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Khurana K, Mahajan S, Acharya S, Kumar S, Toshniwal S. Clinical Biomarkers of Acute Vaso-Occlusive Sickle Cell Crisis. Cureus 2024; 16:e56389. [PMID: 38633967 PMCID: PMC11022002 DOI: 10.7759/cureus.56389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
It is known that an inherited blood condition called sickle cell disease (SCD) is a result of one gene. A number of blood and urine biomarkers have been determined in association with lab and clinical history for SCD patients. SCD has numerous interacting pathways associated with it, which have been identified by biomarkers. These mechanisms consist of some examples, such as endothelial vasodilation response, hypercoagulability, hemolysis, inflammation, oxidative stress, vascular dysfunction, and reperfusion injury among others. To effectively manage SCD, a comprehensive panel of validated blood and urine biomarkers must be established. Despite its monogenic inheritance, the complex nature of the SCD phenotype has impeded progress in its treatment. However, significant strides have been made in clinical biotechnology, paving the way for potential breakthroughs. In SCD, a panel of verified blood and urine biomarkers must be established, however. Despite monogenic inheritance, the great complexity of the SCD phenotype has hindered progress in its management. With few exceptions, clinical biomarkers of illness severity have been found through epidemiological investigations; nevertheless, systematic integration of these biomarkers into clinical treatment algorithms has not occurred. Furthermore, sickle cell crisis, the primary acute consequence of SCD, has been difficult to diagnose with the biomarkers now in use. Inadequate care and a lack of appropriate outcome measures for clinical research are the consequences of these diagnostic constraints. A new chapter in SCD customized treatment has begun with recent advancements in molecular and imaging diagnostics. Strategies in precision medicine are especially relevant now that molecular therapies are within reach. The significance of biochemical indicators linked to clinical manifestation and sub-phenotype identification in SCD is reviewed in this research.
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Affiliation(s)
- Kashish Khurana
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Satish Mahajan
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Saket Toshniwal
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Double-blind, randomized, multicenter phase 2 study of SC411 in children with sickle cell disease (SCOT trial). Blood Adv 2019; 2:1969-1979. [PMID: 30097463 DOI: 10.1182/bloodadvances.2018021444] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/12/2018] [Indexed: 01/21/2023] Open
Abstract
Blood cell membranes in sickle cell disease (SCD) have low docosahexaenoic acid (DHA). DHA treatment reduces sickle cell crisis (SCC) rate and ameliorates the inflammation, oxidative stress, and hypercoagulable state of SCD. SC411 is a novel DHA ethyl ester formulation with a proprietary delivery platform (Advanced Lipid Technology) that enhances DHA bioavailability. The SCOT trial investigated the effect of 3 different doses of SC411 on clinical and biochemical endpoints in 67 children with SCD (5-17 years old). Seventy-six percent of subjects were also receiving hydroxyurea. After 4 weeks of treatment with SC411 at 20, 36, and 60 mg DHA/kg per day or placebo a statistically significant (P < .001) mean percentage increase of blood cell membrane DHA and eicosapentaenoic acid was seen vs baseline: 109.0% (confidence interval [CI], 46.7-171.3), 163.8% (CI, 108.3-219.2), 170.8% (CI, 90.2-251.4), and 28.6% (CI, 250.1 to 107.3), respectively. After 8 weeks of treatment, statistically significant changes vs placebo were also observed in D-dimer (P = .025) and soluble E-selectin (P = .0219) in subjects exposed to 36 mg/kg. A significant increase in hemoglobin was observed against placebo in subjects receiving 20 mg DHA/kg per day (P = .039). SC411 significantly reduced electronic diary recorded SCC, analgesic use at home, and days absent from school because of sickle cell pain. The lower rate of clinical SCC observed in the pooled active groups vs placebo did not reach statistical significance (rate ratio, 0.47; 95% CI, 0.20-1.11; P = .07). All tested doses were safe and well tolerated. This trial was registered at www.clinicaltrials.gov as #NCT02973360.
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Hazin-Costa MF, da Silva Aráujo A, Guerra GL, da Matta MC, Torres LC, Souza AI. Chemokines in pregnant women with sickle cell disease. Cytokine 2018; 113:195-199. [PMID: 30006250 DOI: 10.1016/j.cyto.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 12/31/2022]
Abstract
Pregnancy in sickle cell disease is a problem due to the adverse outcomes related to the disease. Research into the role of chemokines in sickle cell disease is available, but studies investigating the disease in pregnancy are scarce. Our data show the chemokine profiles of pregnant women with sickle cell disease compared with control groups. There were no differences in MCP-1 level among the groups, but IL-8 and MIG were likely related with disease activity. In addition, levels of IP-10 were higher in pregnant women with sickle cell disease and, interestingly, RANTES levels were higher in normal pregnancy when compared to pregnancy in sickle cell disease. More studies should be encouraged to fully elucidate chemokine activity during pregnancy in sickle cell disease.
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Affiliation(s)
- Manuela Freire Hazin-Costa
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos, 300, Boa Vista, 50.070-550 Recife, Pernambuco, Brazil; Fundação de Hematologia e Hemoterapia de Pernambuco HEMOPE, Rua Joaquim Nabuco, 171, Graças, 52.011-000 Recife, Pernambuco, Brazil; Universidade Federal de Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50.670-90 Recife, Pernambuco, Brazil.
| | - Aderson da Silva Aráujo
- Fundação de Hematologia e Hemoterapia de Pernambuco HEMOPE, Rua Joaquim Nabuco, 171, Graças, 52.011-000 Recife, Pernambuco, Brazil
| | - Glaucia Lins Guerra
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos, 300, Boa Vista, 50.070-550 Recife, Pernambuco, Brazil
| | - Marina Cadena da Matta
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos, 300, Boa Vista, 50.070-550 Recife, Pernambuco, Brazil
| | - Leuridan Cavalcante Torres
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos, 300, Boa Vista, 50.070-550 Recife, Pernambuco, Brazil
| | - Ariani Impieri Souza
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos, 300, Boa Vista, 50.070-550 Recife, Pernambuco, Brazil; Faculdade Pernambucana de Saúde (FPS), Av. Mal. Mascarenhas de Morais, 4861, Imbiribeira, 51.180-001 Recife, Pernambuco, Brazil
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Riley TR, Boss A, McClain D, Riley TT. Review of Medication Therapy for the Prevention of Sickle Cell Crisis. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2018; 43:417-437. [PMID: 30013299 PMCID: PMC6027858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article reviews the clinical data concerning the uses of hydroxyurea, L-glutamine, and crizanlizumab in treating pain crises associated with sickle cell disease.
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Beyond hydroxyurea: new and old drugs in the pipeline for sickle cell disease. Blood 2016; 127:810-9. [PMID: 26758919 DOI: 10.1182/blood-2015-09-618553] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/21/2015] [Indexed: 01/09/2023] Open
Abstract
Despite Food and Drug Administration (FDA) approval of hydroxyurea to reduce the frequency of vaso-occlusive episodes, sickle cell disease (SCD) has continued to be treated primarily with analgesics for pain relief. However, elucidation of the multiple pathophysiologic mechanisms leading to vaso-occlusion and tissue injury in SCD has now resulted in a burgeoning effort to identify new treatment modalities to prevent or ameliorate the consequences of the disease. Development of new drugs as well as investigation of drugs previously used in other settings have targeted cell adhesion, inflammatory pathways, upregulation of hemoglobin F, hemoglobin polymerization and sickling, coagulation, and platelet activation. Although these efforts have not yet yielded drugs ready for FDA approval, several early studies have been extremely encouraging. Moreover, the marked increase in clinical pharmaceutical research addressing SCD and the new and old drugs in the pipeline make it reasonable to expect that we will soon have new treatments for SCD.
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