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Silva M, Faustino P. From Stress to Sick(le) and Back Again-Oxidative/Antioxidant Mechanisms, Genetic Modulation, and Cerebrovascular Disease in Children with Sickle Cell Anemia. Antioxidants (Basel) 2023; 12:1977. [PMID: 38001830 PMCID: PMC10669666 DOI: 10.3390/antiox12111977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Sickle cell anemia (SCA) is a genetic disease caused by the homozygosity of the HBB:c.20A>T mutation, which results in the production of hemoglobin S (HbS). In hypoxic conditions, HbS suffers autoxidation and polymerizes inside red blood cells, altering their morphology into a sickle shape, with increased rigidity and fragility. This triggers complex pathophysiological mechanisms, including inflammation, cell adhesion, oxidative stress, and vaso-occlusion, along with metabolic alterations and endocrine complications. SCA is phenotypically heterogeneous due to the modulation of both environmental and genetic factors. Pediatric cerebrovascular disease (CVD), namely ischemic stroke and silent cerebral infarctions, is one of the most impactful manifestations. In this review, we highlight the role of oxidative stress in the pathophysiology of pediatric CVD. Since oxidative stress is an interdependent mechanism in vasculopathy, occurring alongside (or as result of) endothelial dysfunction, cell adhesion, inflammation, chronic hemolysis, ischemia-reperfusion injury, and vaso-occlusion, a brief overview of the main mechanisms involved is included. Moreover, the genetic modulation of CVD in SCA is discussed. The knowledge of the intricate network of altered mechanisms in SCA, and how it is affected by different genetic factors, is fundamental for the identification of potential therapeutic targets, drug development, and patient-specific treatment alternatives.
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Affiliation(s)
- Marisa Silva
- Departamento de Genética Humana, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Av. Padre Cruz, 1649-016 Lisboa, Portugal;
| | - Paula Faustino
- Departamento de Genética Humana, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Av. Padre Cruz, 1649-016 Lisboa, Portugal;
- Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
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Association between periodontal inflamed surface area and serum acute phase biomarkers in patients with sickle cell anemia. Arch Oral Biol 2022; 143:105543. [PMID: 36155345 DOI: 10.1016/j.archoralbio.2022.105543] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of the present cross-sectional study was to investigate the association between periodontal inflamed surface area (PISA) and serum inflammatory biomarkers in patients with sickle cell anemia. DESIGN Patients with sickle cell anemia (n = 80) and systemically healthy individuals (n = 80) were enrolled in the study. Crisis episodes were recorded and blood samples were collected from patients with sickle cell anemia. Clinical periodontal parameters and PISA values were calculated from all patients. Ferritin and high sensitivity C-reactive protein (hs-CRP) levels were analyzed biochemically. RESULTS In sickle cell anemia group, presence of periodontitis (p < 0.001) was more frequent than periodontal health (p < 0.001). All clinical periodontal recordings and PISA values were higher in the sickle cell anemia group compared to controls (p < 0.001). Patients with PISA > 776 mm² had 6.06-fold greater chances of having hs-CRP levels above 10 mg/L (OR = 6.06; 95 % CI: 1.9-19.26) and had 31.41-fold greater chances of having ferritin levels above 1000 ng/L (OR = 31.41; 95 % CI: 6.62-149.16). Also, they had 3.27-fold greater risk of having crisis frequency above three times per year (OR = 3.27; 95 % CI: 1.05-10.23) after adjusting for confounders. CONCLUSION In patients with sickle cell anemia, positive association was evident between PISA values and serum acute phase biomarkers levels as well as the frequency of acute painful crisis. Patients with increased inflammatory burden may have a higher likelihood of developing periodontitis in the presence of sickle cell anemia. PISA value could be a candidate disease activity indicator in patients with an underlying hematological condition.
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Hounkpe BW, Chenou F, Domingos IDF, Cardoso EC, Costa Sobreira MJDV, Araujo AS, Lucena‐Araújo AR, da Silva Neto PV, Malheiro A, Fraiji NA, Costa FF, Bezerra MAC, Santos MNN, De Paula EV. Neutrophil extracellular trap regulators in sickle cell disease: Modulation of gene expression of PADI4, neutrophil elastase, and myeloperoxidase during vaso-occlusive crisis. Res Pract Thromb Haemost 2021; 5:204-210. [PMID: 33537545 PMCID: PMC7845058 DOI: 10.1002/rth2.12463] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent evidence suggests that generation of neutrophil extracellular traps (NETosis), one of the components of immunothrombosis, is associated with the pathogenesis of both venous thromboembolism and sickle cell disease (SCD). NETosis is a complex process regulated by several proteins such as peptidyl arginine deaminase 4 (PADI4), neutrophil elastase (ELANE), and myeloperoxidase (MPO). Among these regulators, PADI4 is responsible of histone citrullination, an essential step for NETosis. Accordingly, its inhibition has been recently cited as a promising therapeutic strategy for diseases such as SCD. Although attractive, this strategy requires supportive evidence of its role in the pathogenesis of SCD. PATIENTS AND METHODS Patients from two independent cohorts were enrolled in this study. Samples were obtained at steady state (53 patients) or during acute episodes of vaso-occlusive crisis (VOC; 28 patients) in patients from cohort 1. mRNA was extracted from granulocytes to analyze PADI4, ELANE, and MPO expression by qPCR. Furthermore, plasma activity of PADI4 was assessed from an independent cohort in 15 patients, within 24 hours from admission for VOC. Race-matched healthy individuals from the same geographic regions were used as controls for each cohort. RESULTS AND CONCLUSIONS Higher levels of gene expression of PADI4 and ELANE were observed during VOC. Furthermore, plasma activity of PADI4 was higher in acute VOC when compared to healthy individuals. These results demonstrate that NETosis regulators are modulated during acute VOC, and pave the way for studies of PADI4 inhibition as a therapeutic strategy for acute VOC in SCD.
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Affiliation(s)
| | - Francine Chenou
- School of Medical SciencesUniversity of CampinasCampinasBrazil
| | | | | | | | - Aderson S. Araujo
- Hematology and Hemotherapy Foundation of Pernambuco ‐ HEMOPERecifeBrazil
| | | | | | - Adriana Malheiro
- Hematology and Hemotherapy Foundation from Amazonas State (HEMOAM)ManausBrazil
| | | | - Fernando Ferreira Costa
- School of Medical SciencesUniversity of CampinasCampinasBrazil
- Hematology and Hemotherapy CenterUniversity of CampinasCampinasBrazil
| | | | | | - Erich Vinicius De Paula
- School of Medical SciencesUniversity of CampinasCampinasBrazil
- Hematology and Hemotherapy CenterUniversity of CampinasCampinasBrazil
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Gueye Tall F, Martin C, Ndour EHM, Faes C, Déme Ly I, Pialoux V, Connes P, Gueye PM, Ndiaye Diallo R, Renoux C, Diagne I, Diop PA, Cissé A, Sall PL, Joly P. Influence of Oxidative Stress Biomarkers and Genetic Polymorphisms on the Clinical Severity of Hydroxyurea-Free Senegalese Children with Sickle Cell Anemia. Antioxidants (Basel) 2020; 9:antiox9090863. [PMID: 32937882 PMCID: PMC7555380 DOI: 10.3390/antiox9090863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022] Open
Abstract
Oxidative stress would play a role in the pathophysiology of sickle cell anemia (SCA). We tested the impact of common SCA genetic modifiers (alpha-thalassemia, G6PD deficiency, HbF quantitative trait loci; QTL) and pro/antioxidant genes polymorphisms (SOD2 rs4880, XO rs207454, MPO rs233322) on oxidative stress biomarkers (AOPP, MDA, MPO, XO, MnSOD, CAT, GPx) and clinical severity in 301 Senegalese SCA hydroxyurea-free children at steady-state (median age 9.1 years, sex ratio H/F = 1.3). Plasma oxidative stress biomarkers were compared with those of a control group (AA). CAT activity, AOPP, and MDA levels were higher in SCA than in AA individuals while XO, GPX, and MnSOD activities were lower. The presence of alpha-thalassemia decreased MDA level and MPO activity but no effect of the HbF QTL or G6PD deficiency was observed. SCA children who experienced their first hospitalized complication before 3 years old had higher MnSOD and CAT activities than the other children while those with no hospitalized VOC in the previous 2 years presented higher GPX activity. Age of the first hospitalized complication and AOPP levels were affected by the MPO rs2333227 SNP. Our results suggest that alpha-thalassemia modulates oxidative stress in SCA, presumably because of a reduction in the MPO activity.
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Affiliation(s)
- Fatou Gueye Tall
- Laboratoire de Biochimie Pharmaceutique-FMPO, Universite Cheikh Anta Diop, Dakar BP 5005, Senegal; (F.G.T.); (E.h.M.N.); (P.M.G.); (R.N.D.); (P.A.D.); (A.C.); (P.L.S.)
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe Biologie Vasculaire et du Globule Rouge, Universite Claude Bernard Lyon 1, COMUE Lyon, 69100 Villeurbanne, France; (C.F.); (V.P.); (P.C.); (C.R.)
- Centre Hospitalier National d’Enfants Albert Royer-Dakar, Dakar BP 5005, Senegal; (C.M.); (I.D.L.)
| | - Cyril Martin
- Centre Hospitalier National d’Enfants Albert Royer-Dakar, Dakar BP 5005, Senegal; (C.M.); (I.D.L.)
- Laboratoire d’Excellence sur le Globule Rouge (Labex GR-Ex), 75000 Paris, France
| | - El hadji Malick Ndour
- Laboratoire de Biochimie Pharmaceutique-FMPO, Universite Cheikh Anta Diop, Dakar BP 5005, Senegal; (F.G.T.); (E.h.M.N.); (P.M.G.); (R.N.D.); (P.A.D.); (A.C.); (P.L.S.)
- Centre Hospitalier National d’Enfants Albert Royer-Dakar, Dakar BP 5005, Senegal; (C.M.); (I.D.L.)
| | - Camille Faes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe Biologie Vasculaire et du Globule Rouge, Universite Claude Bernard Lyon 1, COMUE Lyon, 69100 Villeurbanne, France; (C.F.); (V.P.); (P.C.); (C.R.)
| | - Indou Déme Ly
- Centre Hospitalier National d’Enfants Albert Royer-Dakar, Dakar BP 5005, Senegal; (C.M.); (I.D.L.)
- Service Universitaire de Pédiatrie-FMPO, Universite Cheikh Anta Diop, Dakar BP 5005, Senegal;
| | - Vincent Pialoux
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe Biologie Vasculaire et du Globule Rouge, Universite Claude Bernard Lyon 1, COMUE Lyon, 69100 Villeurbanne, France; (C.F.); (V.P.); (P.C.); (C.R.)
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe Biologie Vasculaire et du Globule Rouge, Universite Claude Bernard Lyon 1, COMUE Lyon, 69100 Villeurbanne, France; (C.F.); (V.P.); (P.C.); (C.R.)
- Laboratoire d’Excellence sur le Globule Rouge (Labex GR-Ex), 75000 Paris, France
| | - Papa Madieye Gueye
- Laboratoire de Biochimie Pharmaceutique-FMPO, Universite Cheikh Anta Diop, Dakar BP 5005, Senegal; (F.G.T.); (E.h.M.N.); (P.M.G.); (R.N.D.); (P.A.D.); (A.C.); (P.L.S.)
| | - Rokhaya Ndiaye Diallo
- Laboratoire de Biochimie Pharmaceutique-FMPO, Universite Cheikh Anta Diop, Dakar BP 5005, Senegal; (F.G.T.); (E.h.M.N.); (P.M.G.); (R.N.D.); (P.A.D.); (A.C.); (P.L.S.)
| | - Céline Renoux
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe Biologie Vasculaire et du Globule Rouge, Universite Claude Bernard Lyon 1, COMUE Lyon, 69100 Villeurbanne, France; (C.F.); (V.P.); (P.C.); (C.R.)
- UF Biochimie des Pathologies Erythrocytaires, Laboratoire de Biochimie et Biologie Moleculaire Grand-Est, Groupement Hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France
| | - Ibrahima Diagne
- Service Universitaire de Pédiatrie-FMPO, Universite Cheikh Anta Diop, Dakar BP 5005, Senegal;
- UFR des Sciences de la Santé–Universite Gaston Berger, Saint-Louis 32002, Senegal
| | - Pape Amadou Diop
- Laboratoire de Biochimie Pharmaceutique-FMPO, Universite Cheikh Anta Diop, Dakar BP 5005, Senegal; (F.G.T.); (E.h.M.N.); (P.M.G.); (R.N.D.); (P.A.D.); (A.C.); (P.L.S.)
| | - Aynina Cissé
- Laboratoire de Biochimie Pharmaceutique-FMPO, Universite Cheikh Anta Diop, Dakar BP 5005, Senegal; (F.G.T.); (E.h.M.N.); (P.M.G.); (R.N.D.); (P.A.D.); (A.C.); (P.L.S.)
| | - Philomène Lopez Sall
- Laboratoire de Biochimie Pharmaceutique-FMPO, Universite Cheikh Anta Diop, Dakar BP 5005, Senegal; (F.G.T.); (E.h.M.N.); (P.M.G.); (R.N.D.); (P.A.D.); (A.C.); (P.L.S.)
- Centre Hospitalier National d’Enfants Albert Royer-Dakar, Dakar BP 5005, Senegal; (C.M.); (I.D.L.)
| | - Philippe Joly
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe Biologie Vasculaire et du Globule Rouge, Universite Claude Bernard Lyon 1, COMUE Lyon, 69100 Villeurbanne, France; (C.F.); (V.P.); (P.C.); (C.R.)
- Laboratoire d’Excellence sur le Globule Rouge (Labex GR-Ex), 75000 Paris, France
- UF Biochimie des Pathologies Erythrocytaires, Laboratoire de Biochimie et Biologie Moleculaire Grand-Est, Groupement Hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France
- Correspondence:
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Chaves NA, Alegria TGP, Dantas LS, Netto LES, Miyamoto S, Bonini Domingos CR, da Silva DGH. Impaired antioxidant capacity causes a disruption of metabolic homeostasis in sickle erythrocytes. Free Radic Biol Med 2019; 141:34-46. [PMID: 31163255 DOI: 10.1016/j.freeradbiomed.2019.05.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/23/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023]
Abstract
This study examined particularly relevant redox pathways such as glycolysis, pentose phosphate pathway (PPP), metHb reductase and nucleotide metabolism, in order to better address how sickle cells deal with redox metabolism disruption. We also investigated the generation of specific oxidative lesions, and the levels of an unexplored antioxidant that could act as a candidate biomarker for oxidative status in sickle cell anemia (SCA). We adopted rigorous exclusion criteria to obtain the studied groups, which were composed by 10 subjects without hemoglobinopathies and 10 SCA patients. We confirmed that sickle cells overwhelm the antioxidant defense system, leading to an impaired antioxidant capacity that significantly contributed to the increase in cholesterol oxidation (ChAld) and hemolysis. Among the antioxidants evaluated, ergothioneine levels decreased in SCA (two-fold). We found strong correlations of ergothioneine levels with other erythrocyte metabolism markers, suggesting its use as an antioxidant therapy alternative for SCA treatment. Moreover, we found higher activities of MetHb reductase, AChE, G6PDH, HXK, and LDH, as well as levels of NADPH, ATP and hypoxanthine in sickle cells. On this basis, we conclude that impaired antioxidant capacity leaves to a loss of glycolysis and PPP shifting mechanism control and further homeostasis rupture, contributing to a decreased lifespan of sickle cells.
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Affiliation(s)
| | - Thiago Geronimo Pires Alegria
- USP - University of Sao Paulo, Institute of Biosciences, Department of Genetics and Evolutionary Biology, Sao Paulo, Brazil
| | - Lucas Souza Dantas
- USP - University of Sao Paulo, Institute of Chemistry, Department of Biochemistry, Sao Paulo, Brazil
| | - Luis Eduardo Soares Netto
- USP - University of Sao Paulo, Institute of Biosciences, Department of Genetics and Evolutionary Biology, Sao Paulo, Brazil
| | - Sayuri Miyamoto
- USP - University of Sao Paulo, Institute of Chemistry, Department of Biochemistry, Sao Paulo, Brazil
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Nolfi-Donegan D, Pradhan-Sundd T, Pritchard KA, Hillery CA. Redox Signaling in Sickle Cell Disease. CURRENT OPINION IN PHYSIOLOGY 2019; 9:26-33. [PMID: 31240269 DOI: 10.1016/j.cophys.2019.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sickle cell disease (SCD) is characterized by chronic hemolysis and repeated episodes of vascular occlusion leading to progressive organ injury. SCD is characterized by unbalanced, simultaneous pro-oxidant and anti-oxidant processes at the molecular, cellular and tissue levels, with the majority of reactions tipped in favor of pro-oxidant pathways. In this brief review we discuss new findings regarding how oxidized hemin, hemolysis, mitochondrial dysfunction and the innate immune system generate oxidative stress while hemopexin, haptoglobin, heme oxygenase-1 (HO-1) and nuclear factor erythroid 2-related factor 2 (Nrf2) may provide protection in human and murine SCD. We will also describe recent clinical trials showing beneficial effects of antioxidant therapy in SCD.
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Affiliation(s)
- Deirdre Nolfi-Donegan
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tirthadipa Pradhan-Sundd
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kirkwood A Pritchard
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Cheryl A Hillery
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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