Affiliations: [a] Department of Physics, Wake Forest University, Winston-Salem, NC, USA
| [b] Translational Science Center, Wake Forest University, Winston-Salem, NC, USA
| [c] Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| [d] Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Correspondence:
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Corresponding author: Daniel B. Kim-Shapiro, Department of Physics, Wake Forest University, Winston-Salem, NC 27109, USA. Tel.: +1 336 758 4993; Fax: +1 336 758 6142; E-mail: [email protected].
Abstract: Sickle cell disease is caused by a mutant form of hemoglobin that polymerizes under hypoxic conditions which leads to red blood cell (RBC) distortion, calcium-influx mediated RBC dehydration, increased RBC adhesivity, reduced RBC deformability, increased RBC fragility, and hemolysis. These impairments in RBC structure and function result in multifaceted downstream pathology including inflammation, endothelial cell activation, platelet and leukocyte activation and adhesion, and thrombosis, all of which contribute vascular occlusion and substantial morbidity and mortality. Hemoglobin released upon RBC hemolysis scavenges nitric oxide (NO) and generates reactive oxygen species (ROS) and thereby decreases bioavailability of this important signaling molecule. As the endothelium-derived relaxing factor, NO acts as a vasodilator and also decreases platelet, leukocyte, and endothelial cell activation. Thus, low NO bioavailability contributes to pathology in sickle cell disease and its restoration could serve as an effective treatment. Despite its promise, clinical trials based on restoring NO bioavailability have so far been mainly disappointing. However, particular “NO donating” agents such as nitrite, which unlike some other NO donors can improve sickle RBC properties, may yet prove effective.
