Mutations and polymorphisms in hemoglobin genes and the risk of pulmonary hypertension and death in sickle cell disease

James G Taylor, Diana Ackah, Crystal Cobb, Nick Orr, Melanie J Percy, Vandana Sachdev, Roberto Machado, Oswaldo Castro, Gregory J Kato, Stephen J Chanock, Mark T Gladwin

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41 Citations (Scopus)

Abstract

Pulmonary hypertension is a common complication of sickle cell disease (SCD) and a risk factor for early death. Hemolysis may participate in its pathogenesis by limiting nitric oxide (NO) bioavailability and producing vasculopathy. We hypothesized that hemoglobin mutations that diminish hemolysis in SCD would influence pulmonary hypertension susceptibility. Surprisingly, coincident alpha-thalassemia (Odds Ratio [OR]=0.95, 95% CI=0.46-1.94, P=NS) was not associated with pulmonary hypertension susceptibility in homozygous SCD. However, pulmonary hypertension cases were less likely to have hemoglobin SC (OR=0.18, 95% confidence interval [CI]=0.06-0.51, P=0.0005) or Sbeta(+) thalassemia (OR=0.25, 95% CI=0.06-1.16, P=0.10). These compound heterozygotes may be protected from pulmonary hypertension because of reduced levels of intravascular hemolysis, but develop this complication at a lower rate possibly due to the presence of non-hemolytic risk factors such as renal dysfunction, iron overload and advancing age. Despite this protective association, patients with SC who did develop pulmonary hypertension remained at significant risk for death during 49 months of follow-up (Hazard Ratio=8.20, P=0.0057).

Original languageEnglish
Pages (from-to)6-14
Number of pages9
JournalAmerican Journal of Hematology
Volume83
Issue number1
DOIs
Publication statusPublished - Jan 2008

Keywords

  • Adult
  • Age Distribution
  • Alleles
  • Anemia, Sickle Cell
  • Chromatography, High Pressure Liquid
  • Chromosomes, Human, Pair 11
  • Cohort Studies
  • False Positive Reactions
  • Female
  • Genetic Markers
  • Genetic Predisposition to Disease
  • Haplotypes
  • Hemoglobins
  • Humans
  • Hypertension, Pulmonary
  • Male
  • Mutation
  • Phenotype
  • Polymorphism, Genetic
  • Risk Factors
  • Survival Rate
  • alpha-Thalassemia
  • Journal Article
  • Research Support, N.I.H., Extramural

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    Taylor, J. G., Ackah, D., Cobb, C., Orr, N., Percy, M. J., Sachdev, V., Machado, R., Castro, O., Kato, G. J., Chanock, S. J., & Gladwin, M. T. (2008). Mutations and polymorphisms in hemoglobin genes and the risk of pulmonary hypertension and death in sickle cell disease. American Journal of Hematology, 83(1), 6-14. https://doi.org/10.1002/ajh.21035