ABSTRACTas a therapy in SCD. 25 Hydroxyurea is a cytostatic drug that inhibits ribonucleotide reductase, arresting cell division in the S-phase; additionally, data suggest that hydroxyurea can generate nitric oxide following administration. 26 We recently reported that hydroxyurea exerts anti-angiogenic effects in VEGF-dependent EC angiogenic in vitro assays and inhibits VEGF-dependent neovascularization in Matrigel implants in C57BL/6 mice. 27 This anti-angiogenic activity appears to be mediated by the down-regulation of endothelial hypoxia-inducible factor-1α (HIF-1α) expression, and consequent modulation of miRNA 221 expression, leading to the inhibition of EC proliferation and invasion/migration.
27To lend further support to the hypothesis of an unbalanced angiogenic state in SCD, we investigated the in vitro effects of plasma from patients with SCD on key steps of EC angiogenic behavior, namely, proliferative capability, invasive capacity and the formation of capillary-like EC structures. The plasma contents of angiogenic factors were associated with these data, as was the incidence of proliferative retinopathy in HbSC patients, a clinical manifestation thought to reflect augmented angiogenesis.
28The angiogenic activity of plasma from patients on hydroxyurea therapy was also examined. Finally, to confirm that SCD pathophysiology is associated with exacerbated angiogenesis, in vivo neovascularization was examined in a SCD mouse model, compared with non-SCD mice, utilizing a Matrigel plug angiogenesis assay.
Methods
PatientsPatients with HbSS or HbSC disease (collectively termed SCD) were recruited, during steady-state, at the Hematology Center, UNICAMP (Table 1). Details on the diagnosis of HbSS/HbSC, our definition of steady-state and criteria for commencing hydroxyurea therapy (15-30 mg hydroxyurea/kg/day) are given in the Online Supplementary Information. All patients had undergone ophthalmoscopy and fluorescein angiography for detection of proliferative retinopathy. A total of 29 HbSS patients, who did not have proliferative retinopathy, were recruited into the study. A total of 33 HbSC patients were recruited, of whom 16 did not have proliferative retinopathy (SC group) and 17 did (SCR group). One HbSC patient had been prescribed hydroxyurea following an ischemic stroke. Homozygous hemoglobin A (HbAA) healthy controls were age-and gender-matched, where possible. Informed written consent was obtained from all participants and the study was approved by the UNICAMP Ethics Committee, in accordance with national guidelines.
Bioplex assayThe Fluorokine ® MAP, Human Angiogenesis Custom Premix Kit A (R&D Systems, Minneapolis, USA) was used to quantify Ang1, basic fibroblast growth factor (bFGF), PlGF, platelet-derived growth factor (PDGF)-AA, PDGF-BB, VEGF, VEGF-D, endostatin and thrombospondin-2 (TSP-2) in plasma, according to the manufacturer's instructions. The preparation of the plasma for the assay is described in the Online Supplementary Information.
In vitro culture of human umbilical vein endothelial c...