title: Sickle cell disease, vasculopathy, and therapeutics.
abstract: Sickle cell disease (SCD) is caused by a mutation in both beta globin genes, resulting in chronic hemolysis and multiorgan disease that ultimately leads to premature death. Although hemoglobin S (HbS) polymerization and vaso-occlusion are central to the pathogenesis of SCD, overlapping pathways implicated in SCD-related endothelial dysfunction include hemolysis, defects in nitric oxide metabolism, ischemia-reperfusion injury, oxidative stress, increased cell-to-cell adhesion, and proinflammatory and coagulation mediators. Progression of organ-specific vasculopathy often precedes organ dysfunction and may provide targets for therapeutic intervention. SCD-related vasculopathies include, but are not limited to, moyamoya that often precedes cerebral infarcts or hemorrhage, proliferative retinopathy prior to loss of eyesight, pulmonary vasculopathy associated with pulmonary hypertension, and renal vasculopathy prior to the onset of chronic renal disease. This review evaluates evidence that SCD vasculopathy is a harbinger for organ dysfunction and reviews the potential for targeted antivasculopathy therapies.
authors.affiliation: Department of Medicine, Hematology/Stem Cell Transplant, Vanderbilt and Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. adetola.kassim@vanderbilt.edu
authors.forename: Adetola A
authors.initials: AA
authors.lastname: Kassim
authors.forename: Michael R
authors.initials: MR
authors.lastname: DeBaun
mesh_terms: D000755:Anemia, Sickle Cell / Q000097:blood / Q000150:complications / Q000235:genetics; D004247:DNA / Q000235:genetics*; D015316:Genetic Therapy / Q000379:methods*; D006451:Hemoglobin, Sickle / Q000235:genetics* / Q000378:metabolism; D006801:Humans; D009154:Mutation; D018384:Oxidative Stress / Q000502:physiology*; D014652:Vascular Diseases / Q000209:etiology / Q000235:genetics / Q000378:metabolism
chemical_list: D006451:Hemoglobin, Sickle; D004247:DNA