title: Gum Arabic as fetal hemoglobin inducing agent in sickle cell anemia; in vivo study.
abstract: BACKGROUND
  High levels of fetal haemoglobin (HbF) decrease sickle cell anaemia (SCA) severity and leads to improved survival. According to in vivo and in vitro studies, butyrate increases HbF production. Its utilization in clinical practice is hampered, however, by its short half-life. Serum butyrate concentrations could be enhanced by colonic bacterial fermentation of Gum Arabic (GA), edible, dried, gummy exudates from Acacia Senegal tree. We hypothesized that regular intake of GA increases serum butyrate levels, thus inducing HbF production and ameliorating symptoms of sickle cell anemia.
  
  
  METHODS
  Fourty seven patients (5-42 years) carrying hemoglobin SS were recruited from April 2014 to January 2015. Patients received 30 g/day GA for 12 weeks. HbF, blood count and erythropoietin level were measured. The main outcome of interest was the level of HbF after 12 weeks. The secondary outcomes were improvement in clinical and laboratory results. The study was ethically approved by Alneelain University IRB.
  
  
  RESULTS
  The study revealed significant increase in HbF level P.V0.000 [95 % CI, 0.43-1.02], MCV P.V:000 [95 % CI, 2.312-6.058] and Hematocrit level P.V:0.026 [95 % CI, 0.124-1.902]. No significant difference was encountered in platelets count P.V: 0.346 [95 % CI,-25.76-71.94], and WBCs count P.V:0.194 [95 % CI,-8.035-1.68]. Thirty seven percent of patients experienced minor side effects which resolved within a week.
  
  
  CONCLUSIONS
  These findings reveal a novel effect of GA, which may be used to foster fetal hemoglobin production.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT02467257. Registered 3rd June 2015.
authors.affiliation: Department of Physiology Faculty of Medicine, Alneelain University, P.O. Box: 11121, Khartoum, 12702 Sudan.
authors.forename: Lamis
authors.initials: L
authors.lastname: Kaddam
authors.affiliation: Alneelain Research Centre Faculty of Medicine, Alneelain University, Khartoum, Sudan.
authors.forename: Imad
authors.initials: I
authors.lastname: FdleAlmula
authors.affiliation: Department of Hematology, Military Hospital, Khartoum, Sudan.
authors.forename: Omer Ali
authors.initials: OA
authors.lastname: Eisawi
authors.affiliation: Department of Pediatrics, Military Hospital, Khartoum, Sudan.
authors.forename: Haydar Awad
authors.initials: HA
authors.lastname: Abdelrazig
authors.affiliation: Department of Community Medicine Faculty of Medicine, Alneelain University, Khartoum, Sudan.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Elnimeiri
authors.affiliation: Department of Physiology, University of Tübingen, Tübingen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Lang
authors.affiliation: Department of Physiology Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
authors.forename: Amal M
authors.initials: AM
authors.lastname: Saeed