Abstract
BackgroundHigh levels of fetal haemoglobin (HbF) decrease sickle cell anaemia (SCA) severity and leads to improved survival. According to in vivo and in vitro studies, butyrate increases HbF production. Its utilization in clinical practice is hampered, however, by its short half-life. Serum butyrate concentrations could be enhanced by colonic bacterial fermentation of Gum Arabic (GA), edible, dried, gummy exudates from Acacia Senegal tree. We hypothesized that regular intake of GA increases serum butyrate levels, thus inducing HbF production and ameliorating symptoms of sickle cell anemia.MethodsFourty seven patients (5–42 years) carrying hemoglobin SS were recruited from April 2014 to January 2015. Patients received 30 g/day GA for 12 weeks. HbF, blood count and erythropoietin level were measured. The main outcome of interest was the level of HbF after 12 weeks. The secondary outcomes were improvement in clinical and laboratory results. The study was ethically approved by Alneelain University IRB.ResultsThe study revealed significant increase in HbF level P.V0.000 [95 % CI, 0.43–1.02], MCV P.V:000 [95 % CI, 2.312–6.058] and Hematocrit level P.V:0.026 [95 % CI, 0.124–1.902]. No significant difference was encountered in platelets count P.V: 0.346 [95 % CI,−25.76–71.94], and WBCs count P.V:0.194 [95 % CI,−8.035–1.68]. Thirty seven percent of patients experienced minor side effects which resolved within a week.ConclusionThese findings reveal a novel effect of GA, which may be used to foster fetal hemoglobin production.Trial registrationClinicalTrials.gov Identifier: NCT02467257. Registered 3rd June 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12878-015-0040-6) contains supplementary material, which is available to authorized users.
Highlights
High levels of fetal haemoglobin (HbF) decrease sickle cell anaemia (SCA) severity and leads to improved survival
To the best of our knowledge this is the first study conducted to investigate the effect of oral administration of GA on fetal hemoglobin production in sickle cell anemia patients. This is an experimental study with the aim to produce primary data for hematological efficacy of oral intake of Gum Arabic as fetal hemoglobin inducer in sickle cell anemia patients
This study revealed a novel effect of GA, as oral HbF inducing agent alone or in combination with HU
Summary
High levels of fetal haemoglobin (HbF) decrease sickle cell anaemia (SCA) severity and leads to improved survival. According to in vivo and in vitro studies, butyrate increases HbF production. We hypothesized that regular intake of GA increases serum butyrate levels, inducing HbF production and ameliorating symptoms of sickle cell anemia. Homozygous sickle cell Anemia (SCA) is an autosomal recessive genetic disease that results from the substitution of valine for glutamic acid at position 6 of the β-globin chain, leading to production of hemoglobin S (HbS) [1]. HbS polymerizes in red blood cells upon deoxygenation. This causes the RBCs to change from biconcave disc shape to an irregular sickled shaped. Sickled cells are extremely susceptible to hemolysis and eryptosis [2], causing chronic anemia [3]. Sickle cell disease (SCD) is the most common genetic disorder among people of African descent [4]
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