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Moura Neto JP, Albuquerque CCMX, Yahouedehou SCMA, Francisco MVL, Fraiji NA, de Siqueira IC, Gonçalves MS. Prevalence of arboviruses in sickle cell disease patients from two different regions of Brazil, the North and Northeast. Braz J Infect Dis 2024; 28:103741. [PMID: 38670165 PMCID: PMC11070587 DOI: 10.1016/j.bjid.2024.103741] [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: 11/29/2023] [Revised: 02/29/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Sickle Cell Disease (SCD) is a hereditary disease characterized by extravascular and intravascular hemolysis and clinical variability, from mild pain to potentially life-threatening. Arboviruses include mainly Zika (ZIKV), Chikungunya (CHKV), and Dengue (DENV) virus, and are considered a public and social health problem. The present cross-sectional observational study aimed to investigate the prevalence of arbovirus infection in SCD patients from two Brazilian cities, Salvador and Manaus located in Bahia and Amazonas states respectively. A total of 409 individuals with SCD were included in the study, and 307 (75.06 %) patients tested positive for DENV-IgG, 161 (39.36 %) for ZIKV-IgG, and 60 (14.67 %) for CHIKV-IgG. Only one individual was positive for DENV-NS1 and another for DENV-IgM, both from Salvador. No individuals had positive serology for ZIKV-IgM or CHIKV-IgM. Arbovirus positivity by IgG testing revealed that the SCD group presented high frequencies in both cities. Interestingly, these differences were only statistically significant for ZIKV-IgG (p = 0.023) and CHIKV-IgG (p = 0.005) among SCD patients from Manaus. The reshaping of arbovirus from its natural habitat by humans due to disorderly urban expansion and the ease of international Mobility has been responsible for facilitating the spread of vector-borne infectious diseases in humans. We found the need for further studies on arboviruses in this population to elucidate the real association and impact, especially in acute infection. We hope that this study will contribute to improvements in the personalized clinical follow-up of SCD patients, identifying the influence of arbovirus infection in severe disease manifestations.
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Affiliation(s)
- José Pereira Moura Neto
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Gonçalo Moniz, Salvador, BA, Brazil; Faculdade de Ciências Farmacêuticas, Laboratório de Análise Especializada em Biologia Molecular (LAEBM), Universidade Federal do Amazonas, Manaus, AM, Brazil; Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.
| | | | | | | | - Nelson Abrahim Fraiji
- Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
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Barros GDS, Leal CVF, Leite LAC, Fujimoto DE, Cançado RD. Real-world evidence of the burden of sickle cell disease: a 5-year longitudinal study at a Brazilian reference center. Hematol Transfus Cell Ther 2024; 46:161-166. [PMID: 38307824 DOI: 10.1016/j.htct.2023.10.001] [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: 06/18/2023] [Revised: 09/15/2023] [Accepted: 10/14/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is an inherited and multisystem blood disorder characterized by hemolytic anemia, vaso-occlusive crises (VOCs), progressive multiorgan damage and increased mortality. In Brazil, it is one of the most common monogenic diseases afflicting 60,000 to 100,000 individuals, however, there are sparse epidemiological data, as well as information on the utilization of public healthcare resources. METHOD This was a 5-year (2016 - 2020) retrospective study conducted at one Brazilian reference center on SCD - Santa Casa de Sao Paulo, in Sao Paulo, Brazil. RESULTS Among a total of 100 eligible adult patients, the median age was 31.0 years old, 84% of the patients were aged between 18 and 45 years old; 59% were women and 91% presented the genotype HbSS. The number of hematologist and non-hematologist visits at the outpatient unit were 2,198 and 1,436, respectively. The number of hospital ER visits was 758, of which 51% required 864 days of hospitalization. The main cause for seeking hospital medical care was the VOCs. The numbers and ratios of VOCs were: 1 to 10 VOCs, 64%; 11 to 20, 15%, and; 21 or more, 1%. There was a statistically significant difference between the number of VOCs and hospitalizations, as well as infection. CONCLUSION Results indicate the burden of SCD on Brazilian patients' daily lives, the impact of VOCs on public healthcare resources, the importance of having a national surveillance program to improve resource utilization and clinical outcomes of patients with SCD and the urgent need for the revitalizing of the current national comprehensive SCD care programs.
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Affiliation(s)
| | | | | | - Denys Eiti Fujimoto
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
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Prohaska CC, Zhang X, Schwantes‐An TL, Stearman RS, Hooker S, Kittles RA, Aldred MA, Lutz KA, Pauciulo MW, Nichols WC, Desai AA, Gordeuk VR, Machado RF. RASA3 is a candidate gene in sickle cell disease-associated pulmonary hypertension and pulmonary arterial hypertension. Pulm Circ 2023; 13:e12227. [PMID: 37101805 PMCID: PMC10124178 DOI: 10.1002/pul2.12227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
Pulmonary hypertension (PH) is associated with significant morbidity and mortality. RASA3 is a GTPase activating protein integral to angiogenesis and endothelial barrier function. In this study, we explore the association of RASA3 genetic variation with PH risk in patients with sickle cell disease (SCD)-associated PH and pulmonary arterial hypertension (PAH). Cis-expression quantitative trait loci (eQTL) were queried for RASA3 using whole genome genotype arrays and gene expression profiles derived from peripheral blood mononuclear cells (PBMC) of three SCD cohorts. Genome-wide single nucleotide polymorphisms (SNPs) near or in the RASA3 gene that may associate with lung RASA3 expression were identified, reduced to 9 tagging SNPs for RASA3 and associated with markers of PH. Associations between the top RASA3 SNP and PAH severity were corroborated using data from the PAH Biobank and analyzed based on European or African ancestry (EA, AA). We found that PBMC RASA3 expression was lower in patients with SCD-associated PH as defined by echocardiography and right heart catheterization and was associated with higher mortality. One eQTL for RASA3 (rs9525228) was identified, with the risk allele correlating with PH risk, higher tricuspid regurgitant jet velocity and higher pulmonary vascular resistance in patients with SCD-associated PH. rs9525228 associated with markers of precapillary PH and decreased survival in individuals of EA but not AA. In conclusion, RASA3 is a novel candidate gene in SCD-associated PH and PAH, with RASA3 expression appearing to be protective. Further studies are ongoing to delineate the role of RASA3 in PH.
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Affiliation(s)
- Clare C. Prohaska
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Xu Zhang
- Division of Hematology and Oncology, Department of MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | | | | | - Stanley Hooker
- Division of Health Equities, Department of Population SciencesCity of HopeDuarteCaliforniaUSA
| | - Rick A. Kittles
- Department of Community Health and Preventive MedicineMorehouse School of MedicineAtlantaGeorgiaUSA
| | - Micheala A. Aldred
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Katie A. Lutz
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Michael W. Pauciulo
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - William C. Nichols
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Ankit A. Desai
- Krannert Institute of Cardiology, Division of Cardiovascular Medicine, Department of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Victor R. Gordeuk
- Division of Hematology and Oncology, Department of MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Roberto F. Machado
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of MedicineIndiana UniversityIndianapolisIndianaUSA
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Earley EJ, Kelly S, Fang F, Alencar CS, Rodrigues DDOW, Soares Cruz DT, Flanagan JM, Ware RE, Zhang X, Gordeuk V, Gladwin M, Zhang Y, Nouraie M, Nekhai S, Sabino E, Custer B, Dinardo C, Page GP. Genome-wide association study of early ischaemic stroke risk in Brazilian individuals with sickle cell disease implicates ADAMTS2 and CDK18 and uncovers novel loci. Br J Haematol 2023; 201:343-352. [PMID: 36602125 PMCID: PMC10155195 DOI: 10.1111/bjh.18637] [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: 09/12/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
Ischaemic stroke is a common complication of sickle cell disease (SCD) and without intervention can affect 11% of children with SCD before the age of 20. Within the Trans-Omics for Precision Medicine (TOPMed), a genome-wide association study (GWAS) of ischaemic stroke was performed on 1333 individuals with SCD from Brazil (178 cases, 1155 controls). Via a novel Cox proportional-hazards analysis, we searched for variants associated with ischaemic stroke occurring at younger ages. Variants at genome-wide significance (p < 5 × 10-8 ) include two near genes previously linked to non-SCD early-onset stroke (<65 years): ADAMTS2 (rs147625068, p = 3.70 × 10-9 ) and CDK18 (rs12144136, p = 2.38 × 10-9 ). Meta-analysis, which included the independent SCD cohorts Walk-PHaSST and PUSH, exhibited consistent association for variants rs1209987 near gene TBC1D32 (p = 3.36 × 10-10 ), rs188599171 near CUX1 (p = 5.89 × 10-11 ), rs77900855 near BTG1 (p = 4.66 × 10-8 ), and rs141674494 near VPS13C (1.68 × 10-9 ). Findings from this study support a multivariant model of early ischaemic stroke risk and possibly a shared genetic architecture between SCD individuals and non-SCD individuals younger than 65 years.
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Affiliation(s)
- Eric Jay Earley
- GenOmics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, Durham, NC, USA
| | - Shannon Kelly
- Benioff Children’s Hospital, University of San Francisco, California, USA
- Vitalant Research Institute, San Francisco, California, USA
| | - Fang Fang
- GenOmics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, Durham, NC, USA
| | | | | | - Dahra Teles Soares Cruz
- Department of Hematology, Fundação de Hematologia e Hemoterapia de Pernambuco, HEMOPE, Pernambuco, Brazil
| | - Jonathan M. Flanagan
- Division of Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Russell E. Ware
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Xu Zhang
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Victor Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark Gladwin
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yingze Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sergei Nekhai
- Center for Sickle Cell Disease, Department of Medicine, Howard University, Washington DC, USA
| | - Ester Sabino
- Instituto de Medicina Tropical, University of São Paulo, Brazil
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California, San Francisco, USA
| | - Carla Dinardo
- Instituto de Medicina Tropical, University of São Paulo, Brazil
| | - Grier P. Page
- GenOmics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, Durham, NC, USA
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Belisário AR, Simões E Silva AC, Moura ICG, Carneiro-Proietti AB, Sabino EC, Loureiro P, Máximo C, Flor-Park MV, Rodrigues DDOW, Ozahata MC, Mota RA, Dinardo CL, Kelly S, Custer B. Estimated glomerular filtration rate in Brazilian adults with sickle cell disease: results from the REDS-III multicenter cohort study. Ann Hematol 2023; 102:1019-1027. [PMID: 36884065 DOI: 10.1007/s00277-023-05150-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/25/2023] [Indexed: 03/09/2023]
Abstract
Chronic kidney disease (CKD) has a significant impact on sickle cell disease (SCD) morbidity and mortality. Early identification of individuals at highest risk of developing CKD may allow therapeutic intervention to prevent worse outcomes. This study aimed to evaluate the prevalence and risk factors for reduced estimated glomerular filtration rate (eGFR) among adults with SCD in Brazil. Participants in the REDS-III multicenter SCD cohort with more severe genotypes aged ≥ 18 years with at least two serum creatinine values were analyzed. The eGFR was calculated using the Jamaica Sickle Cell Cohort Study GFR equation. The eGFR categories were defined according to the K/DOQI. Participants with eGFR ≥ 90 were compared to those with those with eGFR < 90. Among the 870 participants, 647 (74.4%) had eGFR ≥ 90, 211 (24.3%) had eGFR 60 to 89, six (0.7%) had eGFR 30 to 59, and six (0.7%) had ESRD. Male sex (OR: 37.3; 95%CI: 22.4-65.1), higher age (OR: 1.04; 95%CI: 1.02-1.06), higher diastolic blood pressure (OR: 1.03; 95%CI: 1.009-1.06), lower Hb (OR: 0.80; 95%CI: 0.68-0.93), and lower reticulocytes (OR: 0.94; 95%CI: 0.89-0.99) levels were independently associated with eGFR < 90. There was a trend towards higher odds of death in participants with eGFR < 90 (OR: 1.8; 95%CI: 0.95-3.32; p = 0.065). In turn, participants with eGFR < 60 had a 12.2 (95%CI: 2.1-96.9) times higher odds for death when compared to those with eGFR ≥ 60. In this study, eGFR < 90 was observed in one-quarter of adults. Older age, male sex, higher diastolic blood pressure, lower hemoglobin, and lower reticulocyte levels were associated with occurrence of eGFR < 90. Estimated GFR < 60 increased the risk of mortality.
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Affiliation(s)
- André Rolim Belisário
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, MG, 33400-000, Brazil. .,Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
| | - Ana Cristina Simões E Silva
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Anna Bárbara Carneiro-Proietti
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, MG, 33400-000, Brazil
| | - Ester Cerdeira Sabino
- Faculdade de Medicina (FMUSP) and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Paula Loureiro
- Fundação Hemope, Recife, PE, Brazil.,Universidade de Pernambuco, Recife, PE, Brazil
| | | | - Miriam V Flor-Park
- ITACI, Unidade de Onco-Hematologia, Instituto da Criança, HCFMUSP, São Paulo, Brazil
| | | | - Mina Cintho Ozahata
- Department of Computer Science - DCC, University of São Paulo, São Paulo, Brazil
| | - Rosimere Afonso Mota
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Rua das Goiabeiras, 779, Lagoa Santa, MG, 33400-000, Brazil
| | | | | | - Brian Custer
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, UCSF, San Francisco, CA, USA
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Reis de Souza V, Kelly S, Cerdeira Sabino E, Mendes de Oliveira F, Silva T, Miranda Teixeira C, Máximo C, Loureiro P, Barbara de Freitas Carneiro-Proietti A, Gomes I, Custer B, de Almeida-Neto C. Factors Associated with Leg Ulcers in Adults with Sickle Cell Disease in Brazil. Adv Skin Wound Care 2023; 36:98-105. [PMID: 36662043 DOI: 10.1097/01.asw.0000911152.41719.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To define the prevalence of leg ulcers and identify the clinical and laboratory factors associated with leg ulcers in adult participants. METHODS The authors conducted a cross-sectional study of 1,109 patients who were 18 years or older with SS or Sβ0-thalassemia genotypes from a Brazilian cohort. Investigators assessed the prevalence of factors associated with leg ulcers from 2013 to 2017. RESULTS The prevalence of leg ulcers was 21%. Increasing age (odds ratio [OR], 1.07; range, 1.06-1.09), male sex (OR, 2.03; range, 1.44-2.87), treatment with chronic transfusion therapy (OR, 1.88; range, 1.15-3.03), higher indirect bilirubin levels (OR, 1.48; range, 1.02-2.16), and low hemoglobin levels (OR, 2.17; range, 1.52-3.11) were associated with leg ulcers. Participants who self-reported as Black (OR, 6.75; range, 2.63-21.32), mixed (OR, 3.91; range, 1.55-12.20), and other/unknown (OR, 3.84; range, 1.04-15.24) were more likely to have leg ulcers compared with those who self-reported as White. CONCLUSIONS The prevalence of leg ulcers in this Brazilian cohort was higher than the prevalence reported in developed countries. Known factors such as age and male sex were corroborated. The increased bilirubin level and decreased hemoglobin levels among participants with leg ulcers support the hypothesis that hemolysis is correlated with leg ulcer pathogenesis. Self-reported black skin color was an independent predictor of leg ulcers and warrants further study to understand the etiology and implications of this finding.
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Affiliation(s)
- Valquíria Reis de Souza
- Valquíria Reis de Souza, MSc, is Biologist, Instituto de Medicina Tropical, University of São Paulo, Brazil. Shannon Kelly, MD, is Associate Professor, Pediatrics, Vitalant Research Institute, San Francisco, California. Also at Instituto de Medicina Tropical, University of São Paulo, Ester Cerdeira Sabino, MD, PhD, is Associate Professor and Franciane Mendes de Oliveira, BSc, is Master's Degree Student. Tassila Silva, PhD, is Assistant Professor, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte. Carolina Miranda Teixeira, MSc, is Biologist and Master, Faculdade de Medicina, Universidade Federal de Minas Gerais. Claudia Máximo, MD, is Hematologist at Hemorio, Hemocentro do Rio de Janeiro. Paula Loureiro, MD, PhD, is Adjunct Professor and Researcher at Hemope and Universidade de Pernambuco, Recife. Also at Fundação Hemominas, Hemocentro de Minas Gerais, Anna Barbara de Freitas Carneiro-Proietti, MD, PhD, is Senior Researcher. Isabel Gomes, PhD, is Researcher at Universidade Federal de Minas Gerais. Brian Custer, PhD, MPH, is Director, Vitalant Research Institute, San Francisco, California and Professor of Laboratory Medicine, University of California, San Francisco. Cesar de Almeida-Neto, MD, PhD, is Associate Professor at Faculdade de Medicina da Universidade de São Paulo and Chief of Apheresis Department at Fundação Pró-Sangue Hemocentro de São Paulo. Acknowledgment: This work was supported by the National Institutes of Health National Heart, Lung, and Blood Institute by grant HHSN268201100007I. Recipient Epidemiology and Donor Evaluation Study-III: International Component (Brazil), with the participation of the following centers and investigators. Brazilian participants: Instituto de Medicina Tropical de São Paulo (USP): Ester C. Sabino, Cecilia Alencar; Fundação Pró-Sangue (São Paulo): Alfredo Mendrone, Jr, Cesar de Almeida Neto, Ligia Capuani; Instituto de Tratamento do Câncer Infantil (São Paulo): Miriam Park; Faculdade de Medicina da Universidade de São Paulo (São Paulo): Paula Blatyta; Hemominas-Belo Horizonte (Minas Gerais): Anna Bárbara de Freitas Carneiro-Proietti, Andre Belisario, Carolina Miranda Teixeira, Tassila Salomon, Franciane Mendes de Oliveira, Valquíria Reis. Hemominas; Montes Claros (Minas Gerais): Rosemere Afonso Mota, José Wilson Sales; Hemominas-Juiz de Fora (Minas Gerais): Daniela de Oliveira Werneck; Fundação Hemope-Recife (Pernambuco): Paula Loureiro, Aderson Araújo, Dahra Teles Hemorio (Rio de Janeiro): Clarisse Lobo, Claudia Máximo, Luiz Amorin; Instituto de Matemática e Estatística da Universidade de São Paulo-USP (São Paulo): João Eduardo Ferreira, Márcio Katsumi Oikawa, Pedro Losco Takecian, Mina Cintho Ozahata, Rodrigo Muller de Carvalho. US Investigators: Vitalant Research Institute and University of California San Francisco: Brian Scott Custer, Michael P. Busch, and Thelma Therezinha Gonçalez; Research Triangle Institute: Donald Brambilla, Liliana R. Preiss, Christopher McClure; UCSF Benioff Children's Hospital Oakland: Shannon Kelly; National Heart, Lung, and Blood Institute-Simone A. Glynn. The authors have disclosed no other financial relationships related to this article. Submitted February 16, 2022; accepted in revised form August 12, 2022
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Flor-Park MV, Ozahata MC, Moura ICG, Blatyta P, Kelly S, Oliveira CDL, Capuani L, Belisário AR, Carneiro-Proietti ABF, Araujo AS, Loureiro P, Maximo C, Rodrigues DOW, Mota RA, Sabino E, Custer B, Rocha V. Is Severity Score Associated With Indication for Hematopoietic Stem Cell Transplantation in Individuals With Sickle Cell Anemia? Transplant Cell Ther 2022; 28:708.e1-708.e8. [PMID: 35788087 PMCID: PMC10979754 DOI: 10.1016/j.jtct.2022.06.024] [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: 02/15/2022] [Revised: 06/08/2022] [Accepted: 06/26/2022] [Indexed: 10/16/2022]
Abstract
Manifestations of sickle cell disease (SCD) begin early in childhood and cause morbidity and decreased life expectancy. Hematopoietic stem cell transplantation (HSCT) is curative but associated with risk of mortality attributable to the transplant. This risk should be counterbalanced with SCD morbidity and mortality. A severity score using a Bayesian network model was previously validated to predict the risk of death in adult individuals with SCD. The objective of this study is to calculate the severity scores of participants in a multicenter cohort of Brazilians with SCD, using a previously published Bayesian network-derived score, associated with risk of death and then compare the severity scores between participants with and without an indication for HSCT as defined by the Brazilian Ministry of Health (MoH) criteria. This is an observational, retrospective study. We analyzed 2063 individuals with sickle cell anemia from the Recipient Epidemiology and Donor Evaluation Study-III Brazil SCD cohort and applied a Bayesian network-derived score to compare candidates and non-candidates for HSCT according to the Brazilian MoH transplant criteria. Classical statistical methods were used to analyze data and make comparisons. We compared severity scores between cohort members with (n = 431) and without (n = 1632) HSCT indications according to Brazilian MoH. Scores were not different in adult participants with ≥1 HSCT indication when compared to those with no indication (mean 0.342 versus 0.292; median 0.194 versus 0.183, P = .354) and receiver operating characteristic curves did not demonstrate an obvious threshold to differentiate participants with or without HSCT indications. Severity score may predict risk of death but does not differentiate HSCT candidates. Current indications should be evaluated to ensure that patients with more severe disease who might benefit from HSCT are appropriately identified.
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Affiliation(s)
- Miriam V Flor-Park
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, Brazil.
| | | | | | | | - Shannon Kelly
- Vitalant Research Institute, Epidemiology, San Francisco, California; University of California San Francisco Benioff Children's Hospital, Oakland, California
| | | | - Ligia Capuani
- Departamento de Moléstias Infecciosas e Parasitárias da Faculdade de medicina da Universidade de São Paulo, Brazil
| | | | | | - Aderson S Araujo
- Department of Hematology, Fundação de Hematologia e Hemoterapia de Pernambuco, HEMOPE, Pernambuco, Brazil
| | - Paula Loureiro
- Research Department, Fundação de Hematologia e Hemoterapia de Pernambuco, HEMOPE, Pernambuco, Brazil; Research Department, Universidade de Pernambuco, Pernambuco, Brazil
| | - Claudia Maximo
- Department of Hematology, Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti-HEMORIO, Rio de Janeiro, Brazil
| | | | - Rosimere A Mota
- Department of Hematology, Hemocentro Regional de Montes Claros, Fundação HEMOMINAS, Montes Claros, Brazil
| | - Ester Sabino
- Instituto de Medicina Tropical and Departamento de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Brian Custer
- Vitalant Research Institute, Epidemiology, San Francisco, California; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vanderson Rocha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Hematologia, Hemoterapia e Terapia Celular, São Paulo, Brazil; Laboratory of Medical Investigation (LIM 31) in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Haematology, University of Oxford, Churchill Hospital, Oxford, United Kingdom
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Sickle Cell Disease in Bahia, Brazil: The Social Production of Health Policies and Institutional Neglect. SOCIETIES 2022. [DOI: 10.3390/soc12040108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A disease is considered neglected when it is not given due priority in health policies despite the social relevance of that disease, either in terms of the number of individuals affected by it or its morbidity or mortality. Although the causes are structural, neglect in health does not occur in a vacuum. In this paper, we explore how sickle cell disease (SCD) is constructed and neglected in Brazil, based on insights from our long-term participatory qualitative research in the state of Bahia. We present five overarching themes relevant to the social production of SCD, and associated health policies in Brazil: (1) The achievements and setbacks to overcome neglect in SCD, (2) Continuity of comprehensive SCD care; (3) Social movements of people with SCD; (4) Biocultural citizenship; and (5) Academic advocacy. We conclude that it is insufficient to merely recognize the health inequities that differentiate white and black populations in Brazil; racism must be understood as both a producer and a reproducer of this process of neglect. We conclude with a set of recommendations for the main SCD stakeholder groups committed to improving the lives of people living with SCD.
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Phenotypes of sickle cell intensive care admissions: an unsupervised machine learning approach in a single-center retrospective cohort. Ann Hematol 2022; 101:1951-1957. [PMID: 35836008 DOI: 10.1007/s00277-022-04918-4] [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: 02/21/2022] [Accepted: 06/27/2022] [Indexed: 11/01/2022]
Abstract
Sickle cell disease (SCD) is associated with multiple known complications and increased mortality. This study aims to further understand the profile of intensive care unit (ICU) admissions of SCD patients. In this single-center retrospective cohort (approval number 0926-11), we evaluated SCD-related ICU admissions at our hospital in São Paulo, Brazil. Admissions were clustered using clinical data and organ dysfunction at ICU admission. A hierarchical clustering method was used to distinguish phenotypes. From 140 admissions obtained, 125 were included. The mean age was 30 years, 48% were male, and SS genotype was predominant (71.2%). Non-surgical causes of admissions accounted for 85.6% (n = 107). The mean Sequential Organ Failure Assessment score (SOFA) was 4 (IQR 2-7). Vasopressors were required by 12% and mechanical ventilation by 17.6%. After analysis of the average silhouette width, the optimal number of clusters was 3: cluster 1 (n = 69), cluster 2 (n = 25), cluster 3 (n = 31). Cluster 1 had a mean age of 29 years, 87% of SS genotype, and mean SOFA of 4. Cluster 2 had a mean age of 37 years, 80% of SS genotype, and mean SOFA of 8. Cluster 3 had a mean age of 26 years, 29% of SS genotype, and mean SOFA of 3. The need for mechanical ventilation was 11.6%, 44%, and 9.7%, respectively. Mortality was significantly higher in cluster 2 (44%, p = 0.012). This cohort of critical SCD admissions suggested the presence of three different profiles. This can be informative in the ICU setting to identify SCD patients at higher risk of worse outcomes.
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10
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Silva-Pinto AC, Costa FF, Gualandro SFM, Fonseca PBB, Grindler CM, Souza Filho HCR, Bueno CT, Cançado RD. Economic burden of sickle cell disease in Brazil. PLoS One 2022; 17:e0269703. [PMID: 35709301 PMCID: PMC9202914 DOI: 10.1371/journal.pone.0269703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Sickle cell disease (SCD) may cause several impacts to patients and the whole society. About 4% of the population has the sickle cell trait in Brazil, and 60,000 to 100,000 have SCD. However, despite recognizing the significant burden of disease, little is known about SCD costs. Objective To estimate SCD societal costs based on disease burden modelling, under Brazilian societal perspective. Methods A disease burden model was built considering the societal perspective and a one-year time horizon, including direct medical and indirect costs (morbidity and mortality). The sum of life lost and disability years was considered to estimate disability-adjusted life years (DALYs). Data from a public database (DATASUS) and the prevalence obtained from literature or medical experts were used to define complications prevalence and duration. Costs were defined using data from the Brazilian public healthcare system table of procedures and medications (SIGTAP) and the human capital method. Results Annual SCD cost was 413,639,180 USD. Indirect cost accounted for the majority of burden (70.1% of the total; 290,158,365 USD vs 123,480,816 USD). Standard of care and chronic complications were the main source of direct costs among adults, while acute conditions were the main source among children. Vaso-occlusive crisis represented the complication with the highest total cost per year in both populations, 11,400,410 USD among adults and 11,510,960 USD among children. Conclusions SCD management may impose an important economic burden on Brazilian society that may reach more than 400 million USD per year.
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Affiliation(s)
- Ana Cristina Silva-Pinto
- Regional Blood Center, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fernando F. Costa
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | | | - Carmela Maggiuzzu Grindler
- Department of Technical Area of Neonatal, São Paulo State Health Department: Secretaria da Saude do Estado de Sao Paulo, São Paulo, Brazil
| | | | | | - Rodolfo D. Cançado
- Department of Hematology/Oncology, Santa Casa Medical School of Sao Paulo, Sao Paulo, Brazil
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11
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Josephson CD, Glynn S, Mathew S, Birch R, Bakkour S, Baumann Kreuziger L, Busch MP, Chapman K, Dinardo C, Hendrickson J, Hod EA, Kelly S, Luban N, Mast A, Norris P, Custer B, Sabino E, Sachais B, Spencer BR, Stone M, Kleinman S. The Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P): A research program striving to improve blood donor safety and optimize transfusion outcomes across the lifespan. Transfusion 2022; 62:982-999. [PMID: 35441384 PMCID: PMC9353062 DOI: 10.1111/trf.16869] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P) is a new iteration of prior National Heart, Lung, and Blood Institute (NHLBI) REDS programs that focus on improving transfusion recipient outcomes across the lifespan as well as the safety and availability of the blood supply. STUDY DESIGN AND METHODS The US program includes blood centers and hospitals (22 including 6 free-standing Children's hospitals) in four geographic regions. The Brazilian program has 5 participating hemocenters. A Center for Transfusion Laboratory Studies (CTLS) and a Data Coordinating Center (DCC) support synergistic studies and activities over the 7-year REDS-IV-P program. RESULTS The US is building a centralized, vein-to-vein (V2V) database, linking information collected from blood donors, their donations, the resulting manufactured components, and data extracts from hospital electronic medical records of transfused and non-transfused patients. Simultaneously, the Brazilian program is building a donor, donation, and component database. The databases will serve as the backbone for retrospective and prospective observational studies in transfusion epidemiology, transfusion recipient outcomes, blood component quality, and emerging blood safety issues. Special focus will be on preterm infants, patients with sickle cell disease, thalassemia or cancer, and the effect of donor biologic variability and component manufacturing on recipient outcomes. A rapid response capability to emerging safety threats has resulted in timely studies related to Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2). CONCLUSIONS The REDS-IV-P program endeavors to improve donor-recipient-linked research with a focus on children and special populations while also maintaining the flexibility to address emerging blood safety issues.
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Affiliation(s)
- Cassandra D Josephson
- Departments of Pathology and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Simone Glynn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sunitha Mathew
- Public Health and Epidemiology Practice, Westat, Rockville, Maryland, USA
| | - Rebecca Birch
- Public Health and Epidemiology Practice, Westat, Rockville, Maryland, USA
| | - Sonia Bakkour
- Vitalant Research Institute, University of California San Francisco, San Francisco, California, USA
| | | | - Michael P Busch
- Vitalant Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Kathleen Chapman
- Public Health and Epidemiology Practice, Westat, Rockville, Maryland, USA
| | - Carla Dinardo
- Immunohematology, Faculdade de Medicina da Universidade de Sao and Fundacao Pro-Sangue, São Paulo, Brazil
| | - Jeanne Hendrickson
- Departments of Pediatrics and Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eldad A Hod
- Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Shannon Kelly
- Department of Pediatric Hematology & Oncology, UCSF Benioff Children's Hospital, Oakland, California, USA
| | - Naomi Luban
- Children's Research National Institute, Children's National Hospital, Washington, District of Columbia, USA
| | - Alan Mast
- Versiti Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA
| | - Philip Norris
- Vitalant Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Brian Custer
- Vitalant Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Ester Sabino
- Department of Infectious Disease, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Bryan R Spencer
- Scientific Affairs, American Red Cross, Dedham, Massachusetts, USA
| | - Mars Stone
- Vitalant Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Steve Kleinman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Victoria, British Columbia, Canada
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12
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Oliveira PPD, Gesteira ECR, Souza RLD, Paula NCPD, Santos LC, Santos WJD, Silveira EAAD. Educational technology on COVID-19 for families of children and adolescents with sickle cell disease. Rev Bras Enferm 2021; 74:e20201045. [PMID: 34133544 DOI: 10.1590/0034-7167-2020-1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/07/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE to construct and validate educational technology on COVID-19 and essential care for families of children/adolescents with sickle cell disease. METHODS this is a methodological study, in three stages: 1) elaborated educational technology, using the Doak, Doak and Root theoretical-methodological model; 2) content and appearance validation by the content validity coefficient. Delphi technique was applied in two rounds (Delphi I [12 judges]/Delphi II [11 judges]); 3) conducting a pilot test with six families. RESULTS "Sickle cell disease and COVID-19: essential care" included: consequences of COVID-19 in sickle cell disease, guidelines for reducing the risks of contracting the virus and having complications, signs and symptoms of COVID-19, guidelines in case of child/adolescent with suspicion or symptoms of COVID-19. Global content validity coefficient (Delphi II): 0.98. CONCLUSION educational technology presented content and appearance validity for families of children/adolescents with sickle cell disease, related to COVID-19.
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13
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Batista JVGF, Arcanjo GS, Batista THC, Sobreira MJ, Santana RM, Domingos IF, Hatzlhofer BL, Falcão DA, Pereira-Martins DA, Oliveira JM, Araujo AS, Laranjeira LPM, Medeiros FS, Albuquerque FP, Albuquerque DM, Santos MN, Hazin MF, Dos Anjos AC, Costa FF, Araujo AS, Lucena-Araujo AR, Bezerra MA. Influence of UGT1A1 promoter polymorphism, α-thalassemia and β s haplotype in bilirubin levels and cholelithiasis in a large sickle cell anemia cohort. Ann Hematol 2021; 100:903-911. [PMID: 33523291 DOI: 10.1007/s00277-021-04422-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
Hyperbilirubinemia in patients with sickle cell anemia (SCA) as a result of enhanced erythrocyte destruction, lead to cholelithiasis development in a subset of patients. Evidence suggests that hyperbilirubinemia may be related to genetic variations, such as the UGT1A1 gene promoter polymorphism, which causes Gilbert syndrome (GS). Here, we aimed to determine the frequencies of UGT1A1 promoter alleles, alpha thalassemia, and βS haplotypes and analyze their association with cholelithiasis and bilirubin levels. The UGT1A1 alleles, -3.7 kb alpha thalassemia deletion and βS haplotypes were determined using DNA sequencing and PCR-based assays in 913 patients with SCA. The mean of total and unconjugated bilirubin and the frequency of cholelithiasis in GS patients were higher when compared to those without this condition, regardless of age (P < 0.05). Cumulative analysis demonstrated an early age-at-onset for cholelithiasis in GS genotypes (P < 0.05). Low fetal hemoglobin (HbF) levels and normal alpha thalassemia genotype were related to cholelithiasis development (P > 0.05). However, not cholelithiasis but total and unconjugated bilirubin levels were associated with βS haplotype. These findings confirm in a large cohort that the UGT1A1 polymorphism influences cholelithiasis and hyperbilirubinemia in SCA. HbF and alpha thalassemia also appear as modulators for cholelithiasis risk.
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Affiliation(s)
| | - Gabriela S Arcanjo
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil
| | - Thais H C Batista
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil
| | | | - Rodrigo M Santana
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil
| | - Igor F Domingos
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil.,Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Betânia L Hatzlhofer
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil.,Department of Pharmaceutical Sciences, Health Sciences Centre, Federal University of Pernambuco, Recife, Brazil
| | - Diego A Falcão
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil
| | - Diego A Pereira-Martins
- Department of Internal Medicine, Medical School of Ribeirao Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Jéssica M Oliveira
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil
| | - Amanda S Araujo
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | | | - Magnun N Santos
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
| | - Manuela F Hazin
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Brazil
| | - Ana C Dos Anjos
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Brazil
| | - Fernando F Costa
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
| | - Aderson S Araujo
- Department of Internal Medicine, Hematology and Hemotherapy Foundation of Pernambuco, Recife, Brazil
| | | | - Marcos A Bezerra
- Genetics Postgraduate Program, Federal University of Pernambuco, Recife, Brazil.
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14
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Dinardo CL, Oliveira TGM, Kelly S, Ashley-Koch A, Telen M, Schmidt LC, Castilho S, Melo K, Dezan MR, Wheeler MM, Johnsen JM, Nickerson DA, Jain D, Custer B, Pereira AC, Sabino EC. Diversity of variant alleles encoding Kidd, Duffy, and Kell antigens in individuals with sickle cell disease using whole genome sequencing data from the NHLBI TOPMed Program. Transfusion 2021; 61:603-616. [PMID: 33231305 DOI: 10.1111/trf.16204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/17/2020] [Accepted: 10/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Genetic variants in the SLC14A1, ACKR1, and KEL genes, which encode Kidd, Duffy, and Kell red blood cell antigens, respectively, may result in weakened expression of antigens or a null phenotype. These variants are of particular interest to individuals with sickle cell disease (SCD), who frequently undergo chronic transfusion therapy with antigen-matched units. The goal was to describe the diversity and the frequency of variants in SLC14A1, ACKR1, and KEL genes among individuals with SCD using whole genome sequencing (WGS) data. STUDY DESIGN AND METHODS Two large SCD cohorts were studied: the Recipient Epidemiology and Donor Evaluation Study III (REDS-III) (n = 2634) and the Outcome Modifying Gene in SCD (OMG) (n = 640). Most of the studied individuals were of mixed origin. WGS was performed as part of the National Heart, Lung, and Blood Institute's Trans-Omics for Precision Medicine (TOPMed) program. RESULTS In SLC14A1, variants included four encoding a weak Jka phenotype and five null alleles (JKnull ). JKA*01N.09 was the most common JKnull . One possible JKnull mutation was novel: c.812G>T. In ACKR1, identified variants included two that predicted Fyx (FY*X) and one corresponding to the c.-67T>C GATA mutation. The c.-67T>C mutation was associated with FY*A (FY*01N.01) in four participants. FY*X was identified in 49 individuals. In KEL, identified variants included three null alleles (KEL*02N.17, KEL*02N.26, and KEL*02N.04) and one allele predicting Kmod phenotype, all in heterozygosity. CONCLUSIONS We described the diversity and distribution of SLC14A1, ACKR1, and KEL variants in two large SCD cohorts, comprising mostly individuals of mixed ancestry. This information may be useful for planning the transfusion support of patients with SCD.
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Affiliation(s)
- Carla L Dinardo
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
- Institute of Tropical Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Shannon Kelly
- Vitalant Research Institute, San Francisco, California, USA
| | - Allison Ashley-Koch
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Marilyn Telen
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | | | | | | | - Marcia R Dezan
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | - Marsha M Wheeler
- Department of Genome Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Jill M Johnsen
- University of Washington, Seattle, Washington, USA
- Bloodworks, Research Institute, Seattle, USA
| | - Deborah A Nickerson
- Department of Genome Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Deepti Jain
- University of Washington, Seattle, Washington, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), São Paulo, Brazil
| | - Ester C Sabino
- Institute of Tropical Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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15
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Nunes K, Aguiar VRC, Silva M, Sena AC, de Oliveira DCM, Dinardo CL, Kehdy FSG, Tarazona-Santos E, Rocha VG, Carneiro-Proietti ABF, Loureiro P, Flor-Park MV, Maximo C, Kelly S, Custer B, Weir BS, Sabino EC, Porto LC, Meyer D. How Ancestry Influences the Chances of Finding Unrelated Donors: An Investigation in Admixed Brazilians. Front Immunol 2020; 11:584950. [PMID: 33240273 PMCID: PMC7677137 DOI: 10.3389/fimmu.2020.584950] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
A match of HLA loci between patients and donors is critical for successful hematopoietic stem cell transplantation. However, the extreme polymorphism of HLA loci - an outcome of millions of years of natural selection - reduces the chances that two individuals will carry identical combinations of multilocus HLA genotypes. Further, HLA variability is not homogeneously distributed throughout the world: African populations on average have greater variability than non-Africans, reducing the chances that two unrelated African individuals are HLA identical. Here, we explore how self-identification (often equated with "ethnicity" or "race") and genetic ancestry are related to the chances of finding HLA compatible donors in a large sample from Brazil, a highly admixed country. We query REDOME, Brazil's Bone Marrow Registry, and investigate how different criteria for identifying ancestry influence the chances of finding a match. We find that individuals who self-identify as "Black" and "Mixed" on average have lower chances of finding matches than those who self-identify as "White" (up to 57% reduction). We next show that an individual's African genetic ancestry, estimated using molecular markers and quantified as the proportion of an individual's genome that traces its ancestry to Africa, is strongly associated with reduced chances of finding a match (up to 60% reduction). Finally, we document that the strongest reduction in chances of finding a match is associated with having an MHC region of exclusively African ancestry (up to 75% reduction). We apply our findings to a specific condition, for which there is a clinical indication for transplantation: sickle-cell disease. We show that the increased African ancestry in patients with this disease leads to reduced chances of finding a match, when compared to the remainder of the sample, without the condition. Our results underscore the influence of ancestry on chances of finding compatible HLA matches, and indicate that efforts guided to increasing the African component of registries are necessary.
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Affiliation(s)
- Kelly Nunes
- Laboratory of Evolutionary Genetics, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Vitor R. C. Aguiar
- Laboratory of Evolutionary Genetics, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Márcio Silva
- Instituto de Matemática e Estatística, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandre C. Sena
- Instituto de Matemática e Estatística, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Danielli C. M. de Oliveira
- Registro Nacional de Doadores Voluntários de Medula Óssea—REDOME, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, Brazil
| | | | | | - Eduardo Tarazona-Santos
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vanderson G. Rocha
- Fundação Pró Sangue, Hemocentro de São Paulo, São Paulo, Brazil
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paula Loureiro
- Fundação Hemominas, Belo Horizonte, Brazil
- Fundação de Hematologia e Hemoterapia de Pernambuco, HEMOPE, Recife, Brazil
| | - Miriam V. Flor-Park
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, Brazil
| | | | - Shannon Kelly
- Epidemiology, Vitalant Research Institute, San Francisco, CA, United States
- University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA, United States
| | - Brian Custer
- Epidemiology, Vitalant Research Institute, San Francisco, CA, United States
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Bruce S. Weir
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Ester C. Sabino
- Instituto de Medicina Tropical, Departamento de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luís Cristóvão Porto
- Laboratório de Histocompatibilidade e Criopreservação, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diogo Meyer
- Laboratory of Evolutionary Genetics, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
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16
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Blatyta PF, Kelly S, Goncalez TT, Carneiro-Proietti AB, Salomon T, Miranda C, Sabino E, Preiss L, Maximo C, Loureiro P, Custer B, de Almeida-Neto C. Characterization of HIV risks in a Brazilian sickle cell disease population. BMC Public Health 2020; 20:1606. [PMID: 33097032 PMCID: PMC7585195 DOI: 10.1186/s12889-020-09702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A low prevalence of HIV in sickle cell disease (SCD) patients has been reported in the literature though mechanisms for this are not understood. METHODS HIV risk behaviors were compared between SCD cases and non-SCD controls using a self-administered audio computer-assisted self-interview. SCD cases were recruited from a multi-center SCD cohort established in Brazil; controls were recruited from SCD social contacts. Categorical variables were analyzed using Chi-Square or Fisher exact test. Continuous variables were compared using the Mann-Whitney U test. RESULTS There were 152 SCD cases and 154 age/location matched controls enrolled at three participating Brazilian centers during 2016-17. No significant differences in number of sexual partners (lifetime or previous 12 months), male-to-male sex partners or intravenous drug use were observed. Cases received more transfusions, surgeries, and acupuncture treatment. CONCLUSIONS Besides the risk of transfusion-transmitted HIV, which is now exceedingly rare, SCD and non-SCD participants demonstrated similar HIV risk behaviors. Causes other than risk behaviors such as factors inherent to SCD pathophysiology may explain the reported low prevalence of HIV in SCD.
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Affiliation(s)
- P F Blatyta
- Hospital Moysés Deutsch, São Paulo, SP, Brazil.
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - S Kelly
- Vitalant Research Institute, San Francisco, CA, USA
| | - T T Goncalez
- Vitalant Research Institute, San Francisco, CA, USA
| | | | - T Salomon
- Fundação Hemominas, Belo Horizonte, MG, Brazil
| | - C Miranda
- Fundação Hemominas, Belo Horizonte, MG, Brazil
| | - E Sabino
- Instituto de Medicina Tropical da FMUSP, São Paulo, SP, Brazil
| | - L Preiss
- Research Triangle Institute, International, Rockville, MD, USA
| | - C Maximo
- Hemorio, Rio de Janeiro, RJ, Brazil
| | - P Loureiro
- Fundação Hemope and Universidade de Pernambuco, Recife, PE, Brazil
| | - B Custer
- Vitalant Research Institute, San Francisco, CA, USA
| | - C de Almeida-Neto
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Fundação Pró-Sangue de São Paulo, São Paulo, SP, Brazil
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17
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Nembaware V, Mazandu GK, Hotchkiss J, Safari Serufuri JM, Kent J, Kengne AP, Anie K, Munung NS, Bukini D, Bitoungui VJN, Munube D, Chirwa U, Chunda-Liyoka C, Jonathan A, Flor-Park MV, Esoh KK, Jonas M, Mnika K, Oosterwyk C, Masamu U, Morrice J, Uwineza A, Nguweneza A, Banda K, Nyanor I, Adjei DN, Siebu NE, Nkanyemka M, Kuona P, Tayo BO, Campbell A, Oron AP, Nnodu OE, Painstil V, Makani J, Mulder N, Wonkam A. The Sickle Cell Disease Ontology: Enabling Collaborative Research and Co-Designing of New Planetary Health Applications. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2020; 24:559-567. [PMID: 33021900 PMCID: PMC7549008 DOI: 10.1089/omi.2020.0153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Sickle cell disease (SCD) is one of the most common blood disorders impacting planetary health. Over 300,000 newborns are diagnosed with SCD each year globally, with an increasing trend. The sickle cell disease ontology (SCDO) is the most comprehensive multidisciplinary SCD knowledge portal. The SCDO was collaboratively developed by the SCDO working group, which includes experts in SCD and data standards from across the globe. This expert review presents highlights and lessons learned from the fourth SCDO workshop that marked the beginning of applications toward planetary health impact, and with an eye to empower and cultivate multisite SCD collaborative research. The workshop was organized by the Sickle Africa Data Coordinating Center (SADaCC) and attended by 44 participants from 14 countries, with 2 participants connecting remotely. Notably, from the standpoint of democratizing and innovating scientific meeting design, an SCD patient advocate also presented at the workshop, giving a broader real-life perspective on patients' aspirations, needs, and challenges. A major component of the workshop was new approaches to harness SCDO to harmonize data elements used by different studies. This was facilitated by a web-based platform onto which participants uploaded data elements from previous or ongoing SCD-relevant research studies before the workshop, making multisite collaborative research studies based on existing SCD data possible, including multisite cohort, SCD global clinical trials, and SCD community engagement approaches. Trainees presented proposals for systematic literature reviews in key SCD research areas. This expert review emphasizes potential and prospects of SCDO-enabled data standards and harmonization to facilitate large-scale global SCD collaborative initiatives. As the fields of public and global health continue to broaden toward planetary health, the SCDO is well poised to play a prominent role to decipher SCD pathophysiology further, and co-design diagnostics and therapeutics innovation in the field.
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Affiliation(s)
- Victoria Nembaware
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gaston K Mazandu
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jade Hotchkiss
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Jill Kent
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kofi Anie
- London North West University Healthcare NHS Trust and Imperial College London, London, UK.,Sickle Cell Disease Genomics Network of Africa (SickleGenAfrica), University of Ghana, Accra, Ghana
| | - Nchangwi Syntia Munung
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Daima Bukini
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Valentina Josiane Ngo Bitoungui
- Department of Microbiology, Hematology and Immunology, Faculty of Medicine and Pharmaceutical Sciences of the University of Dschang, Dschang, Cameroon
| | - Deogratias Munube
- Department of Paediatric and Child Health, Makerere University/Mulago National Referral Hospital, Kampala, Uganda
| | - Uzima Chirwa
- University Teaching Hospitals-Children's Hospital, University of Zambia, School of Medicine, Lusaka, Zambia
| | - Catherine Chunda-Liyoka
- University Teaching Hospitals-Children's Hospital, University of Zambia, School of Medicine, Lusaka, Zambia
| | - Agnes Jonathan
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Miriam V Flor-Park
- Onco-hematology Unit, Instituto da Criança, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Kevin Kum Esoh
- Department of Biochemistry, Faculty of Science, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Mario Jonas
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Khuthala Mnika
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chandré Oosterwyk
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Upendo Masamu
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Jack Morrice
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Annette Uwineza
- University of Rwanda, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Arthemon Nguweneza
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kambe Banda
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Isaac Nyanor
- Kumasi Centre for Sickle Cell Disease, Komfo Anokye Teaching Hospital, Accra, Ghana
| | - David Nana Adjei
- Sickle Cell Disease Genomics Network of Africa (SickleGenAfrica), University of Ghana, Accra, Ghana
| | - Nathan Edward Siebu
- Sickle Cell Disease Genomics Network of Africa (SickleGenAfrica), University of Ghana, Accra, Ghana
| | - Malula Nkanyemka
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Patience Kuona
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Bamidele O Tayo
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Andrew Campbell
- Division of Hematology, Center for Cancer and Blood Disorders, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Assaf P Oron
- Maternal, Newborn and Child Health, Institute for Disease Modeling, Bellevue, Washington, USA
| | - Obiageli E Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Vivian Painstil
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Julie Makani
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Nicola Mulder
- Computational Biology Division, Faculty of Health Sciences, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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18
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Belisário AR, Blatyta PF, Vivanco D, Oliveira CDL, Carneiro-Proietti AB, Sabino EC, de Almeida-Neto C, Loureiro P, Máximo C, de Oliveira Garcia Mateos S, Flor-Park MV, de Oliveira Werneck Rodrigues D, Afonso Mota R, Gonçalez TT, Hoffmann TJ, Kelly S, Custer B. Association of HIV infection with clinical and laboratory characteristics of sickle cell disease. BMC Infect Dis 2020; 20:638. [PMID: 32854639 PMCID: PMC7457248 DOI: 10.1186/s12879-020-05366-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a multisystem disorder characterized by a wide spectrum of clinical manifestations and severity. Studies investigating potential effects of co-morbid human immunodeficiency virus (HIV) and SCD have produced conflicting results, and additional investigations are needed to elucidate whether the interaction between the two disease states might impact both HIV and SCD clinical outcomes. The association of HIV infection with clinical and laboratory characteristics of patients with SCD was assessed. METHODS This nested case-control study included individuals with SCD with HIV treated at six Brazilian SCD centers. Clinical and laboratory data were abstracted from medical records. HIV positive participants were compared to age, gender, center, and SCD genotype matched HIV negative participants (ratio 1:4). Individual clinical outcomes as well as a composite outcome of any SCD complication and a composite outcome of any HIV-related complication were compared between the two groups. RESULTS Fifteen HIV positive participants were included, 12 (80%) alive and 3 (20%) deceased. Most of the HIV positive patients had HbSS (60%; n = 9), 53% (n = 8) were female, and mean age was 30 ± 13 years. The frequency of individual SCD complications of acute chest syndrome/pneumonia, sepsis/bacteremia, pyelonephritis, ischemic stroke, hemorrhagic stroke, abnormal transcranial Doppler (TCD), and pulmonary hypertension was higher in HIV positive participants when compared to HIV negative, although analyzed individually none were statistically significant. HIV positive participants had significantly higher risk of any SCD complication and of a composite HIV-related complication compared to the HIV negative group (HR = 4.6; 95%CI 1.1-19.6; P = 0.04 and HR = 7.7; 95%CI 1.5-40.2; P = 0.02, respectively). There was a non-significant trend towards higher risk of any infections in participants with HIV positive (HR = 3.5; 95%CI 0.92-13.4; P = 0.07). Laboratory parameters levels were not significantly different in individuals with and without HIV. CONCLUSIONS In summary, our study in SCD patients shows that those with HIV have an increased risk of any SCD complication and HIV-related complications, as well as a suggestive but not significantly increased risk of infections.
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Affiliation(s)
- André Rolim Belisário
- Fundação Hemominas, Alameda Ezequiel Dias, 321, Belo Horizonte, Minas Gerais, 30130-110, Brazil.
| | - Paula F Blatyta
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Diana Vivanco
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | | | | | - Ester Cerdeira Sabino
- Faculdade de Medicina (FMUSP) and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Cesar de Almeida-Neto
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, SP, Brazil
| | - Paula Loureiro
- Fundação Hemope, Recife, Pernambuco, Brazil
- Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Sheila de Oliveira Garcia Mateos
- Faculdade de Medicina (FMUSP) and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
- Fundação Hemorio, Rio de Janeiro, Brazil
| | - Miriam V Flor-Park
- ITACI, Unidade de Onco-hematologia, Instituto da Criança, HCFMUSP, São Paulo, Brazil
| | | | - Rosimere Afonso Mota
- Fundação Hemominas, Alameda Ezequiel Dias, 321, Belo Horizonte, Minas Gerais, 30130-110, Brazil
| | | | - Thomas J Hoffmann
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, USA
- UCSF Benioff Children's Hospital Oakland, Oakland, USA
| | - Brian Custer
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- Vitalant Research Institute, San Francisco, USA
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19
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Tozatto-Maio K, Torres MA, Degaide NHS, Cardoso JF, Volt F, Pinto ACS, Oliveira D, Elayoubi H, Kashima S, Loiseau P, Veelken H, Ferster A, Cappelli B, Rodrigues ES, Scigliuolo GM, Kenzey C, Ruggeri A, Rocha V, Simões BP, Tamouza R, Gluckman E. HLA-Matched Unrelated Donors for Patients with Sickle Cell Disease: Results of International Donor Searches. Biol Blood Marrow Transplant 2020; 26:2034-2039. [PMID: 32712327 DOI: 10.1016/j.bbmt.2020.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/07/2020] [Accepted: 07/11/2020] [Indexed: 01/31/2023]
Abstract
Sickle cell disease (SCD) is the most common inherited hemoglobinopathy. Hematopoietic stem cell transplantation (HCT) is the sole curative therapy for SCD, but few patients will have a matched sibling donor. Patients with SCD are mostly of African origin and thus are less likely to find a matched unrelated donor in international registries. Using HaploStats, we estimated HLA haplotypes for 185 patients with SCD (116 from a Brazilian center and 69 from European Society for Blood and Marrow Transplantation [EBMT] centers) and classified the ethnic origin of haplotypes. Then we assessed the probability of finding an HLA-matched unrelated adult donor (MUD), considering loci A, B, and DRB1 (6/6), in international registries. Most haplotypes were African, but Brazilians showed a greater ethnic admixture than EBMT patients. Nevertheless, the chance of finding at least one 6/6 potential allelic donor was 47% for both groups. Most potential allelic donors were from the US National Marrow Donor Program registry and from the Brazilian REDOME donor registry. Although the probability of finding a donor is higher than previously reported, strategies are needed to improve ethnic diversity in registries. Moreover, predicting the likelihood of having an MUD might influence SCD management.
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Affiliation(s)
- Karina Tozatto-Maio
- Monacord, Centre Scientifique de Monaco, Principauté de Monaco, Monaco; Eurocord, Hôpital Saint Louis, Institut de recherche Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Center for Cell-Based Therapy, Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Hematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
| | | | - Neifi Hassan Saloum Degaide
- Center for Cell-Based Therapy, Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana Fernandes Cardoso
- Brazilian Bone Marrow Registry (REDOME), Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, Brazil
| | - Fernanda Volt
- Monacord, Centre Scientifique de Monaco, Principauté de Monaco, Monaco; Eurocord, Hôpital Saint Louis, Institut de recherche Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Ana Cristina Silva Pinto
- Center for Cell-Based Therapy, Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Danielli Oliveira
- Brazilian Bone Marrow Registry (REDOME), Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, Brazil
| | - Hanadi Elayoubi
- Monacord, Centre Scientifique de Monaco, Principauté de Monaco, Monaco; Eurocord, Hôpital Saint Louis, Institut de recherche Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Simone Kashima
- Center for Cell-Based Therapy, Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Pascale Loiseau
- Saint Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Hendrik Veelken
- Bone Marrow Transplantation Centre Leiden, Leiden University Hospital, Leiden, The Netherlands
| | - Alina Ferster
- Department of Hematology/Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, B-1020 Brussels, Belgium
| | - Barbara Cappelli
- Monacord, Centre Scientifique de Monaco, Principauté de Monaco, Monaco; Eurocord, Hôpital Saint Louis, Institut de recherche Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Evandra Strazza Rodrigues
- Center for Cell-Based Therapy, Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Graziana Maria Scigliuolo
- Monacord, Centre Scientifique de Monaco, Principauté de Monaco, Monaco; Eurocord, Hôpital Saint Louis, Institut de recherche Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Chantal Kenzey
- Monacord, Centre Scientifique de Monaco, Principauté de Monaco, Monaco; Eurocord, Hôpital Saint Louis, Institut de recherche Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Annalisa Ruggeri
- Monacord, Centre Scientifique de Monaco, Principauté de Monaco, Monaco; Eurocord, Hôpital Saint Louis, Institut de recherche Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vanderson Rocha
- Monacord, Centre Scientifique de Monaco, Principauté de Monaco, Monaco; Eurocord, Hôpital Saint Louis, Institut de recherche Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Hematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil; Department of Hematology, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Belinda Pinto Simões
- Center for Cell-Based Therapy, Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ryad Tamouza
- INSERM U955, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Eliane Gluckman
- Monacord, Centre Scientifique de Monaco, Principauté de Monaco, Monaco; Eurocord, Hôpital Saint Louis, Institut de recherche Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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20
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Kelly S, Belisário AR, Werneck Rodrigues DO, Carneiro-Proietti ABF, Gonçalez TT, Loureiro P, Flor-Park MV, Maximo C, Mota RA, Dinardo C, Brambilla D, Preiss L, Sabino E, Custer B. Blood utilization and characteristics of patients treated with chronic transfusion therapy in a large cohort of Brazilian patients with sickle cell disease. Transfusion 2020; 60:1713-1722. [PMID: 32579245 DOI: 10.1111/trf.15818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Red blood cell (RBC) transfusions are used in sickle cell disease (SCD) to treat acute complications or as chronic transfusion therapy (CTT) to prevent severe manifestations. The objectives of this study were to describe blood utilization and adverse events (AEs) associated with RBCs in the Brazilian SCD population and compare characteristics of patients treated or not with CTT. STUDY DESIGN AND METHODS A SCD cohort was established at six Brazilian centers. Medical and blood bank records were abstracted for clinical and transfusion history. Two controls not treated with CTT matched on center, SCD genotype, sex, and age were selected for each CTT case within the cohort to compare characteristics between the two groups. RESULTS Most of the 2794-member cohort had received a transfusion (75.0% of children and 89.2% of adults) with 29.2% of patients receiving transfusion in the prior year. There were 170 (10.6%) children and 115 (9.2%) adults treated with CTT. Children not treated with CTT were more likely to have pain and acute chest hospitalizations in the prior year (25.3% vs. 11.9%, p = 0.0003; and 22.0% vs. 10.7%, p = 0.002, respectively). Both iron overload and alloimmunization were more common in CTT cases compared to controls (65.6% vs. 17.0% and 36.2% vs. 15.9%, respectively). A higher proportion of adults treated with CTT demonstrated oxygen saturation of greater than 95% compared to controls not treated (51.1% vs. 39.2%), while there was no difference in oxygenation between children treated or not. Of 4501 transfusion episodes, 28 (0.62%) AEs were reported. There was no difference in AEs associated with transfusions for acute indications versus CTT. CONCLUSION Red blood cell transfusion was common in Brazilian SCD patients, with utilization driven by CTT. Transfusion reactions were not common; however, alloimmunization and iron overload were frequent among those on CTT, highlighting the need for novel clinical strategies to mitigate these risks.
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Affiliation(s)
- Shannon Kelly
- Vitalant Research Institute, San Francisco, California, USA.,UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | | | | | | | | | - Paula Loureiro
- Hemope/University of Pernambuco, Recife, Pernambuco, Brazil
| | - Miriam V Flor-Park
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, Brazil
| | - Claudia Maximo
- Hemorio, Rio de Janeiro Hemocenter, Rio de Janeiro, Brazil
| | | | - Carla Dinardo
- Pró-Sangue, São Paulo Hemocenter, São Paulo, Brazil.,Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Don Brambilla
- Research Triangle Institute (RTI) International, Triangle Park, North Carolina, USA
| | - Liliana Preiss
- Research Triangle Institute (RTI) International, Triangle Park, North Carolina, USA
| | - Ester Sabino
- Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Brian Custer
- Fundação Hemominas/Minas Gerais Hemocenter, Minas Gerais, Brazil.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California, USA
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21
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Association of HMIP1 C-893A polymorphism and disease severity in patients with sickle cell anemia. Hematol Transfus Cell Ther 2020; 43:243-248. [PMID: 32665180 PMCID: PMC8446232 DOI: 10.1016/j.htct.2020.03.006] [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: 12/13/2019] [Revised: 03/03/2020] [Accepted: 03/16/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Sickle cell anemia (SCA) is a Mendelian disorder with a heterogeneous clinical course. The reasons for this phenotypic diversity are not entirely established, but it is known that high fetal hemoglobin levels lead to a milder course of the disease. Additionally, genetic variants in the intergenic region HBS1L-MYB promote high levels of fetal hemoglobin into adulthood. Objective In the present study, we investigated the HMIP1 C-839A (rs9376092) polymorphism, located at the HBS1L-MYB intergenic region block 1, in SCA patients. Method We analyzed 299 SCA patients followed in two reference centers in Brazil. The HMIP1 C-839A (rs9376092) genotypes were determined by allele specific polymerase chain reactions. Clinical and laboratory data were obtained from patient interviews and medical records. Results The median fetal hemoglobin levels were higher in patients with the HMIP1 C-839A (rs9376092) AA genotype (CC = 6.4%, CA = 5.6% and AA = 8.6%), but this difference did not reach significance (p = 0.194). No association between HMIP1 C-839A (rs9376092) genotypes and other clinical and laboratorial features was detected (p > 0.05). Conclusion In summary, our data could not support the previously related association between the HMIP1 C-893A (rs9376092) polymorphism and differential fetal hemoglobin levels.
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22
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De Santis GC, Costa TCM, Santos FLS, da Silva-Pinto AC, Stracieri ABPL, Pieroni F, Darrigo-Júnior LG, de Faria JTB, Grecco CES, de Moraes DA, Elias Dias JB, Oliveira MC, Covas DT, Cunha R, Simões BP. Blood transfusion support for sickle cell patients during haematopoietic stem cell transplantation: a single-institution experience. Br J Haematol 2020; 190:e295-e297. [PMID: 32419156 DOI: 10.1111/bjh.16703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Gil C De Santis
- Center for Cell-based Therapy and Regional Blood Center of Ribeirão Preto, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Thalita C M Costa
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Flávia L S Santos
- Center for Cell-based Therapy and Regional Blood Center of Ribeirão Preto, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ana C da Silva-Pinto
- Center for Cell-based Therapy and Regional Blood Center of Ribeirão Preto, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ana B P L Stracieri
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Fabiano Pieroni
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Luiz G Darrigo-Júnior
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Joana T B de Faria
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Carlos E S Grecco
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Daniela A de Moraes
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana B Elias Dias
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria C Oliveira
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Dimas T Covas
- Center for Cell-based Therapy and Regional Blood Center of Ribeirão Preto, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Renato Cunha
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Belinda P Simões
- School of Medicine, Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
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23
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Costa Neto A, Santos F, Ribeiro I, Oliveira V, Dezan M, Kashima S, Covas D, Pereira A, Fonseca G, Moreira F, Krieger J, Gualandro S, Rocha V, Mendrone A, Dinardo CL. FcγR2B B2.4 haplotype predicts increased risk of red blood cell alloimmunization in sickle cell disease patients. Transfusion 2020; 60:1573-1578. [PMID: 32681817 DOI: 10.1111/trf.15832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 03/17/2020] [Accepted: 03/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Red blood cell (RBC) alloimmunization is an important transfusion complication which is prevalent among sickle cell disease (SCD) patients. Autoimmune diseases are a known risk factor for RBC alloimmunization, suggesting that autoimmunity and post-transfusion alloantibody development occur through similar physiopathological pathways. Polymorphisms in the FcγR2B gene have already been associated with several autoimmune disorders and hypothetically could be associated with RBC alloimmunization. Our goal was to evaluate if important polymorphisms of FcγR2B have an impact on the risk of RBC alloimmunization among SCD patients. STUDY DESIGN AND METHODS This was a case-control study in which alloimmunized and non-alloimmunized SCD patients were compared in terms of the genotype frequency of the FcγR2B polymorphisms -386G/C, -120 T/A, and 695C/T, genotyped through direct Sanger sequencing. RESULTS A total of 237 patients met the eligibility criteria, 120 cases (alloimmunized) and 117 controls (non-alloimmunized). RBC alloimmunization was associated with female sex (p < 0.001), lifetime number of RBC units transfused (p = 0.002) and 120 T/A FcγR2B genotype (p = 0.031). The FcγR2B promoter region haplotype 2B.4 (386C120A) was positively associated with RBC alloimunization (p = 0.045). The logistic regression (LR) model identified female sex (OR 10.03, CI 95% 5.16-19.49; p < 0.001) and FcγR2B 2B.4 haplotype (OR 4.55, CI95% 1.1118.65; p = 0.035) as independent predictors of RBC alloimmunization in SCD patients. CONCLUSION SCD patients with the FcγR2B 2B.4 haplotype had over a fourfold higher risk for RBC alloimmunization. This highlights the role played by FcγR2B on RBC alloimmunization and may be helpful in identifying the immune responders.
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Affiliation(s)
- Abel Costa Neto
- Serviço de Hematologia, Hemoterapia e Terapia Celular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo/Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Flávia Santos
- Regional Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ingrid Ribeiro
- Serviço de Hematologia, Hemoterapia e Terapia Celular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo/Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.,Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Valeria Oliveira
- Serviço de Hematologia, Hemoterapia e Terapia Celular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo/Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.,Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcia Dezan
- Serviço de Hematologia, Hemoterapia e Terapia Celular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo/Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.,Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Simone Kashima
- Regional Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Dimas Covas
- Regional Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Alexandre Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Guilherme Fonseca
- Serviço de Hematologia, Hemoterapia e Terapia Celular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo/Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Frederico Moreira
- Serviço de Hematologia, Hemoterapia e Terapia Celular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo/Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - José Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Sandra Gualandro
- Serviço de Hematologia, Hemoterapia e Terapia Celular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo/Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo/Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.,Department of Hematology, Churchill Hospital, NHS BT, Oxford University, Oxford, UK
| | - Alfredo Mendrone
- Serviço de Hematologia, Hemoterapia e Terapia Celular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo/Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Carla L Dinardo
- Serviço de Hematologia, Hemoterapia e Terapia Celular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo/Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.,Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
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Belisário AR, Carneiro-Proietti AB, Sabino EC, Araújo A, Loureiro P, Máximo C, Flor-Park MV, Rodrigues DDOW, Ozahata MC, McClure C, Mota RA, Gomes Moura IC, Custer B, Kelly S. Hb S/ β-Thalassemia in the REDS-III Brazil Sickle Cell Disease Cohort: Clinical, Laboratory and Molecular Characteristics. Hemoglobin 2020; 44:1-9. [PMID: 32172616 DOI: 10.1080/03630269.2020.1731530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We described the clinical, laboratory and molecular characteristics of individuals with Hb S (HBB: c.20A>T)/β-thalassemia (Hb S/β-thal) participating in the Recipient Epidemiology and Donor Evaluation Study (REDS-III) Brazil Sickle Cell Disease cohort. HBB gene sequencing was performed to genotype each β-thal mutation. Patients were classified as Hb S/β0-thal, Hb S/β+-thal-severe or Hb S/β+-thal based on prior literature and databases of hemoglobin (Hb) variants. Characteristics of patients with each β-thal mutation were described and the clinical profile of patients grouped into Hb S/β0-thal, Hb S/β+-thal and Hb S/β+-thal-severe were compared. Of the 2793 patients enrolled, 84 (3.0%) had Hb S/β0-thal and 83 (3.0%) had Hb S/β+-thal; 40/83 (48.2%) patients with Hb S/β+-thal had mutations defined as severe. We identified 19 different β-thal mutations, eight Hb S/β0-thal, three Hb S/β+-thal-severe and eight Hb S/β+-thal. The most frequent β0 and β+ mutations were codon 39 (HBB: c.118C>T) and IVS-I-6 (T>C) (HBB: c.92+6T>C), respectively. Individuals with Hb S/β0-thal had a similar clinical and laboratory phenotype when compared to those with Hb S/β+-thal-severe. Individuals with Hb S/β+-thal-severe had significantly lower total Hb and Hb A levels and higher Hb S, white blood cell (WBC) count, platelets and hemolysis markers when compared to those with Hb S/β+-thal. Likewise, individuals with Hb S/β+-thal-severe showed a significantly higher occurrence of hospitalizations, vaso-occlusive events (VOE), acute chest syndrome (ACS), splenic sequestration, blood utilization, and hydroxyurea (HU) therapy.
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Affiliation(s)
| | | | - Ester Cerdeira Sabino
- Faculdade de Medicina (FMUSP), Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | | | - Paula Loureiro
- Fundação Hemope, Pernambuco, Brazil.,Universidade de Pernambuco, Pernambuco, Brazil
| | | | - Miriam V Flor-Park
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, Brazil
| | | | - Mina Cintho Ozahata
- Departamento de Ciências da Computação, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Brian Custer
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, CA, USA.,UCSF, Benioff Children's Hospital Oakland, Oakland, CA, USA
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25
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Blatyta PF, Kelly S, Sabino E, Preiss L, Mendes F, Carneiro-Proietti AB, Werneck Rodrigues DDO, Mota R, Loureiro P, Maximo C, Park M, Mendrone-Jr A, Gonçalez TT, de Almeida Neto C, Custer B. Prevalence of serologic markers of transfusion and sexually transmitted infections and their correlation with clinical features in a large cohort of Brazilian patients with sickle cell disease. Transfusion 2020; 60:343-350. [PMID: 31804727 PMCID: PMC8010912 DOI: 10.1111/trf.15619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) often require red blood cell (RBC) transfusion for clinical complications, so may be exposed to transfusion-transmitted infections (TTIs). The prevalence of markers for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and B (HBV), human T-cell lymphotropic virus (HTLV-1/2), Chagas disease, and syphilis in an SCD cohort in Brazil were studied. STUDY DESIGN AND METHODS Clinical history, interview data, blood samples, and medical chart review data were collected during cohort enrollment from November 2013 to May 2015. Serologic markers of infection were assessed. Standard measures of statistical association were calculated, and multivariable models were developed for the most prevalent infections to identify associated factors. RESULTS Infection markers were evident in 5.2% (144/2779) of the enrolled cohort. Anti-HCV was detected in 69 (2.5%), syphilis antibodies in 34 (1.2%), anti-HTLV-1/2 in 17 (0.6%), HBV surface antigen in 13 (0.5%), Chagas disease antibodies in 13 (0.5%), and anti-HIV in 8 (0.3%) of participants. Factors associated with increased odds of being anti-HCV reactive were older age, illegal drug use, increasing number of RBCs, more than three pain crises in the previous year, and geographic location. Syphilis was associated with older age, females, and smoking history. CONCLUSION HCV infection was more common in older patients who may have received RBCs before testing was performed on donations, suggesting possible historic transfusion transmission. The cohort showed decreasing rates of infections and a reduction in transfusion transmission markers in younger patients compared to historical literature except for syphilis, indicating contemporary reduced risk of TTI.
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Affiliation(s)
- Paula F Blatyta
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, California
| | - Ester Sabino
- Instituto de Medicina Tropical da FMUSP, Sao Paulo, Brazil
| | - Liliana Preiss
- Research Triangle Institute International, Rockville, Maryland
| | | | | | | | - Rosimere Mota
- Hemominas Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Paula Loureiro
- Hemope and Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Miriam Park
- Instituto da Criança-Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Cesar de Almeida Neto
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
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26
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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] [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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28
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Oliveira CDL, Kelly S, de Almeida-Neto C, Carneiro-Proietti AB, Camargo FC, Salomon T, Flor-Park MV, Maximo C, Rodrigues DW, Mota RA, Teixeira CM, Loureiro P, Sabino EC, Custer B. Quality of life in pre-adolescent children with sickle cell disease in Brazil. Pediatr Hematol Oncol 2019; 36:457-467. [PMID: 31490092 PMCID: PMC6872937 DOI: 10.1080/08880018.2019.1660743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sickle cell disease (SCD) affects more than 13 million people and can have a significant impact on the quality of life (QoL) of those persons. We performed a cross-sectional study to evaluate the QoL in SCD children 8-12 years old enrolled from November 2014 to March 2016 in a large multicenter cohort study in Brazil. The PedsQL™ SCD Module was used to evaluate QoL in 412 children from six Brazilian health centers. The mean age of participants was 10.5 years and 193(46.7%) were women. The mean global score was 60.7, with a Cronbach´s alpha of 0.92. There were significant differences in socioeconomic demographics and treatments among participants at the six centers, but age, income, SCD genotype, and use of hydroxyurea did not significantly affect the QoL scores. After adjustment for all of these variables in a linear regression model, a significant difference was observed by site in global QoL score and the dimensions 'worry II'(β0 = 20.7, p < .00), 'treatment´(β0 = 66.8, p < .00) and communication II'(β0 = 45.8, p < .00). These dimensions are affected by the capacity of health professionals to provide clinical and psychological support to patients. Our results suggest that QoL of this patient population varied according the health center even adjusted by sociodemographics characteristics. Additional training of health professionals in psychological and clinical support could directly reduce patient apprehension about the disease its clinical complications.
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Affiliation(s)
| | | | | | | | | | | | - Miriam V. Flor-Park
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, Brazil
| | | | | | | | | | | | | | - Brian Custer
- VitalantResearchInstitute, San Francisco, CA, USA
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Clinical and Genetic Predictors of Priapism in Sickle Cell Disease: Results from the Recipient Epidemiology and Donor Evaluation Study III Brazil Cohort Study. J Sex Med 2019; 16:1988-1999. [PMID: 31668730 DOI: 10.1016/j.jsxm.2019.09.012] [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: 07/10/2019] [Revised: 09/06/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Priapism is the persistent and painful erection of the penis and is a common sickle cell disease (SCD) complication. AIM The goal of this study was to characterize clinical and genetic factors associated with priapism within a large multi-center SCD cohort in Brazil. METHODS Cases with priapism were compared to SCD type-matched controls within defined age strata to identify clinical outcomes associated with priapism. Whole blood single nucleotide polymorphism genotyping was performed using a customized array, and a genome-wide association study (GWAS) was conducted to identify single nucleotide polymorphisms associated with priapism. MAIN OUTCOME MEASURE Of the 1,314 male patients in the cohort, 188 experienced priapism (14.3%). RESULTS Priapism was more common among older patients (P = .006) and more severe SCD genotypes such as homozygous SS (P < .0001). In the genotype- and age-matched analyses, associations with priapism were found for pulmonary hypertension (P = .05) and avascular necrosis (P = .01). The GWAS suggested replication of a previously reported candidate gene association of priapism for the gene transforming growth factor beta receptor 3 (TGFBR3) (P = 2 × 10-4). CLINICAL IMPLICATIONS Older patients with more severe genotypes are at higher risk of priapism, and there is a lack of consensus on standard treatment strategies for priapism in SCD. STRENGTHS & LIMITATIONS This study characterizes SCD patients with any history of priapism from a large multi-center cohort. Replication of the GWAS in an independent cohort is required to validate the results. CONCLUSION These findings extend the understanding of risk factors associated with priapism in SCD and identify genetic markers to be investigated in future studies to further elucidate priapism pathophysiology. Ozahata M, Page GP, Guo Y, et al. Clinical and Genetic Predictors of Priapism in Sickle Cell Disease: Results from the Recipient Epidemiology and Donor Evaluation Study III Brazil Cohort Study. J Sex Med 2019;16:1988-1999.
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Dinardo CL, Kelly S, Dezan MR, Ribeiro IH, Castilho SL, Schimidt LC, Valgueiro MDC, Preiss LR, Custer B, Sabino EC, Westhoff CM. Diversity of RH and transfusion support in Brazilian sickle cell disease patients with unexplained Rh antibodies. Transfusion 2019; 59:3228-3235. [PMID: 31408202 DOI: 10.1111/trf.15479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Genetic diversity in the RH genes among sickle cell disease (SCD) patients is well described but not yet extensively explored in populations of racially diverse origin. Transfusion support is complicated in patients who develop unexpected Rh antibodies. Our goal was to describe RH variation in a large cohort of Brazilian SCD patients exhibiting unexpected Rh antibodies (antibodies against RH antigens to which the patient is phenotypically positive) and to evaluate the impact of using the patient's RH genotype to guide transfusion support. STUDY DESIGN AND METHODS Patients within the Recipient Epidemiology and Evaluation Donor Study (REDS)-III Brazil SCD cohort with unexpected Rh antibodies were selected for study. RHD and RHCE exons and flanking introns were sequenced by targeted next-generation sequencing. RESULTS Fifty-four patients with 64 unexplained Rh antibodies were studied. The majority could not be definitively classified as auto- or alloantibodies using serologic methods. The most common altered RH were RHD*DIIIa and RHD*DAR (RHD locus) and RHCE*ce48C, RHCE*ce733G, and RHCE*ceS (RHCE locus). In 53.1% of the cases (34/64), patients demonstrated only conventional alleles encoding the target antigen: five of 12 anti-D (41.7%), 10 of 12 anti-C (83.3%), 18 of 38 anti-e (47.4%), and one of one anti-E (100%). CONCLUSION RHD variation in this SCD cohort differs from that reported for African Americans, with increased prevalence of RHD*DAR and underrepresentation of the DAU cluster. Many unexplained Rh antibodies were found in patients with conventional RH allele(s) only. RH genotyping was useful to guide transfusion to determine which patients could potentially benefit from receiving RH genotyped donor units.
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Affiliation(s)
- Carla L Dinardo
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, California.,UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Marcia R Dezan
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Liliana R Preiss
- RTI-Research Triangle Institute International, Triangle Park, North Carolina
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California
| | - Ester C Sabino
- Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center, New York, New York
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Flor-Park MV, Kelly S, Preiss L, Custer B, Carneiro-Proietti ABF, Araujo AS, Loureiro P, Maximo C, Rodrigues DOW, Mota RA, Sabino EC, Rocha V. Identification and Characterization of Hematopoietic Stem Cell Transplant Candidates in a Sickle Cell Disease Cohort. Biol Blood Marrow Transplant 2019; 25:2103-2109. [PMID: 31229639 DOI: 10.1016/j.bbmt.2019.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
Sickle cell disease (SCD) is associated with significant morbidity, and allogeneic hematopoietic stem cell transplantation (HSCT) remains the primary curative treatment. Recently, the Brazilian Ministry of Health released a regulation that required the publically funded healthcare system to pay for HSCT for SCD patients with defined indications. We used an existing 2794-member SCD cohort established during 2013 to 2015 to characterize candidates for HSCT and estimate the number of possible donors. Of 2064 patients with SC anemia (SCA), 152 of 974 children (16%) and 279 of 1090 adults (26%) had at least 1 HSCT indication. The most common indication for transplant was stroke (n = 239) followed by avascular necrosis (n = 96), priapism (n = 82), cerebrovascular disease (n = 55), >2 vaso-occlusive episodes (n = 38), alloantibodies and chronic transfusion therapy (n = 18), and >2 acute chest syndrome episodes (n = 11). Increasing age, number of transfusions, abnormal transcranial Doppler, retinopathy, dactylitis, and use of hydroxyurea were more frequent in the 152 children with an indication for HSCT compared with 822 without (P < .001). Of 152 children and 279 adults meeting the eligibility definition, 77 (50%) and 204 (73%), respectively, had at least 1 non-SCD full sibling who could potentially serve as a donor. In conclusion, in a large cohort of SCA patients, 16% of children and 26% of adults had at least 1 indication for HSCT; these indications were associated with the severity of the disease. This study provides clinical data necessary for estimating the costs and infrastructure that would be required to implement HSCT in a public healthcare system.
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Affiliation(s)
- Miriam V Flor-Park
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, Brazil.
| | - Shannon Kelly
- Vitalant Research Institute, Epidemiology, San Francisco, CA, USA; University of California San Francisco Benioff Children's Hospital Oakland, CA, USA
| | - Liliana Preiss
- Division of Bioestatistics and Epidemiology, Research Triangle Institute, Rockville, MD, USA
| | - Brian Custer
- Vitalant Research Institute, Epidemiology, San Francisco, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Aderson S Araujo
- Department of Hematology, Fundação de Hematologia e Hemoterapia de Pernambuco, HEMOPE, Pernambuco, Brazil
| | - Paula Loureiro
- Research Department, Fundação de Hematologia e Hemoterapia de Pernambuco, HEMOPE, Pernambuco, Brazil; Research Department, Universidade de Pernambuco, Pernambuco, Brazil
| | - Claudia Maximo
- Department of Hematology, Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti-HEMORIO, Rio de Janeiro, Brazil
| | | | - Rosimere A Mota
- Department of Hematology, Hemocentro Regional de Montes Claros, Fundação HEMOMINAS, Montes Claros, Brazil
| | - Ester C Sabino
- Instituto de Medicina Tropical and Departamento de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo
| | - Vanderson Rocha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Hematologia, Hemoterapia e Terapia Celular, São Paulo, Brazil; Department of Haematology, University of Oxford, Churchill Hospital, NHS-BT, Oxford, United Kingdom
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Cohn CS, Allen ES, Cushing MM, Dunbar NM, Friedman DF, Goel R, Harm SK, Heddle N, Hopkins CK, Klapper E, Perumbeti A, Ramsey G, Raval JS, Schwartz J, Shaz BH, Spinella PC, Pagano MB. Critical developments of 2018: A review of the literature from selected topics in transfusion. A committee report from the AABB's Clinical Transfusion Medicine Committee. Transfusion 2019; 59:2733-2748. [PMID: 31148175 DOI: 10.1111/trf.15348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The AABB compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine. An abridged version of this work is being made available in TRANSFUSION, with the full-length report available as Appendix S1 (available as supporting information in the online version of this paper). STUDY DESIGN AND METHODS Papers published in late 2017 and 2018 are included, as well as earlier papers cited for background. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are covered: "big data" and "omics" studies, emerging infections and testing, platelet transfusion and pathogen reduction, transfusion therapy and coagulation, transfusion approach to hemorrhagic shock and mass casualties, therapeutic apheresis, and chimeric antigen receptor T-cell therapy. CONCLUSION This synopsis may be a useful educational tool.
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Affiliation(s)
- Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth S Allen
- Department of Pathology, University of California, San Diego, California
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - David F Friedman
- Blood Bank and Transfusion Medicine Department, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruchika Goel
- Division of Transfusion Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Hematology/Oncology, Mississippi Valley Regional Blood Center, Springfield, Illinois
| | - Sarak K Harm
- University of Vermont Medical Center, Burlington, VT
| | - Nancy Heddle
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | | | - Ellen Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ajay Perumbeti
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University, and, New York, New York
| | | | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University in St Louis School of Medicine, Saint Louis, Missouri
| | - Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
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Guo Y, Busch MP, Seielstad M, Endres-Dighe S, Westhoff CM, Keating B, Hoppe C, Bordbar A, Custer B, Butterworth AS, Kanias T, Mast AE, Kleinman S, Lu Y, Page GP. Development and evaluation of a transfusion medicine genome wide genotyping array. Transfusion 2019; 59:101-111. [PMID: 30456907 PMCID: PMC7032526 DOI: 10.1111/trf.15012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many aspects of transfusion medicine are affected by genetics. Current single-nucleotide polymorphism (SNP) arrays are limited in the number of targets that can be interrogated and cannot detect all variation of interest. We designed a transfusion medicine array (TM-Array) for study of both common and rare transfusion-relevant variations in genetically diverse donor and recipient populations. STUDY DESIGN AND METHODS The array was designed by conducting extensive bioinformatics mining and consulting experts to identify genes and genetic variation related to a wide range of transfusion medicine clinical relevant and research-related topics. Copy number polymorphisms were added in the alpha globin, beta globin, and Rh gene clusters. RESULTS The final array contains approximately 879,000 SNP and copy number polymorphism markers. Over 99% of SNPs were called reliably. Technical replication showed the array to be robust and reproducible, with an error rate less than 0.03%. The array also had a very low Mendelian error rate (average parent-child trio accuracy of 0.9997). Blood group results were in concordance with serology testing results, and the array accurately identifies rare variants (minor allele frequency of 0.5%). The array achieved high genome-wide imputation coverage for African-American (97.5%), Hispanic (96.1%), East Asian (94.6%), and white (96.1%) genomes at a minor allele frequency of 5%. CONCLUSIONS A custom array for transfusion medicine research has been designed and evaluated. It gives wide coverage and accurate identification of rare SNPs in diverse populations. The TM-Array will be useful for future genetic studies in the diverse fields of transfusion medicine research.
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Affiliation(s)
- Yuelong Guo
- RTI International, Research Triangle Park, North Carolina
| | - Michael P Busch
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Mark Seielstad
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | | | | | - Brendan Keating
- Penn Transplant Institute, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carolyn Hoppe
- UCSF Benioff Children's Hospital Oakland, Oakland, California
| | | | - Brian Custer
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Adam S Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NIHR Blood and Transplant Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Tamir Kanias
- Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, Wisconsin
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Steve Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Yontao Lu
- Affymetrix Incorporated, Santa Clara, California
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