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Knisely MR, Masese RV, Mathias JG, Yang Q, Hatch D, Lê BM, Luyster F, Garrett ME, Tanabe PJ, Shah NR, Ashley-Koch A. Epigenetic Aging Associations With Psychoneurological Symptoms and Social Functioning in Adults With Sickle Cell Disease. Biol Res Nurs 2024:10998004241250322. [PMID: 38679469 DOI: 10.1177/10998004241250322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Objective: Sickle cell disease (SCD), the most common inherited blood disorder in the United States, is associated with severe psychoneurological symptoms. While epigenetic age acceleration has been linked to psychoneurological symptom burden in other diseases, this connection is unexplored in SCD. This study aimed to assess the association between epigenetic age acceleration and psychoneurological symptom burden in SCD. Methods: In this cross-sectional study, emotional impact, pain impact, sleep impact, social functioning, and cognitive function were assessed in 87 adults living with SCD. DNA methylation data were generated from blood specimens and used to calculate epigenetic age using five clocks (Horvath, Hannum, PhenoAge, GrimAge, & DunedinPACE). Associations between epigenetic age acceleration and symptoms were assessed. Results: The sample (N = 87) had a mean (SD) chronologic age was 30.6 (8.1) years. Epigenetic age acceleration was associated with several symptom outcomes. GrimAge age acceleration (β = -0.49, p = .03) and increased DunedinPACE (β = -2.23, p = .004) were associated with worse emotional impact scores. PhenoAge (β = -0.32, p = .04) and the GrimAge (β = -0.48, p = .05) age acceleration were associated with worse pain impact scores. Increased DunedinPACE (β = -2.07 p = .04) were associated with worse sleep impact scores. Increased DunedinPACE (β = -2.87, p = .005) was associated with worse social functioning scores. We did not find associations between epigenetic age acceleration and cognitive function in this sample. Conclusion: Epigenetic age acceleration was associated with worse symptom experiences, suggesting the potential for epigenetic age acceleration as a biomarker to aid in risk stratification or targets for intervention to mitigate symptom burden in SCD.
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Affiliation(s)
| | - Rita V Masese
- Center for Bioethics, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joacy G Mathias
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Qing Yang
- Duke University School of Nursing, Durham, NC, USA
| | - Daniel Hatch
- Duke University School of Nursing, Durham, NC, USA
| | - Brandon M Lê
- Duke Molecular Physiology Institute, Durham, NC, USA
| | - Faith Luyster
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | | | | | - Nirmish R Shah
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Allison Ashley-Koch
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Knisely MR, Yang Q, Stauffer N, Kenney M, Ashley-Koch A, Myers J, Walker JKL, Tanabe PJ, Shah NR. Evaluating Associations between Average Pain Intensity and Genetic Variation in People with Sickle Cell Disease: An Exploratory Study. Pain Manag Nurs 2023; 24:12-18. [PMID: 36096903 PMCID: PMC9925395 DOI: 10.1016/j.pmn.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pain is one of the most common and deleterious symptoms experienced by individuals with sickle cell disease (SCD). There is a paucity of studies identifying potential genetic mechanisms of pain in this population. AIM Examine associations between 11 functional single nucleotide polymorphisms in 9 candidate genes with reports of average pain intensity in individuals with sickle cell disease. METHOD Cross-sectional analyses were performed on data and blood samples collected through the Duke SCD Implementation Consortium Registry. Participants were asked to rate their pain "on the average" using an 11-point numeric rating scale (0 = no pain; 10 = pain as bad as you can imagine). We genotyped 11 single nucleotide polymorphisms in 9 pain-related genes using TaqMan® Genotyping Assays. Associations between each polymorphism and reports of average pain were evaluated. RESULTS The 86 participants (mean age: 28.7 years; 64% female) included in this study reported moderate pain on average (Mean = 4, Standard Deviation = 2.4). ICAM1 rs1799969 was the only genetic polymorphism that was significantly associated with pain (p = .01). Individuals with one or more minor alleles had lower average pain (Mean = 1.25, Standard Deviation = 1.50) than individuals without a minor allele (Mean = 4.13, Standard Deviation = 2.25). The effect size for ICAM1 rs1799969 was 1.30, which is considered large. The effect sizes for all other single nucleotide polymorphisms ranged from small to medium (range: 0-0.3). CONCLUSIONS Our findings provide preliminary evidence that the minor allele in ICAM1 rs1799969 had protective effects against experiencing more severe pain in sickle cell disease.
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Affiliation(s)
| | - Qing Yang
- Duke University School of Nursing, Durham, North Carolina
| | - Nic Stauffer
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Martha Kenney
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Allison Ashley-Koch
- Departments of Medicine and Biostatistics and Bioinformatics, Duke Molecular Physiology Institute, Durham, North Carolina; Duke University School of Medicine, Durham, North Carolina
| | - John Myers
- Duke University School of Nursing, Durham, North Carolina
| | | | - Paula J Tanabe
- Duke University School of Nursing, Durham, North Carolina
| | - Nirmish R Shah
- Duke University School of Medicine, Durham, North Carolina
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Byrd JT, Daniels CL, Flores DD, Kayle M, Lewinski AA, Smith JB, Xu H, Tanabe PJ. Establishing a research racial justice task force to improve diversity, equity, and inclusion in nursing research. Nurs Outlook 2022; 70:758-761. [PMID: 35961805 PMCID: PMC9987716 DOI: 10.1016/j.outlook.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Jessalyn T Byrd
- Duke University School of Nursing, Durham, NC; Duke University School of Medicine, Durham, NC.
| | - Christin L Daniels
- Duke University School of Nursing, Durham, NC; Duke University School of Medicine, Durham, NC
| | | | | | - Allison A Lewinski
- Duke University School of Nursing, Durham, NC; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC
| | - Jacqueline B Smith
- Duke University School of Nursing, Durham, NC; Duke University School of Medicine, Durham, NC
| | - Hanzhang Xu
- Duke University School of Nursing, Durham, NC; Duke University School of Medicine, Durham, NC; Duke Global Health Institute, Durham, NC
| | - Paula J Tanabe
- Duke University School of Nursing, Durham, NC; Duke University School of Medicine, Durham, NC; Duke-Margolis Center for Health Policy, Durham, NC
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Abstract
BACKGROUND Severe pain is among the most common and deleterious symptoms experienced by individuals with sickle cell disease (SCD), of whom more than 50% report chronic pain. Despite this, the understanding of the biological contributors to persistent severe SCD pain is limited. This exploratory study sought to describe pain phenotypes based on frequency of severe pain experienced over 6 months and identify inflammatory biomarkers associated with pain phenotypes among individuals with SCD. METHODS This study used self-report and electronic health record data collected from 74 individuals enrolled in the Duke Sickle Cell Disease Implementation Consortium Registry. Plasma from previously collected blood specimens was used to generate inflammatory biomarker data using the Inflammation 20-plex ProcartaPlexTM panel. Descriptive statistics were used to describe the occurrence of severe pain over the past 6 months, and bi-variate analyses were used to evaluate the relationship between inflammatory biomarkers and pain phenotypes. RESULTS Among the 74 participants included in this study, 33.8% reported severe pain occurring never or rarely, 40.5% reported severe pain occurring sometimes, and 25.7% reported severe pain occurring often or always. Soluble E-selectin (sE-selectin) was the only inflammatory biomarker significantly associated with the pain phenotype groups (p = 0.049). Post hoc comparisons identified that participants in the often/always severe pain group had significantly higher plasma concentrations of sE-selectin compared to those in the sometimes severe pain group (p = 0.040). CONCLUSIONS Our findings provide preliminary evidence of the frequent occurrence of severe pain and that sE-selectin may be an objective biomarker for the frequent occurrence of severe pain in this population.
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Affiliation(s)
| | | | | | - Qing Yang
- Duke University School of Nursing,
Durham, NC, USA
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Knisely MR, Tanabe PJ, Yang Q, Masese R, Jiang M, Shah NR. Severe Pain Profiles and Associated Sociodemographic and Clinical Characteristics in Individuals With Sickle Cell Disease. Clin J Pain 2021; 37:669-677. [PMID: 34265788 PMCID: PMC8373671 DOI: 10.1097/ajp.0000000000000957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify classes of individuals with sickle cell disease (SCD) who share distinct severe pain profiles and evaluate differences in demographic, clinical, and psychosocial characteristics between classes. METHODS This exploratory, cross-sectional study used data collected for the SCD Implementation Consortium Research Registry at Duke University. Using Adult Sickle Cell Quality of Life-Measurement System pain-item data from 291 adults with SCD, latent class analysis was used to determine classes of individuals sharing distinct severe pain profiles. Bivariate analyses and logistic regression models were used to assess the relationships between pain profile classes and demographic, clinical, and psychosocial characteristics. RESULTS Three classes sharing distinct severe pain profiles were identified: Low Frequency and Impact class (n=73), Moderate Frequency and Impact class (n=94), and High Frequency and Impact class (n=124). When compared with the Low Frequency and Impact class and controlling for age and sex, individuals in the Moderate Frequency and Impact class were more likely to: be female (P=0.031) and unemployed (P=0.013); report worse sleep (P=0.005) and social functioning (P=0.005); have less emotional distress (P=0.004); describe pain as "sore" (P=0.002); and have previous SCD-related lung complications (P=0.016). When compared with the Low Frequency and Impact class, individuals in the High Frequency and Impact class: had worse social functioning (P<0.001) and previous SCD-related lung complications (P=0.006); described pain as "sore" (P<0.001); and were taking pain medication daily for SCD (P=0.001). DISCUSSION Severe pain experiences in SCD are complex; however, there are subgroups of people who report similar experiences of severe pain.
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Affiliation(s)
| | - Paula J Tanabe
- Duke University School of Nursing
- Duke University School of Medicine, Durham, NC
| | | | | | - Meilin Jiang
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Nirmish R Shah
- Duke University School of Nursing
- Duke University School of Medicine, Durham, NC
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Savage WJ, Buchanan GR, Yawn BP, Afenyi-Annan AN, Ballas SK, Goldsmith JC, Hassell KL, James AH, John-Sowah J, Jordan L, Lottenberg R, Murad MH, Ortiz E, Tanabe PJ, Ware RE, Lanzkron SM. Evidence gaps in the management of sickle cell disease: A summary of needed research. Am J Hematol 2015; 90:273-5. [PMID: 25639238 DOI: 10.1002/ajh.23945] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 11/11/2022]
Affiliation(s)
- William J. Savage
- Department of Pathology; Brigham and Women's Hospital; Boston Massachusetts
| | - George R. Buchanan
- Department of Pediatrics; University of Texas Southwestern Medical Center at Dallas; Dallas Texas
| | | | - Araba N. Afenyi-Annan
- Department of Pathology and Lab Medicine; University of North Carolina; Chapel Hill North Carolina
| | - Samir K. Ballas
- Department of Medicine/Hematology; Thomas Jefferson University, Cardeza Foundation; Philadelphia Pennsylvania
| | - Jonathan C. Goldsmith
- Food and Drug Administration; Rare Diseases Program; Office of New Drugs; Silver Spring Maryland
| | | | - Andra H. James
- Department of Obstetrics and Gynecology; Duke University; Durham North Carolina
| | | | - Lanetta Jordan
- University of Miami Miller School of Medicine; Foundation for Sickle Cell Disease Research; Miami Florida
| | | | - M. Hassan Murad
- Department of Preventative; Occupational; and Aerospace Medicine; Mayo Clinic College of Medicine; Rochester Minnesota
| | | | - Paula J. Tanabe
- Schools of Nursing and Medicine; Duke University; Durham North Carolina
| | - Russell E. Ware
- Department of Hematology; Cincinnati Children's Hospital; Cincinnati Ohio
| | - Sophie M. Lanzkron
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
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Yawn BP, Buchanan GR, Afenyi-Annan AN, Ballas SK, Hassell KL, James AH, Jordan L, Lanzkron SM, Lottenberg R, Savage WJ, Tanabe PJ, Ware RE, Murad MH, Goldsmith JC, Ortiz E, Fulwood R, Horton A, John-Sowah J. Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA 2014; 312:1033-48. [PMID: 25203083 DOI: 10.1001/jama.2014.10517] [Citation(s) in RCA: 964] [Impact Index Per Article: 96.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Sickle cell disease (SCD) is a life-threatening genetic disorder affecting nearly 100,000 individuals in the United States and is associated with many acute and chronic complications requiring immediate medical attention. Two disease-modifying therapies, hydroxyurea and long-term blood transfusions, are available but underused. OBJECTIVE To support and expand the number of health professionals able and willing to provide care for persons with SCD. EVIDENCE REVIEW Databases of MEDLINE (including in-process and other nonindexed citations), EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, TOXLINE, and Scopus were searched using prespecified search terms and keywords to identify randomized clinical trials, nonrandomized intervention studies, and observational studies. Literature searches of English-language publications from 1980 with updates through April 1, 2014, addressed key questions developed by the expert panel members and methodologists. FINDINGS Strong recommendations for preventive services include daily oral prophylactic penicillin up to the age of 5 years, annual transcranial Doppler examinations from the ages of 2 to 16 years in those with sickle cell anemia, and long-term transfusion therapy to prevent stroke in those children with abnormal transcranial Doppler velocity (≥200 cm/s). Strong recommendations addressing acute complications include rapid initiation of opioids for treatment of severe pain associated with a vasoocclusive crisis, and use of incentive spirometry in patients hospitalized for a vasoocclusive crisis. Strong recommendations for chronic complications include use of analgesics and physical therapy for treatment of avascular necrosis, and use of angiotensin-converting enzyme inhibitor therapy for microalbuminuria in adults with SCD. Strong recommendations for children and adults with proliferative sickle cell retinopathy include referral to expert specialists for consideration of laser photocoagulation and for echocardiography to evaluate signs of pulmonary hypertension. Hydroxyurea therapy is strongly recommended for adults with 3 or more severe vasoocclusive crises during any 12-month period, with SCD pain or chronic anemia interfering with daily activities, or with severe or recurrent episodes of acute chest syndrome. A recommendation of moderate strength suggests offering treatment with hydroxyurea without regard to the presence of symptoms for infants, children, and adolescents. In persons with sickle cell anemia, preoperative transfusion therapy to increase hemoglobin levels to 10 g/dL is strongly recommended with a moderate strength recommendation to maintain sickle hemoglobin levels of less than 30% prior to the next transfusion during long-term transfusion therapy. A strong recommendation to assess iron overload is accompanied by a moderate strength recommendation to begin iron chelation therapy when indicated. CONCLUSIONS AND RELEVANCE Hydroxyurea and transfusion therapy are strongly recommended for many individuals with SCD. Many other recommendations are based on quality of evidence that is less than high due to the paucity of clinical trials regarding screening, management, and monitoring for individuals with SCD.
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Affiliation(s)
| | | | | | - Samir K Ballas
- Thomas Jefferson University, Cardeza Foundation, Philadelphia, Pennsylvania
| | | | | | - Lanetta Jordan
- Foundation for Sickle Cell Disease Research, University of Miami, Miller School of Medicine, Miami, Florida
| | | | | | - William J Savage
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paula J Tanabe
- Duke University, Schools of Nursing and Medicine, Durham, North Carolina
| | - Russell E Ware
- Cincinnati Children's Hospital Medical Center, Cincinatti, Ohio
| | | | - Jonathan C Goldsmith
- National Heart, Lung, and Blood Institute, Bethesda, Maryland16Dr Goldsmith is now with the Rare Diseases Program, Office of New Drugs, US Food and Drug Administration, Bethesda, Maryland
| | - Eduardo Ortiz
- National Heart, Lung, and Blood Institute, Bethesda, Maryland17Dr Ortiz is now a private senior consultant in Bethesda, Maryland
| | - Robinson Fulwood
- National Heart, Lung, and Blood Institute, Bethesda, Maryland18Dr Fulwood is now retired
| | - Ann Horton
- American Institutes for Research, Silver Spring, Maryland
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