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Thursday, 10 May 2012

"The Possible Future Treatment of Sickle cell anemia"


* Professor Pranab Kumar Bhattacharya MD(cal) FIC path(Ind)- Professor and Head,*Miss Upasana Bhattacharya- daughter of Prof.PK Bhattacharya  **Mr. Rupak Bhattacharya Bsc(cal) MSc(JU),** Mr Ritwik Bhattacharya; **Miss Rupsa Bhattacharya** Mr .Soumak Bhattacharya BHM, MSc-student(PUSHA) New Delhi;All of Residence- 7/51 Purbapalli, Sodepur, Dist 24 parganas(north) kol-110, ***Oindrila Mukherjee*** Mrs. Dalia Mukherjee BA(Hons) cal;*** Mr Debasis Mukherjee Bsc(cal). Dr. Ranu Roy Biswas MD(cal) Asst Professor. *Dr. Anuradha De DCP(cal) MD(AIIMS) Associate Professor; *Dr. Soma Das MBBS(cal) DCH(cal) Demonstrator; **
·       Affiliation-*  Department of Pathology , Calcutta School of Tropical Medicine, CR Avenue ,Kol-73; W.B; India ** 7/51 Purbapalli, Po-Sodepur; Dist 24 pargnas( West Bengal) Kol-20*** Swamijinagar, South Habra, 24 Parganas(north) West Bengal.

Scientists have learned a great deal about sickle cell anaemia during the past 30 years - what causes it, how it affects the patient, and how to treat some of its complications. They also have begun to have success in developing drugs that will prevent the symptoms of sickle cell anaemia and procedures that should ultimately provide a possible cure.
Some researchers are focusing on identifying drugs that will increase the level of fetal hemoglobin in the blood. studies have shown that these people have less severe cases of the disease. Fetal  hemoglobin seems to prevent 
sickling of red cells, and cells containing fetal hemoglobin tend to  survive longer in the bloodstream.
Hydroxyurea appears to work primarily by stimulating production of fetal hemoglobin. There is some evidence that administering hydroxyurea with erythropoietin, a genetically engineered hormone that stimulates red cell 
production, may make hydroxyurea work more better. This combination approach offers the possibility that lower doses of hydroxyurea can be  used to achieve the needed level of fetal haemoglobin to reduce side effects of both toxic drugs to search for safer agents that are just as effective.'Butyrate,- a simple fatty acid tha is widely used as a food additive, is 
also being investigated as an agent that may increase fetal hemoglobin production. Clotrimazole, an over-the-counter medication commonly used to treat fungal infections, is under investigation as a treatment to prevent the loss of 
water from RBC  that contributes to sickling.  Bone marrow transplantation has been shown to provide a cure for severely   affected children with sickle cell disease. Researchers are working on techniques to further reduce some of the risks of bone marrow transplantation for  patients with sickle cell disease.The ultimate cure for sickle cell anemia may be gene therapy.  Gene therapy offers enormous promise as a potential curative therapy for SCD, but concerns over the safety of random genomic insertion must first be resolved . Pre-clinical studies in mice have provided the proof of  principle that transduction of bone marrow stem cells with lentiviral vectors that express a beta-globin gene can prevent Hb S polymerization in vivo. The wide range of abnormalities engendered by the sickle cell mutation offers several other opportunities for therapeutic interventions.For example, the NIH Road Map is supporting ongoing investigations in which high-through put screening approaches are used to discover novel low -molecular-weight compounds that can alter key aspects of the disease, Including hemoglobin polymerization, expression of Hb F, and leukocyte  adhesion. Current clinical trials are evaluating the efficacy of Ca2+- sensitive Gardos channel inhibitors , with or without hydroxyurea, in  preventing dehydration of erythrocytes . Vasoactive drugs (e.g., NO, sildenafil, endothelin antagonists) are being evaluated for the treatment if pulmonary hypertension. Statins are of potentially great interest since they can increase NO production and reduce leukocyte adhesion .  Selective antagonists & Intravenous gammaglobulins are currently under clinical evaluation following a study  demonstrating a dose-dependent reduction in leukocyte adhesion and in the number of interactions between rbc and wbc, accompanied by improvements in
microcirculatory blood flow and survival of sickle transgenic mice . Almost a century after SCD was first 
described, we may be towards the dawn of a new era in which a physician one day might be able to use genetic information to select one or more drugs that target specific aspects of disease pathophysiology that are 
relevant to a particular patient with SCD

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