title: Can angiogenesis be a target of treatment for ribavirin associated hemolytic anemia?
abstract: OBJECTIVE
  Recently ribavirin has been found to inhibit angiogenesis and a number of angiogenesis inhibitors such as sunitinib and sorafenib have been found to cause acute hemolysis. We aimed to investigate whether there is a relation between hemoglobin, haptoglobin and angiogenesis soluble markers which are modifiable and can help in developing strategies against anemia.
  
  
  METHODS
  Fourteen patients chronically infected with hepatitis C virus were treated by pegylated interferon alpha 2a and ribavirin. Serum hemoglobin, haptoglobin and angiogenesis markers of vascular endothelial growth factor and angiopoetin-2 were investigated before and after therapy.
  
  
  RESULTS
  We observed a significant decrease in haptoglobin levels at the end of the treatment period. Hemoglobin levels also decreased but insignificantly by treatment. In contrast with the literature, serum levels of angiogenesis factors did not change significantly by pegylated interferon and ribavirin therapy. We found no correlation of angiogenesis soluble markers with either hemoglobin or haptoglobin.
  
  
  CONCLUSIONS
  This is the first study in the literature investigating a link between angiogenesis soluble markers and ribavirin induced anemia in patients with hepatitis C and we could not find any relation. Future research with larger number of patients is needed to find out modifiable factors that will improve the safety of ribavirin therapy.
authors.affiliation: University of Cumhuriyet, Department of Gastroenterology, Sivas, Turkey. ozlemyonem@gmail.com
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yonem
authors.forename: Serab
authors.initials: S
authors.lastname: Arslan
authors.forename: Cenk
authors.initials: C
authors.lastname: Sokmensuer
authors.forename: Selale
authors.initials: S
authors.lastname: Salmanzade
mesh_terms: D000328:Adult; D000368:Aged; D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000188:drug therapy; D042702:Angiopoietin-2 / Q000097:blood; D000998:Antiviral Agents / Q000009:adverse effects*; D005260:Female; D006242:Haptoglobins / Q000032:analysis; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic / Q000187:drug effects*; D012254:Ribavirin / Q000009:adverse effects*; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: D042702:Angiopoietin-2; D000998:Antiviral Agents; D006242:Haptoglobins; D042461:Vascular Endothelial Growth Factor A; D012254:Ribavirin