Effect of hydroxyurea on G gamma chain fetal hemoglobin synthesis by sickle-cell disease patients

Abstract

Hydroxyurea is used for sickle-cell disease patients in order to increase fetal hemoglobin synthesis and consequently decrease the severity of pain episodes. Fetal hemoglobin, which is formed by γ-globin chains A and G, is present in a constant composition throughout fetal development: about 75% of Gγ and 25% of Aγ. In contrast, adult red cells contain about 40% of Gγ and 60% of Aγ. In the present study, we analyzed the effect of hydroxyurea induction on the γ chain composition of fetal hemoglobin in 31 sickle-cell disease patients treated with hydroxyurea. The control group was composed of 30 sickle-cell disease patients not treated with hydroxyurea in clinical steady state. The patients were older than 13 years and were not matched for age. All patients were seen at Hemocentro/UNICAMP and Boldrini Infantile Center, Campinas, SP, Brazil. The levels of total hemoglobin were significantly higher in patients treated with hydroxyurea (mean ± SD, 9.6 ± 2.16 g/dl) than in untreated patients (8.07 ± 0.91 g/dl). Fetal hemoglobin levels were also higher in treated patients (14.16 ± 8.31%) than in untreated patients (8.8 ± 4.09%), as was the Gγ/Aγ ratio (1.45 ± 0.78 vs 0.98 ± 0.4, P < 0.005). The increase in the Gγ/Aγ ratio in patients treated with hydroxyurea suggests the prevalence of a pattern of fetal hemoglobin synthesis, whereas patients not treated with hydroxyurea maintain the adult pattern of fetal hemoglobin synthesis. Because no correlation was observed between the Gγ/Aγ ratio and total hemoglobin or fetal hemoglobin levels, the increase in Gγ chain synthesis may not imply a higher production of hemoglobin.