Low Erythrocytic Glutathione Peroxidase-1 Activity Correlates with Hemolytic Rate in Patients with Sickle Cell Disease and Is Elevated on Hydroxyurea.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2253-2253
Author(s):  
Gregory J. Kato ◽  
Chun Seok Cho ◽  
Seung Ha Yang ◽  
Sung Won Bae ◽  
Jong Seo Lee ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Glutathione Peroxidase ◽  
Sickle Cell ◽  
Reticulocyte Count ◽  
Oxidant Stress ◽  
Fetal Hemoglobin ◽  
Cell Protein ◽  
Red Cell ◽  
Cell Disease ◽  
Glutathione Peroxidase 1

Abstract Background: Glutathione peroxidase-1 (GPX1) is the most significant catalytic antioxidant in the red cell. Congenital deficiency of GPX1 has been reported in association with hemolytic anemia due to oxidant stress. Hemolytic rate has been implicated in the development of sickle vasculopathy. Methods: Red cell pellets were collected from 32 patients with sickle cell disease and 17 healthy African American control subjects, and were stored frozen until assayed. A novel microplate immunoaffinity capture assay was used that measures both immunoreactive GPX1 protein and enzyme activity. Results: Patients with SCD had higher levels of red cell GPX1 activity than controls (2.42 ± 0.12 vs. 1.86 ± 0.15 units/mg red cell protein (mean ± SEM), p=0.006). GPX1 activity correlated with low reticulocyte count (r=−0.50, p=0.004)(Fig. 1A), low indirect bilirubin (r=–0.45, p=0.01) and high fetal hemoglobin expression (r=0.39, p=0.03). GPX1 activity in SCD patients on hydroxyurea was much higher than those not on hydroxyurea (2.75 ± 0.12, n=21 vs. 1.79 ± 0.13, n=11, p<0.001)(Fig. 1B), suggesting that hydroxyurea might induce GPX1 expression. In the patients off hydroxyurea, low GPX1 activity closely correlated with high serum lactate dehydrogenase level, a marker of high hemolytic rate (r=–0.85, p=0.002), suggesting that low GPX1 levels might contribute to rapid hemolytic rate. In a multivariate model, GPX1 was independently associated with reticulocyte count even when adjusted for fetal hemoglobin level. Conclusions: In addition to fetal hemoglobin, hydroxyurea may also induce expression of GPX1, a potent antioxidant that might have a role in decreasing hemolysis associated with the robust oxidant stress of SCD. This finding is consistent with previously published evidence of GPX1 induction by hydroxyurea in cancer cell lines, with increased antioxidant function. Additional studies are needed to confirm this phenomenon in a larger cohort of patients with SCD and to further evaluate the combined effect of fetal hemoglobin co-induction, but this finding suggests a potential mechanism by which hydroxyurea may produce clinical benefit in SCD even in the absence of significant fetal hemoglobin induction. Figure Figure

Adding Hydroxyurea to Chronic Transfusion Therapy for Stroke in Sickle Cell Disease.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4620-4620
Author(s):  
Susan Claster ◽  
Keith C. Quirolo
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Reticulocyte Count ◽  
Conflicts Of Interest ◽  
Hematological Parameters ◽  
Fetal Hemoglobin ◽  
Venous Access ◽  
Time Frame ◽  
Cell Disease ◽  
Transfusion Therapy

Abstract Abstract 4620 Introduction Transfusions have clearly been shown to prevent stroke in patients with Sickle Cell Disease(SCD). The usual goal of transfusion therapy is to keep the percent sickle Hgb (%S) less than 30. %S greater than 30 has been associated with stroke reoccurance. Inability to transfuse adequately may result from poor vascular access or high hemolytic rate. Hydroxyurea, a drug which requires active erythropoeisis, is usually not given to patients who are chronically transfused. However, the presence of an elevated reticulocyte count in a transfused patient indicates ongoing sickle hematopoiesis. We added Hydroxyurea therapy to two patients who were unable to achieve %S levels less than 30 and who had elevated reticulocyte counts to assess whether this drug could improve their hematological parameters. Results We treated two post stroke patients, one receiving pheresis therapy, and the other on straight transfusion therapy who were unable to achieve 30% Hgb S despite regular transfusions. Patient 1, a 33 y/o female with Hgb SS had been on transfusions since childhood for multiple CVA's and resulting moya-moya. Her last stroke had occurred while she was being chronically transfused and had a % S of 40. Due to venous access issues the patient was receiving straight transfusion only and was unable to adequately suppress her marrow. In 8/07 her %S was greater than 40 and her reticulocyte count was 11.3 %. Hydroxyurea was started at 1500 mg daily(22 mg/kg). Over the next 24 months her Bilirubin dropped from 8.7mg/dl to 1.9 mg/dl, her reticulocyte count dropped to 4%(figure below) and her MCV increased to 104.6 from 90. Her Hgb F rose to 30%.Her %S has not changed. She has remained clinically stable with no new neurological findings. The second patient, a 17 y/o male had been on chronic transfusions since childhood for a stroke which resulted in a dense left hemiparesis. He has been on a pheresis program for 13 years. Despite this his % S remained greater than 40% and had been as high as 60% prepheresis. Hydroxyurea was added in 5/08 at a dose of 25mg/kg. Within 6 months his pretransfusion %S had dropped to 22-27%. No increase in fetal Hgb was detected, possibly due to the exchange transfusion process. His bilirubin, which had been running between 12-16 mg/dl dropped to 7.6-8.9 mg/dl and his reticulocyte count went from an average of 19.6% to 11.2% in the same time frame. He has also remained stable. Discussion These two patients demonstrate that the addition of Hydroxyurea to patients on chronic transfusion can be useful in decreasing hemolytic rate and improving the efficacy of transfusions by decreasing sickle erythropoiesis and increasing fetal hemoglobin synthesis. Further studies of the combination of these two modalities may be warranted in those patients who cannot achieve adequate suppression of sickle erythropoeisis. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Human red cells protein kinase in normal subjects and patients with hereditary spherocytosis, sickle cell disease, and autoimmune hemolytic anemia

Blood ◽  
1976 ◽  
Vol 48 (6) ◽  
pp. 887-898 ◽  
Author(s):  
E Beutler ◽  
E Guinto ◽  
C Johnson
Keyword(s):  
Protein Kinase ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Kinase Activity ◽  
Hereditary Spherocytosis ◽  
Cell Protein ◽  
Protein Kinase Activity ◽  
Red Cell ◽  
Cell Disease ◽  
Membrane Phosphorylation

Abstract A somewhat simplified modification of a previously described method for the measurement of red cell membrane phosphorylation by ATP has been devised. Phosphorylation of membranes was linear with time for only 5- 10 min, and linearity with membrane concentration was observed only when assays were limited to short incubation times. Protein kinase activity of hereditary spherocytosis (HS) membranes was found to be normal. However, the average phosphorylation after 60 min incubation was less in HS membranes than in normal membranes. Findings similar to those in HS membranes were observed in sickle cell disease. The Km of red cell protein kinase for ATP is approximately 10(-5) M. Membrane phosphate binding sites are not saturated in either HS or normal membranes after 1 hr incubation with ATP. Approximately 27% of phosphorylating activity is lost after 1 hr incubation at 37 degrees C. GTP is a very inefficient phosphate donor. Under the conditions of measurement employed, the enzyme is slightly stimulated by 1 muM cAMP, but is not stimulated by 1 muM cGMP. Dephosphorylation of red cell membranes after labeling occurs at a similar rate in HS as in normal membranes. Although a mild abnormally in membrane phosphorylation is observed in HS, this could not be demonstrated to be due to a decrease in protein kinase activity or in alterations of its kinetic properties. The abnormally seen is not specific for HS.

Effects of 5-aza-2′-deoxycytidine on fetal hemoglobin levels, red cell adhesion, and hematopoietic differentiation in patients with sickle cell disease

Blood ◽  
2003 ◽  
Vol 102 (12) ◽  
pp. 3865-3870 ◽  
Author(s):  
Yogen Saunthararajah ◽  
Cheryl A. Hillery ◽  
Don Lavelle ◽  
Robert Molokie ◽  
Louise Dorn ◽  
...  
Keyword(s):  
Cell Adhesion ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Mechanism Of Action ◽  
Globin Gene ◽  
Fetal Hemoglobin ◽  
Red Cell ◽  
Cell Disease ◽  
Hemoglobin F ◽  
Total Hemoglobin

Abstract Fetal hemoglobin (HbF) decreases polymerization of sickle hemoglobin (HbS) and improves outcomes in sickle cell disease (SSD). Therefore, a therapeutic goal in SSD is pharmacologic reactivation of HbF. Silencing of the γ-globin (HbF) gene is associated with DNA methylation. The cytosine analog 5-aza-2′-deoxycytidine (decitabine) hypomethylates DNA by inhibiting DNA methyltransferase. We examined if subcutaneous decitabine could increase HbF levels and improve SSD pathophysiology without cytotoxicity. Eight symptomatic SSD patients resistant or intolerant of standard treatment with hydroxyurea received decitabine 0.2 mg/kg subcutaneously 1 to 3 times per week in 2 cycles of 6-week duration. Treatment decreased neutrophils and increased mean HbF (6.5% to 20.4%, P < .0001) and mean total hemoglobin (76 to 96 g/L [7.6 to 9.6 g/dL], P < .001). Features of vaso-occlusive crisis pathophysiology such as red cell adhesion, endothelial damage, and coagulation pathway activity significantly improved. γ-Globin gene promoter methylation decreased, and platelets and the proportion of megakaryocytes and erythroid cells in the marrow increased without a decrease in marrow cellularity, consistent with a DNA hypomethylating, noncytotoxic mechanism of action. Weekly subcutaneous decitabine produces cumulative increases in HbF and total hemoglobin through a noncytotoxic mechanism of action. Chronic dosing and sustained increases in hemoglobin F and total hemoglobin levels may be possible. Further studies in SSD and thalassemia are indicated.

scholarly journals Association of FOXO3A Polymorphisms with Hematocrit, LDH and Longevity in Patients with Sickle Cell Anemia from CSSCD, Walk-Phasst, and PUSH Clinical Trials

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2176-2176
Author(s):  
Harold T Bae ◽  
Paola Sebastiani ◽  
Victor R. Gordeuk ◽  
Yingze Zhang ◽  
Martin H. Steinberg ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Survival Analysis ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Reticulocyte Count ◽  
Fetal Hemoglobin ◽  
Human Longevity ◽  
Age At Death ◽  
Cell Disease

Abstract Background The FOXO3A genotype is strongly associated with longevity in humans. It encodes a transcription factor that appears to regulate anti-oxidant genes during erythroid differentiation in mice, resulting in a hemolytic anemia. The gene has also been implicated in the regulation of fetal hemoglobin expression in children with sickle cell disease. We performed a gene-wide association study to identify and replicate variants of FOXO3A that might be associated with seven biomarkers in patients with sickle cell anemia. Methods 1198 patients from the Cooperative Study of Sickle Cell Disease (CSSCD) study, 308 patients from the Pulmonary Hypertension and Sickle Cell Disease with Sildenafil Therapy (walk-PHaSST) study, and 220 patients from the Pulmonary Hypertension and the Hypoxic Response in Sickle Cell Disease (PUSH) study were analyzed. Biomarkers included hematocrit, reticulocyte count, fetal hemoglobin (HbF), serum levels of lactate dehydrogenase (LDH), aspartate aminotransferase and bilirubin, and the calculated hemolytic component, each appropriately transformed to achieve normality. A total of 189 single nucleotide polymorphisms (SNP) that were either genotyped or imputed (quality r2 > 0.9) were used. Association between each biomarker and SNP was tested using linear regression assuming an additive genetic model, adjusted for age and sex. None of the patients in the CSSCD were treated with hydroxyurea at the time of measurements of the biomarker variables. In the Walk-PHaSST and PUSH, we first examined whether there was a significant association between the biomarker and treatment effect of hydroxyurea; if there was a significant treatment effect, then we looked at potential SNP-by-treatment interaction. For those with significant interactions, only patients without hydroxyurea treatment were included in the analysis. The genetic analysis results from the three studies were then combined to produce meta-analyzed results. Finally, a survival analysis using Cox regression was performed to model age at death in a subset of 54 patients in the CSSCD. Results Among the seven biomarkers, hematocrit showed the most robust enrichment of associations with FOXO3A SNPs. Eight of the 16 published variants had meta-analyzed p-value <0.05. Of those, six had a consistent direction of effects across all three cohorts. Overall, there were 8 loci with 34 SNPs that had meta-analyzed p<0.05 in hematocrit. The most significantly associated SNP (rs6911407; meta-analyzed Beta=-0.0127, meta-analyzed p=0.0013) is one previously associated with human longevity. LDH was most significantly associated with variant rs12206094 (meta-analyzed Beta=0.0256, meta-analyzed p=0.0072), another SNP previously associated with human longevity. Four of the allelic variants associated with LDH were also associated with hematocrit in the appropriate direction. There were also some evidence of enrichment of associations with reticulocyte counts (2 loci with 22 SNPs), HbF (1 locus with 11 SNPs; 10 SNP associations overlapped with reticulocyte count in the appropriate direction), and hemolytic component (2 loci with 8 SNPs); however, the strengths of associations in these biomarkers were marginal (0.01<p<0.05). The survival analysis revealed one locus significantly associated with age at death in the CSSCD patients (rs2802297; p=0.028). Conclusion FOXO3A genetic polymorphisms are associated with hematocrit and serum LDH in this meta-analysis of patients with sickle cell anemia, with less robust associations with fetal hemoglobin level and reticulocyte count. Our genetic findings are biologically consistent with published knockout mouse data indicating that FOXO3A regulates red cell antioxidant capacity and hemolytic severity. Our observation of fetal hemoglobin association with FOXO3A helps to validate previously presented results from Sheehan and colleagues. Parallel to well-documented results in the general population, we find preliminarily that a FOXO3A allelic variant predicts longevity in patients with sickle cell anemia. FOXO3A appears to play a significant role in phenotypic variation in sickle cell anemia. Disclosures No relevant conflicts of interest to declare.

Risk Factors for Cerebral Vasculopathy in a Sickle Cell Disease Neonatal Cohort: A Prospective Study

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4098-4098
Author(s):  
Julie Sommet ◽  
Corinne Alberti ◽  
Nathalie Couque ◽  
Zinedine Haouari ◽  
Florence Missud ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sickle Cell Disease ◽  
Incidence Rate ◽  
Sickle Cell ◽  
Reticulocyte Count ◽  
Multivariable Analysis ◽  
Fetal Hemoglobin ◽  
Bronchial Obstruction ◽  
Cell Disease ◽  
Upper Airways

Abstract Children with sickle cell disease have a significant vascular morbidity, specifically cerebral vasculopathy (CV) that can be detected by transcranial Doppler. The aim of this study was to identify CV risk factors using longitudinal biological and clinical data including upper and lower respiratory tract evaluation in the newborn cohort of Robert Debre Pediatric Sickle Cell Referral Center. 375 patients with sickle cell anemia with a total of 2677 patient-years and a 7 years median follow-up were evaluated. Among the 59 children presenting CV, seven had a stroke. Overall, the incidence rate of CV was 2.20/100 patient-years (95% CI 1.64-2.76) and the incidence rate of stroke was 0.26/100 patient-years (95% CI 0.07-0.46). The cumulative risk of CV by the age of 11.3 years was 26.0% (95% CI 20.0%-33.3%). CV risk factors were assessed by a Cox model encompassing linear multivariable modelling of longitudinal quantitative variables. The final model retained four variables. Years with upper airways obstruction (HR=1.47, 95%CI 1.05-2.06), bronchial obstruction (HR=1.76, 95%CI 1.49-2.08), fetal hemoglobin level (HR=0.68 per 5% increase 95%CI 0.48-0.96) and reticulocyte count (HR=1.82 per 50000/mm3 increase 95%CI 1.10-3.01) were independent risk factors. An ancillary analysis performed for the 209 patients with α-thalassemia data (29 patients with CV and 180 without) found that α-thalassemia was protective in bivariate analysis but was not retained in multivariable analysis. The final Cox multivariable analysis for CV in this subgroup retained three variables. Years with upper airways obstruction and bronchial obstruction were significant risk factors for CV (with respectively HR=1.57 IC95% [1.05-2.32] and HR=1.73 IC95% [1.37-2.17]) whereas fetal hemoglobin was protective (HR=0.54 per 5% increase IC95% [0.31-0.94]). Reticulocyte count was no more retained as risk factor for CV after introducing α-thalassemia in the final multivariable model. Early evaluation and specific treatment for symptoms of asthma or nocturnal respiratory abnormalities could potentially reduce the risk of CV and stroke. They are currently under evaluation in a multicenter clinical trial with systematic nocturnal polysomnography. Disclosures No relevant conflicts of interest to declare.

scholarly journals Human red cells protein kinase in normal subjects and patients with hereditary spherocytosis, sickle cell disease, and autoimmune hemolytic anemia

Blood ◽  
1976 ◽  
Vol 48 (6) ◽  
pp. 887-898
Author(s):  
E Beutler ◽  
E Guinto ◽  
C Johnson
Keyword(s):  
Protein Kinase ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Kinase Activity ◽  
Hereditary Spherocytosis ◽  
Cell Protein ◽  
Protein Kinase Activity ◽  
Red Cell ◽  
Cell Disease ◽  
Membrane Phosphorylation

A somewhat simplified modification of a previously described method for the measurement of red cell membrane phosphorylation by ATP has been devised. Phosphorylation of membranes was linear with time for only 5- 10 min, and linearity with membrane concentration was observed only when assays were limited to short incubation times. Protein kinase activity of hereditary spherocytosis (HS) membranes was found to be normal. However, the average phosphorylation after 60 min incubation was less in HS membranes than in normal membranes. Findings similar to those in HS membranes were observed in sickle cell disease. The Km of red cell protein kinase for ATP is approximately 10(-5) M. Membrane phosphate binding sites are not saturated in either HS or normal membranes after 1 hr incubation with ATP. Approximately 27% of phosphorylating activity is lost after 1 hr incubation at 37 degrees C. GTP is a very inefficient phosphate donor. Under the conditions of measurement employed, the enzyme is slightly stimulated by 1 muM cAMP, but is not stimulated by 1 muM cGMP. Dephosphorylation of red cell membranes after labeling occurs at a similar rate in HS as in normal membranes. Although a mild abnormally in membrane phosphorylation is observed in HS, this could not be demonstrated to be due to a decrease in protein kinase activity or in alterations of its kinetic properties. The abnormally seen is not specific for HS.

scholarly journals COVID-19 Infection and Outcomes at a Comprehensive Sickle Cell Center

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3105-3105
Author(s):  
Fuad El Rassi ◽  
Abeer N. Abouyabis ◽  
Ross M. Fasano ◽  
Morgan L. McLemore
Keyword(s):  
Chronic Pain ◽  
Sickle Cell Disease ◽  
Organ Failure ◽  
Acute Care ◽  
Sickle Cell ◽  
Fetal Hemoglobin ◽  
Red Cell ◽  
Cell Disease ◽  
Clinical Database ◽  
Virtual Visits

Abstract Introduction: The Grady Comprehensive Sickle Cell (SC) center is the largest adult sickle cell center in the United States (US) and has the first 24/7 acute care unit for management of sickle cell vaso-occlusive events (VOE). In 2019, the center provided 3077 sickle cell outpatient visits and 3695 acute care visits. When the COVID-19 pandemic reached the US, the center had a precipitous drop in the number of both outpatient clinic and acute care visits as state regulations for lockdown were passed. This report follows all the COVID-19 cases at a single adult center for sickle cell disease in one year. Methods: The clinical database has been tracking COVID-19 cases reported. Out of a total of 1343 patients, 55 patients contracted COVID-19 and were tracked in the clinical database with IRB approval. Results: Of the 55 patients with COVID-19, 28 were female and 27 were male. By genotype, 64% of patients were SS, 31% were SC and 5% were Sβ+ thalassemia. 35% of patient were on hydroxyurea for disease modification with the majority of them being of the SS genotype and 31% had elevated fetal hemoglobin determined by a percentage fetal hemoglobin above 5% by hemoglobin electrophoresis. Chronic pain (defined as patients experiencing daily pain episodes for more than 4 days a week for the last 3 months) and calculation of daily morphine equivalents were reported in clinic follow-up and the narcotic database utilization. 47% of the patients had chronic pain and the median morphine equivalents was 90 mg daily (45-225mg). The rate of emergency department (ED) visits or hospitalizations for the sickle cell patients with COVID-19 was 80%. 49% of the SC patients' visits were related to VOE and 27% related to COVID-19 primarily. 20% of SC patients with COVID-19 were not seen in any emergency setting or required any hospitalization. The COVID-19 signs and symptoms experienced by the patients were as follows: 58% had pain as the main presenting symptom, followed by cough and fever (40%), dyspnea (31%), and pneumonia with chest x-ray evidence (25%). 2 patients developed acute respiratory distress syndrome (ARDS) and were intubated, and 2 patients died. 29% of the patients had lung findings on imaging and 16 of 55 patients required treatment with the use of Remdesivir in 9, dexamethasone in 8 and red cell products in 7 of the 16 patients. The 2 patients who died had both presented with COVID-19 infection in June and July 2020 respectively. One patient had presented in June 2020 with VOE and was found to have bilateral lung opacities but was asymptomatic and was discharged home to return few days later with clinical picture of multi-organ failure for which a red cell erythrocytapheresis was attempted. The second patient had presented in July 2020 with COVID-19 pneumonia and was treated with Remdesivir and convalescent plasma with development of multi-organ failure and ARDS. Discussion: Several reports were published regarding the rate of COVID-19 related mortality and morbidity in sickle cell disease. The Grady comprehensive sickle cell center experience differs in the fact that 16 out of 55 patients who had contracted COVID-19 required treatment and 2 of those 16 had died. In fact, the deaths occurred early in the course of the pandemic in June and July 2020 when 20 total cases were diagnosed (from March to Septemeber 2020). The remaining 35 cases registered zero deaths (October 2020 to March 2021) with the rate of complicated COVID-19 hospitalizations decreasing with better treatment available. In addition, the timeline for the COVID-19 cases reported fits the population timeline of 2 peaks respectively happening in the summer of 2020 and the Winter of 2021. During the initial peak, we have noted a decrease in the number of clinic and acute care visits respectively. This was anticipated given the statewide lockdown that was implemented. To circumvent that, the center adopted virtual visits to deliver healthcare needs. This measure has aided in protecting patients against COVID-19. Additionally, it is interesting that despite the second peak in the winter of 2021, there were no reported deaths among the patients who developed COVID-19. This finding can suggest that despite the concern for morbidity and mortality of sickle cell patients, their diligence and awareness to stay home during the pandemic has proven crucial in reducing morbidity and mortality and the option of virtual visits for healthcare delivery was key and should be utilized further in sickle cell care. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals DNA polymorphisms at the BCL11A, HBS1L-MYB, and  -globin loci associate with fetal hemoglobin levels and pain crises in sickle cell disease

2008 ◽  
Vol 105 (33) ◽  
pp. 11869-11874 ◽  
Author(s):  
G. Lettre ◽  
V. G. Sankaran ◽  
M. A. C. Bezerra ◽  
A. S. Araujo ◽  
M. Uda ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Fetal Hemoglobin ◽  
Dna Polymorphisms ◽  
Cell Disease

Vaso-occlusion in sickle cell disease: pathophysiology and novel targeted therapies

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 362-369 ◽  
Author(s):  
Deepa Manwani ◽  
Paul S. Frenette
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Targeted Therapies ◽  
Therapeutic Intervention ◽  
Fetal Hemoglobin ◽  
Cell Disease ◽  
The Past ◽  
Symptomatic Management

Abstract Recurrent and unpredictable episodes of vaso-occlusion are the hallmark of sickle cell disease. Symptomatic management and prevention of these events using the fetal hemoglobin–reactivating agent hydroxyurea are currently the mainstay of treatment. Discoveries over the past 2 decades have highlighted the important contributions of various cellular and soluble participants in the vaso-occlusive cascade. The role of these elements and the opportunities for therapeutic intervention are summarized in this review.

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