Heart Arteries and Sickle Cell Disease / Coeur Artères DREpanocytose

Study Overview
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Brief Summary
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The CADRE study is a multinational observational cohort of patients with sickle-cell disease (SCD) in five west and central sub-Saharan African countries. The aim of this project is to describe the incidence and assess the predictive factors of SCD-related micro- and macro-vascular complications in sub-Saharan Africa.

Detailed Description
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Sickle cell disease (SCD), one of the lost common genetic diseases worldwide, is caused by a mutation in the β globin gene. Most patients with this disease are homozygous for the βS allele (SS), whereas others have inherited a βS allele with another mutation in the β globin gene. In addition to repeated acute ischemic insults due to the red blood cells sickling in the microcirculation, a chronic vasculopathy leads to organ injuries, such as kidney disease, stroke, pulmonary hypertension, retinopathy, bone infarcts, and leg ulcers. CADRE is a multinational prospective observational study undertaken in five countries in sub-Saharan Africa. Patients with SCD will be recruited through outpatients' clinics in public, university and private hospitals and research centers in five countries. The CADRE protocol was approved by the relevant national ethics committee in each of the participating countries. Primary endpoint is to measure the prevalence and the incidence of the main vascular complications in the main types of SCD: glomerulopathy, nephropathy, cardiopathy, pulmonary hypertension, retinopathy, strokes, osteonecrosis and leg ulcers. Secondary endpoints are: to define the clinical and biological predictors of SCD vasculopathy in Africa to search for genetic risk factors for the SCD-related cardiovascular complications, in particular alpha thalassemia, persistence of foetal hemoglobin and other candidate genetic polymorphisms to search for functional risk factors (pulse wave velocity, capillary vasodilatation, blood visosity) for the SCD-related cardiovascular complications to search for new biological determinant of SCD-related cardiovascular complications, in particular alternative markers of hemolysis (microparticules, free heme) and inflammation (cytokines, leucocytes phenotyping, NET (neutrophile extracellular traps))

Official Title
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Heart, Arteries and Sikle Cell Disease, a Multicentric Cohort of Cardiovascular Complications in Subsaharan Africa

Conditions
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Sickle Cell Anemia, Sickle Cell Disease

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age: five-year-old or more signature of informed consent Patients : major sickle cell syndrome confirmed by hemoglobin phenotyping: SS, SC, SBeta+ or Sbeta0 Controls : healthy parents or siblings of the patients, hospital staff or their children, matched on age+/- 3 years and country (1 control for 4 patients) Exclusion Criteria: unstable clinical status such as: vaso-occlusive crisis in the previous 15 days fever or infectious disease in the previous 15 days transfusion in the previous 2 months

Ages Eligible for Study
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Minimum Age: 5 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| sickle cell patients<br>age: five-year-old or more major sickle cell syndrome confirmed by hemoglobin phenotype: SS, SC, SBeta+ or Sbeta0 steady state defined as the absence of vaso-occlusive crisis for the previous 15 days, absence of fever or infectious disease for the previous 8 days and absence of transfusion for the previous 2 months | |
| control patients<br>volunteer parents or siblings of sickle cell patients hospital staff or their children matched on country and age +/- 3 ans with the patients | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence and 10 year-incidence of SCD-related vascular complications in different phenotypes of SCD: glomerulopathy | urinary albumin/creatinin ratio (mg/g) | 10 years | 
| Prevalence and 10 year-incidence of SCD-related vascular complications in different phenotypes of SCD: cardiopathy | left ventricular ejection fraction < 60 % | 10 years | 
| Prevalence and 10 year-incidence of SCD-related vascular complications in different phenotypes of SCD: pulmonary hypertension | tricuspid regurgitation jet velocity (m/s) | 10 years | 
| Prevalence and incidence and the 10 year-incidence of the main SCD-related vascular complications in different phenotypes of SCD: retinopathy | retinal examination | 10 years | 
| Prevalence and 10 year-incidence of SCD-related vascular complications in different phenotypes of SCD:stroke | clinical diagnosis | 10 years | 
| Prevalence and 10 year-incidence of SCD-related vascular complications in different phenotypes of SCD:osteonecrosis | standard radiography | 10 years | 
| Prevalence and 10 year-incidence of SCD-related vascular complications in different phenotypes of SCD: leg ulcers | clinical diagnosis | 10 years | 
| Prevalence and 10 year-incidence of SCD-related vascular complications in different phenotypes of SCD: priapism | clinical diagnosis | 10 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Potential biological risk marker measured at baseline and follow up visits: carotid-femoral pulse wave velocity | measured by Pulsepen, m/s) | 10 years | 
| Potential biological risk marker measured at baseline and follow up visits: complete blood count |  | 10 years | 
| Potential biological risk marker measured at baseline and follow up visits: LDH level |  | 10 years | 
| Potential biological risk marker measured at baseline and follow up visits: bilirubin level |  | 10 years | 
| Potential biological risk marker measured at baseline and follow up visits: microparticules measure |  | 10 years | 
| Potential biological risk marker measured at baseline and follow up visits: free heme level |  | 10 years | 
| Potential biological risk marker measured at baseline and follow up visits: inflammatory cytokines |  | 10 years | 
| Potential biological risk marker measured at baseline and follow up visits: neutrophil extracellular traps |  | 10 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sub-Saharan Africa, Sickle Cell Disease, Vasculopathy, Nephropathy, Pulmonary hypertension, cardiac disease, hemolysis, pulse wave velocity, blood viscosity