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Reilly GR, Xie Y, Scherer RW, Hawkins BS, Lanzkron SM, Scott AW. Terminology for Retinal Findings in Sickle Cell Disease Research: A Scoping Review. Ophthalmol Retina 2024; 8:81-87. [PMID: 37634744 PMCID: PMC10841206 DOI: 10.1016/j.oret.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/14/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To review the current sickle cell disease (SCD) literature to assess how "retinopathy" has been defined and to identify ocular outcomes that have been measured and described. DESIGN A systematic scoping review of SCD literature was completed regarding ocular manifestations of SCD and vision outcomes across all medical specialties. SUBJECTS Participants with SCD and control patients were included in our data extraction. METHODS We reviewed English-language literature from 2000 to 2021 for eligible studies by searching PubMed, Google Scholar, Embase, and the Cochrane library using terms to encompass SCD and ocular findings. MAIN OUTCOME MEASURES Data collection included study information, patient characteristics, vision-related findings (inclusion criteria and/or study outcomes), and retinopathy characteristics (definition, when, how and by whom diagnosed). RESULTS We identified 4006 unique citations and 111 were included in the analysis. Ophthalmologists were senior authors of about half (59/111; 53.2%) of the articles; most articles were published between 2016 and 2021 (71/111; 70.0%). The studies had been conducted primarily in North America (54/111; 48.6%) or Europe (23/111; 20.7%); designs were cross-sectional (51/111; 45.9%), prospective cohort (28/111; 25.2%), retrospective cohort (27/111; 24.3%), and case-control (4/111; 3.6%). Among studies reporting any retinopathy, it was commonly defined as a combination of nonproliferative sickle cell retinopathy and proliferative sickle cell retinopathy (PSR; 52/87; 59.8%), infrequently as PSR only (6/87; 6.9%), or not defined at all (23/87; 26.4%). The Goldberg classification was used to grade retinopathy in almost half of the studies (41/87; 47.1%). Investigators reporting diagnostic methods used clinical fundus examination (56/111; 50.4%), OCT (24/111; 21.6%), fluorescein angiography (20/111; 18.0%), ultrawidefield fundus photographs (15/111; 13.5%), and OCT angiography (10/111; 9.0%), or did not report methods (28/111; 25.2%). CONCLUSIONS There are inconsistencies in documentation of methods and outcomes in studies of SCD ophthalmic findings. Particularly concerning is the lack of documentation of ophthalmic examination methods, qualifications of examiners, and clarity and specificity of sickle cell retinopathy definitions. With the increase in SCD treatment research and novel systemic therapies available, it is important to adopt clear and consistent descriptions and rigorous data collection and reporting of ophthalmic outcomes in SCD studies. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Grace R Reilly
- Drexel University College of Medicine, Philadelphia, Pennsylvania; Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yangyiran Xie
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Roberta W Scherer
- Retired, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Barbara S Hawkins
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie M Lanzkron
- Johns Hopkins University School of Medicine, Division of Hematology, Department of Medicine, Baltimore, Maryland
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Brandsen RP, Diederen RMH, Bakhlakh S, Nur E, Schlingemann RO, Biemond BJ. Natural history and rate of progression of retinopathy in adult patients with sickle cell disease: an 11-year follow-up study. Blood Adv 2023; 7:3080-3086. [PMID: 36897257 PMCID: PMC10331402 DOI: 10.1182/bloodadvances.2022009147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
Sickle cell retinopathy (SCR) is a complication of sickle cell disease (SCD). Proliferative SCR (PSCR) can lead to severe visual impairment due to vitreous hemorrhage or retinal detachment. Knowledge of risk factors for progression and complications of SCR is limited. The aim of this study is to describe the natural history of SCR and to identify risk factors for progressive SCR and development of PSCR. We retrospectively analyzed disease progression in 129 patients with SCD with a median follow-up period of 11 years (interquartile range, 8.5-12). Patients were divided in 2 groups. The genotypes hemoglobin SS (HbSS), HbSβ0-thalassemia, and HbSβ+-thalassemia were grouped together (n = 83; 64.3%), whereas patients with HbSC (n = 46; 35.7%) were grouped separately. Progression of SCR was observed in 28.7% (37 of 129) of patients. Older age (adjusted odds ratio [aOR], 1.073; 95% confidence interval [CI], 1.024-1.125; P = .003), HbSC genotype (aOR, 25.472; 95% CI, 3.788-171.285; P ≤ 0.001), and lower HbF (aOR, 0.786; 95% CI, 0.623-0.993; P = .043) were associated with PSCR at end of follow-up. Lack of any SCR at end of follow-up was associated with female sex (aOR, 2.555; 95% CI, 1.101-5.931; P = .029), HbSS/HbSβ0/HbSβ+ genotype (aOR, 3.733; 95% CI, 1.131-12.321; P = .031), and higher HbF levels (aOR, 1.119; 95% CI, 1.007-1.243; P = .037). Differentiated strategies for screening and follow-up of SCR could be considered for patients at low or high risk.
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Affiliation(s)
- Rajani P. Brandsen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Roselie M. H. Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Siham Bakhlakh
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Reinier O. Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Bart J. Biemond
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Costa SA, Ribeiro CCC, Thomaz EBAF, Costa CPS, Souza SDFC. Mechanisms underlying the adaptive pulp and jaw bone trabecular changes in sickle cell anemia. Oral Dis 2023; 29:786-795. [PMID: 34369045 DOI: 10.1111/odi.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Mechanisms underlying the oral outcomes in sickle cell anemia (HbSS) have been less explored. This study aimed to investigate the association of morbimortality indicators and hydroxyurea use with adaptive pulp and jaw bone trabecular changes in HbSS. METHODS This cross-sectional study included 123 individuals with HbSS. The exposures were the morbimortality indicators of HbSS (number of vaso-occlusive crises, organ damage, hemoglobin level, and leukocyte count) and the use of hydroxyurea for HbSS treatment. The outcomes were adaptive pulp and jaw bone trabecular changes confirmed by radiographic examination. Associations were estimated by Poisson regression in crude and adjusted analyses for sex, skin color, socioeconomic class, and age. RESULTS The vaso-occlusive crises (mean ratio (MR) = 3.5, p = 0.045), lower hemoglobin (MR = 2.4, p = 0.037), and higher leukocyte count (MR = 2.17, p = 0.036) were risk factors, while the use of hydroxyurea was inversely associated with adaptive pulp changes (MR = 0.23, p = 0.024). The vaso-occlusive crises were associated with jaw bone trabecular changes (MR = 1.33, p = 0.02). CONCLUSION Adaptive pulp changes may be a potential clinical marker of chronic vasculopathy in HbSS. The use of hydroxyurea may reduce the frequency of adaptive pulp changes.
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Manwani D, Burnett AL, Paulose J, Yen GP, Burton T, Anderson A, Wang S, Lee S, Saraf SL. Treatment patterns and burden of complications associated with sickle cell disease: A US retrospective claims analysis. EJHAEM 2022; 3:1135-1144. [PMID: 36467832 PMCID: PMC9713207 DOI: 10.1002/jha2.575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 06/17/2023]
Abstract
Complications associated with sickle cell disease (SCD) that are highly impactful for patients but until recently have been less understood include priapism, nephropathy, and neurologic injury. We conducted a retrospective study using US administrative claims data from July 01, 2013 through March 31, 2020 to analyze incidence of these complications, SCD treatment patterns, and healthcare resource utilization (HCRU) and costs among 2524 pediatric and adult patients with SCD (mean [SD] age 43.4 [22.4] years). The most common treatments during follow-up were short-acting opioids (54.0% of patients), red blood cell transfusion (15.9%), and hydroxyurea (11.0%). SCD complications occurred frequently; in the overall population, the highest follow-up incidences per 1000 person-years were for acute kidney injury (53.1), chronic kidney disease (40.6), and stroke (39.0). Complications occurred across all age groups but increased in frequency with age; notably, acute kidney injury was 69.7 times more frequent among ages 65+ than ages 0-15 (p < 0.001). Follow-up per-patient-per-month HCRU also increased with age; however, all-cause healthcare costs were similarly high for all age groups and were driven primarily by inpatient stays. Patients with SCD across the age spectrum have a high burden of complications with the use of current treatments, suggesting unmet needs for treatment management.
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Affiliation(s)
- Deepa Manwani
- Albert Einstein College of MedicineThe Children's Hospital at MontefioreThe BronxNew YorkUSA
| | - Arthur L. Burnett
- Department of UrologyThe Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jincy Paulose
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | - Glorian P. Yen
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | | | | | - Sara Wang
- Optum Life SciencesEden PrairieMinnesotaUSA
| | - Soyon Lee
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | - Santosh L. Saraf
- Sickle Cell CenterDivision of Hematology and OncologyUniversity of Illinois Hospital and Health Sciences SystemChicagoIllinoisUSA
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Zhou YY, Reeves HM, Webb L, Santiago Z, Maitta RW. Chronic red cell exchange in sickle cell patients with iron overload may not affect mortality. Front Med (Lausanne) 2022; 9:892967. [PMID: 36237536 PMCID: PMC9550931 DOI: 10.3389/fmed.2022.892967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yi Yuan Zhou
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Hollie M. Reeves
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - LaRhonda Webb
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Zamira Santiago
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Robert W. Maitta
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
- *Correspondence: Robert W. Maitta
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Brown C, Tonda M, Abboud MR. Voxelotor for the treatment of sickle cell disease in pediatric patients. Expert Rev Hematol 2022; 15:485-492. [DOI: 10.1080/17474086.2022.2082408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Clark Brown
- Department of Pediatrics, Emory School of Medicine, Aflac Cancer and Blood Disorder Center of Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Miguel R. Abboud
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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7
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Smith WR, McClish DK, Bovbjerg VE, Singh HK. Development and validation of the sickle cell stress scale-adult. Eur J Haematol Suppl 2022; 109:215-225. [PMID: 35585659 PMCID: PMC9531901 DOI: 10.1111/ejh.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Disease‐specific stress can partly explain Sickle Cell Disease (SCD) healthcare utilization. We developed and validated two measures of adult SCD‐specific stress for research and clinical care. A large cohort of adults with SCD completed both the 3‐item Likert‐scale adapted from a previous disease stress measure and a 10‐item Likert‐scale questionnaire drafted specifically to measure SCD stress. They concurrently completed a psychosocial and health‐related quality of life scale battery, then subsequently daily pain diaries. Diaires measured: daily intensity, distress and interference of pain; self‐defined vaso‐occlusive crises (VOC), opioid use, and types of healthcare utilization for up to 24 weeks. Analyses tested Cronbach's alpha, correlation of the three‐item and 10‐item stress scales with the concurrent battery, with percentages of pain days, VOC days, opioid use days, and healthcare utilization days, and correlation of baseline stress and 6‐month stress for the 10‐item scale. Cronbach's alpha was high for both the 3‐item (0.73) and 10‐item (0.83) SCD stress scales, test–retest correlation of 0.55, expected correlation with the concurrent battery, and correlation with diary‐measured healthcare utilization over 6 months. The correlations with the 3‐item scale were stronger, but only statistically significant for depression‐anxiety. The correlation between the two stress scales was 0.59. Both the 3‐item and the 10‐item stress scales exhibited good face, construct, concurrent, and predictive validity as well as moderate test–retest reliability. Further scale validation should determine population norms and response to interventions.
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Affiliation(s)
- Wally R Smith
- Section of Research, Division of General Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Viktor E Bovbjerg
- College of Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Harjot K Singh
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
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8
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Decision-Making Involvement, Self-Efficacy, and Transition Readiness in Youth With Sickle Cell Disease. Nurs Res 2022; 71:12-20. [PMID: 34469415 PMCID: PMC8732290 DOI: 10.1097/nnr.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Transition to adult healthcare is a critical time for adolescents and young adults (AYAs) with sickle cell disease, and preparation for transition is important to reducing morbidity and mortality risks associated with transition. OBJECTIVE We explored the relationships between decision-making involvement, self-efficacy, healthcare responsibility, and overall transition readiness in AYAs with sickle cell disease prior to transition. METHODS This cross-sectional, correlational study was conducted with 50 family caregivers-AYAs dyads receiving care from a large comprehensive sickle cell clinic between October 2019 and February 2020. Participants completed the Decision-Making Involvement Scale, the Sickle Cell Self-Efficacy Scale, and the Readiness to Transition Questionnaire. Multiple linear regression was used to assess the relationships between decision-making involvement, self-efficacy, healthcare responsibility, and overall transition readiness in AYAs with sickle cell disease prior to transition to adult healthcare. RESULTS Whereas higher levels of expressive behaviors, such as sharing opinions and ideas in decision-making, were associated with higher levels of AYA healthcare responsibility, those behaviors were inversely associated with feelings of overall transition readiness. Self-efficacy was positively associated with overall transition readiness but inversely related to AYA healthcare responsibility. Parent involvement was negatively associated with AYA healthcare responsibility and overall transition readiness. DISCUSSION While increasing AYAs' decision-making involvement may improve AYAs' healthcare responsibility, it may not reduce barriers of feeling unprepared for the transition to adult healthcare. Facilitating active AYA involvement in decision-making regarding disease management, increasing self-efficacy, and safely reducing parent involvement may positively influence their confidence and capacity for self-management.
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9
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Zaidi AU, Glaros AK, Lee S, Wang T, Bhojwani R, Morris E, Donohue B, Paulose J, Iorga ŞR, Nellesen D. A systematic literature review of frequency of vaso-occlusive crises in sickle cell disease. Orphanet J Rare Dis 2021; 16:460. [PMID: 34727959 PMCID: PMC8561926 DOI: 10.1186/s13023-021-02096-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Sickle cell disease (SCD) is a collection of rare inherited blood disorders affecting approximately 100,000 people in the U.S. and 20-25 million people globally. Individuals with SCD experience recurrent episodes of severe and unpredictable pain that are caused by vaso-occlusive crises (VOCs), a hallmark of the disease. VOCs are the primary cause of hospitalization in SCD, result in missed workdays and school days, and decrease quality of life (QoL). Although VOCs cause significant burden in the lives of individuals with SCD, there is no synthesis on the frequency of VOCs in the real world. This systematic literature review sought to identify literature describing the frequency of VOCs experienced by individuals with SCD in real-world settings. METHODS MEDLINE and 6 congresses were searched (date range: January 1, 2000 to June 30, 2020). Studies were reviewed independently by two researchers. Studies assessing frequency or prevalence of VOCs or VOC-related outcomes were included. RESULTS Of 1438 studies identified in the search, 52 met pre-specified inclusion and exclusion criteria. Reported frequency of VOCs varied widely ranging from a mean or median of 0 VOCs/year to 18.2 VOCs/year. The proportion of patients experiencing ≥ 3 VOCs/year ranged from 4 to 67% and the proportion of patients experiencing ≥ 5 VOCs/year ranged from 18 to 59%. Measures of VOC severity were limited, with 13 studies considering frequency of complicated VOCs and only 1 study reporting duration of VOC episodes. CONCLUSIONS This is the first study to systematically assess published evidence pertaining to VOCs in real-world settings. Reported VOC frequency in real-world settings varied widely, with a majority of studies only considering VOCs managed in an inpatient or outpatient setting. Studies that considered VOCs managed at home reported a higher frequency of VOCs, suggesting that many studies may underestimate the frequency of VOCs. This systematic literature review (SLR) highlights the need for consistent reporting of (1) self-reported VOCs, including those managed at home, (2) definitions of VOCs, (3) complicated VOCs, and (4) duration of VOC episodes in literature.
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Affiliation(s)
| | - Alexander K Glaros
- Children's Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mount Pleasant, MI, USA
| | - Soyon Lee
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Taiji Wang
- Analysis Group, Inc., 1010 El Camino Real, Suite 310, Menlo Park, CA, 94025, USA.
| | - Rhea Bhojwani
- Analysis Group, Inc., 1010 El Camino Real, Suite 310, Menlo Park, CA, 94025, USA
| | - Eric Morris
- Analysis Group, Inc., 1010 El Camino Real, Suite 310, Menlo Park, CA, 94025, USA
| | | | - Jincy Paulose
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Şerban R Iorga
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Dave Nellesen
- Analysis Group, Inc., 1010 El Camino Real, Suite 310, Menlo Park, CA, 94025, USA
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A community-centered approach to sickle cell disease and clinical trials participation: an evaluation of perceptions, facilitators, and barriers. Blood Adv 2021; 5:5323-5331. [PMID: 34543385 PMCID: PMC9153049 DOI: 10.1182/bloodadvances.2020003434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
This paper is an evaluation of perceptions, facilitators, and barriers to clinical trial participation for SCD. This paper contains recommendations by persons directly affected by SCD to improve clinical trials and standard of care.
Sickle cell disease (SCD) is the most common inherited red blood cell disorder in the United States, affecting 70 000 to 100 000 Americans and causing a range of serious medical complications. Although the cause of SCD was established decades ago, existing therapies have varied effectiveness and side effects, and development of novel therapies has been slow. The limitations of existing treatment options highlight the need for new therapies that are aligned with the desires of the community. To date, little has been done to systematically seek and report the opinions and experiences of people with SCD regarding clinical research. In 2019, the American Society of Hematology Research Collaborative conducted 8 community workshops across the United States engaging 472 people, including persons with SCD and caregivers of those living with the disease. The workshop goals included assessing understanding, awareness, and perceptions of clinical research; and identifying the most critical clinical trial considerations of this community. Participants were asked about their experiences living with SCD and their satisfaction with treatment options. Pain and fatigue were reported as symptoms requiring better therapies. Although few participants reported being asked to enroll in a clinical trial, they expressed conditional willingness to participate. A majority were willing to share personal health information to further research and improve health outcomes. To actively engage the SCD community and increase enrollment and retention in clinical trials, researchers should address the treatment priorities of this population and ensure they have access to trusted information about clinical research and opportunities for participation.
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Zuro D, Madabushi SS, Brooks J, Chen BT, Goud J, Salhotra A, Song JY, Parra LE, Pierini A, Sanchez JF, Stein A, Malki MA, Kortylewski M, Wong JYC, Alaei P, Froelich J, Storme G, Hui SK. First Multimodal, Three-Dimensional, Image-Guided Total Marrow Irradiation Model for Preclinical Bone Marrow Transplantation Studies. Int J Radiat Oncol Biol Phys 2021; 111:671-683. [PMID: 34119592 DOI: 10.1016/j.ijrobp.2021.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Total marrow irradiation (TMI) has significantly advanced radiation conditioning for hematopoietic cell transplantation in hematologic malignancies by reducing conditioning-induced toxicities and improving survival outcomes in relapsed/refractory patients. However, the relapse rate remains high, and the lack of a preclinical TMI model has hindered scientific advancements. To accelerate TMI translation to the clinic, we developed a TMI delivery system in preclinical models. METHODS AND MATERIALS A Precision X-RAD SmART irradiator was used for TMI model development. Images acquired with whole-body contrast-enhanced computed tomography (CT) were used to reconstruct and delineate targets and vital organs for each mouse. Multiple beam and CT-guided Monte Carlo-based plans were performed to optimize doses to the targets and to vary doses to the vital organs. Long-term engraftment and reconstitution potential were evaluated by a congenic bone marrow transplantation (BMT) model and serial secondary BMT, respectively. Donor cell engraftment was measured using noninvasive bioluminescence imaging and flow cytometry. RESULTS Multimodal imaging enabled identification of targets (skeleton and spleen) and vital organs (eg, lungs, gut, liver). In contrast to total body irradiation (TBI), TMI treatment allowed variation of radiation dose exposure to organs relative to the target dose. Dose reduction mirrored that in clinical TMI studies. Similar to TBI, mice treated with different TMI regimens showed full long-term donor engraftment in primary BMT and second serial BMT. The TBI-treated mice showed acute gut damage, which was minimized in mice treated with TMI. CONCLUSIONS A novel multimodal image guided preclinical TMI model is reported here. TMI conditioning maintained long-term engraftment with reconstitution potential and reduced organ damage. Therefore, this TMI model provides a unique opportunity to study the therapeutic benefit of reduced organ damage and BM dose escalation to optimize treatment regimens in BMT and hematologic malignancies.
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Affiliation(s)
- Darren Zuro
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, California
| | | | - Jamison Brooks
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, California
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope Medical Center, Duarte, California
| | - Janagama Goud
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, California
| | - Amandeep Salhotra
- Department of Hematology and HCT, City of Hope Medical Center, Duarte, California
| | - Joo Y Song
- Department of Pathology, City of Hope Medical Center, Duarte, California
| | | | - Antonio Pierini
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy
| | - James F Sanchez
- Beckman Research Institute of City of Hope, Duarte, California
| | - Anthony Stein
- Department of Hematology and HCT, City of Hope Medical Center, Duarte, California
| | - Monzr Al Malki
- Department of Hematology and HCT, City of Hope Medical Center, Duarte, California
| | - Marcin Kortylewski
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope, Duarte, California
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, California
| | - Parham Alaei
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Jerry Froelich
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Guy Storme
- Department of Radiotherapy UZ Brussels, Brussels, Belgium
| | - Susanta K Hui
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, California; Beckman Research Institute of City of Hope, Duarte, California; Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota.
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Shafrin J, Thom HHZ, Keeney E, Gaunt DM, Zhao LM, Bhor M, Rizio AA, Bronté-Hall L, Shah N. The impact of vaso-occlusive crises and disease severity on quality of life and productivity among patients with sickle cell disease in the US. Curr Med Res Opin 2021; 37:761-768. [PMID: 33686891 DOI: 10.1080/03007995.2021.1897556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Sickle cell disease (SCD) is a lifelong blood disorder affecting approximately 100,000 individuals in the United States (US). A number of new treatments have recently become available to improve SCD clinical outcomes, but it is unclear how treatment innovations that reduce disease severity could affect patients' humanistic and economic outcomes. METHODS AND MATERIALS To answer this question, an online survey of US adult residents with a self-reported SCD diagnosis was conducted. Humanistic outcomes based on health-related quality of life (HRQoL)) were assessed during and outside of vaso-occlusive crises (VOCs). Economic outcomes were measured by annual household income and whether the respondent received disability insurance. RESULTS Among the 301 respondents completing the survey, average age was 34.4 years and 73.4% were female. Average HRQoL, measured using health utilities, were 0.311 (95% CI: 0.286, 0.337) during a VOC and 0.738 (0.720, 0.756) not during a VOC. The likelihood of claiming disability insurance was correlated with more frequent VOCs (0 VOCs: 12% vs. ≥4 VOCs: 47%, p = .002) and disease severity (Severity Class II: 16% vs. Severity Class III: 39%, p = .03). There was a weak relationship between VOC frequency and household income (0 VOCs: $47,488 vs. ≥4 VOCs: $34,569, p = .06) and no evidence of a relationship between disease severity class and income (Severity Class II: $42,443 vs. Severity Class III: $36,842, p = .29). CONCLUSION In conclusion, disease severity, strongly predicted worse self-reported HRQoL, moderately predicted increased likelihood of collecting disability insurance, and weakly predicted lower household income levels.
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Affiliation(s)
| | - Howard H Z Thom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Daisy M Gaunt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Menaka Bhor
- Novartis Pharmaceutical Company, East Hanover, NJ, USA
| | | | | | - Nirmish Shah
- Hematology, Duke University School of Medicine, Durham, NC, USA
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13
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End points for sickle cell disease clinical trials: renal and cardiopulmonary, cure, and low-resource settings. Blood Adv 2020; 3:4002-4020. [PMID: 31809537 DOI: 10.1182/bloodadvances.2019000883] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/07/2019] [Indexed: 01/19/2023] Open
Abstract
To address the global burden of sickle cell disease and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to patient-reported outcome, pain (non-patient-reported outcomes), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the end-organ considerations, measurement of cure, and low-resource settings panels as well as relevant findings and recommendations from the biomarkers panel.
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14
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Martí-Carvajal AJ, Conterno LO, Knight-Madden JM. Antibiotics for treating acute chest syndrome in people with sickle cell disease. Cochrane Database Syst Rev 2019; 9:CD006110. [PMID: 31531967 PMCID: PMC6749554 DOI: 10.1002/14651858.cd006110.pub5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The clinical presentation of acute chest syndrome is similar whether due to infectious or non-infectious causes, thus antibiotics are usually prescribed to treat all episodes. Many different pathogens, including bacteria, have been implicated as causative agents of acute chest syndrome. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from acute chest syndrome. This is an update of a Cochrane Review first published in 2007, and most recently updated in 2015. OBJECTIVES To determine whether an empirical antibiotic treatment approach (used alone or in combination):1. is effective for acute chest syndrome compared to placebo or standard treatment;2. is safe for acute chest syndrome compared to placebo or standard treatment;Further objectives are to determine whether there are important variations in efficacy and safety:3. for different treatment regimens,4. by participant age, or geographical location of the clinical trials. SEARCH METHODS We searched The Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 23 October 2017), African Index Medicus (1982 to 23 October 2017) and trial registries (23 October 2017).Date of most recent search of the Haemoglobinopathies Trials Register: 10 July 2019. SELECTION CRITERIA We searched for published or unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS Each author intended to independently extract data and assess trial quality by standard Cochrane methodologies, but no eligible randomised controlled trials were identified. MAIN RESULTS For this update, we were unable to find any randomised controlled trials on antibiotic treatment approaches for acute chest syndrome in people with sickle cell disease. AUTHORS' CONCLUSIONS This update was unable to identify randomised controlled trials on efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from acute chest syndrome. While randomised controlled trials are needed to establish the optimum antibiotic treatment for this condition, we do not envisage further trials of this intervention will be conducted, and hence the review will no longer be regularly updated.
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15
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Yates AM, Joshi VM, Aygun B, Moen J, Smeltzer MP, Govindaswamy D, Dowdy J, Cotton A, Kang G, Ware RE, Hankins JS. Elevated tricuspid regurgitation velocity in congenital hemolytic anemias: Prevalence and laboratory correlates. Pediatr Blood Cancer 2019; 66:e27717. [PMID: 30907497 DOI: 10.1002/pbc.27717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 01/26/2023]
Abstract
Elevated tricuspid valve regurgitation jet velocity (TRV ≥ 2.5 m/s) is associated with mortality among adults with sickle cell disease (SCD), but correlative biomarkers are not studied according to treatment exposure or genotypes. To investigate the associations between biomarkers and TRV elevation, we examined the relationship between TRV and hemolytic, inflammatory, and cardiac biomarkers, stratified by disease-modifying treatments and SCD genotype. In total, 294 participants with SCD (mean age, 11.0 ± 3.7 years) and 49 hereditary spherocytosis (HS; mean age, 22.9 ± 19.75 years) were included for comparison and enrolled. TRV was elevated in 30.7% of children with SCD overall: 18.8% in HbSC/HbSβ+ -thalassemia, 28.9% in untreated HbSS/HbSβ0 -thalassemia, 34.2% in HbSS/HbSβ0 -thalassemia hydroxyurea-treated, and 57% in HbSS/HbSβ0 -thalassemia chronic transfusion treated. TRV was elevated in 10.7% and 27.8% in HS children and adults, respectively. In children with SCD, elevated TRV was correlated with hemoglobin (odds ratio [OR] = 0.78, P = 0.004), lactate dehydrogenase (LDH; OR = 2.52, P = 0.005), and N-terminal pro-brain natriuretic peptide (NT-pro BNP; OR = 1.003, P = 0.004). In multivariable logistic regression, adjusting for genotype, sex, hemolytic index, and treatment, hemoglobin concentration remained the only significant variable associated with elevated TRV in untreated HbSS/HbSβ0 -thalassemia participants. TRV was not associated with inflammatory markers, other markers of hemolysis, or NT-pro BNP in untreated HbSS/HbSβ0 -thalassemia. Neither hemoglobin nor LDH was associated with TRV in HbSC/HbSβ+ -thalassemia. These results suggest that elevated TRV is influenced by the degree of anemia, possibly reflecting sickling as part of the disease pathophysiology. Prospective studies should monitor hemoglobin concentration as children with SCD age into adulthood, prompting initiation of TRV screening and monitoring.
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Affiliation(s)
- Amber M Yates
- Division of Pediatric Hematology Oncology, Texas Children's Hospital, Houston, Texas
| | - Vijaya M Joshi
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, Memphis, Tennessee.,Cardiopulmonary Services, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Banu Aygun
- Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Joseph Moen
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Devi Govindaswamy
- Cardiopulmonary Services, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jola Dowdy
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alyssa Cotton
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Guolian Kang
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
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16
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Derebail VK, Zhou Q, Ciccone EJ, Cai J, Ataga KI. Rapid decline in estimated glomerular filtration rate is common in adults with sickle cell disease and associated with increased mortality. Br J Haematol 2019; 186:900-907. [PMID: 31168785 DOI: 10.1111/bjh.16003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/23/2019] [Indexed: 12/14/2022]
Abstract
We evaluated the prevalence of rapid decline in kidney function, its potential risk factors and influence upon mortality in sickle cell disease (SCD) in a retrospective single-center study. Rapid decline of kidney function was defined as estimated glomerular filtration rate (eGFR) loss of >3·0 ml/min/1·73 m2 per year. A multivariable logistic regression model for rapid eGFR decline was constructed after evaluating individual covariates. We constructed multivariate Cox-regression models for rapid eGFR decline and mortality. Among 331 SCD patients (median age 29 years [interquartile range, IQR: 20, 41]; 187 [56·5%] female) followed for median 4·01 years (IQR: 1·66, 7·19), rapid eGFR decline was noted in 103 (31·1%). History of stroke (odds ratio [OR]: 2·91, 95% confidence interval [CI]: 1·25-6·77) and use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (OR: 3·17, 95% CI: 1·28-7·84) were associated with rapid eGFR decline. The rate of eGFR change over time was associated with mortality (hazard ratio [HR]: 0·99, 95% CI: 0·984-0·995, P = 0·0002). In Cox-regression, rapid eGFR decline associated with mortality (HR: 2·07, 95% CI: 1·039-4·138, P = 0·04) adjusting for age, sex and history of stroke. Rapid eGFR decline is common in SCD and associated with increased mortality. Long-term studies are needed to determine whether attenuating loss of kidney function may decrease mortality in SCD.
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Affiliation(s)
- Vimal K Derebail
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Qingning Zhou
- Department of Mathematics and Statistics, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Emily J Ciccone
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
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17
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Houwing ME, de Pagter PJ, van Beers EJ, Biemond BJ, Rettenbacher E, Rijneveld AW, Schols EM, Philipsen JNJ, Tamminga RYJ, van Draat KF, Nur E, Cnossen MH. Sickle cell disease: Clinical presentation and management of a global health challenge. Blood Rev 2019; 37:100580. [PMID: 31128863 DOI: 10.1016/j.blre.2019.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 01/12/2023]
Abstract
Sickle cell disease is an autosomal recessive, multisystem disorder, characterised by chronic haemolytic anaemia, painful episodes of vaso-occlusion, progressive organ failure and a reduced life expectancy. Sickle cell disease is the most common monogenetic disease, with millions affected worldwide. In well-resourced countries, comprehensive care programs have increased life expectancy of sickle cell disease patients, with almost all infants surviving into adulthood. Therapeutic options for sickle cell disease patients are however, still scarce. Predictors of sickle cell disease severity and a better understanding of pathophysiology and (epi)genetic modifiers are warranted and could lead to more precise management and treatment. This review provides an extensive summary of the pathophysiology and management of sickle cell disease and encompasses the characteristics, complications and current and future treatment options of the disease.
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Affiliation(s)
- M E Houwing
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - P J de Pagter
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - E J van Beers
- Department of Internal Medicine and Dermatology, Van Creveldkliniek, University Medical Center Utrecht, Internal mail no C.01.412, 3508, GA, Utrecht, the Netherlands.
| | - B J Biemond
- Department of Internal Medicine and Clinical Haematology, Amsterdam University Medical Centers, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - E Rettenbacher
- Department of Paediatric Haematology, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10, 6500, HB, Nijmegen, the Netherlands.
| | - A W Rijneveld
- Department of Haematology, Erasmus University Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - E M Schols
- Department of Haematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - J N J Philipsen
- Department of Cell Biology, Erasmus University Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - R Y J Tamminga
- Department of Paediatric Oncology and Haematology, University Medical Center Groningen - Beatrix Children's Hospital, Postbus 30001, 9700, RB, Groningen, the Netherlands..
| | - K Fijn van Draat
- Department of Paediatric Haematology, Amsterdam University Medical Centers - Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Plasma Proteins, Sanquin Research, the Netherlands.
| | - E Nur
- Department of Internal Medicine and Clinical Haematology, Amsterdam University Medical Centers, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
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18
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Gupta K, Chen C, Lutty GA, Hebbel RP. Morphine promotes neovascularizing retinopathy in sickle transgeneic mice. Blood Adv 2019; 3:1073-1083. [PMID: 30944099 PMCID: PMC6457224 DOI: 10.1182/bloodadvances.2018026898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/28/2019] [Indexed: 12/11/2022] Open
Abstract
Neovascularizing retinopathy is a significant complication of sickle cell disease (SCD), occurring more frequently in HbSC than HbSS disease. This risk difference is concordant with a divergence of angiogenesis risk, as identified by levels of pro- vs anti-angiogenic factors in the sickle patient's blood. Because our prior studies documented that morphine promotes angiogenesis in both malignancy and wound healing, we tested whether chronic opioid treatment would promote retinopathy in NY1DD sickle transgenic mice. After 10 to 15 months of treatment, sickle mice treated with morphine developed neovascularizing retinopathy to a far greater extent than either of the controls (sickle mice treated with saline and wild-type mice treated identically with morphine). Our dissection of the mechanistic linkage between morphine and retinopathy revealed a complex interplay among morphine engagement with its μ opioid receptor (MOR) on retinal endothelial cells (RECs); morphine-induced production of tumor necrosis factor α and interleukin-6 (IL-6), causing increased expression of both MOR and vascular endothelial growth factor receptor 2 (VEGFR2) on RECs; morphine/MOR engagement transactivating VEGFR2; and convergence of MOR, VEGFR2, and IL-6 activation on JAK/STAT3-dependent REC proliferation and angiogenesis. In the NY1DD mice, the result was increased angiogenesis, seen as neovascularizing retinopathy, similar to the retinal pathology occurring in humans with SCD. Therefore, we conclude that chronic opioid exposure, superimposed on the already angiogenic sickle milieu, might enhance risk for retinopathy. These results provide an additional reason for development and application of opioid alternatives for pain control in SCD.
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Affiliation(s)
- Kalpna Gupta
- Vascular Biology Center, and
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN; and
| | - Chunsheng Chen
- Vascular Biology Center, and
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN; and
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, John Hopkins School of Medicine, Baltimore, MD
| | - Robert P Hebbel
- Vascular Biology Center, and
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN; and
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19
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Langer AL, Leader A, Kim-Schulze S, Ginzburg Y, Merad M, Glassberg J. Inhaled steroids associated with decreased macrophage markers in nonasthmatic individuals with sickle cell disease in a randomized trial. Ann Hematol 2019; 98:841-849. [PMID: 30783732 PMCID: PMC7522666 DOI: 10.1007/s00277-019-03635-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/04/2019] [Indexed: 12/16/2022]
Abstract
Inhaled mometasone was shown to improve pain scores and decrease soluble vascular cell adhesion molecule (sVCAM) concentration in a randomized controlled trial of nonasthmatic patients with sickle cell disease. We sought to explore potential changes in systemic inflammation as a mechanism underlying this effect. Serum samples from 41 trial participants (15 placebo- and 26 mometasone-treated) were analyzed using a 92 inflammatory marker panel at baseline and after 8 weeks of mometasone therapy. Individual marker analysis and correlation analysis were conducted. Adjusted for age, the mometasone-treated group decreased the concentration of CXCL9, CXCL11, CD40, IL-10, and IL-18 relative to placebo-treated participants. Hierarchical clustering and correlation analysis identified additional evidence for a decrease in cytokines linking to macrophage signaling and migration. There was no statistically significant change in markers of asthma and allergy, indicating that the improvement was unlikely mediated by modulation of occult reactive airway disease. This analysis of inflammatory markers suggests that decrease in macrophage activity may be involved in the mediation of the clinical benefit seen with use of inhaled mometasone in nonasthmatic patients with sickle cell disease.Trial registration: clinicaltrials.gov identifier: NCT02061202.
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Affiliation(s)
- Arielle L Langer
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Andrew Leader
- Department of Oncological Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Seunghee Kim-Schulze
- Department of Oncological Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Yelena Ginzburg
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Miriam Merad
- Department of Oncological Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1620, New York, NY, 10029-6574, USA.
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20
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21
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Sagi V, Song-Naba WL, Benson BA, Joshi SS, Gupta K. Mouse Models of Pain in Sickle Cell Disease. ACTA ACUST UNITED AC 2018; 85:e54. [PMID: 30265442 DOI: 10.1002/cpns.54] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sickle cell disease (SCD) is a genetic blood disorder that impacts millions of individuals worldwide. SCD is characterized by debilitating pain that can begin during infancy and may continue to increase throughout life. This pain can be both acute and chronic. A characteristic feature specific to acute pain in SCD occurs during vaso-occlusive crisis (VOC) due to the blockade of capillaries with sickle red blood cells. The acute pain of VOC is intense, unpredictable, and requires hospitalization. Chronic pain occurs in a significant population with SCD. Treatment options for sickle pain are limited and primarily involve the use of opioids. However, long-term opioid use is associated with numerous side effects. Thus, pain management in SCD remains a major challenge. Humanized transgenic mice expressing exclusively human sickle hemoglobin show features of pain and pathobiology similar to that in patients with SCD. Therefore, these mice offer the potential for investigating the mechanisms of pain in SCD and allow for development of novel targeted analgesic therapies. © 2018 by John Wiley & Sons, Inc.
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Affiliation(s)
- Varun Sagi
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Waogwende L Song-Naba
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Barbara A Benson
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Sonal S Joshi
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Kalpna Gupta
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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22
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van Straaten S, Verhoeven J, Hagens S, Schutgens R, van Solinge W, van Wijk R, van Beers EJ. Organ involvement occurs in all forms of hereditary haemolytic anaemia. Br J Haematol 2018; 185:602-605. [PMID: 30183081 DOI: 10.1111/bjh.15575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stephanie van Straaten
- Laboratory of Clinical Chemistry & Haematology, University Medical Centre Utrecht, Utrecht, Netherlands.,Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Jill Verhoeven
- Laboratory of Clinical Chemistry & Haematology, University Medical Centre Utrecht, Utrecht, Netherlands.,Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Sanne Hagens
- Laboratory of Clinical Chemistry & Haematology, University Medical Centre Utrecht, Utrecht, Netherlands.,Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Roger Schutgens
- Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Wouter van Solinge
- Laboratory of Clinical Chemistry & Haematology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Richard van Wijk
- Laboratory of Clinical Chemistry & Haematology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Eduard J van Beers
- Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, Netherlands
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23
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Hankins JS, Estepp JH, Hodges JR, Villavicencio MA, Robison LL, Weiss MJ, Kang G, Schreiber JE, Porter JS, Kaste SC, Saving KL, Bryant PC, Deyo JE, Nottage KA, King AA, Brandow AM, Lebensburger JD, Adesina O, Chou ST, Zemel BS, Smeltzer MP, Wang WC, Gurney JG. Sickle Cell Clinical Research and Intervention Program (SCCRIP): A lifespan cohort study for sickle cell disease progression from the pediatric stage into adulthood. Pediatr Blood Cancer 2018; 65:e27228. [PMID: 29797644 DOI: 10.1002/pbc.27228] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Previous natural history studies have advanced the understanding of sickle cell disease (SCD), but generally have not included sufficient lifespan data or investigation of the role of genetics in clinical outcomes, and have often occurred before the widespread use of disease-modifying therapies, such as hydroxyurea and chronic erythrocyte transfusions. To further advance knowledge of SCD, St. Jude Children's Research Hospital established the Sickle Cell Clinical Research and Intervention Program (SCCRIP), to conduct research in a clinically evaluated cohort of individuals with SCD across their lifetime. PROCEDURES Initiated in 2014, the SCCRIP study prospectively recruits patients diagnosed with SCD and includes retrospective and longitudinal collection of clinical, neurocognitive, geospatial, psychosocial, and health outcomes data. Biological samples are banked for future genomics and proteomics studies. The organizational structure of SCCRIP is based upon organ/system-specific working groups and is opened to the research community for partnerships. RESULTS As of August 2017, 1,044 (92.3% of eligible) patients with SCD have enrolled in the study (860 children and 184 adults), with 11,915 person-years of observation. Population demographics included mean age at last visit of 11.3 years (range 0.7-30.1), 49.8% females, 57.7% treated with hydroxyurea, 8.5% treated with monthly transfusions, and 62.9% hemoglobin (Hb) SS or HbSB0 -thalassemia, 25.7% HbSC, 8.4% HbsB+ -Thalassemia, 1.7% HbS/HPFH, and 1.2% other. CONCLUSIONS The SCCRIP cohort will provide a rich resource for the conduct of high impact multidisciplinary research in SCD.
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Affiliation(s)
- Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jeremie H Estepp
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jason R Hodges
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Mitchell J Weiss
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jane E Schreiber
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jerlym S Porter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sue C Kaste
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kay L Saving
- OSF Healthcare Children's Hospital of Illinois, University of Illinois College of Medicine, Peoria, Illinois
| | - Paulette C Bryant
- Department of Pediatric Hematology and Oncology, Novant Health Hemby Children's Hospital, Charlotte, North Carolina
| | - Jeffrey E Deyo
- Department of Pediatric Hematology/Oncology, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana
| | | | - Allison A King
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri
| | - Amanda M Brandow
- Section of Pediatric Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeffrey D Lebensburger
- Department of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Oyebimpe Adesina
- Division of Hematology, University of Washington, Seattle, Washington
| | - Stella T Chou
- Division of Hematology and the Apheresis Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Babette S Zemel
- Department of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Winfred C Wang
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James G Gurney
- School of Public Health, University of Memphis, Memphis, Tennessee
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Silva PO, Ferreira AS, Lima CMDA, Guimarães FS, Lopes AJ. Balance control is impaired in adults with sickle cell anaemia. Somatosens Mot Res 2018; 35:109-118. [PMID: 30010483 DOI: 10.1080/08990220.2018.1481829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Musculoskeletal involvement and cerebrovascular disease are common in sickle cell anaemia (SCA). These changes are potentially important factors that modify the control of balance in this population. OBJECTIVE To assess balance control in adults with SCA and investigate the associations among balance, posture and muscle function. METHODS Twenty neurologically intact (i.e. without previous episodes of overt stroke or transient ischaemic attack) adults with SCA and 18 controls were evaluated. All participants underwent static balance measurement through stabilometry, postural evaluation through photogrammetry and assessment of muscle function through handgrip and respiratory muscle strength. RESULTS Compared to the controls, the adults with SCA exhibited greater displacement of the centre of mass, particularly in the mediolateral direction. Moreover, the adults with SCA exhibited greater postural deviations for the following variables: angles of the right and left hip, horizontal asymmetry of the scapula in relation to T3, angles of the right and left leg-heel and horizontal alignment of the pelvis. Handgrip strength, respiratory muscle strength and haemoglobin (Hb) levels were significantly correlated with postural balance measurements. Significant correlations between balance and posture were only observed between the variables of balance and the postural parameters that involved the angulations calculated from the vertical alignment of the pelvis, hip and ankle. CONCLUSIONS Neurologically intact adults with SCA exhibit damage in static balance, particularly in the mediolateral direction. These patients present postural deviations due to changes in the hip and ankle joints. In addition, balance control is related to posture, Hb level and muscle function.
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Affiliation(s)
- Priscila Oliveira Silva
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil
| | - Arthur Sá Ferreira
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil
| | | | - Fernando Silva Guimarães
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil
| | - Agnaldo José Lopes
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil.,b Postgraduate Programme in Medical Sciences , State University of Rio de Janeiro , Rio de Janeiro , Brazil
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