Abstract

This study investigated associations between SNPs in genes encoding metabolizing drug enzymes and laboratory parameters in sickle cell anemia patients under hydroxyurea (SCA-HU+). We evaluated hematologic and biochemical parameters by electronic methods and SNPs by PCR-RFLP and multiplex PCR in 35 SCA-HU+ patients and 67 SCA-HU− patients. The HbS, total cholesterol, lactate dehydrogenase, aspartate aminotransferase, total bilirubin and fractions levels, and leukocyte, eosinophil, monocyte, and erythroblast counts were reduced in SCA-HU+ patients (p < 0.05). Moreover, they presented higher HbF, C-reactive protein, and ferritin levels and elevated MCH and MCV values (p < 0.05). Genotype frequencies of variants GA + AA of MPO −463G>A and c1c2 + c2c2 of CYP2E1 −1293G>C/−1053C>T were higher in SCA-HU+ patients (p < 0.05). Independent associations were found between the variant A allele and lower total cholesterol, between c2 allele and low alpha-1 antitrypsin and between the null GSTT1 variant and high indirect and total bilirubin in SCA-HU+ patients. In SCA-HU− patients, independent associations were found between the variant A allele and high uric acid and between c2 allele and high urea. Our results suggest that SNPs MPO −463G>A, CYP2E1 −1293G>C/−1053C>T, and GSTT1 can be associated with alterations in lipid, inflammatory, renal, hemolytic, and hepatic profiles. However, further studies are needed to elucidate these associations.

Highlights

  • Sickle cell anemia (SCA) is a monogenic disease, characterized by clinical heterogeneity [1]

  • Based on the variability of response in SCA patients treated with HU and the effect of singlenucleotide polymorphisms (SNPs) on the metabolism of drugs, we investigated the influence of SNPs CYP2E1 −1293G>C/−1053C>T, MPO −463G>A, NQO C609T, and GSTT1/GSTM1 on laboratory parameters in SCA patients treated with HU

  • hemoglobin variant S (HbS) levels were lower in SCA-HU+ patients than in the control group, and HbF levels were higher in SCA-HU+ patients when compared to the SCA-HU− patients (p < 0 001)

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Summary

Introduction

Sickle cell anemia (SCA) is a monogenic disease, characterized by clinical heterogeneity [1]. The clinical diversity of SCA patients has been attributed to several factors, such as sociodemographic, socioeconomic, environmental, and genetic factors [2, 3]. Fetal hemoglobin (HbF: α2γ2) is a classic genetic modulator associated with a less-severe SCA outcome, and high concentration of HbF inhibits the polymerization of the hemoglobin variant S (HbS) by formation of asymmetric hybrids with gamma (γ) chain and βS chain (α2γβS) that present high affinity for oxygen [4, 5]. Hydroxyurea (HU) is the most used drug to treat SCA patients with severe profile and increased HbF [6, 7]. Several studies have demonstrated that HU use in SCA can improve the clinical profile by reducing painful crises, hospital stay, blood transfusion, and acute chest syndrome episodes [1, 8].

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