Sickle Red Blood Cells Research Articles

Splenic filtration of red blood cells in physiology, malaria and sickle cell disease.

The human spleen clears the blood from circulating microorganisms and red blood cells (RBCs) displaying alterations. This review analyzes how generic mechanisms by which the spleen senses RBC, such pitting, trapping and erythrophagocytosis, impact the pathogenesis of two major spleen-related diseases, malaria and sickle cell disease (SCD). Scintigraphy, functional histology, comparison of circulating and splenic RBC, ex-vivo perfusion of human spleens and in-silico modeling enable relevant exploration of how the spleen retains and processes RBC in health and disease. Iterative cross-validations between medical observations, in-vitro experiments and in-silico modeling point to mechanical sensing of RBC as a central event in both conditions. Spleen congestion is a common pathogenic process explaining anemia and splenomegaly, the latter carrying a risk of severe complications such as acute splenic sequestration crisis and hypersplenism in SCD. Sickling of hemoglobin S-containing RBC may contribute to these complications without necessarily being the trigger. Ongoing progress in the exploration and understanding of spleen-related complications in malaria and SCD open the way to optimized prognosis evaluation and therapeutic applications.

FT-4202, a selective pyruvate kinase R activator for sickle cell disease.

Anemia in patients with sickle cell disease (SCD) increases 2,3-diphosphoglycerate (2,3-DPG), decreasing hemoglobin-oxygen (Hb-O2) affinity to improve oxygen offloading and promote hemoglobin polymerization (sickling) of red blood cells (RBCs). We report the discovery of FT-4202, an investigational, selective pyruvate kinase type-R (PKR) activator with a multimodal mechanism of action and potential to increase ATP and decrease 2,3-DPG, resulting in increased Hb-O2 affinity, decreased Hb polymerization, and improved RBC health. FT-4202 was identified via structure-enabled lead optimization medicinal chemistry using X-ray crystallography, molecular modeling, and thermal shift assays. FT-4202, an allosteric PKR activator, stabilizes the tetrameric enzyme and increases PKR activity in human and mouse RBCs in vitro. Seven-day oral administration of FT-4202 in Berkeley SCD mice reduced 2,3-DPG, increased Hb-O2 affinity, and reduced RBC sickling versus control. There were no adverse in vitro safety findings. FT-4202 offers a therapeutic opportunity to modify the course of SCD.

Liver and renal biochemical profiles of people with sickle cell disease in Africa: a systematic review and meta-analysis of case-control studies

BackgroundSickle cell disease (SCD) is a genetic blood disorder characterized by a painful vaso-occlusive crisis due to the sickling of red blood cells in capillaries. Complications often lead to liver and renal dysfunctions, contributing to morbidity and mortality, particularly for children under 5. This systematic review and meta-analysis aimed to evaluate the liver and renal functions of people with SCD (HbSS) compared to those without it (HbAA) in Africa.MethodsThe protocol was registered with PROSPERO (CRD42022346771). We searched PubMed, Embase, Web of Science, and Google Scholar using the keywords “liver function”, “renal function”, “sickle cell disease”, and “Africa” on 6th May 2023 for peer-reviewed articles with abstracts in English. We included case-control studies comparing SCD (HbSS) with controls without hemoglobinopathies (HbAA). We used the random-effect model to calculate the pooled average values for the blood tests of people with SCD in RStudio version 4.2.2.ResultsOverall, 17 articles were analyzed from five African countries involving 1312 people with SCD and 1558 controls. The pooled mean difference of liver enzymes aspartate transaminase (AST) was 8.62 (95% CI − 2.99–20.23, I2 = 97.0%, p < 0.01), alanine transaminase (ALT) 7.82 (95% CI − 0.16–15.80, I2 = 99%, p < 0.01) and alkaline phosphatase (ALP) − 2.54 (95% CI − 64.72 – 59.64, I2 = 99%, p < 0.01) compared to controls. The pooled mean difference for the renal biochemical profiles creatinine − 3.15 (95% CI − 15.02; 8.72, I2=99%, p < 0.01) with a funnel plot asymmetry of t = 1.09, df = 9, p = 0.3048 and sample estimates bias of 6.0409. The pooled mean difference for serum urea was − 0.57 (95% CI − 3.49; 2.36, I2 = 99%, p < 0.01), and the estimated glomerular filtration (eGFR) rate was 19.79 (95% CI 10.89–28.68 mL/min/1.73 m2, I2 = 87%, p < 0.01) compared to controls.ConclusionPeople with SCD have slightly elevated liver enzymes and estimated glomerular filtration rates compared to controls in Africa. With all the heterogeneity (I2) > 50%, there was substantial variation in the reported articles’ results.Systematic review registrationPROSPERO CRD42022346771

Assessment of serum protein profile in sickle cell disease

Background: Sickle Cell disease (SCD) is known to be caused by a mutation in the beta-globin gene of the hemoglobin that affects the red blood cells (RBCs) and is passed down through generations. This study was carried out to determine the effect of sickling of RBC on serum protein profile in SCD individuals. Methods: A case-controlled study was carried out among 80 patients. They were forty-five sickle cell disease individuals (HbSS) attending Children Specialist Hospital Ilorin and thirty-five healthy controls (HbAA). The levels of total protein and albumin were determined spectrophotometrically and serum protein electrophoresis (SPE) was carried out using cellulose acetate electrophoresis. Results: Significant hypoalbuminemia and hypergammaglobulinemia were observed in SCD groups compared with controls. A higher proportion of the SCD group, 11(25%) had hypergammaglobulinemia and 21(49%) had hypoalbuminemia (P&lt;0.05). Plasma protein electrophoresis in SCD patients shows an intense colour at the gamma region which was not seen in control. There was a significant relationship between the patterns of serum protein electrophoresis and the frequency of crisis. Conclusions: Sickle cell disease crisis and other associated underlying conditions may be prevented early through assessment of serum protein profile, especially SPE. Hypergammaglobulinemia and hypoalbuminemia may be associated with frequent episode of crisis.

Nitrosyl hemoglobin formation from nitrite in normal and sickle blood

Sickle cell anemia is caused by a single mutation in the gene encoding the beta subunit of hemoglobin. Due to this mutation, sickle cell hemoglobin (HbS) polymerizes under hypoxic conditions, decreasing red blood cell deformability and leading to multiple pathological effects that cause substantial morbidity and mortality. Several pre-clinical and human studies have demonstrated that the anion nitrite has potential therapeutic benefits for patients with sickle cell disease. Nitrite is reduced to nitric oxide (NO) by deoxygenated hemoglobin contributing to vasodilation, decreasing platelet activation, decreasing cellular adhesion to activated endothelium, and decreasing red cell hemolysis; all of which could ameliorate patient morbidities. Previous work on extracellular hemoglobin has shown that solution phase HbS reduces nitrite to NO faster than normal adult hemoglobin (HbA), while polymerized HbS reduces nitrite slower than HbA. In this work, we compared the rate of nitrite reduction to NO measured by the formation of nitrosyl hemoglobin in sickle and normal red blood cells at varying hemoglobin oxygen saturations. We found the overall rate of nitrite reduction between normal and sickle red blood cells was similar and confirmed this result under partially oxygenated conditions, but normal red blood cells reduced nitrite faster than sickle red blood cells under anoxia where HbS polymerization is maximal. These results are consistent with previous work using extracellular hemoglobin where the rate of reduction by solution phase HbS makes up for the slower reduction by polymer phase HbS under partially oxygenated conditions, but the polymer phase kinetics dominates in the complete absence of oxygen.

Hypertonicity and/or acidosis induce marked rheological changes under hypoxic conditions in sickle trait red blood cells.

Deformability and sickling of red blood cells (RBCs) from individuals with sickle cell trait (SCT) was evaluated under harsh biophysical conditions that mimic certain vascular beds invivo. RBC deformability in osmotic-gradient ektacytometry was decreased in HbAS (SCT) compared to HbAA (wild-type) RBCs at supraphysiological osmolalities. RBC deformability was also measured by oxygen-gradient ektacytometry. Whereas RBC sickling was not observed under isotonic and neutral pH conditions, hypertonicity and acidosis alone or in combination induced reversible sickling of SCT RBC. These data suggest that hyperosmolality and/or acidosis enhance hypoxia-induced sickling of SCT RBC.

Could oxygen gradient ektacytometry help to detect sickle cell trait carriers at risk for kidney disorders or exercise-related complications?

The study of Ellsworth etal. (Br J Haematol, 2024) demonstrated the usefulness of oxygen gradient ektacytometry technique to better identify the physiological parameters that could increase the risk of sickling of red blood cells (RBCs) from sickle cell trait (SCT) carriers. Oxygen gradient ektacytometry combined with pH and osmolality modulations could help in identifying SCT carriers at risk for kidney disorders or exercise-related complications. Other factors than the percentages of haemoglobin S are probably involved in the propensity of RBCs from SCT carriers to sickle during deoxygenation. Commentary on: Ellsworth etal. Hypertonicity and/or acidosis induce marked rheological changes under hypoxic conditions in sickle trait red blood cells. Br J Haematol 2024; 205:1565-1569.

A Comparative Evaluation of the Antisickling, Elemental and Proximate Analysis of the Leaves of Three Khaya species Found in Nigeria

Sickle cell disease (SCD) is traditionally treated in Nigeria by the Traditional Medical Practitioners (TMPs) with medicinal plants and other plant products. One of the herbs commonly used singly or in combination with other plant materials is Khaya, which is widely distributed in Africa, with three species existing in Nigeria. These are Khaya senegalensis A. Juss (KS), Khaya grandifoliola (WELW) CDC (KG) and Khaya ivorensis A. Chev. (KI). In this study we evaluated the anti-sickling activities of the leaf extracts of the three Khaya species leaves with a view to authenticating the ethnomedicinal claims, and assess the proximate as well as the elemental constituents that may contribute to the properties. Dried leaves of the Khaya species were extracted by cold maceration and Soxhlet methods using water, ethanol and petroleum spirit as extractives. Filtered extracts were concentrated in vacuo at 40oC and dried in a lyophilizer. Inhibitory and reversal models were employed to evaluate their anti-sickling effects on Hb SS red blood cells following standard procedures. Proximate and elemental analysis were determined using the simple analytical procedure as described by the Association of Official Analytical Chemistry (AOAC) of 1987, 13th Edition Washington DC P1094 and Dry Ashing method of AOAC 2006 respectfully. Anti-sickling results showed that the Soxhlet ethanol extracts of the Khaya species demonstrated significant (p≤0.05) ability to reverse and inhibit the sickling of red blood cells in-vitro with KI having the highest inhibitory and reversal of 60.04+1.77% and 74.97+2.23% respectively at 4 mg/ml concentration. The proximate analysis revealed the richness of the Khaya leaves in minerals, proteins and carbohydrates. Khaya leaves contained calcium, magnesium, sodium, phosphorus, and other essential elements within the limits of dietary requirement. Khaya species could therefore be recommended for further development into herbal remedy in the management of sickle cell disease.

LC-MS/MS Analysis of crude Flavonoid Compounds from &lt;i&gt;Justicia secunda&lt;/i&gt; from Democratic Republic of the Congo and evaluation of their antisickling Activity

&lt;i&gt;Justicia secunda&lt;/i&gt; 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 &lt;i&gt;J. secunda&lt;/i&gt; using LC-ESI/MS/MS. &lt;i&gt;J. secunda&lt;/i&gt; 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 &lt;i&gt;J. secunda&lt;/i&gt; and identify potential compounds for the development of novel anti-sickling agents.

Black Americans With Sickle Cell Disease (SCD) Demonstrate Accelerated Epigenetic Pace of Aging Compared to Black Americans Without SCD.

Sickle cell disease (SCD) is a chronic medical condition characterized by red blood cell sickling, vaso-occlusion, hemolytic anemia, and subsequently, end-organ damage and reduced survival. Because of this significant pathophysiology and early mortality, we hypothesized that patients with SCD are experiencing accelerated biological aging compared with individuals without SCD. We utilized the DunedinPACE measure to compare the epigenetic pace of aging in 131 Black Americans with SCD to 1391 Black American veterans without SCD. SCD patients displayed a significantly accelerated pace of aging (DunedinPACE mean difference of 0.057 points) compared with the veterans without SCD, whereby SCD patients were aging ≈0.7 months more per year than those without SCD (p = 4.49 × 10-8). This was true, even though the SCD patients were significantly younger according to chronological age than the individuals without SCD, making the epigenetic aging discrepancy even more apparent. This association became stronger when we removed individuals with posttraumatic stress disorder from the non-SCD group (p = 2.18 × 10-9), and stronger still when we restricted the SCD patients to those with hemoglobin SS and Sβ0 thalassemia genotypes (p = 1.61 × 10-10). These data support our hypothesis that individuals with SCD experience accelerated biological aging as measured by global epigenetic variation. The assessment of epigenetic measures of biological aging may prove useful to identify which SCD patients would most benefit from clinical interventions to reduce mortality.

Morphological Factors and Forces Acting in Normal and Sickled Erythrocytes in Sickle Cell Anemia: A Mathematical Model

We carried out a theoretical study that considers the morphological factors and forces acting on a normal and a sickled blood cell. Sickle cell disease is associated with vaso-occlusion which creates blood flow crises as a result of loss in shape memory of the normal red blood cell. Certain forces and chemical compositions acting on the cell could retain the shape memory. The problem of a second order partial differential equation modeled was solved to get the forces and chemical composition required to restore the sickled red blood cells back to its original shape. The results gotten showed that, increase in chemical reaction increased the RBC growth by creating a stretching force that causes the sickle cell to regain elasticity with improved oxygen.

Oxygen release from hemoglobin has limited effects on mitochondrial respiration measured from red blood cells. Reply to the Comment on "Increased retention of functional mitochondria in mature sickle red blood cells is associated with increased sickling tendency, hemolysis and oxidative stress".

Not available.

Exercise and training in sickle cell disease: Safety, potential benefits, and recommendations.

Sickle cell disease (SCD) is a genetic disorder characterized by complex pathophysiological mechanisms leading to vaso-occlusive crisis, chronic pain, chronic hemolytic anemia, and vascular complications, which require considerations for exercise and physical activity. This review aims to elucidate the safety, potential benefits, and recommendations regarding exercise and training in individuals with SCD. SCD patients are characterized by decreased exercise capacity and tolerance. Acute intense exercise may be accompanied by biological changes (acidosis, increased oxidative stress, and dehydration) that could increase the risk of red blood cell sickling and acute clinical complications. However, recent findings suggest that controlled exercise training is safe and well tolerated by SCD patients and could confer benefits in disease management. Regular endurance exercises of submaximal intensity or exercise interventions incorporating resistance training have been shown to improve cardiorespiratory and muscle function in SCD, which may improve quality of life. Recommendations for exercise prescription in SCD should be based on accurate clinical and functional evaluations, taking into account disease phenotype and cardiorespiratory status at rest and in response to exercise. Exercise programs should include gradual progression, incorporating adequate warm-up, cool-down, and hydration strategies. Exercise training represents promising therapeutic strategy in the management of SCD. It is now time to move through the investigation of long-term biological, physiological, and clinical effects of regular physical activity in SCD patients.

Does hemoglobin affect measures of mitochondrial respiration in red blood cells? Comment to "Increased retention of functional mitochondria in mature sickle red blood cells is associated with increased sickling tendency, hemolysis and oxidative stress".

Does hemoglobin affect measures of mitochondrial respiration in red blood cells? Comment to "Increased retention of functional mitochondria in mature sickle red blood cells is associated with increased sickling tendency, hemolysis and oxidative stress".

End Organ Affection in Sickle Cell Disease.

Sickle cell disease is an orphan disease affecting ethnic minorities and characterized by profound systemic manifestations. Although around 100,000 individuals with SCD are living in the US, the exact number of individuals is unknown, and it is considered an orphan disease. This single-gene disorder leads to red blood cell sickling and the deoxygenation of hemoglobin, resulting in hemolysis. SCD is associated with acute complications such as vaso-occlusive crisis, infections, and chronic target organ complications such as pulmonary disease and renal failure. While genetic therapy holds promise to alter the fundamental disease process, the major challenge in the field remains the target end organ damage and ways to mitigate or reverse it. Here, we provide an overview of the clinical manifestations and pathogenesis with a focus on end-organ damage and current therapeutic options, including recent FDA-approved stem cell and gene editing therapies.

Mechanisms of Iron-Mediated Renal Injury in a Mouse Model of Sickle Cell Disease

Background: Sickle cell disease (SCD) is a hematologic disorder characterized by polymerization of the mutated hemoglobin S and sickling of red blood cells, leading to hemolysis, release of free heme/iron, and subsequent tissue iron accumulation. The kidney is one of the most frequently affected organs by iron overload, and chronic hemolysis is associated with chronic kidney disease severity in SCD. The potential role of iron overload in causing the observed renal injury in SCD has never been established. The goal of our study is to identify the impact of iron accumulation on the renal phenotype in SCD. We hypothesized that renal iron accumulation causes injury by oxidative stress dependent ferroptosis and/or mitochondrial dysfunction and subsequent kidney damage, that is worse in males than in females. Methods: We used 20-week-old male and female humanized SCD mice (HbSS) and age-matched genetic controls (HbAA). Mice were treated with either vehicle or the iron chelator Deferiprone (DFP, 100 mg/kg/day) for 8 weeks. Urinary excretion of protein and albumin as markers of renal injury were measured. Glomerular filtration rate (GFR) was measured transdermally after injection of FITC-sinistrin. Thiobarbituric acid reactive substance (TBARS) assay was performed for assessment of lipid peroxidation. Mitochondrial bioenergetics was assessed by Oroboros O2k Fluorometer of permeabilized renal cortices. Results: We previously demonstrated comparable iron accumulation in the kidney of male and female mice. However, HbSS males developed a more severe renal injury than females at 20 weeks of age, evidenced by proteinuria (2.52 ± 0.16 vs. 0.55 ± 0.16 mg/24hrs, p=0.0008) and albuminuria (76.44 ± 6.85 vs. 33.9 ± 8.81 μg/24hrs, p=0.0005). There was higher lipid peroxidation, a hallmark of ferroptosis, in the renal cortex of female HbSS than HbAA mice (1.31 ± 0.07 vs. 1.07 ± μM/mg, p=0.04). Bioenergetics studies revealed significantly lower state 3 oxygen consumption rate (108.2 ± 18.1 vs 164.8 ± 9.3 pmol/(s*mg), p=0.05), signifying lower oxidative phosphorylation capacity in HbSS males. In addition, there was significant reduction in state 4◦ respiration (36.4 ± 3.4 vs. 52.8 ± 3.4 pmol/(s*mg), p=0.03) in male HbSS mice. I also detected a decrease in maximum complex IV activity in male HbSS mice (325.5 ± 63.8 vs. 639.5 ± 51.3 pmol/(s*mg), p=0.02). Treatment with DFP improved proteinuria (2.66 ± 0.09 vs. 1.3 ± 0.14 mg/24hrs, p=0.0011) and GFR (165.3 ± 9.4 vs. 236.6 ± 12.6 μl/min, p=0.0058) in male HbSS mice. Conclusion: Iron accumulation causes renal injury which may be attributed to ferroptosis and mitochondrial dysfunction in SCD mice. Funding: NHLBI—R00HL144817 and ASN Norman Siegel Research Grant to MK. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Metabolic Reprogramming of Human Macrophages by Sickle Cell Hemoglobin

BACKGROUND: Sickle cell disease is caused by a single nucleotide mutation in the β-globin gene, resulting in the substitution of valine for glutamic acid, polymerization of hemoglobin and sickling of red blood cells (RBCs) under low oxygen conditions causing chronic hemolysis, and organs damage. SCA is characterized by the presence of cell-free plasma hemoglobin. Organ damage is associated with chronic inflammation and pro-inflammatory macrophages phenotype. Typically, anti-inflammatory response is elicited by the phagocytosis of senescent RBCs and cell-free hemoglobin. We have demonstrated that treatment of human macrophages with sickle cell hemoglobin (HbS) leads to lysosome accumulation, autophagy activation, and pro-inflammatory phenotype. The propensity of mutant HbS to polymerize under low pH may promote lysosomal HbS polymer accumulation, hindering degradation, and inducing macrophage differentiation towards a pro-inflammatory state. The differentiation of macrophages into specific phenotypes is associated with significant metabolic reprogramming. HYPOTHESIS: We hypothesize that the uptake of HbS by human macrophages induces their metabolic reprogramming via mitochondrial remodeling. METHODS: Human THP-1 cells were differentiated into macrophages with PMA and treated with either purified HbS or normal hemoglobin (HbA). Mitochondria were detected with MitoTrackerTM Green FM dye, and mitochondrial ROS (mtROS) level was detected by Mito SOX Red Kit. Transmission electron microscopy imaging was performed at Talos 200X transmission electron microscope. EPView (Olympus) software was used for the structure analysis. Total RNA was isolated by Trizol and sequenced on an Illumina® NextSeq 500. Comparisons between treatments were conducted using Gene Set Enrichment Analysis (GSEA). RESULTS: Immunofluorescent staining demonstrated accumulation of mitochondria after treatment with HbS compared to untreated (ctrl) or HbA-treated macrophages. Electron microscopy revealed an increase in the number and size of mitochondria. In 25 random microphotographs of cytoplasm, we detected 51 mitochondria in control, 79 in HbA treated and, 96 in HbS treated macrophages. The mitochondria volume and cristae size were significantly increased in macrophages treated with HbS. There was no increase in mtROS production in HbS treatment compared to ctrl. As expected, HbA treatment reduced mtROS production. The mitochondrial gene set (242 genes) was the second most enriched GSEA set in HbS-treated compared to HbA-treated macrophages. The larger mitochondrial size may be associated with a reduction of fission or an increase in fusion. We did not find differences in the expression of mitochondrial fission and fusion genes between HbS and HbA-treated macrophages. The increase in the mitochondrial size and cristae size may also be associated with increased oxidative phosphorylation. We found significant enrichment of genes responsible for oxidative phosphorylation in the HbS-treated macrophages. We did not find significant differences in the expression of glycolysis genes. CONCLUSION: Treatment of human macrophages with HbS significantly increases the number and volume of mitochondria, size of the cristae, and oxidative phosphorylation without upregulation of mtROS production and reduction of glycolysis. This work was supported by NIH Research Grants SC1HL150685, P50HL118006, and R01HL125005. We thank Drs. Castle Raley and Keith Crandall, George Washington University SPH Genomics Core, for sequencing and guidance in data analysis; Dr. Christine Brantner, GW Nanofabrication and Imaging Center, for TEM imaging. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

A novel high-titer, bifunctional lentiviral vector for autologous hematopoietic stem cell gene therapy of sickle cell disease

A major limitation of gene therapy for sickle cell disease (SCD) is the availability and access to a potentially curative one-time treatment, due to high treatment costs. We have developed a high-titer bifunctional lentiviral vector (LVV) in a vector backbone that has reduced size, high vector yields, and efficient gene transfer to human CD34+ hematopoietic stem and progenitor cells (HSPC). This LVV contains locus control region cores expressing an anti-sickling βAS3-globin gene and two microRNA adapted short hairpin RNA simultaneously targeting BCL11A and ZNF410 transcripts to maximally induce fetal hemoglobin (HbF) expression. This LVV induces high levels of anti-sickling hemoglobins (HbAAS3 + HbF), while concurrently reducing sickle hemoglobin (HbS). The reduction in HbS and increased anti-sickling hemoglobin impedes deoxygenated HbS polymerization and red blood cell sickling at low vector copy per cell in transduced SCD patient CD34+ cells differentiated into erythrocytes. The dual alterations in red cell hemoglobins ameliorated the SCD phenotype in the SCD Berkeley mouse model in vivo. With high titer and enhanced transduction of HSPC at low multiplicity of infection, this LVV will increase the number of patient doses of vector from production lots to reduce costs and help improve accessibility to gene therapy for SCD.

Enhancing Disease Diagnosis: Statistical Analysis of Haematological Parameters in Sickle Cell Patients, Integrating Predictive Analytics

Sickle cell disease (SCD) affects 30 million people worldwide, causing a range of symptoms from mild to severe, including Vaso occlusive crises (VOC). SCD leads to damaging cycles of sickling and desickling of red blood cells due to HbS polymer formation, resulting in chronic haemolytic anaemia and tissue hypoxia. We propose using machine learning to categorize SCD patients based on haemoglobin, reticulocyte count, and LDH levels, crucial markers of hemolysis. Statistical analysis, particularly Linear Regression, demonstrates how haemoglobin depletion occurs using LDH and reticulocyte parameters.&#x0D; Bilirubin and haemoglobin, two integral biomarkers in clinical biochemistry and haematology, serve distinct yet interconnected roles in human physiology. Bilirubin, a product of heme degradation, is a critical indicator of liver function and various hepatic disorders, while haemoglobin, found in red blood cells, is responsible for oxygen transport throughout the body. Understanding the statistical relationship between these biomarkers has far-reaching clinical implications, enabling improved diagnosis, prognosis, and patient care. This research paper conducts a comprehensive statistical analysis of bilirubin and haemoglobin using various regression techniques to elucidate their intricate association. The primary objective of this study is to characterize the relationship between bilirubin and haemoglobin. Through meticulous data analysis, we explore whether these biomarkers exhibit positive, negative, or no correlation. Additionally, this research develops predictive models for estimating haemoglobin levels based on bilirubin data, offering valuable tools for healthcare professionals in clinical practice.

Endurance training and hydroxyurea have synergistic effects on muscle function and energetics in sickle cell disease mice

Sickle cell disease (SCD) is an hemoglobinopathy resulting in the production of an abnormal Hb (HbS) which can polymerize in deoxygenated conditions, leading to the sickling of red blood cells (RBC). These alterations can decrease the oxygen-carrying capacity leading to impaired function and energetics of skeletal muscle. Any strategy which could reverse the corresponding defects could be of interest. In SCD, endurance training is known to improve multiples muscle properties which restores patient's exercise capacity but present reduced effects in anemic patients. Hydroxyurea (HU) can increase fetal hemoglobin production which can reduce anemia in patients. The present study was conducted to determine whether HU can improve the effects of endurance training to improve muscle function and energetics. Twenty SCD Townes mice have been trained for 8 weeks with (n = 11) or without (n = 9) HU. SCD mice muscle function and energetics were analyzed during a standardized rest-exercise-recovery protocol, using Phosphorus-31 Magnetic resonance spectroscopy (31P-MRS) and transcutaneous stimulation. The combination of training and HU specifically decreased fatigue index and PCr consumption while muscle oxidative capacity was improved. These results illustrate the potential synergistic effects of endurance training and HU on muscle function and energetics in sickle cell disease.