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镰状细胞病血管内溶血的治疗方法。

Therapeutics for sickle cell disease intravascular hemolysis.

作者信息

Xue Jianyao, Li Xiang-An

机构信息

Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, KY, United States.

Lexington VA Healthcare System, Lexington, KY, United States.

出版信息

Front Physiol. 2024 Sep 13;15:1474569. doi: 10.3389/fphys.2024.1474569. eCollection 2024.

Abstract

Sickle cell disease (SCD) is a genetic disorder predominantly affecting individuals of African descent, with a significant global health burden. SCD is characterized by intravascular hemolysis, driven by the polymerization of mutated hemoglobin within red blood cells (RBCs), leading to vascular inflammation, organ damage, and heme toxicity. Clinical manifestations include acute pain crises, hemolytic anemia, and multi-organ dysfunction, imposing substantial morbidity and mortality challenges. Current therapeutic strategies mitigate these complications by increasing the concentration of RBCs with normal hemoglobin via transfusion, inducing fetal hemoglobin, restoring nitric oxide signaling, inhibiting platelet-endothelium interaction, and stabilizing hemoglobin in its oxygenated state. While hydroxyurea and gene therapies show promise, each faces distinct challenges. Hydroxyurea's efficacy varies among patients, and gene therapies, though effective, are limited by issues of accessibility and affordability. An emerging frontier in SCD management involves harnessing endogenous clearance mechanisms for hemolysis products. A recent work by Heggland et al. showed that CD-36-like proteins mediate heme absorption in hematophagous ectoparasite, a type of parasite that feeds on the blood of its host. This discovery underscores the need for further investigation into scavenger receptors (e.g., CD36, SR-BI, SR-BII) for their possible role in heme uptake and detoxification in mammalian species. In this review, we discussed current SCD therapeutics and the specific stages of pathophysiology they target. We identified the limitations of existing treatments and explored potential future developments for novel SCD therapies. Novel therapeutic targets, including heme scavenging pathways, hold the potential for improving outcomes and reducing the global burden of SCD.

摘要

镰状细胞病(SCD)是一种主要影响非洲裔个体的遗传性疾病,在全球造成了重大的健康负担。SCD的特征是血管内溶血,由红细胞(RBC)内突变血红蛋白的聚合驱动,导致血管炎症、器官损伤和血红素毒性。临床表现包括急性疼痛危机、溶血性贫血和多器官功能障碍,带来了严重的发病率和死亡率挑战。目前的治疗策略通过输血增加正常血红蛋白的红细胞浓度、诱导胎儿血红蛋白、恢复一氧化氮信号传导、抑制血小板与内皮细胞的相互作用以及稳定血红蛋白的氧合状态来减轻这些并发症。虽然羟基脲和基因疗法显示出前景,但每种疗法都面临着独特的挑战。羟基脲的疗效在患者中存在差异,而基因疗法虽然有效,但受到可及性和可负担性问题的限制。SCD管理的一个新兴前沿领域涉及利用内源性清除机制来清除溶血产物。Heggland等人最近的一项研究表明,CD - 36样蛋白介导吸血外寄生虫(一种以宿主血液为食的寄生虫)对血红素的吸收。这一发现强调了需要进一步研究清道夫受体(如CD36、SR - BI、SR - BII)在哺乳动物物种中血红素摄取和解毒方面可能发挥的作用。在这篇综述中,我们讨论了当前的SCD治疗方法及其针对的病理生理学特定阶段。我们确定了现有治疗方法的局限性,并探索了SCD新疗法未来可能的发展方向。包括血红素清除途径在内的新型治疗靶点有可能改善治疗效果并减轻SCD的全球负担。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7924/11427376/c1f083cfa282/fphys-15-1474569-g001.jpg

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