Elevated hypercoagulability markers in hemoglobin sc disease

Hemoglobin SC disease is a very prevalent hemoglobinopathy, however very little is known specifically about this condition. There appears to be an increased risk of thromboembolic events in hemoglobin SC disease, but studies evaluating the hemostatic alterations are lacking. We describe a cross-sectional observational study evaluating coagulation activation markers in adult hemoglobin SC patients, in comparison with sickle cell anemia patients and healthy controls. A total of 56 hemoglobin SC and 39 sickle cell anemia patients were included in the study, all in steady state, and 27 healthy controls. None of the patients were in use of hydroxyurea. Hemoglobin SC patients presented a significantly up-regulated relative expression of tissue factor, as well as elevations in thrombin-antithrombin complex and D-dimer, in comparison to controls (p<0.01). Hemoglobin SC patients presented lower tissue factor expression, and thrombin-antithrombin complex and D-dimer levels when compared to sickle cell anemia patients (p<0.05). Endothelial activation (soluble thrombomodulin and soluble vascular cell adhesion molecule-1), and inflammation (tumor necrosis factor-alpha) markers were both significantly elevated in hemoglobin SC patients when compared to controls, being as high as the levels seen in sickle cell anemia. Overall, in hemoglobin SC patients, higher hemolytic activity and inflammation were associated with a more intense activation of coagulation, and hemostatic activation was associated with two very prevalent chronic complications seen in hemoglobin SC disease: retinopathy and osteonecrosis. In summary, our results demonstrate that hemoglobin SC patients present a hypercoagulable state, although this manifestation was not as intense as that seen in sickle cell anemia.Hemoglobin SC disease is a very prevalent hemoglobinopathy, however very little is known specifically about this condition. There appears to be an increased risk of thromboembolic events in hemoglobin SC disease, but studies evaluating the hemostatic alte1004466471CNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOsem informaçãosem informaçã

Key endothelial cell angiogenic mechanisms are stimulated by the circulating milieu in sickle cell disease and attenuated by hydroxyurea

As hypoxia-induced inflammatory angiogenesis may contribute to sickle cell disease manifestations, we compared the angiogenic molecular profiles of plasma from sickle cell disease individuals and correlated these with in vitro endothelial cell-mediated angiogenesis-stimulating activity and in vivo neovascularization. Bioplex demonstrated that plasma from steady-state sickle cell anemia patients presented elevated concentrations of pro-angiogenic factors (Angiopoietin-1, basic fibroblast growth factor, vascular endothelial growth factor, vascular endothelial growth factor-D and placental growth factor) and displayed potent pro-angiogenic activity, significantly augmenting endothelial cell proliferation, migration and capillary-like structure formation. In vivo neovascularization of Matrigel plugs was significantly greater in sickle cell disease mice, compared with non-sickle cell disease mice, consistent with an upregulation of angiogenesis in the disease. In plasma from patients with hemoglobin SC disease without proliferative retinopathy, anti-angiogenic endostatin and thrombospondin-2 were significantly elevated. In contrast, plasma from hemoglobin SC individuals with proliferative retinopathy displayed a pro-angiogenic profile and had more significant effects on endothelial cell proliferation and capillary formation than plasma of patients without retinopathy. Hydroxyurea therapy was associated with significant reductions in plasma angiogenic factor profile, in association with an inhibition of endothelial cell-mediated angiogenic mechanisms and neovascularization. Thus, sickle cell anemia and retinopathic hemoglobin SC individuals present a highly angiogenic circulating milieu, capable of stimulating key endothelial cell-mediated angiogenic mechanisms. Combination anti-angiogenic therapy for preventing progression of unregulated neovascularization and associated manifestations in sickle cell disease, such as pulmonary hypertension, may be indicated; furthermore, the benefits and drawbacks of the potent anti-angiogenic effects of hydroxyurea should be clarified.As hypoxia-induced inflammatory angiogenesis may contribute to sickle cell disease manifestations, we compared the angiogenic molecular profiles of plasma from sickle cell disease individuals and correlated these with in vitro endothelial cell-mediated an1006730739FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO2008/57441-0; 2009/16334-0565036/201

Prominent Role Of Platelets In The Formation Of Circulating Neutrophil-red Cell Heterocellular Aggregates In Sickle Cell Anemia

[No abstract available]9911e214e217Hidalgo, A., Chang, J., Jang, J.E., Peired, A.J., Chiang, E.Y., Frenette, P.S., Heterotypic interactions enabled by polarized neutrophil microdomains mediate thromboinflammatory injury (2009) Nat Med, 15 (4), pp. 384-391Turhan, A., Jenab, P., Bruhns, P., Ravetch, J.V., Coller, B.S., Frenette, P.S., Intravenous immune globulin prevents venular vaso-occlusion in sickle cell mice by inhibiting leukocyte adhesion and the interactions between sickle erythrocytes and adherent leukocytes (2004) Blood, 103 (6), pp. 2397-2400Turhan, A., Weiss, L.A., Mohandas, N., Coller, B.S., Frenette, P.S., Primary role for adherent leukocytes in sickle cell vascular occlusion: A new paradigm (2002) Proc Natl Acad Sci USA, 99 (5), pp. 3047-3051May, A.E., Langer, H., Seizer, P., Bigalke, B., Lindemann, S., Gawaz, M., Platelet-leukocyte interactions in inflammation and atherothrombosis (2007) Semin Thromb Hemost, 33 (2), pp. 123-127Gawaz, M., Fateh-Moghadam, S., Pilz, G., Gurland, H.J., Werdan, K., Platelet activation and interaction with leucocytes in patients with sepsis or multiple organ failure (1995) Eur J Clin Invest, 25 (11), pp. 843-851Polanowska-Grabowska, R., Wallace, K., Field, J.J., Chen, L., Marshall, M.A., Figler, R., P-selectin-mediated platelet-neutrophil aggregate formation activates neutrophils in mouse and human sickle cell disease (2010) Art Thromb Vascular Biol, 30 (12), pp. 2392-2399Brittain, J.E., Knoll, C.M., Ataga, K.I., Orringer, E.P., Parise, L.V., Fibronectin bridges monocytes and reticulocytes via integrin alpha4beta1 (2008) Br J Haematol, 141 (6), pp. 872-881Chaar, V., Picot, J., Renaud, O., Bartolucci, P., Nzouakou, R., Bachir, D., Aggregation of mononuclear and red blood cells through an {alpha}4{beta}1-Lu/basal cell adhesion molecule interaction in sickle cell disease (2010) Haematologica, 95 (11), pp. 1841-1848Finnegan, E.M., Turhan, A., Golan, D.E., Barabino, G.A., Adherent leukocytes capture sickle erythrocytes in an in vitro flow model of vasoocclusion (2007) Am J Hematol, 82 (4), pp. 266-275Wun, T., Paglieroni, T., Tablin, F., Welborn, J., Nelson, K., Cheung, A., Platelet activation and platelet-erythrocyte aggregates in patients with sickle cell anemia (1997) J Lab Clin Med, 129 (5), pp. 507-516Hynes, R.O., Integrins: Versatility, modulation, and signaling in cell adhesion (1992) Cell, 69 (1), pp. 11-25Novelli, E.M., Kato, G.J., Ragni, M.V., Zhang, Y., Hildesheim, M.E., Nouraie, M., Plasma thrombospondin-1 is increased during acute sickle cell vaso-occlusive events and associated with acute chest syndrome, hydroxyurea therapy, and lower hemolytic rates (2012) Am J Hematol, 87 (3), pp. 326-330Proenca-Ferreira, R., Brugnerotto, A.F., Garrido, V.T., Dominical, V.M., Vital, D.M., Ribeiro Mde, F., Endothelial activation by platelets from sickle cell anemia patients (2014) PloS one, 9 (2)Kutlar, A., Ataga, K.I., McMahon, L., Howard, J., Galacteros, F., Hagar, W., A potent oral P-selectin blocking agent improves microcirculatory blood flow and a marker of endothelial cell injury in patients with sickle cell disease (2012) Am J Hematol, 87 (5), pp. 536-539Telen, M.J., Wun, T., McCavit, T.L., De Castro, L.M., Krishnamurti, L., Lanzkron, S., GMI 1070: Reduction In Time To Resolution Of Vaso-Occlusive Crisis and Decreased Opioid Use In a Prospective, Randomized, Multi-Center Double Blind, Adaptive Phase 2 Study In Sickle Cell Disease (2013) Blood, 122 (21), p. 7. , Abstrac

Human eosinophil adhesion and degranulation stimulated with eotaxin and RANTES in vitro: Lack of interaction with nitric oxide

<p>Abstract</p> <p>Background</p> <p>Airway eosinophilia is considered a central event in the pathogenesis of asthma. The toxic components of eosinophils are thought to be important in inducing bronchial mucosal injury and dysfunction. Previous studies have suggested an interaction between nitric oxide (NO) and chemokines in modulating eosinophil functions, but this is still conflicting. In the present study, we have carried out functional assays (adhesion and degranulation) and flow cytometry analysis of adhesion molecules (VLA-4 and Mac-1 expression) to evaluate the interactions between NO and CC-chemokines (eotaxin and RANTES) in human eosinophils.</p> <p>Methods</p> <p>Eosinophils were purified using a percoll gradient followed by immunomagnetic cell separator. Cell adhesion and degranulation were evaluated by measuring eosinophil peroxidase (EPO) activity, whereas expression of Mac-1 and VLA-4 was detected using flow cytometry.</p> <p>Results</p> <p>At 4 h incubation, both eotaxin (100 ng/ml) and RANTES (1000 ng/ml) increased by 133% and 131% eosinophil adhesion, respectively. L-NAME alone (but not D-NAME) also increased the eosinophil adhesion, but the co-incubation of L-NAME with eotaxin or RANTES did not further affect the increased adhesion seen with chemokines alone. In addition, L-NAME alone (but not D-NAME) caused a significant cell degranulation, but it did not affect the CC-chemokine-induced cell degranulation. Incubation of eosinophils with eotaxin or RANTES, in absence or presence of L-NAME, did not affect the expression of VLA-4 and Mac-1 on eosinophil surface. Eotaxin and RANTES (100 ng/ml each) also failed to elevate the cyclic GMP levels above baseline in human eosinophils.</p> <p>Conclusion</p> <p>Eotaxin and RANTES increase the eosinophil adhesion to fibronectin-coated plates and promote cell degranulation by NO-independent mechanisms. The failure of CC-chemokines to affect VLA-4 and Mac-1 expression suggests that changes in integrin function (avidity or affinity) are rather involved in the enhanced adhesion.</p

Cytotoxicity and DNA damage in the neutrophils of patients with sickle cell anaemia treated with hydroxyurea

Hydroxyurea (HU) is the most important advance in the treatment of sickle cell anaemia (SCA) for preventing complications and improving quality of life for patients. However, some aspects of treatment with HU remain unclear, including their effect on and potential toxicity to other blood cells such as neutrophils. This study used the measurement of Lactate Dehydrogenase (LDH) and Methyl ThiazolTetrazolium (MTT) and the comet assay to investigate the cytotoxicity and damage index (DI) of the DNA in the neutrophils of patients with SCA using HU.In the LDH and MTT assays, a cytoprotective effect was observed in the group of patients treated, as well as an absence of toxicity. When compared to patients without the treatment, the SS group (n=20, 13 women and 07 men, aged 18-69 years), and the group of healthy individuals (AA) used as a control group (n=52, 28 women and 24 men, aged 19-60 years), The SSHU group (n=21, 11 women and 10 men, aged 19-63 years) showed a significant reduction (p20 months), demonstrating that despite the cytoprotective effects in terms of cell viability, the use of HU can induce DNA damage in neutrophils

Reconceptualizing power and gendered subjectivities in domestic cooking spaces

Drawing on evidence from the Global North and South, this paper explores the power dynamics of domestic kitchens in different geographical contexts. Noting the gendered nature of domesticity, it contrasts those perspectives which regard women’s primary responsibility for foodwork as inherently oppressive, with others which see kitchens and associated domestic spaces as sites of potential empowerment for women. The paper explores the complex, spatially-distributed, character of power surrounding domestic foodwork, decentring Anglo-American understandings of the relationship between gender, power and domestic space by foregrounding the experiences of a range of women from across the globe. The paper also examines the increasing role of men in domestic settings, particularly in the Global North, assessing the extent to which their engagement in cooking and other domestic practices may be challenging conventional understandings of the relationship between gender, power and space. Focusing on the spatial dynamics of the domestic kitchen, this paper advances a more nuanced understanding of the co-constitutive nature of the relationship between gender and power, including the instabilities and slippages that occur in the performance of various domestic foodwork tasks. The paper advocates future research on the boundaries of home, work and leisure, focusing on their significance in the constitution and transformation of male and female subjectivities

Nitric oxide synthetic pathway and cGMP levels are altered in red blood cells from end-stage renal disease patients

Red blood cells (RBCs) enzymatically produce nitric oxide (NO) by a functional RBC-nitric oxide synthase (RBC-NOS). NO is a vascular key regulatory molecule. In RBCs its generation is complex and influenced by several factors, including insulin, acetylcholine, and calcium. NO availability is reduced in end-stage renal disease (ESRD) and associated with endothelial dysfunction. We previously demonstrated that, through increased phosphatidylserine membrane exposure, ESRD-RBCs augmented their adhesion to human cultured endothelium, in which NO bioavailability decreased. Since RBC-NOS-dependent NO production in ESRD is unknown, this study aimed to investigate RBC-NOS levels/activation, NO production/bioavailability in RBCs from healthy control subjects (C, N = 18) and ESRD patients (N = 27). Although RBC-NOS expression was lower in ESRD-RBCs, NO, cyclic guanosine monophosphate (cGMP), RBC-NOS Serine1177 phosphorylation level and eNOS/Calmodulin (CaM)/Heat Shock Protein-90 (HSP90) interaction levels were higher in ESRD-RBCs, indicating increased enzyme activation. Conversely, following RBCs stimulation with insulin or ionomycin, NO and cGMP levels were significantly lower in ESRD- than in C-RBCs, suggesting that uremia might reduce the RBC-NOS response to further stimuli. Additionally, the activity of multidrug-resistance-associated protein-4 (MRP4; cGMP-membrane transporter) was significantly lower in ESRD-RBCs, suggesting a possible compromised efflux of cGMP across the ESRD-RBCs membrane. This study for the first time showed highest basal RBC-NOS activation in ESRD-RBCs, possibly to reduce the negative impact of decreased NOS expression. It is further conceivable that high NO production only partially affects cell function of ESRD-RBCs maybe because in vivo they are unable to respond to physiologic stimuli, such as calcium and/or insulin

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Abstracts from the 8th International Conference on cGMP Generators, Effectors and Therapeutic Implications

This work was supported by a restricted research grant of Bayer AG

Intravascular Hemolysis: A Disease Mechanism Not To Be Ignored

[No abstract available]13219799Olivieri, N.F., Weatherall, D.J., (2009) Clinical Aspects of Beta Thalassemia and Related Disorders, pp. 357-416. , Steinberg MH, Forget BG, Higgs DR, Weatherall DJ (eds): Disorders of Hemoglobin, ed 2. New York, Cambridge University Press chapt 17Rother, R.P., Bell, L., Hillmen, P., Gladwin, M.T., The clinical sequelae of intravascular hemolysis and extracellular plasma hemoglobin: A novel mechanism of human disease (2005) JAMA, 293, pp. 1653-1662Kato, G.J., Gladwin, M.T., Steinberg, M.H., Deconstructing sickle cell disease: Reappraisal of the role of hemolysis in the development of clinical subphenotypes (2007) Blood Rev, 21, pp. 37-47Rodeghiero, F., Ruggeri, M., Short-and longterm risks of splenectomy for benign haematological disorders should we revisit the indications (2012) Br J Haematol, 158, pp. 16-29Atichartakarn, V., Chuncharunee, S., Archararit, N., Udomsubpayakul, U., Aryurachai, K., Intravascular hemolysis, vascular endothelial cell activation, and thrombophilia in splenectomized patients with hemoglobin E/α-thalassemia disease (2014) Acta Haematol, 132, pp. 100-107Westerman, M., Pizzey, A., Hirschman, J., Cerino, M., Weil-Weiner, Y., Ramotar, P., Eze, A., Porter, J., Microvesicles in haemoglobinopathies offer insights into mechanisms of hypercoagulability, haemolysis and the effects of therapy (2008) Br J Haematol, 142, pp. 126-135Sakamoto, T.M., Canalli, A.A., Traina, F., Franco-Penteado, C.F., Gambero, S., Saad, S.T., Conran, N., Costa, F.F., Altered red cell and platelet adhesion in hemolytic diseases: Hereditary spherocytosis, paroxysmal nocturnal hemoglobinuria and sickle cell disease (2013) Clin Biochem, , E-pub ahead of printRabhi, S., Benjelloune, H., Meziane, M., Amrani, M., Berrady, R., Mikou, O., Mernissi, F.Z., Bono, W., Hereditary spherocytosis with leg ulcers healing after splenectomy (2011) South Med J, 104, pp. 150-152Crary, S.E., Ramaciotti, C., Buchanan, G.R., Prevalence of pulmonary hypertension in hereditary spherocytosis (2011) Am J Hematol, 86, pp. E73-E76Djaldetti, M., Bergman, M., Salman, H., Cohen, A.M., Fibach, E., Bessler, H., On the mechanism of post-splenectomy leukocytosis in mice (2003) Eur J Clin Invest, 33, pp. 811-81