Placental transcriptome profile of women with sickle cell disease reveals differentially expressed genes involved in migration, trophoblast differentiation and inflammation

Baptista, Letícia C.; Costa, Maria Laura; Surita, Fernanda Garanhani; Rocha, Cristiane S.; Lopes-Cendes, Íscia; Souza, Bruno Batista de; Costa, Fernando Ferreira; Melo, Mônica Barbosa de

doi:10.1016/j.bcmd.2020.102458

Cited by 4 publications

(2 citation statements)

References 49 publications

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“…All these findings suggest that, even despite the absence of manifest obstetrical complications the pro-oxidant and pro-inflammatory environment sustained by chronic hemolysis and vaso-occlusion, with cycles of ischemia and reperfusion, inevitably causes a placental impairment. Accordingly, transcriptome analyses highlighted in placenta samples from SCD pregnancies the altered expression of several genes associated with migration, trophoblast differentiation and inflammation [35]. Interestingly, recent observations in patients with SCD report abnormalities in placental DNA methylation status, leading to gene expression changes also in cases without evident clinical impact [36].…”

Section: Discussionmentioning

confidence: 99%

Red Blood Cell Exchange as a Valid Therapeutic Approach for Pregnancy Management in Sickle Cell Disease: Three Explicative Cases and Systematic Review of Literature

Valentini,

Pellegrino,

Ceglie

et al. 2023

JCM

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Pregnancy in women with sickle cell disease (SCD) is a high-risk situation, especially during the third trimester of gestation and in the post-partum period, due to chronic hypoxia and vaso-occlusive phenomena occurring in the maternal–fetal microcirculation: as a result, unfavorable outcomes, such as intra-uterine growth restriction, prematurity or fetal loss are more frequent in SCD pregnancies. Therefore, there is a consensus on the need for a strict and multidisciplinary follow-up within specialized structures. Transfusion support remains the mainstay of treatment of SCD pregnancies, whereas more targeted modalities are still controversial: the benefit of prophylactic management, either by simple transfusions or by automated red blood cell exchange (aRBCX), is not unanimously recognized. We illustrate the cases of three SCD pregnant patients who underwent aRBCX procedures at our institution in different clinical scenarios. Moreover, we carried out a careful literature revision to investigate the management of pregnancy in SCD, with a particular focus on the viability of aRBCX. Our experience and the current literature support the use of aRBCX in pregnancy as a feasible and safe procedure, provided that specialized equipment and an experienced apheresis team is available. However, further research in this high-risk population, with appropriately powered prospective trials, is desirable to refine the indications and timing of aRBCX and to confirm the advantages of this approach on other transfusion modalities.

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Section: Discussionmentioning

confidence: 99%

Red Blood Cell Exchange as a Valid Therapeutic Approach for Pregnancy Management in Sickle Cell Disease: Three Explicative Cases and Systematic Review of Literature

Valentini,

Pellegrino,

Ceglie

et al. 2023

JCM

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“…It was postulated that these changes contribute to vaso‐occlusion and tissue hypoxemia. Several recent studies showed altered placental DNA methylation and gene expression profiles involved in inflammation, migration, and pulmonary pressure, which possibly contribute to the abnormal placental development 38–41 …”

Section: Sca and Pregnancymentioning

confidence: 99%

Hydroxyurea treatment for sickle cell anemia during pregnancy and lactation: Current evidence and knowledge gaps

et al. 2023

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Sickle cell anemia (SCA) is a life‐threatening genetic condition contributing to high‐risk pregnancies affecting both the mother and fetus. With improved management of children with SCA, this life‐threatening hematological disorder has evolved into a chronic disease of adults, and consequently parenthood has now become a possible and important life goal for many patients. Providing continuous management with healthy red blood cell function and avoiding SCA‐associated complications, such as pain crises, acute chest syndrome, and stroke, are crucial for a healthy pregnancy. Despite its excellent safety profile in non‐pregnant adults and children, and based on theoretical concerns derived from data using animal models and supraphysiological dosing, hydroxyurea is currently contraindicated for pregnant and lactating women with SCA. Clinical experience of hydroxyurea use during pregnancy is increasingly reported, however, and has shown inconsistent results of fetal or infant adverse effects. How the hydroxyurea exposure level may correlate with pregnancy outcomes is still unclear. Accordingly, efforts should be made to systemically evaluate exposure and safety of hydroxyurea treatment during pregnancy and lactation. Novel approaches such as physiologically based pharmacokinetic (PBPK) modeling, coupled with the ex vivo human placental cotyledon perfusion assay, provide opportunities to understand hydroxyurea exposure not only in pregnant women but also in the developing fetus. Combined with animal data, research using these approaches might be able to define safe and effective hydroxyurea dosing regimens for pregnant and lactating women with SCA, when the benefits of continuing hydroxyurea treatment likely outweigh the risks of non‐treatment, by avoiding substantial morbidity and even mortality for both mothers and infants.

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Micro-haemodynamics at the maternal–fetal interface: Experimental, theoretical and clinical perspectives

Zhou

Doman

Schirrmann

et al. 2022

Current Opinion in Biomedical Engineering

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Placental transcriptome profile of women with sickle cell disease reveals differentially expressed genes involved in migration, trophoblast differentiation and inflammation

Cited by 4 publications

References 49 publications

Red Blood Cell Exchange as a Valid Therapeutic Approach for Pregnancy Management in Sickle Cell Disease: Three Explicative Cases and Systematic Review of Literature

Red Blood Cell Exchange as a Valid Therapeutic Approach for Pregnancy Management in Sickle Cell Disease: Three Explicative Cases and Systematic Review of Literature

Hydroxyurea treatment for sickle cell anemia during pregnancy and lactation: Current evidence and knowledge gaps

Micro-haemodynamics at the maternal–fetal interface: Experimental, theoretical and clinical perspectives

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