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      Current challenges in the management of patients with sickle cell disease – A report of the Italian experience

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          Abstract

          Sickle cell disease (SCD) is an inherited red blood cell disorder caused by a structural abnormality of hemoglobin called sickle hemoglobin (HbS). Clinical manifestations of SCD are mainly characterized by chronic hemolysis and acute vaso-occlusive crisis, which are responsible for severe acute and chronic organ damage. SCD is widespread in sub-Saharan Africa, in the Middle East, Indian subcontinent, and some Mediterranean regions. With voluntary population migrations, people harboring the HbS gene have spread globally. In 2006, the World Health Organization recognized hemoglobinopathies, including SCD, as a global public health problem and urged national health systems worldwide to design and establish programs for the prevention and management of SCD. Herein we describe the historical experience of the network of hemoglobinopathy centers and their approach to SCD in Italy, a country where hemoglobinopathies have a high prevalence and where SCD, associated with different genotypes including ß-thalassemia, is present in the native population.

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          The effect of prolonged administration of hydroxyurea on morbidity and mortality in adult patients with sickle cell syndromes: results of a 17-year, single-center trial (LaSHS).

          The aim of this prospective study was to evaluate the long-term efficacy and safety of hydroxyurea (HU) in patients with sickle cell disease (SCD). Thirty-four patients with sickle cell anemia (hemoglobin S [HbS]/HbS), 131 with HbS/beta(0)-thal, and 165 with HbS/beta(+)-thal participated in this trial. HU was administered to 131 patients, whereas 199 patients were conventionally treated. The median follow-up period was 8 years for HU patients and 5 years for non-HU patients. HU produced a dramatic reduction in the frequency of severe painful crises, transfusion requirements, hospital admissions, and incidence of acute chest syndrome. The probability of 10-year survival was 86% and 65% for HU and non-HU patients, respectively (P = .001), although HU patients had more severe forms of SCD. The 10-year probability of survival for HbS/HbS, HbS/beta (0)-thal, and HbS/IVSI-110 patients was 100%, 87%, and 82%, respectively, for HU patients and 10%, 54%, and 66%, for non-HU patients. The multivariate analysis showed that fetal hemoglobin values at baseline and percentage change of lactate dehydrogenase between baseline and 6 months were independently predicted for survival in the HU group. These results highlight the beneficial effect of HU, which seems to modify the natural history of SCD and raise the issue of expanding its use in all SCD patients.
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            Hemopexin therapy improves cardiovascular function by preventing heme-induced endothelial toxicity in mouse models of hemolytic diseases.

            Hemolytic diseases are characterized by enhanced intravascular hemolysis resulting in heme-catalyzed reactive oxygen species generation, which leads to endothelial dysfunction and oxidative damage. Hemopexin (Hx) is a plasma heme scavenger able to prevent endothelial damage and tissue congestion in a model of heme overload. Here, we tested whether Hx could be used as a therapeutic tool to counteract heme toxic effects on the cardiovascular system in hemolytic diseases. By using a model of heme overload in Hx-null mice, we demonstrated that heme excess in plasma, if not bound to Hx, promoted the production of reactive oxygen species and the induction of adhesion molecules and caused the reduction of nitric oxide availability. Then, we used β-thalassemia and sickle cell disease mice as models of hemolytic diseases to evaluate the efficacy of an Hx-based therapy in the treatment of vascular dysfunction related to heme overload. Our data demonstrated that Hx prevented heme-iron loading in the cardiovascular system, thus limiting the production of reactive oxygen species, the induction of adhesion molecules, and the oxidative inactivation of nitric oxide synthase/nitric oxide, and promoted heme recovery and detoxification by the liver mainly through the induction of heme oxygenase activity. Moreover, we showed that in sickle cell disease mice, endothelial activation and oxidation were associated with increased blood pressure and altered cardiac function, and the administration of exogenous Hx was found to almost completely normalize these parameters. Hemopexin treatment is a promising novel therapy to protect against heme-induced cardiovascular dysfunction in hemolytic disorders.
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              Temporal discrimination and the indifference interval. Implications for a model of the "internal clock".

              A Treisman (1962)
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                Author and article information

                Contributors
                +39 0953782683 , diberuss@unict.it
                lucia.defranceschi@univr.it
                rcolombatti@gmail.com
                paolorigano@gmail.com
                silverio.perrotta@unicampania.it
                vincenzo.voi@unito.it
                palazzi.giovanni@policlinico.mo.it
                carmelo.fidone@asp.rg.it
                alequota@hotmail.com
                giovanna.graziadei@policlinico.mi.it
                pietrangelo.antonello@unimore.it
                valeria.pinto@galliera.it
                gbruffo@gmail.com
                francesco.sorrentino@aslroma2.it
                venturelli.donatella@policlinico.mo.it
                maddalena.casale@unicampania.it
                ferrara.francesca@policlinico.mo.it
                laura.sainati@unipd.it
                maria.cappellini@unimi.it
                antonio.piga@unito.it
                aurelio.maggio@ospedaliriunitipalermo.it
                +39 3281503364 , gianluca.forni@galliera.it
                Journal
                Orphanet J Rare Dis
                Orphanet J Rare Dis
                Orphanet Journal of Rare Diseases
                BioMed Central (London )
                1750-1172
                30 May 2019
                30 May 2019
                2019
                : 14
                : 120
                Affiliations
                [1 ]ISNI 0000 0004 1757 1969, GRID grid.8158.4, Oncoematologia Pediatrica, Azienda Policlinico-Vittorio Emanuele, , Università di Catania, ; Via Santa Sofia 78, 95123 Catania, Italy
                [2 ]Dipartimento di Medicina, Sezione Medicina Interna, Università di Verona, Policlinico GB Rossi, AOUI, Verona, Italy
                [3 ]ISNI 0000 0004 1757 3470, GRID grid.5608.b, Clinica di Oncoematologia Pediatrica, Dipartimento della Salute della Donna e del Bambino Azienda Ospedaliera, , Università di Padova, ; Padova, Italy
                [4 ]U.O.C Ematologia e Malattie Rare del Sangue e degli Organi Ematopoietici-P.O. Cervello Palermo, Palermo, Italy
                [5 ]ISNI 0000 0001 2200 8888, GRID grid.9841.4, Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, , Università̀ degli Studi della Campania “Luigi Vanvitelli”, ; Napoli, Italy
                [6 ]ISNI 0000 0004 0493 6869, GRID grid.415081.9, Dipartimento di Scienze Cliniche e Biologiche, , Università di Torino, Ospedale San Luigi Gonzaga, ; Orbassano, Italy
                [7 ]ISNI 0000000121697570, GRID grid.7548.e, Dipartimento Integrato Materno Infantile U. O. Complessa di Pediatria Università degli Studi di Modena e Reggio Emilia, ; Modena, Italy
                [8 ]Unità operativa semplice Studio Emoglobinopatie Simt, Ragusa, Italy
                [9 ]U.O.S talassemia PO Vittorio Emanuele, Gela, Italy
                [10 ]UOC di Medicina Generale, Centro Malattie Rare Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Pad, Granelli, Milano, Italy
                [11 ]ISNI 0000000121697570, GRID grid.7548.e, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, , Università degli Studi di Modena e Reggio Emilia, ; Modena, Italy
                [12 ]ISNI 0000 0004 1757 8650, GRID grid.450697.9, Centro della Microcitemia e delle Anemie Congenite, Ospedale Galliera, ; Via Volta 6, 16128 Genova, Italy
                [13 ]U.O. Ematologia con Talassemia ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
                [14 ]ISNI 0000 0004 1760 4441, GRID grid.416628.f, U.O. Talassemici Centro Anemia Rare e Disturbi del metabolismo del Ferro ASL ROMA 2 Ospedale S Eugenio, ; Roma, Italy
                [15 ]ISNI 0000000121697570, GRID grid.7548.e, Struttura Complessa di Immuno-trasfusionale Azienda Ospedaliero, , Universitaria di Modena, ; Modena, Italy
                [16 ]Struttura Complessa di Pediatria-Microcitemie dell’Ospedale San Luigi di Orbassano, Orbassano, TO Italy
                Author information
                http://orcid.org/0000-0001-9369-7473
                Article
                1099
                10.1186/s13023-019-1099-0
                6543611
                31146777
                94274bc2-2551-4fab-973a-1fa2fcf605c1
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 20 March 2019
                : 19 May 2019
                Categories
                Review
                Custom metadata
                © The Author(s) 2019

                Infectious disease & Microbiology
                hemoglobin disorder,hemoglobinopathy,hydroxyurea,migrants,sickle cell screening,sickle cell disease,transfusion,vaso-occlusion crisis

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