Abstract
Fetal hemoglobin (HbF) has well-known tempering effects on the symptoms of sickle cell disease and its levels vary among patients with different haplotypes of the sickle hemoglobin gene. Compared with sickle cell anemia haplotypes found in patients of African descent, HbF levels in Saudi and Indian patients with the Arab-Indian (AI) haplotype exceed that in any other haplotype by nearly twofold. Genetic association studies have identified some loci associated with high HbF in the AI haplotype but these observations require functional confirmation. Saudi patients with the Benin haplotype have HbF levels almost twice as high as African patients with this haplotype but this difference is unexplained. Hydroxyurea is still the only FDA approved drug for HbF induction in sickle cell disease. While most patients treated with hydroxyurea have an increase in HbF and some clinical improvement, 10 to 20% of adults show little response to this agent. We review the genetic basis of HbF regulation focusing on sickle cell anemia in Saudi Arabia and discuss new drugs that can induce increased levels of HbF.
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Affiliation(s)
- Alawi H Habara
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, 02118
| | - Elmutaz M Shaikho
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, 02118
| | - Martin H Steinberg
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, 02118
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Sepúlveda N, Manjurano A, Campino SG, Lemnge M, Lusingu J, Olomi R, Rockett KA, Hubbart C, Jeffreys A, Rowlands K, Clark TG, Riley EM, Drakeley CJ. Malaria Host Candidate Genes Validated by Association With Current, Recent, and Historical Measures of Transmission Intensity. J Infect Dis 2017; 216:45-54. [PMID: 28541483 PMCID: PMC5853769 DOI: 10.1093/infdis/jix250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 05/24/2017] [Indexed: 01/19/2023] Open
Abstract
Background Human malaria susceptibility is determined by multiple genetic factors. It is unclear, however, which genetic variants remain important over time. Methods Genetic associations of 175 high-quality polymorphisms within several malaria candidate genes were examined in a sample of 8096 individuals from northeast Tanzania using altitude, seroconversion rates, and parasite rates as proxies of historical, recent, and current malaria transmission intensity. A principal component analysis was used to derive 2 alternative measures of overall malaria propensity of a location across different time scales. Results Common red blood cell polymorphisms (ie, hemoglobin S, glucose-6-phosphate dehydrogenase, and α-thalassemia) were the only ones to be associated with all 3 measures of transmission intensity and the first principal component. Moderate associations were found between some immune response genes (ie, IL3 and IL13) and parasite rates, but these could not be reproduced using the alternative measures of malaria propensity. Conclusions We have demonstrated the potential of using altitude and seroconversion rate as measures of malaria transmission capturing medium- to long-term time scales to detect genetic associations that are likely to persist over time. These measures also have the advantage of minimizing the deleterious effects of random factors affecting parasite rates on the respective association signals.
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Affiliation(s)
- Nuno Sepúlveda
- London School of Hygiene and Tropical Medicine
- Centre of Statistics and Applications, University of Lisbon, Portugal
| | - Alphaxard Manjurano
- London School of Hygiene and Tropical Medicine
- Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Moshi
| | - Susana G Campino
- London School of Hygiene and Tropical Medicine
- Wellcome Trust Sanger Institute, Hinxton
| | - Martha Lemnge
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - John Lusingu
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Raimos Olomi
- Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Moshi
| | - Kirk A Rockett
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
| | - Christina Hubbart
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
| | - Anna Jeffreys
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
| | - Kate Rowlands
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
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Abstract
Polymerization of deoxy sickle cell hemoglobin (HbS) is well recognized as the primary event that triggers the classic cycles of sickling/unsickling of patients red blood cells (RBCs). RBCs are also subjected to continuous endogenous and exogenous oxidative onslaughts resulting in hemolytic rate increases which contribute to the evolution of vasculopathies associated with this disease. Compared to steady-state conditions, the occurrences of vaso-occlusive crises increase the levels of both RBC-derived microparticles as well as extracellular Hb in circulation. Common byproduct resulting from free Hb oxidation and from Hb-laden microparticles is heme (now recognized as damage associated molecular pattern (DAMP) molecule) which has been shown to initiate inflammatory responses. This review provides new insights into the interplay between microparticles, free Hb and heme focusing on Hb's pseudoperoxidative activity that drives RBC's cytosolic, membrane changes as well as oxidative toxicity towards the vascular system. Emerging antioxidative strategies that include the use of protein and heme scavengers in controlling Hb oxidative pathways are discussed.
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Affiliation(s)
- Abdu I Alayash
- Laboratory of Biochemistry and Vascular Biology, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD, USA.
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Abstract
Sickle cell disease (SCD) is an inherited monogenic disease characterized by misshapen red blood cells that causes vaso-occlusive disease, vasculopathy, and systemic inflammation. Approximately 300,000 infants are born per year with SCD globally. Acute, chronic, and acute-on-chronic complications contribute to end-organ damage and adversely affect quantity and quality of life. Hematopoietic stem cell transplantation is the only cure available today, but is not feasible for the vast majority of people suffering from SCD. Fortunately, new therapies are in late clinical trials and more are in the pipeline, offering hope for this unfortunate disease, which has increasing global burden.
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Affiliation(s)
- Sharl Azar
- Division of Hematology and Medical Oncology, Department of Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mailstop L586, Portland, OR 97239, USA.
| | - Trisha E Wong
- Division of Hematology/Oncology, Department of Pediatrics, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mailstop CDRCP, Portland, OR 97239, USA; Division of Transfusion Services, Department of Pathology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mailstop HRC9, Portland, OR 97239, USA
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Ducrocq R, Pascaud O, Bévier A, Finet C, Benkerrou M, Elion J. Strategy linking several analytical methods of neonatal screening for sickle cell disease. J Med Screen 2016; 8:8-14. [PMID: 11373853 DOI: 10.1136/jms.8.1.8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background The French national programme for the neonatal screening of sickle cell disease (SCD) was set up in 1995. This screening is targeted at newborn infants at risk. Over 5 years, 115 480 newborn infants were tested from 80 maternity departments from the northern part of the Paris area. 250 Patients with SCD were identified— that is, one in 462 newborn infants tested. Carriers for a haemoglobin (Hb) variant are frequent (5.34%). Some uncommon Hb variants were also identified, which gave rise to pitfalls to the testing when associated with HbS: HbKorle-Bu, HbHope, HbBougardirey-Mali, and HbLadésirade (4% of SS-like profiles). Objective An effective screening strategy was developed to avoid these false positive and false negative responses. Methods Isoelectric focusing (IEF), the method of primary screening, is rapid and inexpensive. Cation exchange high performance liquid chromatography (CE-HPLC), which is automated, fast, and quantitative was selected as a secondary method. Results IEF diagnosed normal profiles in 89% of the tested samples from newborn infants. CE-HPLC identified most of the common Hb variants by their retention time and the measure of HbA/HbS ratio, important for the differential diagnosis between an asymptomatic HbS carrier and an HbS/&bgr;+thal compound heterozygote. Furthermore, the high sensitivity of the CE-HPLC detected as little as 0.5% of a Hb variant. This avoided false negatives in samples from premature or transfused newborn infants. All samples with SS-like profiles were confirmed with a second CE-HPLC with another programme. A combination of these three methods confirmed the status of 99.7% of the samples from the tested newborn infants. Some cases required a reverse phase-HPLC method (for &ggr;-globin or &agr;-globin chain variants). Finally, some exceptional samples required confirmation by testing DNA extracted with Güthrie paper for a precise diagnosis. Conclusions This effective strategy combining several methods dramatically reduces the risk of errors. Many families are thus spared unnecessary worrying recalls. The only unavoidable cause of false positives remains the HbS/hereditary fetal Hb (HPFH).
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Affiliation(s)
- R Ducrocq
- Laboratoire de Biochimie Génétique, Hôpital Robert Debré, 48 Boulevard Sérurier, 75935 Paris, France.
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Torres LS, Okumura JV, Silva DGH, Mimura KKO, Belini-Júnior É, Oliveira RG, Lobo CLC, Oliani SM, Bonini-Domingos CR. Inflammation in Sickle Cell Disease: Differential and Down-Expressed Plasma Levels of Annexin A1 Protein. PLoS One 2016; 11:e0165833. [PMID: 27802331 PMCID: PMC5089686 DOI: 10.1371/journal.pone.0165833] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/18/2016] [Indexed: 01/09/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited hemolytic anemia whose pathophysiology is driven by polymerization of the hemoglobin S (Hb S), leading to hemolysis and vaso-occlusive events. Inflammation is a fundamental component in these processes and a continuous inflammatory stimulus can lead to tissue damages. Thus, pro-resolving pathways emerge in order to restore the homeostasis. For example there is the annexin A1 (ANXA1), an endogenous anti-inflammatory protein involved in reducing neutrophil-endothelial interactions, accelerating neutrophil apoptosis and stimulating macrophage efferocytosis. We investigated the expression of ANXA1 in plasma of SCD patients and its relation with anemic, hemolytic and inflammatory parameters of the disease. Three SCD genotypes were considered: the homozygous inheritance for Hb S (Hb SS) and the association between Hb S and the hemoglobin variants D-Punjab (Hb SD) and C (Hb SC). ANXA1 and proinflammatory cytokines were quantified by ELISA in plasma of SCD patients and control individuals without hemoglobinopathies. Hematological and biochemical parameters were analyzed by flow cytometry and spectrophotometer. The plasma levels of ANXA1 were about three-fold lesser in SCD patients compared to the control group, and within the SCD genotypes the most elevated levels were found in Hb SS individuals (approximately three-fold higher). Proinflammatory cytokines were higher in SCD groups than in the control individuals. Anemic and hemolytic markers were higher in Hb SS and Hb SD genotypes compared to Hb SC patients. White blood cells and platelets count were higher in Hb SS genotype and were positively correlated to ANXA1 levels. We found that ANXA1 is down-regulated and differentially expressed within the SCD genotypes. Its expression seems to depend on the inflammatory, hemolytic and vaso-occlusive characteristics of the diseased. These data may lead to new biological targets for therapeutic intervention in SCD.
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Affiliation(s)
- Lidiane S. Torres
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
- * E-mail: (LST); (SMO)
| | - Jéssika V. Okumura
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Danilo G. H. Silva
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Kallyne K. O. Mimura
- Laboratory of Immunomorphology, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Édis Belini-Júnior
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Renan G. Oliveira
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Clarisse L. C. Lobo
- Institute of Hematology Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sonia M. Oliani
- Laboratory of Immunomorphology, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
- * E-mail: (LST); (SMO)
| | - Claudia R. Bonini-Domingos
- Laboratory of Hemoglobin and Hematologic Genetic Diseases, Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
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DeWitt MA, Magis W, Bray NL, Wang T, Berman JR, Urbinati F, Heo SJ, Mitros T, Muñoz DP, Boffelli D, Kohn DB, Walters MC, Carroll D, Martin DIK, Corn JE. Selection-free genome editing of the sickle mutation in human adult hematopoietic stem/progenitor cells. Sci Transl Med 2016; 8:360ra134. [PMID: 27733558 PMCID: PMC5500303 DOI: 10.1126/scitranslmed.aaf9336] [Citation(s) in RCA: 317] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/22/2016] [Indexed: 12/19/2022]
Abstract
Genetic diseases of blood cells are prime candidates for treatment through ex vivo gene editing of CD34+ hematopoietic stem/progenitor cells (HSPCs), and a variety of technologies have been proposed to treat these disorders. Sickle cell disease (SCD) is a recessive genetic disorder caused by a single-nucleotide polymorphism in the β-globin gene (HBB). Sickle hemoglobin damages erythrocytes, causing vasoocclusion, severe pain, progressive organ damage, and premature death. We optimize design and delivery parameters of a ribonucleoprotein (RNP) complex comprising Cas9 protein and unmodified single guide RNA, together with a single-stranded DNA oligonucleotide donor (ssODN), to enable efficient replacement of the SCD mutation in human HSPCs. Corrected HSPCs from SCD patients produced less sickle hemoglobin RNA and protein and correspondingly increased wild-type hemoglobin when differentiated into erythroblasts. When engrafted into immunocompromised mice, ex vivo treated human HSPCs maintain SCD gene edits throughout 16 weeks at a level likely to have clinical benefit. These results demonstrate that an accessible approach combining Cas9 RNP with an ssODN can mediate efficient HSPC genome editing, enables investigator-led exploration of gene editing reagents in primary hematopoietic stem cells, and suggests a path toward the development of new gene editing treatments for SCD and other hematopoietic diseases.
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Affiliation(s)
- Mark A DeWitt
- Innovative Genomics Initiative, University of California, Berkeley, Berkeley, CA 94720, USA. Department of Molecular and Cellular Biology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Wendy Magis
- Children's Hospital Oakland Research Institute, University of California San Francisco (UCSF) Benioff Children's Hospital, Oakland, CA 94609, USA
| | - Nicolas L Bray
- Innovative Genomics Initiative, University of California, Berkeley, Berkeley, CA 94720, USA. Department of Molecular and Cellular Biology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Tianjiao Wang
- Innovative Genomics Initiative, University of California, Berkeley, Berkeley, CA 94720, USA. Department of Molecular and Cellular Biology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Jennifer R Berman
- Digital Biology Center, Bio-Rad Laboratories, Pleasanton, CA 94588, USA
| | - Fabrizia Urbinati
- Departments of Microbiology, Immunology, and Molecular Genetics; Pediatrics; and Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Seok-Jin Heo
- Children's Hospital Oakland Research Institute, University of California San Francisco (UCSF) Benioff Children's Hospital, Oakland, CA 94609, USA
| | - Therese Mitros
- Department of Molecular and Cellular Biology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Denise P Muñoz
- Children's Hospital Oakland Research Institute, University of California San Francisco (UCSF) Benioff Children's Hospital, Oakland, CA 94609, USA
| | - Dario Boffelli
- Children's Hospital Oakland Research Institute, University of California San Francisco (UCSF) Benioff Children's Hospital, Oakland, CA 94609, USA
| | - Donald B Kohn
- Departments of Microbiology, Immunology, and Molecular Genetics; Pediatrics; and Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Mark C Walters
- Children's Hospital Oakland Research Institute, University of California San Francisco (UCSF) Benioff Children's Hospital, Oakland, CA 94609, USA. Blood and Marrow Transplant Program, Division of Hematology, UCSF Benioff Children's Hospital, Oakland, CA 94609, USA
| | - Dana Carroll
- Innovative Genomics Initiative, University of California, Berkeley, Berkeley, CA 94720, USA. Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT 84112, USA.
| | - David I K Martin
- Children's Hospital Oakland Research Institute, University of California San Francisco (UCSF) Benioff Children's Hospital, Oakland, CA 94609, USA.
| | - Jacob E Corn
- Innovative Genomics Initiative, University of California, Berkeley, Berkeley, CA 94720, USA. Department of Molecular and Cellular Biology, University of California, Berkeley, Berkeley, CA 94720, USA.
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49
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Abstract
A fraction of erythrocytes appear as target cells in stained blood smears in sickle cell disease, due to a inheritance of the hemoglobin variant Hb S, polymerizing upon deoxygenation. These cells appear in a three dimension as thin cups. A process of their formation in this disease is proposed based on a band 3-based mechanism of the erythrocyte shape control, able to explain the erythrocyte echinocytosis by glucose depletion. It indicates that their formation is due to a stomatocytogenic slow outward transport of the dibasic form of endogenous Pi with an H(+) by band 3, promoted by the decrease of the Donnan ratio, which decreases cell pH and volume, attributed by a decrease of cell KCl concentration by the higher efflux of K(+)Cl(-) cotransport and Ca(2+) activation of the Gardos channel. Its implications are briefly discussed with respect to target cells per se, target cell formation in other hemoglobinopathies, acquired and inherited disorders of the lipid metabolism and dehydrated hereditary stomatocytosis as well as a stomatocyte presence in a double heterozygote of Hb S and Hb C and of an involvement of the process of target cell formation in acanthocytosis in acquired and inherited disorders.
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Affiliation(s)
- P Wong
- Laboratoire de Chimie des Protéines, Montréal, Québec, Canada.
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50
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Birkeland P, Gardner K, Kesse-Adu R, Davies J, Lauritsen J, Rom Poulsen F, Tolias CM, Thein SL. Intracranial Aneurysms in Sickle-Cell Disease Are Associated With the Hemoglobin SS Genotype But Not With Moyamoya Syndrome. Stroke 2016; 47:1710-3. [PMID: 27301940 DOI: 10.1161/strokeaha.116.012664] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms and aneurysmal subarachnoid hemorrhage may occur more frequently in sickle-cell disease (SCD), and this could be related to the sickle genotype and moyamoya syndrome seen in SCD. METHODS Records from a total of 1002 patients with SCD attending 2 specialized adult hematologic services were retrospectively reviewed. We analyzed data of a cohort of 767 patients attending 1 SCD clinic between 2002 and 2013 and of 235 patients from the other clinic who have had neurovascular imaging between 2007 and 2014. RESULTS We identified 4 patients in the cohort who had an aneurysmal subarachnoid hemorrhage during 9063 patient-years. The highest incidence rate was seen among women in the age group 30 to 39 years with the hemoglobin SS (HbSS) genotype (440 per 100 000 patient-years). Unruptured intracranial aneurysms were found in 20 of the 324 patients, who had imaging data; the prevalence was significantly higher in patients with HbSS genotype compared with other sickle genotypes with the highest prevalence (15%) observed in women in the age group 30 to 39 years. Fifty-one HbSS patients had a moyamoya vasculopathy, but only 3 of these had concomitant intracranial aneurysms. CONCLUSIONS Intracranial aneurysms are common in HbSS SCD. There was also a trend toward more common occurrence of aneurysmal subarachnoid hemorrhage in HbSS; women in the age group 30 to 39 years were most at risk. There was no correlation between the occurrence of intracranial aneurysms and moyamoya syndrome.
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Affiliation(s)
- Peter Birkeland
- From the Department of Neurosurgery, King's College Hospital, London, United Kingdom (P.B., C.M.T.); Departments of Neurosurgery (P.B., F.R.P.) and Orthopaedic Surgery (J.L.), Odense University Hospital, Denmark; Molecular Haematology, King's College London, London, United Kingdom (K.G., S.L.T.); Department of Haematology, Guy's and St. Thomas Hospital, London, United Kingdom (R.K.-A.); Department of Anaesthetics, Derriford Hospital, Plymouth, United Kingdom (J.D.); Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (J.L., F.R.P.); and Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (S.L.T.).
| | - Kate Gardner
- From the Department of Neurosurgery, King's College Hospital, London, United Kingdom (P.B., C.M.T.); Departments of Neurosurgery (P.B., F.R.P.) and Orthopaedic Surgery (J.L.), Odense University Hospital, Denmark; Molecular Haematology, King's College London, London, United Kingdom (K.G., S.L.T.); Department of Haematology, Guy's and St. Thomas Hospital, London, United Kingdom (R.K.-A.); Department of Anaesthetics, Derriford Hospital, Plymouth, United Kingdom (J.D.); Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (J.L., F.R.P.); and Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (S.L.T.)
| | - Rachel Kesse-Adu
- From the Department of Neurosurgery, King's College Hospital, London, United Kingdom (P.B., C.M.T.); Departments of Neurosurgery (P.B., F.R.P.) and Orthopaedic Surgery (J.L.), Odense University Hospital, Denmark; Molecular Haematology, King's College London, London, United Kingdom (K.G., S.L.T.); Department of Haematology, Guy's and St. Thomas Hospital, London, United Kingdom (R.K.-A.); Department of Anaesthetics, Derriford Hospital, Plymouth, United Kingdom (J.D.); Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (J.L., F.R.P.); and Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (S.L.T.)
| | - John Davies
- From the Department of Neurosurgery, King's College Hospital, London, United Kingdom (P.B., C.M.T.); Departments of Neurosurgery (P.B., F.R.P.) and Orthopaedic Surgery (J.L.), Odense University Hospital, Denmark; Molecular Haematology, King's College London, London, United Kingdom (K.G., S.L.T.); Department of Haematology, Guy's and St. Thomas Hospital, London, United Kingdom (R.K.-A.); Department of Anaesthetics, Derriford Hospital, Plymouth, United Kingdom (J.D.); Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (J.L., F.R.P.); and Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (S.L.T.)
| | - Jens Lauritsen
- From the Department of Neurosurgery, King's College Hospital, London, United Kingdom (P.B., C.M.T.); Departments of Neurosurgery (P.B., F.R.P.) and Orthopaedic Surgery (J.L.), Odense University Hospital, Denmark; Molecular Haematology, King's College London, London, United Kingdom (K.G., S.L.T.); Department of Haematology, Guy's and St. Thomas Hospital, London, United Kingdom (R.K.-A.); Department of Anaesthetics, Derriford Hospital, Plymouth, United Kingdom (J.D.); Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (J.L., F.R.P.); and Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (S.L.T.)
| | - Frantz Rom Poulsen
- From the Department of Neurosurgery, King's College Hospital, London, United Kingdom (P.B., C.M.T.); Departments of Neurosurgery (P.B., F.R.P.) and Orthopaedic Surgery (J.L.), Odense University Hospital, Denmark; Molecular Haematology, King's College London, London, United Kingdom (K.G., S.L.T.); Department of Haematology, Guy's and St. Thomas Hospital, London, United Kingdom (R.K.-A.); Department of Anaesthetics, Derriford Hospital, Plymouth, United Kingdom (J.D.); Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (J.L., F.R.P.); and Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (S.L.T.)
| | - Christos M Tolias
- From the Department of Neurosurgery, King's College Hospital, London, United Kingdom (P.B., C.M.T.); Departments of Neurosurgery (P.B., F.R.P.) and Orthopaedic Surgery (J.L.), Odense University Hospital, Denmark; Molecular Haematology, King's College London, London, United Kingdom (K.G., S.L.T.); Department of Haematology, Guy's and St. Thomas Hospital, London, United Kingdom (R.K.-A.); Department of Anaesthetics, Derriford Hospital, Plymouth, United Kingdom (J.D.); Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (J.L., F.R.P.); and Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (S.L.T.)
| | - Swee Lay Thein
- From the Department of Neurosurgery, King's College Hospital, London, United Kingdom (P.B., C.M.T.); Departments of Neurosurgery (P.B., F.R.P.) and Orthopaedic Surgery (J.L.), Odense University Hospital, Denmark; Molecular Haematology, King's College London, London, United Kingdom (K.G., S.L.T.); Department of Haematology, Guy's and St. Thomas Hospital, London, United Kingdom (R.K.-A.); Department of Anaesthetics, Derriford Hospital, Plymouth, United Kingdom (J.D.); Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (J.L., F.R.P.); and Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (S.L.T.)
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