RESUMO
A Anemia Falciforme (AF) é uma doença hereditária homozigótica caracterizada por anemia hemolítica grave e manifestações clínicas variáveis, considerada uma doença inflamatória crônica. A AF resulta de uma mutação pontual em uma base nitrogenada no sexto códon do gene da beta globina, levando a substituição do nucleotídeo adenina por timina (GAG →GTG), o que resulta na produção do aminoácido valina no lugar do ácido glutâmico. A fisiopatologia inflamatória da AF está centralizada na capacidade de polimerização da HbS que leva à hemólise crônica e à vaso-oclusão. Os pacientescom AF encontram-se em um estado inflamatório crônico de origem multifatorial, que envolve células endoteliais, eritrócitos, leucócitos e plaquetas através do aumento nas interações entre célula-célula e célula-endotélio iniciando uma lesão endotelial. O estudo foi do tipo transversal prospectivo com a finalidade de investigar a associação dos haplótipos com o perfil inflamatório de pacientes com AF. Foi realizada a confirmação da HbSS e em seguida o estudo dos haplótipos da mutação BS no gene da cadeia beta globínica. Foram dosados os marcadores IL-6, IL-8, TNF-α, IL-17, PCR-us, IL-10 e TGF-βem 67 pacientes com AF e em 26 indivíduos saudáveis. Observou-se a prevalência do haplótipo Bantu (67,1%) na população de pacientes estudada, seguido do haplótipo Benin (28,3%). O estudo confirma que os pacientes com AF encontram-se em um estado inflamatório crônico, pois apresentaram valores elevados de marcadores pró-inflamatórios e antiinflamatório, quando comparadas à indivíduos saudáveis. O haplótipo Bantu obteve mais elevados índices das citocinas pró-inflamatórias e da PCR-us quando comparados aos valores para o Haplótipo Benin...
The Sickle Cell Anemia (SCA) is an inherited disease characterized by homozygous severe hemolytic anemia and clinical variables, considered a chronic inflammatory disease. SCA results from a mutation in a nitrogenous base in the sixth codon of the beta globin gene, leading to substitution of adenine for thymine nucleotide (GAG →GTG), which results in the production of the amino acid valine in place of glutamic acid. The inflammatory pathophysiology of SCA is centered on the ability of HbS polymerization that leads to chronic hemolysis and vaso-occlusion. SCA patients are a chronic inflammatory state of multifactorial origin that involves endothelial cells, erythrocytes, leukocytes and platelets by increasing the interactions between cell-cell and cell-endothelium starting an endothelial injury. The study was a cross-sectional prospective in order to investigate the association of haplotypes with the inflammatory profile of patients with AF. Was performed to confirm the HbSS and then study the haplotypes BS mutation in the gene for beta globin chain. We measured markers IL-6, IL-8, TNF-α, IL-17, CRP, IL-10 and TGF-β on 67 patients with SCA and 26 healthy subjects. We observed the prevalence of Bantu haplotype (67.1%) in the patient population studied, followed by the Benin haplotype (28.3%). The study confirms that SCA patients are in a chronic inflammatory state, as had elevated markers of proinflammatory and anti-inflammatory when compared to healthy subjects. The Bantu achieved higher levels of proinflammatory cytokines and CRP compared to the values for Haplotype Benin...
Assuntos
Humanos , Anemia Falciforme , Haplótipos , InflamaçãoRESUMO
Background: Sickle cell anemia is a chronic inflammatory disease characterized by an increased production of proinflammatory cytokines including tumor necrosis factor-alpha. Hydroxyurea, by decreasing the polymerization of hemoglobin, reduces inflammatory states. The effect of the genetic polymorphisms of sickle cell patients on tumor necrosis factor-alpha levels remains unknown. Objective: The aim of this study was to investigate the association of tumor necrosis factor-alpha levels with β-globin haplotypes and the use of hydroxyurea. Methods: A cross-sectional study was performed of 67 patients with sickle cell anemia diagnosed at steady-state in a referral hospital in Fortaleza, Ceará, Brazil. A group of 26 healthy individuals was used as control. βS-haplotype analysis was performed by restriction fragment length polymorphism-polymerase chain reaction. The tumor necrosis factor-alpha levels were measured by the enzyme-linked immunosorbent assay test. Laboratory data (complete blood count and fetal hemoglobin) and information regarding the use of hydroxyurea were obtained from medical records. Statistical analysis was performed using R software with the Kruskal-Wallis and Mann-Whitney tests. Statistical significance was established for p-values < 0.05 for all analyses. Results: The mean age of the participants was 35.48 years. Patients with sickle cell anemia had significantly higher tumor necrosis factor-alpha levels than controls (p-values < 0.0001). Tumor necrosis factor-alpha levels were lower in sickle cell anemia patients who were receiving hydroxyurea treatment than those who were not (p-value = 0.1249). Sickle cell anemia patients with Bantu/n genotype had significantly higher levels than patients with the Bantu/Benin genotype (p-value = 0.0021). Conclusion: In summary, βS-globin haplotypes, but not hydroxyurea therapy, have a role in modulating tumor necrosis factor-alpha levels in sickle cell anemia adults at steady-state...