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Gibson JS, Rees DC. Emerging drug targets for sickle cell disease: shedding light on new knowledge and advances at the molecular level. Expert Opin Ther Targets 2023; 27:133-149. [PMID: 36803179 DOI: 10.1080/14728222.2023.2179484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
INTRODUCTION In sickle cell disease (SCD), a single amino acid substitution at β6 of the hemoglobin (Hb) chain replaces glutamate with valine, forming HbS instead of the normal adult HbA. Loss of a negative charge, and the conformational change in deoxygenated HbS molecules, enables formation of HbS polymers. These not only distort red cell morphology but also have other profound effects so that this simple etiology belies a complex pathogenesis with multiple complications. Although SCD represents a common severe inherited disorder with life-long consequences, approved treatments remain inadequate. Hydroxyurea is currently the most effective, with a handful of newer treatments, but there remains a real need for novel, efficacious therapies. AREAS COVERED This review summarizes important early events in pathogenesis to highlight key targets for novel treatments. EXPERT OPINION A thorough understanding of early events in pathogenesis closely associated with the presence of HbS is the logical starting point for identification of new targets rather than concentrating on more downstream effects. We discuss ways of reducing HbS levels, reducing the impact of HbS polymers, and of membrane events perturbing cell function, and suggest using the unique permeability of sickle cells to target drugs specifically into those more severely compromised.
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Affiliation(s)
- John S Gibson
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - David C Rees
- Department of Paediatric Haematology, King's College Hospital, London, UK
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Anti sickling potential and chemical profiling of traditionally used Woodfordia fruticosa (L.) Kurz leaves. ARAB J CHEM 2022. [DOI: 10.1016/j.arabjc.2021.103539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Nakagawa A, Lui FE, Wassaf D, Yefidoff-Freedman R, Casalena D, Palmer MA, Meadows J, Mozzarelli A, Ronda L, Abdulmalik O, Bloch KD, Safo MK, Zapol WM. Identification of a small molecule that increases hemoglobin oxygen affinity and reduces SS erythrocyte sickling. ACS Chem Biol 2014; 9:2318-25. [PMID: 25061917 PMCID: PMC4205001 DOI: 10.1021/cb500230b] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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Small
molecules that increase the oxygen affinity of human hemoglobin
may reduce sickling of red blood cells in patients with sickle cell
disease. We screened 38 700 compounds using small molecule
microarrays and identified 427 molecules that bind to hemoglobin.
We developed a high-throughput assay for evaluating the ability of
the 427 small molecules to modulate the oxygen affinity of hemoglobin.
We identified a novel allosteric effector of hemoglobin, di(5-(2,3-dihydro-1,4-benzodioxin-2-yl)-4H-1,2,4-triazol-3-yl)disulfide
(TD-1). TD-1 induced a greater increase in oxygen affinity of human
hemoglobin in solution and in red blood cells than did 5-hydroxymethyl-2-furfural
(5-HMF), N-ethylmaleimide (NEM), or diformamidine disulfide. The three-dimensional
structure of hemoglobin complexed with TD-1 revealed that monomeric
units of TD-1 bound covalently to β-Cys93 and β-Cys112,
as well as noncovalently to the central water cavity of the hemoglobin
tetramer. The binding of TD-1 to hemoglobin stabilized the relaxed
state (R3-state) of hemoglobin. TD-1 increased the oxygen affinity
of sickle hemoglobin and inhibited in vitro hypoxia-induced
sickling of red blood cells in patients with sickle cell disease without
causing hemolysis. Our study indicates that TD-1 represents a novel
lead molecule for the treatment of patients with sickle cell disease.
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Affiliation(s)
- Akito Nakagawa
- Anesthesia Center
for Critical Care Research, Department of Anesthesia, Critical Care,
and Pain Medicine, Massachusetts General Hospital and Harvard Medical
School, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Francine E. Lui
- Anesthesia Center
for Critical Care Research, Department of Anesthesia, Critical Care,
and Pain Medicine, Massachusetts General Hospital and Harvard Medical
School, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Dina Wassaf
- The Broad Institute
of MIT and Harvard, Chemical Biology Platform, 7 Cambridge Center, Cambridge, Massachusetts 02142, United States
| | - Revital Yefidoff-Freedman
- Anesthesia Center
for Critical Care Research, Department of Anesthesia, Critical Care,
and Pain Medicine, Massachusetts General Hospital and Harvard Medical
School, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Dominick Casalena
- The Broad Institute
of MIT and Harvard, Chemical Biology Platform, 7 Cambridge Center, Cambridge, Massachusetts 02142, United States
| | - Michelle A. Palmer
- The Broad Institute
of MIT and Harvard, Chemical Biology Platform, 7 Cambridge Center, Cambridge, Massachusetts 02142, United States
| | - Jacqueline Meadows
- Department
of Medicinal Chemistry, Institute for Structural Biology and Drug
Discovery, School of Pharmacy, Virginia Commonwealth University, 800 East Leigh Street, Richmond, Virginia 23219, United States
| | - Andrea Mozzarelli
- Department
of Pharmacy, University of Parma, Parco Area delle Scienze 23/A, 43124 Parma, Italy
| | - Luca Ronda
- Department
of Neuroscience, University of Parma, Parco Area delle Scienze 23/A, 43124 Parma, Italy
| | - Osheiza Abdulmalik
- Division of Hematology,
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, United States
| | - Kenneth D. Bloch
- Anesthesia Center
for Critical Care Research, Department of Anesthesia, Critical Care,
and Pain Medicine, Massachusetts General Hospital and Harvard Medical
School, 55 Fruit Street, Boston, Massachusetts 02114, United States
| | - Martin K. Safo
- Department
of Medicinal Chemistry, Institute for Structural Biology and Drug
Discovery, School of Pharmacy, Virginia Commonwealth University, 800 East Leigh Street, Richmond, Virginia 23219, United States
| | - Warren M. Zapol
- Anesthesia Center
for Critical Care Research, Department of Anesthesia, Critical Care,
and Pain Medicine, Massachusetts General Hospital and Harvard Medical
School, 55 Fruit Street, Boston, Massachusetts 02114, United States
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Hannemann A, Cytlak UMC, Gbotosho OT, Rees DC, Tewari S, Gibson JS. Effects of o-vanillin on K⁺ transport of red blood cells from patients with sickle cell disease. Blood Cells Mol Dis 2014; 53:21-6. [PMID: 24594314 PMCID: PMC4039999 DOI: 10.1016/j.bcmd.2014.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/24/2014] [Indexed: 01/26/2023]
Abstract
Aromatic aldehydes like o-vanillin were designed to reduce the complications of sickle cell disease (SCD) by interaction with HbS, to reduce polymerisation and RBC sickling. Present results show that o-vanillin also directly affects RBC membrane permeability. Both the K(+)-Cl(-) cotransporter (KCC) and the Ca(2+)-activated K(+) channel (or Gardos channel) were inhibited with IC50 of about 0.3 and 1 mM, respectively, with activities almost completely abolished by 5 mM. Similar effects were observed in RBCs treated with the thiol reacting reagent N-ethylmaleimide or with the Ca(2+) ionophore A23187, to circumvent any action via HbS polymerisation. The deoxygenation-induced cation conductance (sometimes termed P(sickle)) was partially inhibited, whilst deoxygenation-induced exposure of phosphatidylserine was completely abrogated. Na(+)/K(+) pump activity was also reduced. Notwithstanding, o-vanillin stimulated K(+) efflux through an unidentified pathway and resulted in reduction in cell volume (as measured by wet weight-dry weight). These actions are relevant to understanding how aromatic aldehydes may affect RBC membrane permeability per se as well as HbS polymerisation and thereby inform design of compounds most efficacious in ameliorating the complications of SCD.
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Affiliation(s)
- A Hannemann
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, United Kingdom
| | - U M C Cytlak
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, United Kingdom
| | - O T Gbotosho
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, United Kingdom
| | - D C Rees
- Department of Paediatric Haematology, King's College London School of Medicine, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, United Kingdom
| | - S Tewari
- Department of Paediatric Haematology, King's College London School of Medicine, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, United Kingdom
| | - J S Gibson
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, United Kingdom.
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Pauline N, Cabral BNP, Anatole PC, Jocelyne AMV, Bruno M, Jeanne NY. The in vitro antisickling and antioxidant effects of aqueous extracts Zanthoxyllum heitzii on sickle cell disorder. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:162. [PMID: 23829696 PMCID: PMC3708797 DOI: 10.1186/1472-6882-13-162] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 07/03/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Several plant extracts from Rutaceae family are currently used to the management of sickle cell disorder (SCD) in the African. Few reports have shown that extracts from Zanthoxyllum or Fagara genus demonstrated anti-sickling property. This study investigates the in vitro antisickling and antioxidant properties of extracts from Zanthoxyllum heitzii. METHODS The sickling of red blood cells (RBCs) was induced using sodium metabisulfite (2%) followed by treatment with extracts at different concentrations. The osmotic fragility tests permits to explore the effect of Z. heitzii extracts on haemoglobin S solubility and sickle cells membrane stability. For each extract, qualitative phytochemical tests were used to identify the presence of alkaloids, tannins, saponins, flavonoids, glycosides and phenols, while some quantitative methods such as Folin, Ferric Reducing Antioxidant Power (FRAP) and diphenyl 1, 2 picryl hydrazyl (DPPH) were used to determine the antioxidant potential of these extracts. RESULTS Sodium metabisulphite increased the sickling of RBCs from 29.62 to 55.46% during 2 h. Treatment of sickling cells with extracts at different concentrations showed that a decrease of the percentage of sickling cells was found in both induced and non induced sickling cells. The fruits extract of Z. heitzii demonstrated the best anti-sickling property. The same extract at 250 μg/mL showed the best membrane cell stability compared to others. All the extracts revealed an antioxidant and anti-radical activities although lesser compared to the standard. CONCLUSION The fruit extract of Z. Heitzii demonstrated the most significant antisickling effect with a potential for use in the clinical management of SCD.
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Affiliation(s)
- Nanfack Pauline
- Department of Biochemistry and Physiological Sciences, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaounde, Cameroon
| | - Biapa Nya Prosper Cabral
- Department of Biochemistry, Faculty of Sciences, University of Dschang, Cameroon, PO Box 67, Dschang, Cameroon
| | - Pieme Constant Anatole
- Department of Biochemistry and Physiological Sciences, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaounde, Cameroon
| | - Ama Moor Vicky Jocelyne
- Department of Biochemistry and Physiological Sciences, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaounde, Cameroon
- University Center teaching hospital, Yaoundé, Cameroon
| | - Moukette Bruno
- Department of Biochemistry and Physiological Sciences, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaounde, Cameroon
| | - Ngogang Yonkeu Jeanne
- Department of Biochemistry and Physiological Sciences, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaounde, Cameroon
- University Center teaching hospital, Yaoundé, Cameroon
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Chikezie PC. Sodium metabisulfite-induced polymerization of sickle cell hemoglobin incubated in the extracts of three medicinal plants (Anacardium occidentale, Psidium guajava, and Terminalia catappa). Pharmacogn Mag 2011; 7:126-32. [PMID: 21716622 PMCID: PMC3113351 DOI: 10.4103/0973-1296.80670] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 10/30/2010] [Accepted: 05/09/2011] [Indexed: 12/02/2022] Open
Abstract
Background: The exploitation and utilization of vast varieties of herbal extracts may serve as alternative measures to deter aggregation of deoxygenated sickle cell hemoglobin (deoxyHbS) molecules. Objective: The present in vitro study ascertained the capacity of three medicinal plants, namely, Anacardium occidentale, Psidium guajava, and Terminalia catappa, to alter polymerization of HbS. Materials and Methods: Spectrophotometric method was used to monitor the level of polymerization of hemolysate HbS molecules treated with sodium metabisulfite (Na2 S2 O5) at a regular interval of 30 s for a period of 180 s in the presence of separate aqueous extracts of A. occidentale, P. guajava, and T. catappa. At time intervals of 30 s, the level of polymerization was expressed as percentage of absorbance relative to the control sample at the 180th s. Results: Although extracts of the three medicinal plants caused significant (P < 0.05) reduction in polymerization of deoxyHbS molecules, the corresponding capacity in this regard diminished with increase in incubation time. Aqueous extract of P. guajava exhibited the highest capacity to reduced polymerization of deoxyHbS molecules. Whereas at t > 60 s, extract concentration of 400 mg% of A. occidentale activated polymerization of deoxyHbS molecules by 6.23±1.34, 14.53±1.67, 21.15±1.89, and 24.42±1.09%, 800 mg% of T. catappa at t > 30 s gave values of 2.50±1.93, 5.09±1.96, 10.00±0.99, 15.38±1.33, and 17.31±0.97%. Conclusion: The capacity of the three medicinal plants to interfere with polymerization of deoxyHbS molecules depended on the duration of incubation and concentration of the extracts.
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Abdulmalik O, Obeng D, Asakura T. Sickle cell disease: current therapeutic approaches. Expert Opin Ther Pat 2005. [DOI: 10.1517/13543776.15.11.1497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abdulmalik O, Safo MK, Chen Q, Yang J, Brugnara C, Ohene-Frempong K, Abraham DJ, Asakura T. 5-hydroxymethyl-2-furfural modifies intracellular sickle haemoglobin and inhibits sickling of red blood cells. Br J Haematol 2005; 128:552-61. [PMID: 15686467 DOI: 10.1111/j.1365-2141.2004.05332.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In an attempt to find new types of anti-sickling agents that specifically bind to intracellular sickle haemoglobin (HbS) without inhibition by plasma and tissue proteins or other undesirable consequences, we identified 5-hydroxymethyl-2-furfural (5HMF), a naturally occurring aromatic aldehyde, as an agent that fulfils this criterion. Preliminary studies in vitro showed that 5HMF forms a high-affinity Schiff-base adduct with HbS and inhibits red cell sickling by allosterically shifting oxygen equilibrium curves towards the left. Further studies with transgenic (Tg) sickle mice showed that orally administered 5HMF was rapidly absorbed into the bloodstream from the gastrointestinal tract without being destroyed, traversed the red blood cell membrane and specifically bound with, and modified, HbS molecules at levels as high as 90%. Pretreatment of Tg sickle mice with 5HMF inhibited the formation of sickle cells and significantly prolonged survival time under severe hypoxia, compared with untreated mice, which died within 15 min because of sickling-dependent pulmonary sequestration. These results indicate the feasibility of 5HMF as an attractive potential candidate for therapy of sickle cell disease.
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Affiliation(s)
- Osheiza Abdulmalik
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Brugnara C, De Franceschi L, Armsby CC, Saadane N, Trudel M, Beuzard Y, Rittenhouse A, Rifai N, Platt O, Alper SL. A new therapeutic approach for sickle cell disease. Blockade of the red cell Ca(2+)-activated K+ channel by clotrimazole. Ann N Y Acad Sci 1995; 763:262-71. [PMID: 7677336 DOI: 10.1111/j.1749-6632.1995.tb32411.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- C Brugnara
- Department of Pathology, Children's Hospital, Boston, MA 02115, USA
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