حالة الاجهاد التأكسدي وازالة سموم البيليروبين غير المقترن في المرضى المصابين بفقر الدم المنجلي

Oxidative stress state and detoxification of un-conjugated bilirubin in patients with sickle cell anemia

Sickle cell anemia (SCA) is the most common hereditary disorder of hemoglobin (Hb), which affects approximately a million people worldwide. It is characterized by a single nucleotide substitution in the β-globin gene, leading to the production of abnormal sickle hemoglobin (HbS) with multi-system consequences.
While oxidative stress plays a significant role in the pathophysiology of hemolysis, vessel occlusion, and the subsequent organ damage in sickle cell patients, SCA is also characterized by red cell hemoglobin’s propensity to polymerize and transform the red cell from a biconcave disk shape into a sickle shape, resulting in a typical vaso-occlusive episode and accelerated hemolysis, which in turn affects multiple organ systems in the body. The hepatobiliary system in the digestive tract is most frequently impacted by SCA. The spectrum of acute clinical presentations is frequently referred to as sickle cell hepatopathy, and the manifestations range from benign hyperbilirubinemia to overt liver failure.
The objective of this study is to synthesize a new nanocomposite composed of Prussian blue coated magnetite nanoparticles and investigate their capacity to remove precipitate bilirubin.
This case-control study was done between (May, 2022 and Feb., 2023), at Kerbala Teaching Hospital for pediatrics / thalassemia center and the advanced postgraduate laboratories of the chemistry and biochemistry department in the College of Medicine at university of Kerbala.
There were 100 participants with age range between 15-60 years, that were divided into two groups: 50 patients with sickle cell anemia, whose diagnosis was confirmed by a consultant and 50 healthy people who served as healthy controls.
The exanimation serum levels of antioxidants including catalase(CAT), glutathione peroxidase (G-Px) and reduced glutathione (GSH)were detected using a clinical chemistry analyzer, in addition to measuring the serum level of lipid peroxidation end product malonedialdehyde (MDA) in sickle cell anemia patients.
On the other hand, the chemical co-precipitation method was used to synthesis a Prussian blue-iron oxide nanocomposite that was used as un adsorbent to remove bilirubin because it is a well-documented toxic compound that leads to vessel occlusion and organ damage and through multiple pathways contribute to liver failure diseases. UV Visible Spectrophotometer, zeta-potential, X-Ray diffraction, and transmission electron microscope were used to characterize the nanocomposite.
The results of the study showed a decrease in the levels of serum G-Px and GSH with highly significant differences (P≤ 0.001) and an increase in the level of MDA with significant differences (P≥ 0.05) in patients compared to the control group; while there are no significant differences in levels of CAT function tests in patients as compared with the control group.
The performance of iron oxide@Prussian blue nanocomposites (Fe3O4 @PBNPs) for the removal of bilirubin from blood serum samples were tested in batch mode (pH: 7, the dose of adsorbent: 1mg/mL, and contact time: 30 min, initial concentration: 0.25 mg/mL, Temp. 37.7 ºC) and the result showed the maximum adsorption capacity of bilirubin was 81%.These findings discern the presence of high amounts of precipitate bilirubin in the blood, that may contribute to the development of the spectrum of acute clinical complications including sickle cell hepatopathy. The results of the present work show that Fe3O4@PBNPs have great potential to utilize as a nonhazardous and bio adsorbent for effective adsorption of bilirubin in aqueous solution, blood, and patient serum pool.