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[PMID]:29192832
[Au] Autor:Rochon ER; Corti P; Gladwin MT
[Ad] Endereço:1 Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute University of Pittsburgh Pittsburgh, Pennsylvania and.
[Ti] Título:Hemoglobin α in Pulmonary Endothelium: Ironing Out Nitric Oxide Signaling.
[So] Source:Am J Respir Cell Mol Biol;57(6):639-641, 2017 12.
[Is] ISSN:1535-4989
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Endotélio Vascular/metabolismo
Hemoglobina A/metabolismo
Hipertensão Pulmonar/metabolismo
Óxido Nítrico/metabolismo
Transdução de Sinais
[Mh] Termos MeSH secundário: Endotélio Vascular/patologia
Seres Humanos
Hipertensão Pulmonar/patologia
[Pt] Tipo de publicação:EDITORIAL
[Nm] Nome de substância:
31C4KY9ESH (Nitric Oxide); 9034-51-9 (Hemoglobin A)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1165/rcmb.2017-0272ED


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[PMID]:28699687
[Au] Autor:Al Balushi HWM; Wali Y; Al Awadi M; Al-Subhi T; Rees DC; Brewin JN; Hannemann A; Gibson JS
[Ad] Endereço:Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
[Ti] Título:The super sickling haemoglobin HbS-Oman: a study of red cell sickling, K permeability and associations with disease severity in patients heterozygous for HbA and HbS-Oman (HbA/S-Oman genotype).
[So] Source:Br J Haematol;179(2):256-265, 2017 Oct.
[Is] ISSN:1365-2141
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Studying different sickle cell genotypes may throw light on the pathogenesis of sickle cell disease (SCD). Here, the clinical profile, red cell sickling and K permeability in 29 SCD patients (15 patients with severe disease and 14 with a milder form) of HbA/S-Oman genotype were analysed. The super sickling nature of this Hb variant was confirmed. The red cell membrane permeability to K was markedly abnormal with elevated activities of P , Gardos channel and KCl cotransporter (KCC). Results were consistent with Ca entry and Mg loss via P stimulating Gardos channel and KCC activities. The abnormal red cell behaviour was similar to that in the commonest genotype of SCD, HbSS, in which the level of mutated Hb is considerably higher. Although activities of all three K transporters also correlated with the level of HbS-Oman, there was no association between transport phenotype and disease severity. The super sickling behaviour of HbS-Oman may obviate the need for solute loss and red cell dehydration to encourage Hb polymerisation, required in other SCD genotypes. Disease severity was reduced by concurrent α thalassaemia, as observed in other SCD genotypes, and represents an obvious genetic marker for prognostic tests of severity in young SCD patients of the HbA/S-Oman genotype.
[Mh] Termos MeSH primário: Eritrócitos Anormais/metabolismo
Hemoglobina A/genética
Hemoglobinas Anormais/genética
Heterozigoto
Canais de Potássio Ativados por Cálcio de Condutância Intermediária/metabolismo
Potássio/metabolismo
Talassemia alfa
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Criança
Pré-Escolar
Feminino
Seres Humanos
Canais de Potássio Ativados por Cálcio de Condutância Intermediária/genética
Masculino
Meia-Idade
Permeabilidade
Índice de Gravidade de Doença
Talassemia alfa/genética
Talassemia alfa/metabolismo
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hemoglobins, Abnormal); 0 (Intermediate-Conductance Calcium-Activated Potassium Channels); 0 (KCNN4 protein, human); 0 (hemoglobin S-Oman); 9034-51-9 (Hemoglobin A); RWP5GA015D (Potassium)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE
[do] DOI:10.1111/bjh.14851


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[PMID]:28694727
[Au] Autor:Desmons A; Jaisson S; Leroy N; Gillery P; Guillard E
[Ad] Endereço:Laboratory of Pediatric Biology and Research, University Hospital of Reims, Reims, France.
[Ti] Título:Labile glycated haemoglobin and carbamylated haemoglobin are still critical points for HbA measurement.
[So] Source:Biochem Med (Zagreb);27(2):378-386, 2017 Jun 15.
[Is] ISSN:1330-0962
[Cp] País de publicação:Croatia
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Haemoglobin A (HbA ) is a key analyte for the monitoring of glycemic balance in diabetic patients and is used for diabetes diagnosis in many countries. The potential interference of carbamylated haemoglobin (cHb) and labile glycated haemoglobin (LA ) on HbA assays must remain a matter of vigilance. Such a situation has occurred in our laboratory with a kit replacement on the Bio-Rad Variant™ II testing system, a cation-exchange high performance liquid chromatography (HPLC) system. With this method, LA and cHb coeluted in a same peak which may have different consequences on HbA values. MATERIALS AND METHODS: The influence of increasing LA and cHb values on HbA results was studied with glycation and carbamylation of samples. Samples from patients with high and normal blood urea concentrations were assayed by HPLC and immunological assay. RESULTS: We observed that the degree of interference greatly varied depending on the nature of the interfering Hb fractions found under the so-called "LA peak". Thus, we have decided to apply a decision tree using "LA " thresholds depending on: (i) the retention time, (ii) the shape of the peak, (iii) other analytes, like urea. If the peak recognized as "LA " is mainly formed by LA we consider that there is no interference until 4%. If the peak is mainly formed by cHb, we consider an interference threshold equal to 2%. CONCLUSIONS: This situation reminds that cHb and LA remain critical issues in chromatography-based HbA assays and that adapted criteria must be set up for result interpretation.
[Mh] Termos MeSH primário: Glicemia/análise
Hemoglobina A Glicada/análise
Testes Hematológicos/métodos
Hemoglobina A/análogos & derivados
[Mh] Termos MeSH secundário: Cromatografia Líquida de Alta Pressão
Testes Diagnósticos de Rotina/normas
Testes Hematológicos/normas
Hemoglobina A/análise
Seres Humanos
Kit de Reagentes para Diagnóstico/normas
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glycated Hemoglobin A); 0 (Reagent Kits, Diagnostic); 60616-87-7 (hemoglobin A, carbamylated); 9034-51-9 (Hemoglobin A)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170712
[St] Status:MEDLINE
[do] DOI:10.11613/BM.2017.039


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[PMID]:28609534
[Au] Autor:Powers JM; Buchanan GR; Adix L; Zhang S; Gao A; McCavit TL
[Ad] Endereço:Division of Hematology and Oncology, Baylor College of Medicine, Houston, Texas2Department of Pediatrics, Baylor College of Medicine, Houston, Texas3Texas Children's Hospital, Houston.
[Ti] Título:Effect of Low-Dose Ferrous Sulfate vs Iron Polysaccharide Complex on Hemoglobin Concentration in Young Children With Nutritional Iron-Deficiency Anemia: A Randomized Clinical Trial.
[So] Source:JAMA;317(22):2297-2304, 2017 06 13.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Iron-deficiency anemia (IDA) affects millions of persons worldwide, and is associated with impaired neurodevelopment in infants and children. Ferrous sulfate is the most commonly prescribed oral iron despite iron polysaccharide complex possibly being better tolerated. Objective: To compare the effect of ferrous sulfate with iron polysaccharide complex on hemoglobin concentration in infants and children with nutritional IDA. Design, Setting, and Participants: Double-blind, superiority randomized clinical trial of infants and children aged 9 to 48 months with nutritional IDA (assessed by history and laboratory criteria) that was conducted in an outpatient hematology clinic at a US tertiary care hospital from September 2013 through November 2015; 12-week follow-up ended in January 2016. Interventions: Three mg/kg of elemental iron once daily as either ferrous sulfate drops or iron polysaccharide complex drops for 12 weeks. Main Outcomes and Measures: Primary outcome was change in hemoglobin over 12 weeks. Secondary outcomes included complete resolution of IDA (defined as hemoglobin concentration >11 g/dL, mean corpuscular volume >70 fL, reticulocyte hemoglobin equivalent >25 pg, serum ferritin level >15 ng/mL, and total iron-binding capacity <425 µg/dL at the 12-week visit), changes in serum ferritin level and total iron-binding capacity, adverse effects. Results: Of 80 randomized infants and children (median age, 22 months; 55% male; 61% Hispanic white; 40 per group), 59 completed the trial (28 [70%] in ferrous sulfate group; 31 [78%] in iron polysaccharide complex group). From baseline to 12 weeks, mean hemoglobin increased from 7.9 to 11.9 g/dL (ferrous sulfate group) vs 7.7 to 11.1 g/dL (iron complex group), a greater difference of 1.0 g/dL (95% CI, 0.4 to 1.6 g/dL; P < .001) with ferrous sulfate (based on a linear mixed model). Proportion with a complete resolution of IDA was higher in the ferrous sulfate group (29% vs 6%; P = .04). Median serum ferritin level increased from 3.0 to 15.6 ng/mL (ferrous sulfate) vs 2.0 to 7.5 ng/mL (iron complex) over 12 weeks, a greater difference of 10.2 ng/mL (95% CI, 6.2 to 14.1 ng/mL; P < .001) with ferrous sulfate. Mean total iron-binding capacity decreased from 501 to 389 µg/dL (ferrous sulfate) vs 506 to 417 µg/dL (iron complex) (a greater difference of -50 µg/dL [95% CI, -86 to -14 µg/dL] with ferrous sulfate; P < .001). There were more reports of diarrhea in the iron complex group than in the ferrous sulfate group (58% vs 35%, respectively; P = .04). Conclusions and Relevance: Among infants and children aged 9 to 48 months with nutritional iron-deficiency anemia, ferrous sulfate compared with iron polysaccharide complex resulted in a greater increase in hemoglobin concentration at 12 weeks. Once daily, low-dose ferrous sulfate should be considered for children with nutritional iron-deficiency anemia. Trial Registration: clinicaltrials.gov Identifier: NCT01904864.
[Mh] Termos MeSH primário: Anemia Ferropriva/sangue
Anemia Ferropriva/tratamento farmacológico
Transtornos da Nutrição Infantil/complicações
Compostos Ferrosos/farmacologia
Hemoglobina A/efeitos dos fármacos
Compostos de Ferro/farmacologia
Polissacarídeos/farmacologia
[Mh] Termos MeSH secundário: Anemia Ferropriva/etiologia
Pré-Escolar
Método Duplo-Cego
Feminino
Ferritinas/sangue
Compostos Ferrosos/administração & dosagem
Compostos Ferrosos/efeitos adversos
Hemoglobina A/metabolismo
Seres Humanos
Lactente
Ferro/metabolismo
Compostos de Ferro/administração & dosagem
Compostos de Ferro/efeitos adversos
Perda de Seguimento
Masculino
Adesão à Medicação/estatística & dados numéricos
Polissacarídeos/administração & dosagem
Polissacarídeos/efeitos adversos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Ferrous Compounds); 0 (Iron Compounds); 0 (Polysaccharides); 39R4TAN1VT (ferrous sulfate); 9007-73-2 (Ferritins); 9034-51-9 (Hemoglobin A); E1UOL152H7 (Iron)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170614
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.6846


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[PMID]:28259625
[Au] Autor:Tiensomjitr K; Prabpai S; Kongsaeree P
[Ad] Endereço:Department of Chemistry and Center for Excellence in Protein and Enzyme Technology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand.
[Ti] Título:Characterization of the selective alkylation site in hemoglobin A by dihydroartemisinin with tandem mass spectrometry.
[So] Source:Int J Biol Macromol;99:358-364, 2017 Jun.
[Is] ISSN:1879-0003
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:The reaction between the antimalarial drug dihydroartemisinin (DHA) and hemoglobin A (HbA) was investigated in vitro. A fluorescein-tagged artemisinin analog reacted with HbA and fluorescent HbA-drug adducts could be visualized on SDS-PAGE to confirm stable covalent reaction adducts and necessity of the endoperoxide moiety and Fe(II). Mass spectrometric analyses revealed that DHA favourably alkylated protein part rather than heme and the modification site was identified to be at Tyr35 of the beta globin chain.
[Mh] Termos MeSH primário: Antimaláricos/metabolismo
Artemisininas/metabolismo
Hemoglobina A/metabolismo
[Mh] Termos MeSH secundário: Alquilação/efeitos dos fármacos
Antimaláricos/química
Antimaláricos/farmacologia
Artemisininas/química
Artemisininas/farmacologia
Sítios de Ligação
Corantes Fluorescentes/química
Hemoglobina A/química
Seres Humanos
Modelos Moleculares
Conformação Proteica em alfa-Hélice
Conformação Proteica em Folha beta
Espectrometria de Massas em Tandem
Tirosina/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antimalarials); 0 (Artemisinins); 0 (Fluorescent Dyes); 42HK56048U (Tyrosine); 6A9O50735X (dihydroartemisinin); 9034-51-9 (Hemoglobin A)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170424
[Lr] Data última revisão:
170424
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170306
[St] Status:MEDLINE


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[PMID]:28249145
[Au] Autor:Ribeil JA; Hacein-Bey-Abina S; Payen E; Magnani A; Semeraro M; Magrin E; Caccavelli L; Neven B; Bourget P; El Nemer W; Bartolucci P; Weber L; Puy H; Meritet JF; Grevent D; Beuzard Y; Chrétien S; Lefebvre T; Ross RW; Negre O; Veres G; Sandler L; Soni S; de Montalembert M; Blanche S; Leboulch P; Cavazzana M
[Ad] Endereço:From the Departments of Biotherapy (J.-A.R., A.M., E.M., L.C., M.C.), Clinical Pharmacy (P. Bourget), Pediatric Neuroradiology (D.G.), General Pediatrics (M.M.), and Pediatric Immunology-Hematology Unit (B.N., S.B.), Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Biothera
[Ti] Título:Gene Therapy in a Patient with Sickle Cell Disease.
[So] Source:N Engl J Med;376(9):848-855, 2017 03 02.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Sickle cell disease results from a homozygous missense mutation in the ß-globin gene that causes polymerization of hemoglobin S. Gene therapy for patients with this disorder is complicated by the complex cellular abnormalities and challenges in achieving effective, persistent inhibition of polymerization of hemoglobin S. We describe our first patient treated with lentiviral vector-mediated addition of an antisickling ß-globin gene into autologous hematopoietic stem cells. Adverse events were consistent with busulfan conditioning. Fifteen months after treatment, the level of therapeutic antisickling ß-globin remained high (approximately 50% of ß-like-globin chains) without recurrence of sickle crises and with correction of the biologic hallmarks of the disease. (Funded by Bluebird Bio and others; HGB-205 ClinicalTrials.gov number, NCT02151526 .).
[Mh] Termos MeSH primário: Anemia Falciforme/terapia
Terapia Genética
Globinas beta/genética
[Mh] Termos MeSH secundário: Adolescente
Anemia Falciforme/sangue
Ensaios Clínicos como Assunto
Expressão Gênica
Terapia Genética/efeitos adversos
Vetores Genéticos
Hemoglobina A/metabolismo
Seres Humanos
Lentivirus
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (beta-Globins); 9034-51-9 (Hemoglobin A)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170525
[Lr] Data última revisão:
170525
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170302
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1609677


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[PMID]:28218841
[Au] Autor:Samuel PP; Ou WC; Phillips GN; Olson JS
[Ad] Endereço:Department of BioSciences and ‡Department of Chemistry, Rice University , Houston, Texas 77251, United States.
[Ti] Título:Mechanism of Human Apohemoglobin Unfolding.
[So] Source:Biochemistry;56(10):1444-1459, 2017 Mar 14.
[Is] ISSN:1520-4995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Removal of heme from human hemoglobin (Hb) results in formation of an apoglobin heterodimer. Titration of this apodimer with guanidine hydrochloride (GdnHCl) leads to biphasic unfolding curves indicating two distinct steps. Initially, the heme pocket unfolds and generates a dimeric intermediate in which ∼50% of the original helicity is lost, but the α ß interface is still intact. At higher GdnHCl concentrations, this intermediate dissociates into unfolded monomers. This structural interpretation was verified by comparing GdnHCl titrations for adult human hemoglobin A (HbA), recombinant fetal human hemoglobin (HbF), recombinant Hb cross-linked with a single glycine linker between the α chains, and recombinant Hbs with apolar heme pocket mutations that markedly stabilize native conformations in both subunits. The first phase of apoHb unfolding is independent of protein concentration, little affected by genetic cross-linking, but significantly shifted toward higher GdnHCl concentrations by the stabilizing distal pocket mutations. The second phase depends on protein concentration and is shifted to higher GdnHCl concentrations by genetic cross-linking. This model for apoHb unfolding allowed us to quantitate subtle differences in stability between apoHbA and apoHbF, which suggest that the ß and γ heme pockets have similar stabilities, whereas the α γ interface is more resistant to dissociation than the α ß interface.
[Mh] Termos MeSH primário: Apoproteínas/química
Hemoglobina Fetal/química
Guanidina/química
Hemoglobina A/química
Hemoglobinas/química
[Mh] Termos MeSH secundário: Apoproteínas/genética
Apoproteínas/metabolismo
Clonagem Molecular
Escherichia coli/genética
Escherichia coli/metabolismo
Hemoglobina Fetal/genética
Hemoglobina Fetal/metabolismo
Expressão Gênica
Glicina/química
Glicina/metabolismo
Heme/química
Heme/isolamento & purificação
Heme/metabolismo
Hemoglobina A/genética
Hemoglobina A/metabolismo
Hemoglobinas/genética
Hemoglobinas/metabolismo
Seres Humanos
Cinética
Desnaturação Proteica
Domínios Proteicos
Dobramento de Proteína
Multimerização Proteica
Estabilidade Proteica
Estrutura Secundária de Proteína
Desdobramento de Proteína
Proteínas Recombinantes/química
Proteínas Recombinantes/genética
Proteínas Recombinantes/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Apoproteins); 0 (Hemoglobins); 0 (Recombinant Proteins); 0 (apohemoglobin); 42VZT0U6YR (Heme); 9034-51-9 (Hemoglobin A); 9034-63-3 (Fetal Hemoglobin); JU58VJ6Y3B (Guanidine); TE7660XO1C (Glycine)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170515
[Lr] Data última revisão:
170515
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170221
[St] Status:MEDLINE
[do] DOI:10.1021/acs.biochem.6b01235


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[PMID]:28170418
[Au] Autor:Cortés-Castell E; Palazón-Bru A; Pla C; Goicoechea M; Rizo-Baeza MM; Juste M; Gil-Guillén VF
[Ad] Endereço:Department of Pharmacology, Pediatrics and Organic Chemistry, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.
[Ti] Título:Impact of prematurity and immigration on neonatal screening for sickle cell disease.
[So] Source:PLoS One;12(2):e0171604, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Others have described a relationship between hemoglobin A levels and gestational age, gender and ethnicity. However, studies are needed to determine normal cut-off points considering these factors. To address this issue we designed a study to determine the percentiles of normality of neonatal hemoglobin A levels taking these factors into account. METHODS: This cross-sectional study involved 16,025 samples for sickle cell disease screening in the province of Alicante, Spain, which has a high immigration rate. The primary variable was hemoglobin A, and the secondary variables were gender, gestational age (preterm and full term) and maternal origin (Spain, the rest of Europe, North Africa, Sub-Saharan Africa, Latin America and Asia). Percentiles of normality (1 and 99) were obtained by origin, gender and gestational age using quantile regression models and bootstrap samples. The association between these percentiles of normality and altered levels (≥1%) of hemoglobin E was analyzed. We obtained the percentiles of normality (1 and 99) for each maternal origin, gender and gestational age. RESULTS: Of a total of 88 possible E carriers, 65 had above-normal hemoglobin A levels (74%). The levels of normality for hemoglobin A varied greatly according to the maternal origin and gestational age. CONCLUSION: With the levels of normality that we established it is possible to discard samples with unrecorded blood transfusions. Our methodology could be applied to other diseases in the neonatal screening.
[Mh] Termos MeSH primário: Anemia Falciforme/diagnóstico
Emigração e Imigração
Recém-Nascido Prematuro
Triagem Neonatal
[Mh] Termos MeSH secundário: Anemia Falciforme/epidemiologia
Estudos Transversais
Feminino
Idade Gestacional
Hemoglobina A
Seres Humanos
Recém-Nascido
Masculino
Programas de Rastreamento
Espanha/epidemiologia
Espanha/etnologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
9034-51-9 (Hemoglobin A)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170825
[Lr] Data última revisão:
170825
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170208
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0171604


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[PMID]:28130333
[Au] Autor:Parikh J; Kapela A; Tsoukias NM
[Ad] Endereço:Department of Biomedical Engineering, Florida International University, Miami, Florida; and.
[Ti] Título:Can endothelial hemoglobin-α regulate nitric oxide vasodilatory signaling?
[So] Source:Am J Physiol Heart Circ Physiol;312(4):H854-H866, 2017 Apr 01.
[Is] ISSN:1522-1539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We used mathematical modeling to investigate nitric oxide (NO)-dependent vasodilatory signaling in the arteriolar wall. Detailed continuum cellular models of calcium (Ca ) dynamics and membrane electrophysiology in smooth muscle and endothelial cells (EC) were coupled with models of NO signaling and biotransport in an arteriole. We used this theoretical approach to examine the role of endothelial hemoglobin-α (Hbα) as a modulator of NO-mediated myoendothelial feedback, as previously suggested in Straub et al. ( 491: 473-477, 2012). The model considers enriched expression of inositol 1,4,5-triphosphate receptors (IP Rs), endothelial nitric oxide synthase (eNOS) enzyme, Ca -activated potassium (K ) channels and Hbα in myoendothelial projections (MPs) between the two cell layers. The model suggests that NO-mediated myoendothelial feedback is plausible if a significant percentage of eNOS is localized within or near the myoendothelial projection. Model results show that the ability of Hbα to regulate the myoendothelial feedback is conditional to its colocalization with eNOS near MPs at concentrations in the high nanomolar range (>0.2 µM or 24,000 molecules). Simulations also show that the effect of Hbα observed in in vitro experimental studies may overestimate its contribution in vivo, in the presence of blood perfusion. Thus, additional experimentation is required to quantify the presence and spatial distribution of Hbα in the EC, as well as to test that the strong effect of Hbα on NO signaling seen in vitro, translates also into a physiologically relevant response in vivo. Mathematical modeling shows that although regulation of nitric oxide signaling by hemoglobin-α (Hbα) is plausible, it is conditional to its presence in significant concentrations colocalized with endothelial nitric oxide synthase in myoendothelial projections. Additional experimentation is required to test that the strong effect of Hbα seen in vitro translates into a physiologically relevant response in vivo.
[Mh] Termos MeSH primário: Endotélio Vascular/fisiologia
Hemoglobina A/fisiologia
Óxido Nítrico/fisiologia
Transdução de Sinais/fisiologia
Vasodilatação/fisiologia
[Mh] Termos MeSH secundário: Algoritmos
Simulação por Computador
Eritrócitos/efeitos dos fármacos
Retroalimentação Fisiológica
Seres Humanos
Receptores de Inositol 1,4,5-Trifosfato/efeitos dos fármacos
Modelos Teóricos
Óxido Nítrico Sintase Tipo III/biossíntese
Canais de Potássio Cálcio-Ativados/biossíntese
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Inositol 1,4,5-Trisphosphate Receptors); 0 (Potassium Channels, Calcium-Activated); 31C4KY9ESH (Nitric Oxide); 9034-51-9 (Hemoglobin A); EC 1.14.13.39 (NOS3 protein, human); EC 1.14.13.39 (Nitric Oxide Synthase Type III)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170728
[Lr] Data última revisão:
170728
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170129
[St] Status:MEDLINE
[do] DOI:10.1152/ajpheart.00315.2016


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[PMID]:28128441
[Au] Autor:Estcourt LJ; Malouf R; Trivella M; Fergusson DA; Hopewell S; Murphy MF
[Ad] Endereço:Haematology/Transfusion Medicine, NHS Blood and Transplant, Level 2, John Radcliffe Hospital, Headington, Oxford, UK, OX3 9BQ.
[Ti] Título:Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support.
[So] Source:Cochrane Database Syst Rev;1:CD011305, 2017 01 27.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many people diagnosed with haematological malignancies experience anaemia, and red blood cell (RBC) transfusion plays an essential supportive role in their management. Different strategies have been developed for RBC transfusions. A restrictive transfusion strategy seeks to maintain a lower haemoglobin level (usually between 70 g/L to 90 g/L) with a trigger for transfusion when the haemoglobin drops below 70 g/L), whereas a liberal transfusion strategy aims to maintain a higher haemoglobin (usually between 100 g/L to 120 g/L, with a threshold for transfusion when haemoglobin drops below 100 g/L). In people undergoing surgery or who have been admitted to intensive care a restrictive transfusion strategy has been shown to be safe and in some cases safer than a liberal transfusion strategy. However, it is not known whether it is safe in people with haematological malignancies. OBJECTIVES: To determine the efficacy and safety of restrictive versus liberal RBC transfusion strategies for people diagnosed with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without a haematopoietic stem cell transplant (HSCT). SEARCH METHODS: We searched for randomised controlled trials (RCTs) and non-randomised trials (NRS) in MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1982), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 6), and 10 other databases (including four trial registries) to 15 June 2016. We also searched grey literature and contacted experts in transfusion for additional trials. There was no restriction on language, date or publication status. SELECTION CRITERIA: We included RCTs and prospective NRS that evaluated a restrictive compared with a liberal RBC transfusion strategy in children or adults with malignant haematological disorders or undergoing HSCT. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We identified six studies eligible for inclusion in this review; five RCTs and one NRS. Three completed RCTs (156 participants), one completed NRS (84 participants), and two ongoing RCTs. We identified one additional RCT awaiting classification. The completed studies were conducted between 1997 and 2015 and had a mean follow-up from 31 days to 2 years. One study included children receiving a HSCT (six participants), the other three studies only included adults: 218 participants with acute leukaemia receiving chemotherapy, and 16 with a haematological malignancy receiving a HSCT. The restrictive strategies varied from 70 g/L to 90 g/L. The liberal strategies also varied from 80 g/L to 120 g/L.Based on the GRADE rating methodology the overall quality of the included studies was very low to low across different outcomes. None of the included studies were free from bias for all 'Risk of bias' domains. One of the three RCTs was discontinued early for safety concerns after recruiting only six children, all three participants in the liberal group developed veno-occlusive disease (VOD). Evidence from RCTsA restrictive RBC transfusion policy may make little or no difference to: the number of participants who died within 100 days (two trials, 95 participants (RR: 0.25, 95% CI 0.02 to 2.69, low-quality evidence); the number of participants who experienced any bleeding (two studies, 149 participants; RR:0.93, 95% CI 0.73 to 1.18, low-quality evidence), or clinically significant bleeding (two studies, 149 participants, RR: 1.03, 95% CI 0.75 to 1.43, low-quality evidence); the number of participants who required RBC transfusions (three trials; 155 participants: RR: 0.97, 95% CI 0.90 to 1.05, low-quality evidence); or the length of hospital stay (restrictive median 35.5 days (interquartile range (IQR): 31.2 to 43.8); liberal 36 days (IQR: 29.2 to 44), low-quality evidence).We are uncertain whether the restrictive RBC transfusion strategy: decreases quality of life (one trial, 89 participants, fatigue score: restrictive median 4.8 (IQR 4 to 5.2); liberal median 4.5 (IQR 3.6 to 5) (very low-quality evidence); or reduces the risk of developing any serious infection (one study, 89 participants, RR: 1.23, 95% CI 0.74 to 2.04, very low-quality evidence).A restrictive RBC transfusion policy may reduce the number of RBC transfusions per participant (two trials; 95 participants; mean difference (MD) -3.58, 95% CI -5.66 to -1.49, low-quality evidence). Evidence from NRSWe are uncertain whether the restrictive RBC transfusion strategy: reduces the risk of death within 100 days (one study, 84 participants, restrictive 1 death; liberal 1 death; very low-quality evidence); decreases the risk of clinically significant bleeding (one study, 84 participants, restrictive 3; liberal 8; very low-quality evidence); or decreases the number of RBC transfusions (adjusted for age, sex and acute myeloid leukaemia type geometric mean 1.25; 95% CI 1.07 to 1.47 - data analysis performed by the study authors)No NRS were found that looked at: quality of life; number of participants with any bleeding; serious infection; or length of hospital stay.No studies were found that looked at: adverse transfusion reactions; arterial or venous thromboembolic events; length of intensive care admission; or readmission to hospital. AUTHORS' CONCLUSIONS: Findings from this review were based on four studies and 240 participants.There is low-quality evidence that a restrictive RBC transfusion policy reduces the number of RBC transfusions per participant. There is low-quality evidence that a restrictive RBC transfusion policy has little or no effect on: mortality at 30 to 100 days, bleeding, or hospital stay. This evidence is mainly based on adults with acute leukaemia who are having chemotherapy. Although, the two ongoing studies (530 participants) are due to be completed by January 2018 and will provide additional information for adults with haematological malignancies, we will not be able to answer this review's primary outcome. If we assume a mortality rate of 3% within 100 days we would need 1492 participants to have a 80% chance of detecting, as significant at the 5% level, an increase in all-cause mortality from 3% to 6%. Further RCTs are required in children.
[Mh] Termos MeSH primário: Anemia/terapia
Transfusão de Eritrócitos/métodos
Neoplasias Hematológicas/tratamento farmacológico
Neoplasias Hematológicas/radioterapia
[Mh] Termos MeSH secundário: Doença Aguda
Adulto
Anemia/sangue
Anemia/etiologia
Criança
Transfusão de Eritrócitos/efeitos adversos
Neoplasias Hematológicas/sangue
Transplante de Células-Tronco Hematopoéticas
Hemoglobina A/análise
Seres Humanos
Leucemia/sangue
Leucemia/tratamento farmacológico
Leucemia/radioterapia
Estudos Prospectivos
Qualidade de Vida
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
9034-51-9 (Hemoglobin A)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170128
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011305.pub2



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