Pathways to pulmonary hypertension in sickle cell disease: the search for prevention and early intervention. Issue 10 (3rd October 2017)

• Record Type: Journal Article
• Authors: Shilo, Natalie R.; Morris, Claudia R.
• Is Part Of: Expert review of hematology. Volume 10:Issue 10(2017)
• Page Start: 875
• Page End: 890
• Publication Date: 2017-10-03
• Subjects: Arginase -- arginine -- endothelial dysfunction -- hemolysis -- nitric oxide -- oxidative stress -- pulmonary hypertension -- sickle cell disease; Hematology -- Periodicals; 616.15005
• DOI: 10.1080/17474086.2017.1364989
• Languages: English
• ISSNs: 1747-4086

Abstract

ABSTRACT: Introduction : Pulmonary hypertension (PH) develops in a significant number of patients with sickle cell disease (SCD), resulting in increased morbidity and mortality. This review focuses on PH pathophysiology, risk stratification, and new recommendations for screening and treatment for patients with SCD. Areas covered : An extensive PubMed literature search was performed. While the pathophysiology of PH in SCD is yet to be fully deciphered, it is known that the etiology is multifactorial; hemolysis, hypercoagulability, hypoxemia, ischemic-reperfusion injury, oxidative stress, and genetic susceptibility all contribute in varying degrees to endothelial dysfunction. Hemolysis, in particular, seems to play a key role by inciting an imbalance in the regulatory axis of nitric oxide and arginine metabolism. Systematic risk stratification starting in childhood based on clinical features and biomarkers that enable early detection is necessary. Multi-faceted, targeted interventions, before irreversible vasculopathy develops, will allow for improved patient outcomes and life expectancy. Expert commentary : Despite progress in our understanding of PH in SCD, clinically proven therapies remain elusive and additional controlled clinical trials are needed. Prevention of disease starts in childhood, a critical window for intervention. Given the complex and multifactorial nature of SCD, patients will ultimately benefit from combination therapies that simultaneously targets multiple mechanisms.