Antisickling Agents Research Articles

LC-MS/MS Analysis of crude Flavonoid Compounds from <i>Justicia secunda</i> from Democratic Republic of the Congo and evaluation of their antisickling Activity

<i>Justicia secunda</i> Vahl (Acanthaceae) is a tropical herbaceous plant traditionally used by indigenous peoples of the Democratic Republic of the Congo (DRC) to treat symptoms associated with sickle cell disease (SCD), a genetic condition with life-threatening complications. Given the lack of side-effect-free drugs, alternative herbal therapies that can reduce or reverse red blood cell sickling may serve as safe and effective treatments. The primary objective of this study is to conduct a phytochemical screening of crude flavonoids extracted from <i>J. secunda</i> using LC-ESI/MS/MS. <i>J. secunda</i> extracts were evaluated for their phytoconstituents and anti-sickling properties. The anti-sickling properties were assessed through reverse sickling estimation, polymerization and oxidation inhibition, and osmotic fragility assays. Fractionation of the methanol extract and chemical profiling were performed by flash chromatography and high-performance thin-layer chromatography analysis respectively. Characterization and identification of the crude flavonoids were done using chromatography and spectroscopy methods. Chemical screening of crude flavonoids revealed the presence of 12 flavonoid O-glycosides based on one flavonol (methoxy-kaempferol) and two flavones (luteolin and apigenin). The crude flavonoid extracts demonstrated maximum reversal of sickled red blood cells (91.9 ± 0.8%), significant inhibition of hemoglobin polymerization (77.8 ± 7.6%) and hemoglobin S auto-oxidation (96.3 ± 0.2), and provided maximum protection of red blood cells against hyperhemolysis. The results validate the traditional use of <i>J. secunda</i> and identify potential compounds for the development of novel anti-sickling agents.

A study of the molecular interactions of hemoglobin with diverse classes of therapeutic agents

Investigation of the interaction of hemoglobin (Hb) with therapeutic agents may be useful from three perspectives. First, there are a few therapeutic agents targeting precisely Hb. Second, the high concentration in the blood makes it a likely target for (often unwanted) side reactions of drugs targeting other systems in the body. Third, with its complex and well-studied reactivity, Hb offers itself as a useful model protein for understanding the interactions of therapeutic molecules with proteins via various mechanisms that include allosteric effects, coordination chemistry, metal- or aminoacid-based redox processes, and solution-based oxidative and nitrosative stress chain reactions. Presented here is a review of the molecular interactions described for hemoglobin with various therapeutic agents of organic, coordinative, or organometallic types. These interactions are typically studied by spectroscopy (fluorescence, UV–vis, circular dichroism, infrared, NMR), X-rays diffraction and molecular modeling (especially docking). Classes of therapeutic agents whose molecular interactions with Hb have been described include antioxidants (e.g., ascorbate, tocopherol, glutathione, carotenoids), anti-sickling agents, various organic chemotherapeutics, and metallodrugs.

X-ray crystallography and sickle cell disease drug discovery-a tribute to Donald Abraham.

X-ray crystallography and structure-based drug discovery have played a major role in the discovery of antisickling agents that target hemoglobin (Hb) for the treatment of sickle cell disease (SCD). Sickle cell disease, the most common inherited hematologic disorder, occurs as a result of a single point mutation of βGlu6 in normal human adult hemoglobin (HbA) to βVal6 in sickle hemoglobin (HbS). The disease is characterized by polymerization of HbS and sickling of red blood cells (RBCs), leading to several secondary pathophysiologies, including but not limited to vaso-occlusion, hemolytic anemia, oxidative stress, inflammation, stroke, pain crisis, and organ damage. Despite the fact that SCD was the first disease to have its molecular basis established, the development of therapies was for a very long time a challenge and took several decades to find therapeutic agents. The determination of the crystal structure of Hb by Max Perutz in the early 60s, and the pioneering X-ray crystallography research by Donald J. Abraham in the early 80s, which resulted in the first structures of Hb in complex with small molecule allosteric effectors of Hb, gave much hope that structure-based drug discovery (SBDD) could be used to accelerate development of antisickling drugs that target the primary pathophysiology of hypoxia-induced HbS polymerization to treat SCD. This article, which is dedicated to Donald J. Abraham, briefly reviews structural biology, X-ray crystallography and structure-based drug discovery from the perspective of Hb. The review also presents the impact of X-ray crystallography in SCD drug development using Hb as a target, emphasizing the major and important contributions by Don Abraham in this field.

Comparative antisickling and antioxidant activities of Pseudobombax ellipticum cultivars in relation to their metabolite profiling using LC/MS.

Pseudobombax ellipticum is native to South America and is cultivated worldwide mostly for its medicinal benefits. The plant is used traditionally in respiratory disorders such as dry cough, in the treatment of fever and stomach pain, and as an antimicrobial and analgesic. The antisickling and antioxidant effects of the flowers of P. ellipticum (Kunth) Dugand (red) and P. ellipticum cultivar alba (white) were compared using an in vitro assay in 2% sodium metabisulfite sickling induction model, DPPH, and metal chelation assays. Both red and white flowers exhibited antioxidant and antisickling activities. In DPPH assay, lower IC50 (34.89 ± 0.98 and 53.28 ± 1.14 μg mL-1) in red and white flowers respectively were detected relative to Trolox as a positive control (56.82 ± 0.87 μg mL-1). Comparable metal chelation activity (81.4 and 77.8 μM EDTA equivalent/mg) was detected in red and white flowers of both cultivars respectively. The average readings of the "reversal of sickling test "revealed a decrease in sickling percent from 49% to 15% in red flowers and to 18% in white flowers. Also, polymerization inhibition rate was increased from 0.34 to 1 and to 0.92 in red and white flowers respectively. Total phenolics, flavonoids and anthocyanins were quantified in red and white flowers as (163.9, 43.13 mg gallic acid equivalent/g extract), (71.92, 34.5 mg rutin equivalent/g extract) and (127.0, 85.9 mg pelargonidine-3-mono glucoside equivalent/kg extract), respectively. Liquid chromatography mass spectrometry (LC-MS) analysis was further employed for detection and identification of anthocyanins in flower extracts. Eight new anthocyanins were identified for the first time in genus Pseudobombax. These results reveal the potential role for both red and white flower extracts as possible antisickling agents in sickle cell anemia management.

Untargeted Metabolomics on Dried Blood Spots of Patients with Sickle Cell Disease Treated with the Pyruvate Kinase Activator Mitapivat

Background Sickle cell disease (SCD) is one of the most common inherited red blood cell (RBC) disorders. The disease is characterized by polymerization of sickle hemoglobin (HbS) upon deoxygenation resulting in, among other things, chronic life-threatening complications. The pathophysiology of SCD is multifactorial and highly complex. Novel anti-sickling agents under development for SCD include oral, small molecule pyruvate kinase activators such as mitapivat (AG-348). Mitapivat could reduce HbS polymerization by decreasing the level of the glycolytic intermediate metabolite 2,3-diphosphoglycerate (2,3-DPG), thereby increasing the oxygen affinity of hemoglobin, and the level of adenosine triphosphate (ATP) to increase cellular energy. We investigated, as an exploratory outcome, changes in untargeted metabolomics on dried blood spots (DBS) of patients with SCD treated with mitapivat in the 8-week Dose Finding Period of an investigator-initiated, open label, phase 2 study (EudraCT 2019-003438-18, ESTIMATE study). Methods Untargeted metabolomics was performed by direct-infusion high-resolution mass spectrometry on DBS of patients ≥16 years with SCD (HbSS, HbS/β0 or HbS/β+-thalassemia) collected at baseline and at completion of the 8-week Dose Finding Period. In this period, patients received initial dosing of 20 mg mitapivat twice daily with a maximum of two sequential dose escalations to 50 mg and 100 mg twice daily every two weeks depending on safety. DBS samples obtained from healthy adults were used to calculate Z-scores. Data analyses were conducted in MetaboAnalyst (v5.0) without data filtering or normalization. Distinct metabolic profiles between baseline samples of patients with SCD and healthy controls were identified by multivariate principal component analysis and partial least square discriminant analysis, as well as independent two-sample t-tests with equal group variance. False Discovery Rate (FDR) adjusted p-values were used to correct for multiple testing. A significance level of 0.05 was applied. Distinctive increased or decreased metabolites were also analyzed at treatment week 8 and compared to baseline in the cohort of patients with SCD. Additional analyses were performed in Graphpad Prism (v9.3.0) including paired two-sample t-tests for individual Z-scores of features. Results In total, 1907 unique metabolite features were identified in DBS of 9 patients with SCD (n=7 HbSS, n=1 HbS/β0, n=1 HbS/β+-thalassemia; median age 22 years (range 16-59 years); 6/9 (67%) female) and 29 healthy controls (median age 38 years (range 25-65 years); 21/29 (72%) female). One HbSS patient and one healthy control were determined as outliers and excluded from final analysis. A total of 55 metabolites were significantly different between patient samples at baseline and healthy control samples. The top 35 are shown in a heatmap (Figure 1) and include increased acyl carnitines, (derivatives of) polyamines, purines and pyrimidines, and decreased carbohydrates and benzenoids. Patient samples showed an increase in 8/55 metabolites, of which 5 towards normalization, after 8-week treatment with mitapivat (unadjusted p-value <0.05), and no significant decreases (Table 1). In patients a significant increase was seen in 2/1907 unique metabolite features after 8 weeks of treatment with mitapivat compared to baseline: butenylcarnitine, which is an acyl carnitine, and inosinic acid, or inosine-5-monophosphate (5'-IMP), which is a purine nucleotide (FDR-adjusted p-value <0.05; data not shown). Conclusion Patients with SCD showed a distinct metabolic profile compared to healthy controls. The distinctions were determined by metabolites produced by RBC-related pathways including the glycolytic and purinergic signaling pathway that mediate hypoxic metabolic reprogramming, carnitine derivatives, involved in turnover and repair of the RBC membrane, and polyamines, that probably stabilize the RBC membrane (as reported from other hereditary hemolytic anemias). Moreover, after 8 weeks of treatment with mitapivat showed, again, changes in an acyl carnitine and purine nucleotide compared to baseline. We conclude that the distinct metabolic profile from healthy controls is a promising starting point to further unravel the underlying pathophysiology of SCD and to characterize the endogenous and exogenous effects of pyruvate kinase activators and other novel therapies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

An Endogenous Metabolic Modulator Composition Improves Hydration Status and Decreases Adhesion Properties of Red Blood Cells from Patients with Sickle Cell Disease

Background Sickle cell disease (SCD) is a group of hemoglobinopathies caused by point mutations in the β-globin gene leading to abnormal red blood cells (RBCs). There are various forms of SCD; sickle cell anemia (SCA) is characterized by homozygosity for hemoglobin (Hb) S (HbSS) whereas HbSC disease results from compound heterozygosity for HbS and HbC. HbC does not lead to RBC sickling, but induces loss of intracellular K+ and H2O causing RBC dehydration. Similarly, in HbSS RBCs, through dehydration, an increase of the intracellular concentration of poorly soluble HbS enhances polymerization upon deoxygenation, causing RBCs to become rigid and to sickle. Until recently, the only approved therapy for SCD was hydroxyurea (HU). HU increases fetal Hb (HbF) levels and improves RBC hydration and deformability. For decades, amino acids have been explored as potential treatment to restore the disrupted pathophysiological pathways in SCD. RCitNacQCarLKHVS, an Endogenous Metabolic Modulator (EMM) composition of ten different amino acids and derivatives, was designed to target and support RBC metabolism. In this study, we investigated the effect of ex vivo treatment of this EMM on RBC properties and function in SCA and HbSC. Methods Blood of 12 different adult SCD patients (9 HbSS [of whom 6 were on chronic RBC exchange (RBCX)], 3 HbSC) and 2 healthy controls was collected. Whole blood was incubated at standardized hematocrit (20%, patient plasma) in the presence or absence of different RCitNacQCarLKHVS concentrations for 4h at 37°C. Routine hematological parameters were measured using the Cell-Dyn Sapphire (Abbott Diagnostics). Percentage of total dense RBCs (%DRBCs) was analyzed from 10/12 patients (4 HbSS on RBCX, 3 HbSS not on RBCX, 3 HbSC) using the Advia 120/2120 hematology analyzer (Siemens Healthcare Diagnostics). Point of sickling (PoS), RBC deformability (EImax), and hydration status (Ohyper) were assessed by oxygen gradient ektacytometry and osmotic gradient ektacytometry, respectively, in 12/12 patients using the Lorrca (RR Mechatronics). Blood viscosity was measured in 6/12 patients (3 HbSS not on RBCX and 3 HbSC) at 37°C using a cone-plate viscometer (Brookfield). The hematocrit-to-viscosity ratio (HVR) was calculated as follows: hematocrit/blood viscosity at 300 s-1. RBC adhesion to laminin (BioLamina) was assessed in 4/12 patients (3 HbSS not on RBCX, 1 HbSC) using a microfluidic device (IBIDI μ-Slide VI 0.4). Statistical analysis was performed in Graphpad Prism v9.3.0 using the Friedman test. Results Ex vivo treatment of blood of SCD patients with RCitNacQCarLKHVS showed a significant dose-dependent increase in Ohyper as measured by osmotic gradient ektacytometry (Figure 1), indicating an improvement of RBC hydration status of SCD RBCs. This was accompanied by a significant increase in mean corpuscular volume (MCV) and reduction in mean corpuscular Hb concentration (MCHC). RBCs of healthy controls showed a similar trend in Ohyper, MCV and MCHC. In addition, %DRBCs showed a significant dose-dependent decrease in both HbSS and HbSC RBCs as a result of RCitNacQCarLKHVS treatment. Oxygen gradient ektacytometry showed a significant increase in maximum deformability (EImax), but no significant change in point of sickling. The HVR did not significantly change during dose-response experiments. Median RBC adhesion to laminin decreased as a result of ex vivo treatment with RCitNacQCarLKHVS (Figure 2). Conclusion Ex vivo treatment with RCitNacQCarLKHVS demonstrated a significant dose-dependent increase in RBC hydration (Ohyper, MCV, MCHC and %DRBCs), deformability (EImax) and decreased adhesion properties in SCD RBCs. Dehydrated and dense RBCs with reduced deformability and increased adhesion are more prone to hemolysis, and associated with vaso-occlusive complications such as priapism, skin ulcers, and nephropathy. Results from this study therefore suggest benefit of EMM in modulating clinically-relevant rheological properties such as hydration state and adhesion of SCD RBCs in both SCA and HbSC. The fact that HVR did not change may represent an additional therapeutic benefit, especially for HbSC patients who have, in general, higher blood viscosity compared to HbSS patients. Moreover, it would be worthwhile to investigate if the concomitant use of select amino acid combinations with HU or other anti-sickling agents has an additional beneficial effect in SCD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Drug discovery by a basic research scientist.

I was fortunate to do my military service during the Vietnam era as a medical officer at the National Institutes of Health (NIH) in Bethesda, Maryland. My first research at NIH was concerned with making a variety of optical measurements on nucleic acid bases and proteins, including single crystal spectra in linearly polarized light and near infrared circular dichroism, interpreting the spectra using molecular orbital and crystal field theories. What I do now is drug discovery, a field at the opposite end of the scientific spectrum. This article gives a brief account of my transition from spectroscopy to sickle cell hemoglobin polymerization to protein folding to drug discovery for treating sickle cell disease. My lab recently developed a high throughput assay to screen the 12,657 compounds of the California Institute of Biomedical Research ReFrame drug repurposing library. This is a precious library because the compounds have either been FDA approved or have been tested in clinical trials. Since the 1970s numerous agents have been reported in the literature to inhibit HbS polymerization and/or sickling with only one successful drug, hydroxyurea, and another of dubious value, voxelotor, even though it has been approved by the FDA. Our screen has discovered 106 anti-sickling agents in the ReFrame compound library. We estimate that as many as 21 of these compounds could become oral drugs for treating sickle cell disease because they inhibit at concentrations typical of the free concentrations of oral drugs in human serum.

Inhibition of the Aquaporin-1 Cation Conductance by Selected Furan Compounds Reduces Red Blood Cell Sickling.

In sickle cell disease (SCD), the pathological shift of red blood cells (RBCs) into distorted morphologies under hypoxic conditions follows activation of a cationic leak current (Psickle) and cell dehydration. Prior work showed sickling was reduced by 5-hydroxylmethyl-2-furfural (5-HMF), which stabilized mutant hemoglobin and also blocked the Psickle current in RBCs, though the molecular basis of this 5-HMF-sensitive cation current remained a mystery. Work here is the first to test the hypothesis that Aquaporin-1 (AQP1) cation channels contribute to the monovalent component of Psickle. Human AQP1 channels expressed in Xenopus oocytes were evaluated for sensitivity to 5-HMF and four derivatives known to have differential efficacies in preventing RBC sickling. Ion conductances were measured by two-electrode voltage clamp, and osmotic water permeability by optical swelling assays. Compounds tested were: 5-HMF; 5-PMFC (5-(phenoxymethyl)furan-2-carbaldehyde); 5-CMFC (5-(4-chlorophenoxymethyl)furan-2-carbaldehyde); 5-NMFC (5-(2-nitrophenoxymethyl)-furan-2-carbaldehyde); and VZHE006 (tert-butyl (5-formylfuran-2-yl)methyl carbonate). The most effective anti-sickling agent, 5-PMFC, was the most potent inhibitor of the AQP1 ion conductance (98% block at 100 µM). The order of sensitivity of the AQP1 conductance to inhibition was 5-PMFC > VZHE006 > 5-CMFC ≥ 5-NMFC, which corresponded with effectiveness in protecting RBCs from sickling. None of the compounds altered AQP1 water channel activity. Combined application of a selective AQP1 ion channel blocker AqB011 (80 µM) with a selective hemoglobin modifying agent 5-NMFC (2.5 mM) increased anti-sickling effectiveness in red blood cells from human SCD patients. Another non-selective cation channel known to be expressed in RBCs, Piezo1, was unaffected by 2 mM 5-HMF. Results suggest that inhibition of AQP1 ion channels and capacity to modify hemoglobin are combined features of the most effective anti-sickling agents. Future therapeutics aimed at both targets could hold promise for improved treatments for SCD.

Anti sickling potential and chemical profiling of traditionally used Woodfordia fruticosa (L.) Kurz leaves

Woodfordia fruticosa (L.) Kurz is a widely used plant in traditional medicine systems. The tribal communities of Amarkantak, Madhya Pradesh (India) are using this plant for the treatment of general weakness, blood related complications like blood deficiency, blood purification and for the treatment of symptoms related to sickle cell disease (SCD). SCD is a genetic disease with life threatening complications. In the absence of any drugs without any side effects, the alternative plant based therapies that may either reduce/ reverse the sickling of the red blood cells can be safe and effective therapeutic agents. We evaluated W. fruticosa extracts for phytoconstituents, anti-oxidant and anti-inflammatory properties. Anti-sickling properties of the extracts were evaluated by estimation of reverse sickling, polymerization inhibition and osmotic fragility assays. Chemical profiling of the methanol extract was done using LC-MS analysis. Phytochemicals such as alkaloids, steroids, tannin, and saponins were present in all the extracts. Methanol extract displayed maximum reversal (66 ± 1%) of sickled Red blood Cells (RBC) and significantly inhibited Hb polymerization. The hexane and methanol extracts led to minimum hemolysis of sickled RBC in the osmotic fragility assays. Total tannin (365 ± 2.4 TAE) content was highest in acetone extract, while the total flavonoid and phenolic content (156.9 ± 2.0 QE) and (113.7 ± 0.7 GAE) were highest in methanol extract. The methanol extract displayed minimum IC 50 (8.1 ± 1.5) in 2, 2-diphenylpicrylhydrazyl (DPPH) while the acetone extract had minimum IC 50 (215.8 ± 5.7) in 2,2′-azino-bis 3-ethylbenzothiazoline-6-sulfonic acid (ABTS) assay. The hexane extract displayed maximum Ferric reducing anti-oxidant power (FRAP) value (1.5 ± 0.5 mM Fe(II)/mg dry weight) that were higher than methanol and aqueous extracts (1.45 ± 0.1, 1.45 ± 0.05 mM Fe(II)/mg dry weight). The methanol extract provided maximum RBC protection from hemolysis (73.8 ± 0.8%). Maximum Lipoxygenase (LOX) inhibition was observed by the acetone and methanol extracts at 400 μg/mL while the hexane extract displayed maximum Xanthine oxidase (XO) inhibition (57.0 ± 0.5%). LC-MS profiling of the methanol extract identified several secondary metabolites that might be responsible for the observed activities. The results validate the traditional use of W. fruticosa and present us with potential compounds for further development of novel anti sickling agents.

Exploration of Structure–Activity Relationship of Aromatic Aldehydes Bearing Pyridinylmethoxy-Methyl Esters as Novel Antisickling Agents

Aromatic aldehydes elicit their antisickling effects primarily by increasing the affinity of hemoglobin (Hb) for oxygen (O2). However, challenges related to weak potency and poor pharmacokinetic properties have hampered their development to treat sickle cell disease (SCD). Herein, we report our efforts to enhance the pharmacological profile of our previously reported compounds. These compounds showed enhanced effects on Hb modification, Hb-O2 affinity, and sickling inhibition, with sustained pharmacological effects in vitro. Importantly, some compounds exhibited unusually high antisickling activity despite moderate effects on the Hb-O2 affinity, which we attribute to an O2-independent antisickling activity, in addition to the O2-dependent activity. Structural studies are consistent with our hypothesis, which revealed the compounds interacting strongly with the polymer-stabilizing αF-helix could potentially weaken the polymer. In vivo studies with wild-type mice demonstrated significant pharmacologic effects. Our structure-based efforts have identified promising leads to be developed as novel therapeutic agents for SCD.

Assessment of Red Blood Cell-Mediated Microvascular Occlusion in Sickle Cell Disease By a Novel Electrical Impedance-Based Microfluidic Device

Introduction: Sickle cell disease (SCD) is a recessive genetic disorder caused by the mutated sickle hemoglobin (HbS) in red blood cells (RBCs). HbS polymerizes in a hypoxic environment, which leads to increased adhesiveness and decreased deformability of RBCs, and ultimately contributes to microvascular occlusion in SCD. As RBC deformability and the associated microvascular occlusion are predictors of individual microcirculatory health, previous studies have developed microfluidic devices for deformability-based RBC sorting in microscale flow, albeit with relatively low throughput. An easy-to-use, point-of-care assay to rapidly assess RBC-mediated microvascular occlusion can be clinically useful in examining the outcome of novel targeted and curative therapies, such as anti-sickling drugs and gene therapies, for patients with SCD. Here, we present an electrical impedance-based microfluidic device and functional assessment of RBC-mediated microvascular occlusion in SCD. Methods: Venous blood samples were collected in EDTA from subjects with homozygous SCD (HbSS, N=12) and controls (HbAA, N=5) under consent in an IRB-approved protocol. Microfluidic devices were fabricated using standard photolithography and polydimethylsiloxane (PDMS) micro-molding protocols. The microchannel consisted of micropillar arrays forming microcapillaries from 3-12 μm, with each array coupled with a pair of gold electrodes on the channel bottom surface (Figure 1A). Two 40-μm-wide side passageways mimicking the anastomoses in the capillary bed were designed to prevent microchannel upstream clogging (Figure 1A inset). A macroscopic view of the device is shown in Figure 1B. The 12-μm array was designed to filter large-cell aggregates and was excluded from our analysis. An impedance analyzer coupled with a custom printed-circuit board was used to record the electrical impedance at a spot frequency of 10 kHz. Prior to the experiments, the microchannel was blocked and rinsed to prevent non-specific adhesion of blood cells. Thereafter, the initial electrical impedance reading of each array was obtained. RBCs suspended at 20% hematocrit in PBS were then perfused through the microchannel under the same inlet pressure for 20 min. Next, the microchannel was washed and a second electrical impedance reading was obtained. The microchannel was then imaged under an inverted microscope, and occlusions of each array were manually quantified. The electrical impedance and occlusion results are reported as percent changes. Data are reported as mean ± standard deviation (SD). Pearson's correlation coefficient (PCC) was used to derive correlation statistics. Results: We observed increased microcapillary occlusion caused by HbSS- vs. HbAA-containing RBCs (Figure 1C, mean microcapillary occlusion percentage ± SD (%) = 24.33 ± 16.88 vs. 5.01 ± 1.25 for 3-μm array, 6.05 ± 4.09 vs. 2.19 ± 0.59 for 4-μm array, 2.77 ± 2.59 vs. 0.82 ± 0.82 for 6-μm array, 1.08 ± 2.28 vs. 0 ± 0 for 8-μm array, and 0.42 ± 1.14 vs. 0 ± 0 for 10-μm array). Similarly, we observed elevated electrical impedance change induced by HbSS- vs. HbAA-containing RBCs (Figure 1D, mean electrical impedance change ± SD (%) = 12.03 ± 8.97 vs. 2.44 ± 0.84 for 3-μm array, 1.79 ± 1.65 vs. 0.91 ± 0.42 for 4-μm array, 0.88 ± 1.14 vs. 0.58 ± 0.67 for 6-μm array, 0.16 ± 0.31 vs. 0.32 ± 0.37 for 8-μm array, and 0.06 ± 0.16 vs. 0.05 ± 0.17 for 10-μm array). Moreover, we found that the electrical impedance changes of individual arrays exhibited a significant correlation to the occlusion percentage within the corresponding arrays (Figure 1E, PCC = 0.9817, N = 85, p &amp;lt; 0.001). Conclusions: Findings suggest that a novel microfluidic platform integrated with micropillar arrays and electrical impedance readout can be used for standardized in vitro functional assessment of RBC-mediated microvascular occlusion in SCD. Electrical impedance change due to RBC-mediated microcapillary occlusion may serve as a new parameter for monitoring RBC health and function without the need for high-resolution microscopic imaging. RBC mediated microcapillary occlusion may serve as a new parameter to assess the clinical efficacy of treatments that improve RBC deformability and rheology, such as hemoglobin modifying drugs, anti-sickling agents, and therapies with curative intent. Disclosures Maji: Xatek Inc.: Patents &amp; Royalties. An:Hemex Health, Inc.: Patents &amp; Royalties. Ahuja:Genentech: Consultancy, Honoraria; Sanofi Genzyme: Consultancy, Honoraria; XaTek, Inc.: Consultancy, Patents &amp; Royalties, Research Funding. Little:BioChip Labs: Patents &amp; Royalties: SCD Biochip (patent, no royalties); Hemex Health, Inc.: Patents &amp; Royalties: Microfluidic electropheresis (patent, no royalties); Bluebird Bio: Research Funding; GBT: Research Funding; GBT: Membership on an entity's Board of Directors or advisory committees; NHLBI: Research Funding. Mohseni:Xatek Inc.: Consultancy, Patents &amp; Royalties, Research Funding. Suster:Xatek Inc.: Consultancy, Patents &amp; Royalties, Research Funding. Gurkan:BioChip Labs: Patents &amp; Royalties; Xatek Inc.: Patents &amp; Royalties; Dx Now Inc.: Patents &amp; Royalties; Hemex Health, Inc.: Consultancy, Current Employment, Patents &amp; Royalties, Research Funding.

An Investigation of Structure-Activity Relationships of Azolylacryloyl Derivatives Yielded Potent and Long-Acting Hemoglobin Modulators for Reversing Erythrocyte Sickling.

Aromatic aldehydes that bind to sickle hemoglobin (HbS) to increase the protein oxygen affinity and/or directly inhibit HbS polymer formation to prevent the pathological hypoxia-induced HbS polymerization and the subsequent erythrocyte sickling have for several years been studied for the treatment of sickle cell disease (SCD). With the exception of Voxelotor, which was recently approved by the U.S. Food and Drug Administration (FDA) to treat the disease, several other promising antisickling aromatic aldehydes have not fared well in the clinic because of metabolic instability of the aldehyde moiety, which is critical for the pharmacologic activity of these compounds. Over the years, our group has rationally developed analogs of aromatic aldehydes that incorporate a stable Michael addition reactive center that we hypothesized would form covalent interactions with Hb to increase the protein affinity for oxygen and prevent erythrocyte sickling. Although, these compounds have proven to be metabolically stable, unfortunately they showed weak to no antisickling activity. In this study, through additional targeted modifications of our lead Michael addition compounds, we have discovered other novel antisickling agents. These compounds, designated MMA, bind to the α-globin and/or β-globin to increase Hb affinity for oxygen and concomitantly inhibit erythrocyte sickling with significantly enhanced and sustained pharmacologic activities in vitro.

The enduring legacy of Koji Nakanishi's research on bioorganic chemistry and natural products. Part 1: Isolation, structure determination and mode of action.

In this brief review on Koji Nakanishi's remarkable career in natural products chemistry, we have highlighted a number of his accomplishments that illustrate the broad diversity of his interests. These include the isolation, structure determination, and biological mechanism of action of many natural products including the triterpenoid pristimerin; the diterpenoid ginkgolides; insect and crustacean molting hormones; phytoalexins; the toxic red tide principle brevetoxin; the vanadium tunicate pigments; philanthotoxin from killer wasps; antisickling agents; mitomycin DNA adducts; insect antifeedants; a mitotic hormone, the small molecule fish attractants from the sea anemone; new isolation and purification technologies; molecular chemistry of vision; age-related macular degeneration; and the development of the exciton circular dichroism (CD) chirality method for microscale determination of absolute configuration of natural products and chirality of other chiral molecules and supramolecular assembly.

Microfluidic assessment of red blood cell mediated microvascular occlusion.

Abnormal red blood cell (RBC) deformability contributes to hemolysis, thrombophilia, inflammation, and microvascular occlusion in various circulatory diseases. A quantitative and objective assessment of microvascular occlusion mediated by RBCs with abnormal deformability would provide valuable insights into disease pathogenesis and therapeutic strategies. To that end, we present a new functional microfluidic assay, OcclusionChip, which mimics two key architectural features of the capillary bed in the circulatory system. First, the embedded micropillar arrays within the microchannel form gradient microcapillaries, from 20 μm down to 4 μm, which mimic microcapillary networks. These precisely engineered microcapillaries retain RBCs with impaired deformability, such that stiffer RBCs occlude the wider upstream microcapillaries, while less stiff RBCs occlude the finer downstream microcapillaries. Second, the micropillar arrays are coupled with two side passageways, which mimic the arteriovenous anastomoses that act as shunts in the capillary bed. These side microfluidic anastomoses prevent microchannel blockage, and enable versatility and testing of clinical blood samples at near-physiologic hematocrit levels. Further, we define a new generalizable parameter, Occlusion Index (OI), which is an indicative index of RBC deformability and the associated microcapillary occlusion. We demonstrate the promise of OcclusionChip in diverse pathophysiological scenarios that result in impaired RBC deformability, including mercury toxin, storage lesion, end-stage renal disease, malaria, and sickle cell disease (SCD). Hydroxyurea therapy improves RBC deformability and increases fetal hemoglobin (HbF%) in some, but not all, treated patients with SCD. HbF% greater than 8.6% has been shown to improve clinical outcomes in SCD. We show that OI associates with HbF% in 16 subjects with SCD. Subjects with higher HbF levels (HbF > 8.6%) displayed significantly lower OI (0.88% ± 0.10%, N = 6) compared with those with lower HbF levels (HbF ≤ 8.6%) who displayed greater OI (3.18% ± 0.34%, N = 10, p < 0.001). Moreover, hypoxic OcclusionChip assay revealed a significant correlation between hypoxic OI and subject-specific sickle hemoglobin (HbS) level in SCD. OcclusionChip enables versatile in vitro assessment of microvascular occlusion mediated by RBCs in a wide range of clinical conditions. OI may serve as a new parameter to evaluate the efficacy of treatments improving RBC deformability, including hemoglobin modifying drugs, anti-sickling agents, and genetic therapies.

Fetal Hemoglobin Promotes P. Falciparum Growth in Sickle Cell Disease Erythrocytes

Introduction: We have demonstrated that sickle hemoglobin (HbS) polymerization in low oxygen (O2) is the main driver of sickle cell trait (AS) resistance to P.falciparum malaria. This suggests that homozygous sickle cell disease (SS) individuals should have even greater resistance to malaria. Instead SS individuals infected by P. falciparum often have increased malaria morbidity and mortality compared to individuals with normal hemoglobin (AA) or AS. The reasons for this paradox are poorly understood. We propose that fetal hemoglobin (HbF) inhibits polymerization thereby allowing parasite proliferation. To test this hypothesis the following experiments were performed. Methods: AA and SS erythrocytes were collected within two weeks of the assay date. P. falciparum 3D7 parasites were used for growth assays. Growth assays were performed at 1, 3, 5, 7.5, 10 and 16% O2 using synchronized schizonts obtained by magnet purification via the MACS system. Staging was performed via light microscopy analysis of May-Grünwald-Giemsa-stained cytospins. Parasite Multiplication Rate (PMR) was determined via flow cytometry using parasitemia at 64 and 16 hours post infection (hpi) as previously described. Results: In contrast to AS erythrocytes, SS RBCs contain varying amounts of HbF that differ by cell and by individual. In hypoxic SS RBCs with low (3.8%) HbF, P. falciparum parasites remain immature (early trophozoites) in 1, 3, and 5% O2 (Fig. 1) at 36 hpi, when they should have matured into schizonts. However, in SS RBCs with high (22.6%) HbF, 12, 16 and 27% of parasites matured into schizonts in 1, 3 and 5% O2 respectively compared to 0, 0, and 1% in the SS RBCs with 3.8% HbF. Preliminary data also demonstrate that the parasite multiplication rate (PMR), a surrogate of proliferation, in SS RBCs improves with increasing O2 and HbF. Using SS/Hereditary Persistence of Fetal Hemoglobin RBCs with 42% HbF, proliferation in 5% O2 or higher is exponential with a PMR of 2.6 or greater (Fig. 2). In RBCs isolated from SS patients treated with hydroxyurea with HbF of 26.4 or 21%, PMR is 2 or more in 7.5% O2 or greater. Conclusion: These data demonstrate that HbF promotes P. falciparum growth in SS erythrocytes. In addition, the data initiates a resolution of the malaria paradox. HbS in both hypoxic AS and SS surely inhibits P. falciparum growth due to HbS polymerization at low O2. But high levels of anti-sickling HbF observed in erythrocytes from many individuals with SS reverses this inhibition despite the increased content of HbS in SS individuals. Even small increases in P. falciparum proliferation within the broadly compromised SS host may enhance the malaria associated morbidity and mortality seen in this population. These data further suggest the importance of anti-malarial prophylaxis in patients with SS especially those treated with hydroxyurea or anti-sickling agents. Disclosures No relevant conflicts of interest to declare.

Characterization of Sickling During Controlled Automated Deoxygenation with Oxygen Gradient Ektacytometry.

In sickle cell disease (SCD), a single point mutation in the gene coding for beta-globin causes the production of abnormal hemoglobin S (HbS). When deoxygenated, HbS can polymerize, forming rigid rods of hemoglobin, resulting in the sickling of red blood cells (RBCs). These sickled RBCs have significantly reduced deformability, causing vaso-occlusion, which leads to numerous SCD-related clinical complications, including pain, stroke, and organ damage. RBC deformability is also reduced by RBC dehydration, resulting in dense red blood cells that are more likely to sickle. To date, there is not a single widely available, rapid, and reproducible laboratory assay capable of predicting the disease severity or directly monitoring the treatment effects for novel, non-fetal hemoglobin inducing therapies. In this study, we describe a protocol to measure RBC deformability as a function of pO2 that allows for the quantitation of sickling behavior in SCD patients. Oxygen gradient ektacytometry measures RBC deformability, expressed as the elongation index (EI), as a function of pO2. RBCs are exposed to a fixed shear stress of 30 Pa during one round of deoxygenation and reoxygenation. Six readout parameters are produced. Of these, the point of sickling (PoS), defined as the pO2 at which maximum EI (EImax) shows a 5% decrease, and minimum EI during deoxygenation (EImin) are the most informative, reflecting an individual patient's pO2 at which sickling starts and the minimal deformability of a patient's red blood cells, respectively. PoS is associated with an individual patient's hemoglobin affinity for oxygen, whereas EImin shows a strong correlation with fetal hemoglobin levels. We conclude that oxygen gradient ektacytometry is a promising technique to monitor the treatment of patients with SCD, as a biomarker for anti-sickling agents in clinical and preclinical trials, and an important tool to study sickling behavior of RBCs from individuals with SCD and sickle cell traits.

Conceptual DFT study of the chemical reactivity of four natural products with anti-sickling activity

Theoretical reactivity indices based on the conceptual density functional theory were computed to investigate the reactivity of four anti-sickling plant-isolated terpenes: betulinic acid, betulinic acid acetate, friedelan-3-one, and ursolic acid. Herein, global reactivity indices such as the HOMO energy, electronic chemical potential, hardness, and electrophilicity and the local reactivity descriptors like Fukui functions, dual descriptors, and molecular electrostatic potentials for the anti-sickling agents are discussed. The binding energies of water on the most active site are in between − 19 and − 6 kcal/mol at B3LYP/6-31G(d). A molecular docking of anti-sickling agents and deoxyhemoglobin including binding energies, hydrogen bond distances and pictorial representation of viable docked poses revealed that betulinic acid and ursolic acid are the most potent molecules with a common binding site.

Antisickling Drugs Targeting βCys93 Reduce Iron Oxidation and Oxidative Changes in Sickle Cell Hemoglobin.

Sickle cell disease is a genetic blood disorder caused by a single point mutation in the β globin gene where glutamic acid is replaced by valine at the sixth position of the β chain of hemoglobin (Hb). At low oxygen tension, the polymerization of deoxyHbS into fibers occurs in red blood cells (RBCs) leading to an impaired blood vessel transit. Sickle cell hemoglobin (HbS), when oxidized with hydrogen peroxide (H2O2), stays longer in a highly oxidizing ferryl (Fe4+) form causing irreversible oxidation of βCys93 to a destabilizing cysteic acid. We have previously reported that an antisickling drug can be designed to bind specifically to βCys93 and effectively protect against its irreversible oxidation by H2O2. Here, we report oxygen dissociation, oxidation, and polymerization kinetic reactions for four antisickling drugs (under different preclinical/clinical developmental stages) that either site-specifically target βCys93 or other sites on the HbS molecule. Molecules that specifically bind to or modify βCys93, such as 4,4′-di(1,2,3-triazolyl) disulfide (TD-3) and hydroxyurea (HU) were contrasted with molecules that target other sites on Hb including 5-hydroxymethyl-2-furfural (5-HMF) and L-glutamine. All reagents induced a left shift in the oxygen dissociation curve (ODC) except L-glutamine. In the presence of H2O2 (2.5:1, H2O2:heme), both TD-3 and HU reduced the ferryl heme by 22 and 37%, respectively, which corresponded to a 3- to 2-fold reduction in the levels of βCys93 oxidation as verified by mass spectrometry. Increases in the delay times prior to polymerization of HbS under hypoxia were in the following order: TD-3 > HU > 5-HMF = L-glutamine. Designing antisickling agents that can specifically target βCys93 may provide a dual antioxidant and antisickling therapeutic benefits in treating this disease.

Image-Based Flow Cytometry and Angle-Resolved Light Scattering to Define the Sickling Process.

Red blood cells (RBCs) from sickle cell patients exposed to a low oxygen tension reveal highly heterogeneous cell morphologies due to the polymerization of sickle hemoglobin (HbS). We show that angle-resolved light scattering approach with the use of image-based flow cytometry provides reliable quantitative data to define the change in morphology of large populations of RBCs from sickle cell patients when the cells are exposed for different times to low oxygen. We characterize the RBC morphological profile by means of a set of morphological and physical parameters, which includes cell shape, size, and orientation. These parameters define the cell as discocyte, sickle, elongated, as well as irregularly or abnormal RBC shaped cells, including echinocytes, holly-leaf, and granular structures. In contrast to microscopy, quick assessment of large numbers of cells provides statistically relevant information of the dynamic process of RBC sickling in time. The use of this approach facilitates the understanding of the processes that define the propensity of sickle blood samples to change their shape, and the ensuing vaso-occlusive events in the circulation of the patients. Moreover, it assists in the evaluation of treatments that include the use of anti-sickling agents, gene therapy-based hemoglobin modifications, as well as other approaches to improve the quality of life of sickle cell patients. © 2019 International Society for Advancement of Cytometry.

Rapid and reproducible characterization of sickling during automated deoxygenation in sickle cell disease patients.

In sickle cell disease (SCD), sickle hemoglobin (HbS) polymerizes upon deoxygenation, resulting in sickling of red blood cells (RBCs). These sickled RBCs have strongly reduced deformability, leading to vaso‐occlusive crises and chronic hemolytic anemia. To date, there are no reliable laboratory parameters or assays capable of predicting disease severity or monitoring treatment effects. We here report on the oxygenscan, a newly developed method to measure RBC deformability (expressed as Elongation Index ‐ EI) as a function of pO2. Upon a standardized, 22 minute, automated cycle of deoxygenation (pO2 median 16 mmHg ± 0.17) and reoxygenation, a number of clinically relevant parameters are produced in a highly reproducible manner (coefficients of variation <5%). In particular, physiological modulators of oxygen affinity, such as, pH and 2,3‐diphosphoglycerate showed a significant correlation (respectively R = ‑0.993 and R = 0.980) with Point of Sickling (PoS5%), which is defined as the pO2 where a 5% decrease in EI is observed during deoxygenation. Furthermore, in vitro treatment with antisickling agents, including GBT440, which alter the oxygen affinity of hemoglobin, caused a reproducible left‐shift of the PoS, indicating improved deformability at lower oxygen tensions. When RBCs from 21 SCD patients were analyzed, we observed a significantly higher PoS in untreated homozygous SCD patients compared to treated patients and other genotypes. We conclude that the oxygenscan is a state‐of‐the‐art technique that allows for rapid analysis of sickling behavior in SCD patients. The method is promising for personalized treatment, development of new treatment strategies and could have potential in prediction of complications.