Manifestations of HbSE sickle cell disease: a systematic review.

BACKGROUND: Sickle cell disease (SCD) is commonly encountered in Africa and Middle Eastern countries. The causative mutation in the gene encoding the hemoglobin subunit ß (HBB) leads to various genotypic variants of the disease. This results in varied phenotypes, with a spectrum of complications, from benign to fatal. Hemoglobin SS (HBSS) genotype is associated with most of these complications; hence, it is a severe form of SCD. On the other hand, rare genotypes such as hemoglobin SE (HBSE) are considered benign. There is limited literature about the clinical manifestations and characteristics of patients with HBSE. We pooled all available data describing the phenotypic manifestations of HBSE heterozygote worldwide to perform a systematic review. METHODS: We performed a systematic review according to PRISMA guidelines using PubMed, SCOPUS, and Google Scholar databases. Two independent reviewers (FA and IK) evaluated studies for eligibility and extracted data. We synthesized data on demographics, manifestations, and management of HBSE disease. PROSPERO Registration Number: CRD42021229877. RESULTS: We found 68 HBSE patients reported in the literature. 24 cases were extracted from case reports whereas 44 cases from case series and retrospective studies. Turkey reported the highest number of patients (n = 22). 32 (47%) of the patients were males. The mean age was 20.9 ± 18.26 years. The mean HBS and HBE percentages were 61.1% ± 7.25% and 32.3% ± 5.06%, respectively, whereas the mean hemoglobin was 11.64 ± 1.73 g/dl. Reported manifestations of HBSE disease included acute vaso-occlusive pain crisis (n = 22, 32.3%), splenomegaly (n = 11, 16.1%), hemolytic anemia (n = 10, 14.7%), infections (n = 8. 11.7%), bone infarction (n = 4, 5.8%), gallstones (n = 3, 4.4%), venous thromboembolism (VTE) (n = 2, 2.9%) and stroke (n = 2, 2.9%), and hematuria (n = 2, 2.9%). Death due to HBSE complications was reported in three patients. CONCLUSION: HBSE is a rare genotypic variant of SCD. It has been considered a benign form; however, there are multiple reports of severe complications. Severe complications observed in HBSE disease include vaso-occlusive crisis, acute chest syndrome, stroke, bone marrow embolism, and death.

Short incubation periods of atypical H-type BSE in cattle with EK211 and KK211 prion protein genotypes after intracranial inoculation.

In 2006, a case of atypical H-type BSE (H-BSE) was found to be associated with a germline mutation in the PRNP gene that resulted in a lysine substitution for glutamic acid at codon 211 (E211K). The E211K amino acid substitution in cattle is analogous to E200K in humans, which is associated with the development of genetic Creutzfeldt-Jakob disease (CJD). In the present study, we aimed to determine the effect of the EK211 prion protein genotype on incubation time in cattle inoculated with the agent of H-BSE; to characterize the molecular profile of H-BSE in KK211 and EK211 genotype cattle; and to assess the influence of serial passage on BSE strain. Eight cattle, representing three PRNP genotype groups (EE211, EK211, and KK211), were intracranially inoculated with the agent of H-BSE originating from either a case in a cow with the EE211 prion protein genotype or a case in a cow with E211K amino acid substitution. All inoculated animals developed clinical disease; post-mortem samples were collected, and prion disease was confirmed through enzyme immunoassay, anti-PrPSc immunohistochemistry, and western blot. Western blot molecular analysis revealed distinct patterns in a steer with KK211 H-BSE compared to EK211 and EE211 cattle. Incubation periods were significantly shorter in cattle with the EK211 and KK211 genotypes compared to the EE211 genotype. Inoculum type did not significantly influence the incubation period. This study demonstrates a shorter incubation period for H-BSE in cattle with the K211 genotype in both the homozygous and heterozygous forms.

Acute chest syndrome in sickle cell disease/HBE patient, A case report.

The presented case will shed some light on one of the rarest complications of HBSE disease, which is acute chest syndrome, and will highlight the management of that complication.

Influence of Interspecies Transmission of Atypical Bovine Spongiform Encephalopathy Prions to Hamsters on Prion Characteristics.

Bovine spongiform encephalopathy (BSE) is a prion disease in cattle and is classified into the classical type (C-BSE) and two atypical BSEs, designated as high type (H-BSE) and low type (L-BSE). These classifications are based on the electrophoretic migration of the proteinase K-resistant core (PrPres) of the disease-associated form of the prion protein (PrPd). In a previous study, we succeeded in transmitting the H-BSE prion from cattle to TgHaNSE mice overexpressing normal hamster cellular PrP (PrPC). Further, Western blot analysis demonstrated that PrPres banding patterns of the H-BSE prion were indistinguishable from those of the C-BSE prion in TgHaNSE mice. In addition, similar PrPres glycoprofiles were detected among H-, C-, and L-BSE prions in TgHaNSE mice. Therefore, to better understand atypical BSE prions after interspecies transmission, H-BSE prion transmission from TgHaNSE mice to hamsters was investigated, and the characteristics of classical and atypical BSE prions among hamsters, wild-type mice, and mice overexpressing bovine PrPC (TgBoPrP) were compared in this study using biochemical and neuropathological methods. Identical PrPres banding patterns were confirmed between TgHaNSE mice and hamsters in the case of all three BSE prion strains. However, these PrPres banding patterns differed from those of TgBoPrP and wild-type mice infected with the H-BSE prion. In addition, glycoprofiles of TgHaNSE mice and hamsters infected with the L-BSE prion differed from those of TgBoPrP mice infected with the L-BSE prion. These data indicate that the PrPC amino acid sequences of new host species rather than other host environmental factors may affect some molecular aspects of atypical BSE prions. Although three BSE prion strains were distinguishable based on the neuropathological features in hamsters, interspecies transmission modified some molecular properties of atypical BSE prions, and these properties were indistinguishable from those of C-BSE prions in hamsters. Taken together, PrPres banding patterns and glycoprofiles are considered to be key factors for BSE strain typing. However, this study also revealed that interspecies transmission could sometimes influence these characteristics.

Estimation of prion infectivity in tissues of cattle infected with atypical BSE by real time-quaking induced conversion assay.

Atypical bovine spongiform encephalopathy (BSE), first identified in 2004, poses a threat due to the potential to spread the disease to cattle and other animals, including humans. Here, we estimated prion titers in various tissues of cattle infected with atypical BSE using a real-time quaking-induced conversion assay that detects amyloid seeding activity of a disease-specific prion protein, PrPSc, a major component of prions. PrPSc was detected both in and outside of nerve tissues, and some of the peripheral nerve tissues contained relatively high prion titers. Low titers of prions were also observed in masseter, jejunum, and adrenal glands. Quantitative data on prion infectivity in tissues of atypical BSE-affected cattle is useful to assess the risk of atypical BSE.

Intra- and Interspecies Transmission of Atypical BSE - What Can We Learn from It?

After the detection of the first cases of atypical bovine spongiform encephalopathy (BSE) more than ten years ago, the etiology, pathogenesis and agent distribution of these novel BSE forms in cattle were completely unknown. Many studies have been performed in the meantime to elucidate the pathogenic mechanisms of these diseases. A wealth of data has been accumulated regarding the distribution of the abnormal isoform of the prion protein, PrPSc, in tissues of affected cattle, confirming the general restriction of the PrPSc and agent distribution to the central and peripheral nervous system, albeit at slightly higher levels as compared to classical BSE. However, due to lack of data, the assumptions regarding the spontaneous etiology of both atypical BSE forms (H-BSE and L-BSE) and also the origin of the classical BSE epidemic are still mainly speculative. By performing subpassage experiments of both the atypical BSE forms in a variety of conventional and transgenic mice and Syrian Gold hamsters, we aimed to improve our understanding of the strain stability of these BSE forms. It turned out that under these experimental conditions, both the atypical BSE forms may alter their phenotypes and become indistinguishable from classical BSE. Information about the classical and atypical BSE strain characteristics help to improve our understanding of the correlation between all three BSE forms.

Identification of H-type BSE in Portugal.

During the bovine spongiform encephalopathy (BSE) epidemic, Portugal was the third most affected country. As a result of a successful national eradication plan, the number of BSE affected animals has been progressively declining in Portugal with no cases identified in 2013. However, within the scope of this active surveillance scheme, we have identified the first H-type BSE case born after the introduction of the reinforced ban in fallen stock. Here, we report the phenotypic features of this case and the analysis of the protein coding sequence of prnp as well as the prnp promoter and intron 1 insertion-deletions.

Back pain: the sole of presentation of sickle cell disease.

Diagnosing back pain in children and adolescents can be a challenge to health care providers. Although studies show that more than half of the cases of back pain in children are of non-organic cause, missing the right diagnosis could be detrimental. We present a case of lower back pain in a ten-year-old male whom we eventually diagnosed with hemoglobin SE mutation, which responded well to pain management. Hence, sickle cell disease with vaso-occlusive crisis should be incorporated into the list of differential diagnoses in children with back pain.

Clinical and hematological presentation among Indian patients with common hemoglobin variants.

BACKGROUND: Co-inheritance of structural hemoglobin variants like HbS, HbD(Punjab) and HbE can lead to a variable clinical presentation and only few cases have been described so far in the Indian population. METHODS: We present the varied clinical and hematological presentation of 22 cases (HbSD(Punjab) disease-15, HbSE disease-4, HbD(Punjab)E disease-3) referred to us for diagnosis. RESULTS: Two of the 15 HbSD(Punjab) disease patients had moderate crisis, one presented with mild hemolytic anemia; however, the other 12 patients had a severe clinical presentation with frequent blood transfusion requirements, vaso occlusive crisis, avascular necrosis of the femur and febrile illness. The 4 HbSE disease patients had a mild to moderate presentation. Two of the 3 HbD(Punjab)E patients were asymptomatic with one patient's sibling having a mild presentation. The hemoglobin levels of the HbSD(Punjab) disease patients ranged from 2.3 to 8.5 g/dl and MCV from 76.3 to 111.6 fl. The hemoglobin levels of the HbD(Punjab)E and HbSE patients ranged from 10.8 to 11.9 and 9.8 to 10.0 g/dl whereas MCV ranged from 67.1 to 78.2 and 74.5 to 76.0 fl respectively. CONCLUSIONS: HbSD(Punjab) disease patients should be identified during newborn screening programmes and managed in a way similar to sickle cell disease. Couple at risk of having HbSD(Punjab) disease children may be given the option of prenatal diagnosis in subsequent pregnancies.

Encefalopatia espongiforme bovina atípica: uma revisão / Atypical bovine spongiform encephalopathy: a review

Bovine spongiform encephalopathy (BSE), caused by an infectious prion, emerged in the 1980s in Europe as a new disease in cattle and, since then, several actions are being taken for its prevention and control. Restricting the feeding of ruminants with animal by-products and the removal and destruction of specific risk materials (SRM) for the condition of carcasses in slaughterhouses have been proven effective to control the disease, in addition to the reduction of human exposure to the agent, as this is an important zoonosis. However, in 2004 the first atypical cases of BSE were diagnosed, in which the causative agents showed different molecular weights in Western blot (WB), compared to the classical form of the agent. In addition to the molecular differences, clinical presentations proved to be differentiated in atypical forms, affecting mainly cattle older than eight years. Because it is a new form of the disease, many studies are being conducted to elucidate the pathogenesis, epidemiology and zoonotic potential of atypical BSE. The aim of this study was to review the main aspects of atypical BSE emphasizing its etiology, epidemiology, clinical signs, diagnosis and control and prevention measures.

A encefalopatia espongiforme bovina (EEB), causada por um príon infectante, surgiu na década de 1980 na Europa como uma nova doença nos rebanhos bovinos e, desde então, estão sendo tomadas várias ações para sua prevenção e controle. A restrição da alimentação de ruminantes com subprodutos de origem animal e a remoção e destruição dos materiais de risco específico para a doença das carcaças em frigoríficos se mostraram efetivas medidas para o controle da doença, além de reduzirem a exposição humana ao agente, pois se trata de uma importante zoonose. No entanto, em 2004 os primeiros casos atípicos de EEB foram diagnosticados, nos quais os agentes causais apresentavam alterações de peso molecular na prova de Western blot, em relação ao agente da forma clássica. Além das diferenças moleculares dos agentes, as apresentações clínicas mostraram-se diferenciadas nas formas atípicas, acometendo principalmente bovinos com idade superior a oito anos. Por se tratar de uma nova forma da doença, muitos estudos estão sendo conduzidos buscando elucidar a patogenia, epidemiologia e seu potencial zoonótico. Objetivou-se neste estudo revisar os principais aspectos relacionados às EEB atípicas enfatizando sua etiologia, epidemiologia, sinais clínicos, diagnóstico e medidas de controle.

Encefalopatia espongiforme bovina atípica: uma revisão / Atypical bovine spongiform encephalopathy: a review

A encefalopatia espongiforme bovina (EEB), causada por um príon infectante, surgiu na década de 1980 na Europa como uma nova doença nos rebanhos bovinos e, desde então, estão sendo tomadas várias ações para sua prevenção e controle. A restrição da alimentação de ruminantes com subprodutos de origem animal e a remoção e destruição dos materiais de risco específico para a doença das carcaças em frigoríficos se mostraram efetivas medidas para o controle da doença, além de reduzirem a exposição humana ao agente, pois se trata de uma importante zoonose. No entanto, em 2004 os primeiros casos atípicos de EEB foram diagnosticados, nos quais os agentes causais apresentavam alterações de peso molecular na prova de Western blot, em relação ao agente da forma clássica. Além das diferenças moleculares dos agentes, as apresentações clínicas mostraram-se diferenciadas nas formas atípicas, acometendo principalmente bovinos com idade superior a oito anos. Por se tratar de uma nova forma da doença, muitos estudos estão sendo conduzidos buscando elucidar a patogenia, epidemiologia e seu potencial zoonótico. Objetivou-se neste estudo revisar os principais aspectos relacionados às EEB atípicas enfatizando sua etiologia, epidemiologia, sinais clínicos, diagnóstico e medidas de controle.(AU)

Bovine spongiform encephalopathy (BSE), caused by an infectious prion, emerged in the 1980s in Europe as a new disease in cattle and, since then, several actions are being taken for its prevention and control. Restricting the feeding of ruminants with animal by-products and the removal and destruction of specific risk materials (SRM) for the condition of carcasses in slaughterhouses have been proven effective to control the disease, in addition to the reduction of human exposure to the agent, as this is an important zoonosis. However, in 2004 the first atypical cases of BSE were diagnosed, in which the causative agents showed different molecular weights in Western blot (WB), compared to the classical form of the agent. In addition to the molecular differences, clinical presentations proved to be differentiated in atypical forms, affecting mainly cattle older than eight years. Because it is a new form of the disease, many studies are being conducted to elucidate the pathogenesis, epidemiology and zoonotic potential of atypical BSE. The aim of this study was to review the main aspects of atypical BSE emphasizing its etiology, epidemiology, clinical signs, diagnosis and control and prevention measures.(AU)

Double heterozygous for hemoglobin S and hemoglobin E - a case report from central India.

Double heterozygosity for HbS and HbE is rare. HbS and HbE are seen in SC, ST and OBC communities from this part of country. Inter caste marriages amongst these communities have resulted into this compound heterozygous condition. Double heterozygous state for HbS and HbE is clinically silent as compared to HbS-ß Thalassaemia and HbSS cases. At Regional Hemoglobinopathy Detection and Management Center, we report a case of 15-year-old male, Teli (OBC) by caste who came for screening for sickle cell disorder. Sickling, solubility test and Hb electrophoresis on agar gel at alkaline pH was carried out. His sickling and solubility tests were positive and on hemoglobin electrophoresis it showed two bands one at Hb A(2) position and another at HbS position. For further confirmation sample was subjected for quantitation of haemoglobin on high performance liquid chromatography (HPLC), Bio-Rad. On quantitation he was having HbS 59.8%, HbE 33.5% and HbF 3.2% confirming his double heterozygous state for HbS and HbE. On family screening his father turned out to be sickle cell trait and mother as hemoglobin E trait.