Erythrocyte oxidative stress markers in children with sickle cell disease

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=> array:1 [ 0 => array:4 [ "autoresLista" => "Priscila Bacarin Hermann, Mara Albonei Dudeque Pianovski, Railson Henneberg, Aguinaldo José Nascimento, Maria Suely Soares Leonart" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Priscila Bacarin" "apellidos" => "Hermann" "email" => array:1 [ 0 => "prihermann@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Mara Albonei Dudeque" "apellidos" => "Pianovski" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Railson" "apellidos" => "Henneberg" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Aguinaldo José" "apellidos" => "Nascimento" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Maria Suely Soares" "apellidos" => "Leonart" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Clinical Analysis, Clinical Laboratory, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pediatric Hematology and Oncology, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Marcadores de estresse oxidativo em eritrócitos de crianças com doença falciforme" ] ] "textoCompleto" => "IntroductionSickle cell disease is one of the most common hematologic disorders in the world and is a serious public health problem in many countries, including Brazil.<a class="elsevierStyleCrossRef" href="#bib0155">1</a> There are over 2 million Brazilian carriers of the sickle gene, and this disease is estimated to have an incidence of one in every 1000 live births. In 2001, a decree of the Ministry of Health included screening for hemoglobinopathies in the pre-existing screening programs.<a class="elsevierStyleCrossRef" href="#bib0160">2</a>Sickle cell disease has been characterized as a multi-system disease, associated with episodes of acute illness and progressive organ damage, which begins in infancy and is primarily responsible for a shortened life expectancy in affected patients.<a class="elsevierStyleCrossRef" href="#bib0165">3</a> Rates of morbidity and mortality are still high for patients with sickle cell disease. In Brazil, up to 25% of the children affected died during their first 5 years of life, but early diagnosis and treatment might reduce these rates and improve their quality of life.<a class="elsevierStyleCrossRef" href="#bib0170">4</a>Sickle hemoglobin results from a substitution of glutamic acid to valine at the sixth amino acid position of the β-globin chain.<a class="elsevierStyleCrossRef" href="#bib0175">5</a> This ostensibly minor change is the origin of hemoglobin S, and is responsible for significant changes in the stability and solubility of the molecule.<a class="elsevierStyleCrossRef" href="#bib0180">6</a> The tendency of deoxygenated hemoglobin S to undergo polymerization underlies the innumerable expressions of the sickling syndromes with intravascular hemolysis.<a class="elsevierStyleCrossRef" href="#bib0185">7</a> Free plasma hemoglobin is able to initiate lipid peroxidation, and the heme, which readily dissociates from methemoglobin, may contribute significantly to oxidative stress,<a class="elsevierStyleCrossRef" href="#bib0190">8</a> which might play a significant role in the pathophysiology of sickle cell disease-related microvascular dysfunction, vaso-occlusion, and development of organ damage.<a class="elsevierStyleCrossRef" href="#bib0195">9</a> Biomarkers of oxidative stress can therefore be potentially useful, both to identify patients who are at high risk of oxidative damage and to evaluate the effects of anti-oxidative therapies.<a class="elsevierStyleCrossRef" href="#bib0200">10</a>The purpose of this work was to evaluate the parameters of oxidative stress in erythrocytes from children with sickle cell disease, including percentages of hemolysis, methemoglobin, reduced glutathione, thiobarbituric acid-reactive substances, glucose 6-phosphate dehydrogenase activity, reactive oxygen species, and the anti-oxidant enzymes catalase and superoxide dismutase.MethodsChemicalsMeta-phosphoric acid, 2-mercaptoethanol, pyrogallol, 2,2-azobis(2-amidinopropane)hydrochloride (AAPH), ethylenediaminetetraacetic acid (EDTA), and 5,5-dithiobis-2-nitrobenzoic acid (DTNB) were obtained from Sigma–Aldrich (St. Louis, MO, USA). Sodium and potassium phosphates, saponin, trichloroacetic acid, and thiobarbituric acid were supplied by Vetec Ltda (Rio de Janeiro, RJ, Brazil). Sodium citrate, tris(hydroxymethyl)aminomethane, and methanol were obtained from Merck (Darmstadt, Germany). G6-PD activity was determined using a PD410 kit by Randox Laboratories (Antrim, United Kingdom). All organic solvents were of high quality and were double-distilled, and all the other chemicals were of analytical grade.Blood samplesBlood samples were obtained from 45 children diagnosed with sickle cell disease (21 males and 24 females with a mean age of 9 years; range: 3–13) at the hematopediatric department of Hospital de Clínicas, Universidade Federal do Paraná (UFPR). A control group consisted of 280 children without hemoglobinopathies (137 males and 143 females with a mean age of 10 years old; range: 8–11 years) who were participants of the university extension project entitled “Incidence of anemia and parasitic infections in school-aged children in municipal schools of metropolitan region of Curitiba-Parana – Brazil,” from UFPR. The use of human subjects was approved by the Ethical Committee for Research Involving Humans, Hospital de Clínicas, UFPR. Informed consent was obtained from the guardians for all the children. Children with any hematological alteration were excluded from the study.A venous blood sample of 5mL was collected from each patient in K3-EDTA coated tubes. Aliquots (200μL) of whole blood were separated for determination of G6-PD activity. Then, samples were centrifuged at 3000×g for 10min. The plasma and the buffy coat were removed by aspiration, and the erythrocytes were washed with phosphate buffered saline (PBS) (NaCl, 150mmol/L; NaH2PO4, 1.9mmol/L; and Na2HPO4, 8.1mmol/L) three times. Finally, red blood cells were suspended in PBS solution and water to obtain suspensions with hematocrits of approximately 10% and 40% for PBS solution and of approximately 40% for water solution. Hemoglobin concentration was measured in all suspensions. Not all analyses were performed in each specimen due to the limited volumes available.Hematologic parametersThe complete blood count was determined using the Pentra 80 electronic cell counter (Horiba Medical, Japan).Methemoglobin concentrationMethemoglobin concentration was determined according to a method based on Naoum et al.<a class="elsevierStyleCrossRef" href="#bib0205">11</a> adapted to small volumes. Aliquots (100μL) of 10% erythrocyte suspensions were hemolyzed with 100μL of 1% saponin and were stabilized in 1000μL of 60mmol/L phosphate buffer; the absorbance was then determined at 630nm (for methemoglobin) and at 540nm (for oxyhemoglobin). Methemoglobin concentration was expressed as a percentage in relation to hemoglobin concentration.Reduced glutathione determinationReduced glutathione (GSH) concentration was determined by a method previously described by Beutler,<a class="elsevierStyleCrossRef" href="#bib0210">12</a> by evaluating the reduction of 5,5′-dithiobis(2-nitrobenzoic acid) (DTNB) by sulfhydryl compounds from the formation of a yellow colored anionic product whose absorbance was measured at 412nm. Aliquots of 50μL of 40% suspension of red blood cell in PBS were used. The GSH concentration was expressed in μmol/gHb.Lipid peroxidationLipid peroxidation of red blood cell membranes was assessed based on Cesquini et al.<a class="elsevierStyleCrossRef" href="#bib0215">13</a> Aliquots (600μL) of a 10% suspension of red blood cell were added to 250μL of 25% trichloroacetic acid and 600μL of 1% thiobarbituric acid, boiled for 15min at 100°C, and cooled for 5min at 0°C. The absorbance of the thiobarbituric acid reactive substances (TBARS) formed was then read at 532nm using ¿=156/(mmolecm) and the concentrations are expressed in nmol/gHb.Measurement of hemolysisHemolysis of red blood cell was carried out as described by Banerjee et al.,<a class="elsevierStyleCrossRef" href="#bib0220">14</a> adapted to microplates by mixing 10% suspension of red blood cell in PBS with varying amounts of AAPH solution (providing final concentrations of 50, 100, and 150mmol/L). This reaction mixture was incubated for 3h at 37°C with shaking. The extent of hemolysis was determined spectrophotometrically by measuring the absorbance of the hemolysate at 540nm in a microplate reader (Thermo Scientific, Thermo Plate, USA). Red blood cells in a solution of 200mmol/L of AAPH were used as the 100% hemolysis control.Activity of glucose6-phosphate dehydrogenase (G6-PD)Aliquots (200μL) of whole blood before erythrocyte isolation were washed with 2mL PBS three times. G6-PD activity was determined using the Cobas Mira automated analyzer (Roche, Mannheim, Germany) with the PD410 commercial kit (Randox, Antrim, United Kingdom) as described in the manufacturer's manual.Superoxide dismutase activityThe enzyme activity was based on a method adapted from Beutler<a class="elsevierStyleCrossRef" href="#bib0210">12</a> of the auto-oxidation of pyrogallol. Aliquots of 200μL of packed red blood cell were hemolyzed with 300μL of cold deionized water, and a chloroform-ethanol extract was prepared. The mixture was centrifuged at 2300×g for 10min. Varying amounts of the clear supernatant extract (0, 20, 40, 60, 80, 100 and 300μL) were added to a solution of tris–HCl and water. After 10min, 20μL of a 1mmol/L pyrogallol solution was added to each tube and the absorbance was measured at 412nm in a microplate. The amount of extract required to inhibit pyrogallol auto-oxidation by 50% was used to determine the level of enzyme activity.Catalase activityThe enzyme activity was determined by a method adapted from Beutler<a class="elsevierStyleCrossRef" href="#bib0210">12</a> that measures the rate of decomposition of hydrogen peroxide by catalase spectrophotometrically at 240nm. Aliquots of 50μL of 40% suspension of red blood cell were added to 450μL of a hemolyzing solution of β-mercaptoethanol (0.7mmol/L) and EDTA (0.27mol/L). This solution was diluted 1:100 in PBS and 10μL of the final solution was added to 990μL of hydrogen peroxide solution. The decrease in absorbance of the system was measured for 10min.Intracellular reactive oxygen speciesReactive oxygen species were determined according to a method based on López-Revuelta et al.<a class="elsevierStyleCrossRef" href="#bib0225">15</a> adapted to small volumes of blood samples in a microplate. Erythrocytes (995μL of 10%, v/v suspension in PBS) were incubated with 5μL of dichlorodihydrofluorescein-diacetate (DCFDA, 10mol/L) at 37°C for 30min. This suspension was diluted in 9.0mL of PBS and 37.5μL of this was then added to 112.5μL of PBS in 96-well plates. Determination of reactive oxygen species was performed using a GloMax®-Multi Microplate Multimode Reader fluorimeter (Promega Corporation, USA). Under these conditions, DCFDA was hydrolyzed to 2′,7′-dichlorodihydrofluorescein (DCFH2), which then became available for oxidation by reactive oxygen species to produce fluorescent 2,7-dichlorofluorescein (DCF). Fluorescence was determined at 530nm after excitation at 495nm. Reactive oxygen species formation was expressed as fluorescence units (UF)/gHb.Statistical analysesStatistical analysis was performed using Statistica 8.0 software (StatSoft, USA). No outliers were identified. The Kolmogorov–Smirnov test was used to assess the normality and all parameters were distributed normally. Data were expressed as mean±standard deviation and compared between groups using Student's t-test; a p-value <0.05 was considered significant.ResultsData from blood counts of healthy children and patients with sickle cell disease are illustrated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Statistically significant differences were observed for all parameters, except for medium corpuscular hemoglobin (MCH; p<0.05).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Data from oxidative stress parameters are illustrated in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, comparing patients with sickle cell disease with healthy children. Statistically significant differences were observed for methemoglobin, TBARS, percentage of hemolysis, G6-PD activity, and reactive oxygen species (p<0.05).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionNormal erythrocytes suffer oxidative stress due to the production of reactive oxygen species that results from oxygen metabolism. However, this is efficiently repaired by the highly powerful antioxidant systems of the cell without any problematic effect. Oxidative stress occurs as a result of an imbalance between reactive oxygen species production and antioxidant defenses.<a class="elsevierStyleCrossRef" href="#bib0230">16</a>In sickle cell disease, oxidative stress may result from high levels of meta hemoglobin S, which is less stable than meta hemoglobin A, leading to intravascular hemolysis,<a class="elsevierStyleCrossRef" href="#bib0235">17</a> ischemia-reperfusion injury, chronic inflammation, and higher auto-oxidation of sickle hemoglobin.<a class="elsevierStyleCrossRefs" href="#bib0240">18,19</a> Many potential antioxidants are of interest in relation to sickle cell disease,<a class="elsevierStyleCrossRef" href="#bib0250">20</a> and several studies have demonstrated significant increases in stress markers and differing behavior in antioxidant defense systems in patients with sickle cell disease when compared to those in healthy subjects.<a class="elsevierStyleCrossRef" href="#bib0255">21</a>The present results for blood counts confirm several features of sickle cell disease that are already known, such as the hemolytic anemia,<a class="elsevierStyleCrossRef" href="#bib0255">21</a> evidenced by low levels of hemoglobin<a class="elsevierStyleCrossRef" href="#bib0185">7</a> and increased levels of white blood cells and platelets.<a class="elsevierStyleCrossRef" href="#bib0180">6</a>As previously demonstrated,<a class="elsevierStyleCrossRef" href="#bib0190">8</a> methemoglobin levels are increased in individuals with sickle cell disease. There is an electron transfer in the bonding interaction between the heme and the oxygen (O2) in oxygenated hemoglobin. When hemoglobin deoxygenates, the heme iron normally remains in the ferrous state.<a class="elsevierStyleCrossRef" href="#bib0250">20</a> In this exchange, alterations wherein hemoglobin autoxidizes result in methemoglobin, with the heme iron in ferric state.<a class="elsevierStyleCrossRef" href="#bib0190">8</a> Alterations in erythrocyte function or structure can lead to an enhanced flow of methemoglobin that can lead to oxidative stress.<a class="elsevierStyleCrossRef" href="#bib0225">15</a>The increased intra- and extra-erythrocytic oxidative stress induces lipid peroxidation and membrane instability.<a class="elsevierStyleCrossRef" href="#bib0220">14</a> TBARS is one of the existing biomarkers, and this evaluation is an indirect quantification of lipid peroxidation processes, which makes it a good indicator of pro-oxidant stimuli. In accordance with results reported previously,<a class="elsevierStyleCrossRefs" href="#bib0245">19,20,22</a> the present study observed significantly higher levels of TBARS in patients with sickle cell disease than in the controls.Rigid and deformed sickle erythrocytes have a shortened lifespan and undergo both intravascular and extravascular hemolysis.<a class="elsevierStyleCrossRef" href="#bib0265">23</a> Higher percentages of hemolysis in erythrocyte from children with sickle cell disease than in the control group were observed, both in basal suspensions of erythrocytes and in suspensions incubated with an oxidizing agent.G6-PD is an important enzyme related to the antioxidant defense in erythrocytes.<a class="elsevierStyleCrossRef" href="#bib0250">20</a> Higher activity of this enzyme in patients with sickle cell disease was found than in the control group. It was previously reported that erythrocytes from patients with sickle cell disease have an increased percentage of reticulocytes, while the activity of G6-PD in reticulocytes is normal, but declines exponentially as the red cells age.<a class="elsevierStyleCrossRef" href="#bib0270">24</a>Sickle cells spontaneously generate approximately two times more reactive oxygen species than normal red blood cells.<a class="elsevierStyleCrossRef" href="#bib0275">25</a> In accordance with the findings of George et al.,<a class="elsevierStyleCrossRef" href="#bib0280">26</a> elevated levels of reactive oxygen species in sickle erythrocytes were also demonstrated.Reduced glutathione (GSH) is present at high concentrations in erythrocytes and acts by itself or via glutathione peroxidase as a major reducing source to maintain cell integrity.<a class="elsevierStyleCrossRef" href="#bib0235">17</a> The measurements of GSH and its oxidized form glutathione disulfide (GSSG) have been considered useful indicators of in vivo oxidative stress.<a class="elsevierStyleCrossRef" href="#bib0285">27</a> The majority of studies of adults with sickle cell disease reported some deficits of endogenous synthesis of GSH, probably due to its consumption by increased oxidant production.<a class="elsevierStyleCrossRefs" href="#bib0280">26,28</a> Although Rusanova et al.<a class="elsevierStyleCrossRef" href="#bib0260">22</a> showed high levels of GSH in pediatric patients with sickle cell disease, the present study found no difference in GSH levels between children with sickle cell disease and the control group.Superoxide dismutase can convert superoxide to hydrogen peroxide, and catalase can remove excess hydrogen peroxide.<a class="elsevierStyleCrossRef" href="#bib0230">16</a> According to Silva et al.,<a class="elsevierStyleCrossRef" href="#bib0250">20</a> the increased pro-oxidant generation in sickle cell disease results in an antioxidant deficiency. However, there are some discrepancies between studies on superoxide dismutase and catalase levels in this disease, with some studies observing increased activity and others observing decreased levels.<a class="elsevierStyleCrossRef" href="#bib0295">29</a> An increase in these enzymes activity potentially constitutes a defense mechanism in response to increased oxidative stress,<a class="elsevierStyleCrossRef" href="#bib0245">19</a> or might be a consequence of increased reticulocyte content in blood samples from patients with sickle cell disease. However, a decrease in enzyme levels was related to disease severity in patients.<a class="elsevierStyleCrossRefs" href="#bib0250">20,22</a> These seemingly contradictory findings could be due to differences in the extent of oxidative stress, disease severity, enzyme polymorphism, and the enzyme co-factor.<a class="elsevierStyleCrossRef" href="#bib0295">29</a> The present results showed no difference between the activities of these enzymes in children with sickle cell disease and those in healthy children, according with Cho et al.<a class="elsevierStyleCrossRef" href="#bib0300">30</a> with regard to catalase. These results may be due to large individual variability found among patients.In light of evidence suggesting that an excess of oxidative stress has implications in sickle cell disease pathophysiology, the assessment of oxidative stress parameters in these patients may provide useful information regarding the use of current medications and may lead to the development of new therapeutic strategies.<a class="elsevierStyleCrossRefs" href="#bib0200">10,19,20</a> Monitoring the oxidative stress involves the observation of different parameters associated with pro-oxidant and antioxidant biomarkers.<a class="elsevierStyleCrossRef" href="#bib0285">27</a> However, the use of an isolated biomarker and the measurement of individual antioxidants are not likely to be useful indexes of oxidative status. The oxidant–antioxidant balance involves biochemical reactions that require the evaluation of many endpoints.<a class="elsevierStyleCrossRef" href="#bib0280">26</a>The present study evaluated eight oxidative stress markers, including pro-oxidant and antioxidant parameters. The results indicate the presence of a hyperoxidative status in children with sickle cell disease, which can be observed by their high levels of methemoglobin, TBARS, hemolysis, reactive oxygen species, and G6-PD activity. Simple techniques were used to determine these parameters using small volumes of blood. These parameters that appeared altered in children with sickle cell disease can be useful in the evaluation of disease progression and treatment.Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres696342" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec706078" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres696343" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec706077" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:12 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Chemicals" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Blood samples" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Hematologic parameters" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Methemoglobin concentration" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Reduced glutathione determination" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Lipid peroxidation" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Measurement of hemolysis" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Activity of glucose6-phosphate dehydrogenase (G6-PD)" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Superoxide dismutase activity" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Catalase activity" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Intracellular reactive oxygen species" ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Statistical analyses" ] ] ] 6 => array:2 [ "identificador" => "sec0075" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0080" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-06" "fechaAceptado" => "2015-10-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec706078" "palabras" => array:3 [ 0 => "Oxidative stress" 1 => "Sickle cell disease" 2 => "Children" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec706077" "palabras" => array:3 [ 0 => "Estresse oxidativo" 1 => "Doença falciforme" 2 => "Crianças" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo determine eight parameters of oxidative stress markers in erythrocytes from children with sickle cell disease and compare with the same parameters in erythrocytes from healthy children, since oxidative stress plays an important role in the pathophysiology of sickle cell disease and because this disease is a serious public health problem in many countries. MethodsBlood samples were obtained from 45 children with sickle cell disease (21 males and 24 females with a mean age of 9 years; range: 3–13 years) and 280 blood samples were obtained from children without hemoglobinopathies (137 males and 143 females with a mean age of 10 years; range: 8–11 years), as a control group. All blood samples were analyzed for methemoglobin, reduced glutathione, thiobarbituric acid reactive substances, percentage of hemolysis, reactive oxygen species, and activity of the enzymes glucose 6-phosphate dehydrogenase, superoxide dismutase, and catalase. Data were analyzed using Student's t-test and were expressed as the mean±standard deviation. A p-value of <0.05 was considered significant. ResultsSignificant differences were observed between children with sickle cell disease and the control group for the parameters methemoglobin, thiobarbituric acid reactive substances, hemolysis, glucose 6-phosphate dehydrogenase activity, and reactive oxygen species, with higher levels in the patients than in the controls. ConclusionsOxidative stress parameters in children's erythrocytes were determined using simple laboratory methods with small volumes of blood; these biomarkers can be useful to evaluate disease progression and outcomes in patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivoDeterminar parâmetros de estresse oxidativo em eritrócitos de crianças com doença falciforme e compará-los com os mesmos parâmetros em eritrócitos de crianças saudáveis, pois o estresse oxidativo desempenha um importante papel na fisiopatologia da doença falciforme, considerada um sério problema de saúde pública em muitos países. MétodosForam obtidas amostras de sangue de 45 crianças com doença falciforme (21 meninos e 24 meninas com média de 9 anos, variação de 3 a 13 anos) e 280 amostras de sangue de crianças sem hemoglobinopatias (137 meninos e 143 meninas com média de 10 anos, variação de 8 a 11 anos), como grupo controle. Em todas as amostras foram determinados meta-hemoglobina, glutationa reduzida, substâncias reativas ao ácido tiobarbitúrico, porcentagem de hemólise, espécies reativas de oxigênio e atividade das enzimas glucose6-fosfato desidrogenase, superóxido dismutase e catalase. Os dados foram analisados com o teste t de Student e foram expressos como média±desvio padrão. Um valor de p<0,05 foi considerado significativo. ResultadosForam observadas diferenças significativas entre as crianças com doença falciforme e o grupo controle para os parâmetros meta-hemoglobina, substâncias reativas ao ácido tiobarbitúrico, porcentagem de hemólise, espécies reativas de oxigênio e atividade da enzima glucose6-fosfato desidrogenase, com níveis aumentados nos pacientes. ConclusõesFoi possível determinar parâmetros de estresse oxidativo em eritrócitos de crianças, com técnicas laboratoriais simples e pequenos volumes de sangue. Esses biomarcadores podem ser úteis na avaliação da progressão e dos resultados de tratamentos da doença." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Hermann PB, Pianovski MA, Henneberg R, Nascimento AJ, Leonart MS. Erythrocyte oxidative stress markers in children with sickle cell disease. J Pediatr (Rio J). 2016;92:394–9." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "RBC, red blood cells; MCV, medium corpuscular volume; MCH, medium corpuscular hemoglobin; MCHC, medium corpuscular hemoglobin concentration; WBC, white blood cells; PLA, platelets; CV, Pearson's coefficient of variation (%). Data are presented as mean±standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Control group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">CV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Patients \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">CV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n=280 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n=45 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RBC (106/mm3)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2±0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin (g/dl)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.5±0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.9±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hematocrit (%)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.4±2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.7±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MCV (fl)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.3±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.3±11.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MCH (pg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.2±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.9±4.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MCHC (g/dl)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.3±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.5±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WBC (103/mm3)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8±6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PLA (103/mm3)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">292.4±58.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">458.5±199.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1139693.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Statistically significance difference (Student's t-test)." ] ] ] "descripcion" => array:1 [ "en" => "Hematological values in healthy children (control group) and patients with sickle cell disease." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "METHb, methemoglobin; GSH, reduced glutathione; TBARS, thiobarbituric acid reactive substances; HEMO, hemolysis; G6-PD, glucose 6-phosphate dehydrogenase; SOD, superoxide dismutase; CAT, catalase; ROS, reactive oxygen species. Data presented as mean±standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Control group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Patients \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n=100 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n=45 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">METHb (%)<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GSH (μmol/gHb) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.4±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TBARS (nmol/gHb)<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.6±5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.5±20.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEMO 0<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7±1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEMO 50<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.0±7.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.2±19.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEMO 100<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.5±10.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.7±13.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEMO 150<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.1±7.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.6±5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">G6-PD (U/gHb)<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.2±3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SOD (U/gHb) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1846.1±457.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1832.4±647.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CAT (U/gHb) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6 105±6.6 104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9·105±8.5·104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ROS (UF/gHb)<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1468.0±296.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2427.5±1110.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1139694.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Statistically significant difference (Student's t-test)." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "Percentages of hemolysis with addition of 0–150mmol/L of AAPH solutions." ] ] ] "descripcion" => array:1 [ "en" => "Oxidative stress parameters in normal children (control group) and patients with sickle cell disease." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiologic and social aspects of sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.A. 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Marcadores de estresse oxidativo em eritrócitos de crianças com doença falciforme

Priscila Bacarin Hermanna,

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prihermann@hotmail.com

Corresponding author.

, Mara Albonei Dudeque Pianovskib, Railson Henneberga, Aguinaldo José Nascimentoa, Maria Suely Soares Leonarta

a Department of Clinical Analysis, Clinical Laboratory, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil

b Department of Pediatric Hematology and Oncology, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sickle cell disease is one of the most common hematologic disorders in the world and is a serious public health problem in many countries&#44; including Brazil&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> There are over 2 million Brazilian carriers of the sickle gene&#44; and this disease is estimated to have an incidence of one in every 1000 live births&#46; In 2001&#44; a decree of the Ministry of Health included screening for hemoglobinopathies in the pre-existing screening programs&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Sickle cell disease has been characterized as a multi-system disease&#44; associated with episodes of acute illness and progressive organ damage&#44; which begins in infancy and is primarily responsible for a shortened life expectancy in affected patients&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Rates of morbidity and mortality are still high for patients with sickle cell disease&#46; In Brazil&#44; up to 25&#37; of the children affected died during their first 5 years of life&#44; but early diagnosis and treatment might reduce these rates and improve their quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Sickle hemoglobin results from a substitution of glutamic acid to valine at the sixth amino acid position of the &#946;-globin chain&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> This ostensibly minor change is the origin of hemoglobin S&#44; and is responsible for significant changes in the stability and solubility of the molecule&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> The tendency of deoxygenated hemoglobin S to undergo polymerization underlies the innumerable expressions of the sickling syndromes with intravascular hemolysis&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Free plasma hemoglobin is able to initiate lipid peroxidation&#44; and the heme&#44; which readily dissociates from methemoglobin&#44; may contribute significantly to oxidative stress&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> which might play a significant role in the pathophysiology of sickle cell disease-related microvascular dysfunction&#44; vaso-occlusion&#44; and development of organ damage&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> Biomarkers of oxidative stress can therefore be potentially useful&#44; both to identify patients who are at high risk of oxidative damage and to evaluate the effects of anti-oxidative therapies&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The purpose of this work was to evaluate the parameters of oxidative stress in erythrocytes from children with sickle cell disease&#44; including percentages of hemolysis&#44; methemoglobin&#44; reduced glutathione&#44; thiobarbituric acid-reactive substances&#44; glucose 6-phosphate dehydrogenase activity&#44; reactive oxygen species&#44; and the anti-oxidant enzymes catalase and superoxide dismutase&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Chemicals</span><p id="par0025" class="elsevierStylePara elsevierViewall">Meta-phosphoric acid&#44; 2-mercaptoethanol&#44; pyrogallol&#44; 2&#44;2-azobis&#40;2-amidinopropane&#41;hydrochloride &#40;AAPH&#41;&#44; ethylenediaminetetraacetic acid &#40;EDTA&#41;&#44; and 5&#44;5-dithiobis-2-nitrobenzoic acid &#40;DTNB&#41; were obtained from Sigma&#8211;Aldrich &#40;St&#46; Louis&#44; MO&#44; USA&#41;&#46; Sodium and potassium phosphates&#44; saponin&#44; trichloroacetic acid&#44; and thiobarbituric acid were supplied by Vetec Ltda &#40;Rio de Janeiro&#44; RJ&#44; Brazil&#41;&#46; Sodium citrate&#44; tris&#40;hydroxymethyl&#41;aminomethane&#44; and methanol were obtained from Merck &#40;Darmstadt&#44; Germany&#41;&#46; G6-PD activity was determined using a PD410 kit by Randox Laboratories &#40;Antrim&#44; United Kingdom&#41;&#46; All organic solvents were of high quality and were double-distilled&#44; and all the other chemicals were of analytical grade&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Blood samples</span><p id="par0030" class="elsevierStylePara elsevierViewall">Blood samples were obtained from 45 children diagnosed with sickle cell disease &#40;21 males and 24 females with a mean age of 9 years&#59; range&#58; 3&#8211;13&#41; at the hematopediatric department of Hospital de Cl&#237;nicas&#44; Universidade Federal do Paran&#225; &#40;UFPR&#41;&#46; A control group consisted of 280 children without hemoglobinopathies &#40;137 males and 143 females with a mean age of 10 years old&#59; range&#58; 8&#8211;11 years&#41; who were participants of the university extension project entitled &#8220;Incidence of anemia and parasitic infections in school-aged children in municipal schools of metropolitan region of Curitiba-Parana &#8211; Brazil&#44;&#8221; from UFPR&#46; The use of human subjects was approved by the Ethical Committee for Research Involving Humans&#44; Hospital de Cl&#237;nicas&#44; UFPR&#46; Informed consent was obtained from the guardians for all the children&#46; Children with any hematological alteration were excluded from the study&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A venous blood sample of 5<span class="elsevierStyleHsp" style=""></span>mL was collected from each patient in K3-EDTA coated tubes&#46; Aliquots &#40;200<span class="elsevierStyleHsp" style=""></span>&#956;L&#41; of whole blood were separated for determination of G6-PD activity&#46; Then&#44; samples were centrifuged at 3000<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">g</span> for 10<span class="elsevierStyleHsp" style=""></span>min&#46; The plasma and the buffy coat were removed by aspiration&#44; and the erythrocytes were washed with phosphate buffered saline &#40;PBS&#41; &#40;NaCl&#44; 150<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#59; NaH<span class="elsevierStyleInf">2</span>PO<span class="elsevierStyleInf">4</span>&#44; 1&#46;9<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#59; and Na<span class="elsevierStyleInf">2</span>HPO<span class="elsevierStyleInf">4</span>&#44; 8&#46;1<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41; three times&#46; Finally&#44; red blood cells were suspended in PBS solution and water to obtain suspensions with hematocrits of approximately 10&#37; and 40&#37; for PBS solution and of approximately 40&#37; for water solution&#46; Hemoglobin concentration was measured in all suspensions&#46; Not all analyses were performed in each specimen due to the limited volumes available&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Hematologic parameters</span><p id="par0040" class="elsevierStylePara elsevierViewall">The complete blood count was determined using the Pentra 80 electronic cell counter &#40;Horiba Medical&#44; Japan&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Methemoglobin concentration</span><p id="par0045" class="elsevierStylePara elsevierViewall">Methemoglobin concentration was determined according to a method based on Naoum et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> adapted to small volumes&#46; Aliquots &#40;100<span class="elsevierStyleHsp" style=""></span>&#956;L&#41; of 10&#37; erythrocyte suspensions were hemolyzed with 100<span class="elsevierStyleHsp" style=""></span>&#956;L of 1&#37; saponin and were stabilized in 1000<span class="elsevierStyleHsp" style=""></span>&#956;L of 60<span class="elsevierStyleHsp" style=""></span>mmol&#47;L phosphate buffer&#59; the absorbance was then determined at 630<span class="elsevierStyleHsp" style=""></span>nm &#40;for methemoglobin&#41; and at 540<span class="elsevierStyleHsp" style=""></span>nm &#40;for oxyhemoglobin&#41;&#46; Methemoglobin concentration was expressed as a percentage in relation to hemoglobin concentration&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Reduced glutathione determination</span><p id="par0050" class="elsevierStylePara elsevierViewall">Reduced glutathione &#40;GSH&#41; concentration was determined by a method previously described by Beutler&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> by evaluating the reduction of 5&#44;5&#8242;-dithiobis&#40;2-nitrobenzoic acid&#41; &#40;DTNB&#41; by sulfhydryl compounds from the formation of a yellow colored anionic product whose absorbance was measured at 412<span class="elsevierStyleHsp" style=""></span>nm&#46; Aliquots of 50<span class="elsevierStyleHsp" style=""></span>&#956;L of 40&#37; suspension of red blood cell in PBS were used&#46; The GSH concentration was expressed in &#956;mol&#47;gHb&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Lipid peroxidation</span><p id="par0055" class="elsevierStylePara elsevierViewall">Lipid peroxidation of red blood cell membranes was assessed based on Cesquini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> Aliquots &#40;600<span class="elsevierStyleHsp" style=""></span>&#956;L&#41; of a 10&#37; suspension of red blood cell were added to 250<span class="elsevierStyleHsp" style=""></span>&#956;L of 25&#37; trichloroacetic acid and 600<span class="elsevierStyleHsp" style=""></span>&#956;L of 1&#37; thiobarbituric acid&#44; boiled for 15<span class="elsevierStyleHsp" style=""></span>min at 100<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; and cooled for 5<span class="elsevierStyleHsp" style=""></span>min at 0<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; The absorbance of the thiobarbituric acid reactive substances &#40;TBARS&#41; formed was then read at 532<span class="elsevierStyleHsp" style=""></span>nm using <span class="elsevierStyleItalic">¿</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>156&#47;&#40;mmole<span class="elsevierStyleHsp" style=""></span>cm&#41; and the concentrations are expressed in nmol&#47;gHb&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Measurement of hemolysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Hemolysis of red blood cell was carried out as described by Banerjee et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> adapted to microplates by mixing 10&#37; 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The mixture was centrifuged at 2300<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">g</span> for 10<span class="elsevierStyleHsp" style=""></span>min&#46; Varying amounts of the clear supernatant extract &#40;0&#44; 20&#44; 40&#44; 60&#44; 80&#44; 100 and 300<span class="elsevierStyleHsp" style=""></span>&#956;L&#41; were added to a solution of tris&#8211;HCl and water&#46; After 10<span class="elsevierStyleHsp" style=""></span>min&#44; 20<span class="elsevierStyleHsp" style=""></span>&#956;L of a 1<span class="elsevierStyleHsp" style=""></span>mmol&#47;L pyrogallol solution was added to each tube and the absorbance was measured at 412<span class="elsevierStyleHsp" style=""></span>nm in a microplate&#46; The amount of extract required to inhibit pyrogallol auto-oxidation by 50&#37; was used to determine the level of enzyme activity&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Catalase activity</span><p id="par0075" class="elsevierStylePara elsevierViewall">The enzyme activity was determined by a method adapted from Beutler<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> that measures the rate of decomposition of hydrogen peroxide by catalase spectrophotometrically at 240<span class="elsevierStyleHsp" style=""></span>nm&#46; Aliquots of 50<span class="elsevierStyleHsp" style=""></span>&#956;L of 40&#37; suspension of red blood cell were added to 450<span class="elsevierStyleHsp" style=""></span>&#956;L of a hemolyzing solution of &#946;-mercaptoethanol &#40;0&#46;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41; and EDTA &#40;0&#46;27<span class="elsevierStyleHsp" style=""></span>mol&#47;L&#41;&#46; This solution was diluted 1&#58;100 in PBS and 10<span class="elsevierStyleHsp" style=""></span>&#956;L of the final solution was added to 990<span class="elsevierStyleHsp" style=""></span>&#956;L of hydrogen peroxide solution&#46; The decrease in absorbance of the system was measured for 10<span class="elsevierStyleHsp" style=""></span>min&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Intracellular reactive oxygen species</span><p id="par0080" class="elsevierStylePara elsevierViewall">Reactive oxygen species were determined according to a method based on L&#243;pez-Revuelta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> adapted to small volumes of blood samples in a microplate&#46; Erythrocytes &#40;995<span class="elsevierStyleHsp" style=""></span>&#956;L of 10&#37;&#44; v&#47;v suspension in PBS&#41; were incubated with 5<span class="elsevierStyleHsp" style=""></span>&#956;L of dichlorodihydrofluorescein-diacetate &#40;DCFDA&#44; 10<span class="elsevierStyleHsp" style=""></span>mol&#47;L&#41; at 37<span class="elsevierStyleHsp" style=""></span>&#176;C for 30<span class="elsevierStyleHsp" style=""></span>min&#46; This suspension was diluted in 9&#46;0<span class="elsevierStyleHsp" style=""></span>mL of PBS and 37&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;L of this was then added to 112&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;L of PBS in 96-well plates&#46; Determination of reactive oxygen species was performed using a GloMax<span class="elsevierStyleSup">&#174;</span>-Multi Microplate Multimode Reader fluorimeter &#40;Promega Corporation&#44; USA&#41;&#46; Under these conditions&#44; DCFDA was hydrolyzed to 2&#8242;&#44;7&#8242;-dichlorodihydrofluorescein &#40;DCFH<span class="elsevierStyleInf">2</span>&#41;&#44; which then became available for oxidation by reactive oxygen species to produce fluorescent 2&#44;7-dichlorofluorescein &#40;DCF&#41;&#46; Fluorescence was determined at 530<span class="elsevierStyleHsp" style=""></span>nm after excitation at 495<span class="elsevierStyleHsp" style=""></span>nm&#46; Reactive oxygen species formation was expressed as fluorescence units &#40;UF&#41;&#47;gHb&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Statistical analyses</span><p id="par0085" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using Statistica 8&#46;0 software &#40;StatSoft&#44; USA&#41;&#46; No outliers were identified&#46; The Kolmogorov&#8211;Smirnov test was used to assess the normality and all parameters were distributed normally&#46; Data were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation and compared between groups using Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#59; a <span class="elsevierStyleItalic">p</span>-value &#60;0&#46;05 was considered significant&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">Data from blood counts of healthy children and patients with sickle cell disease are illustrated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Statistically significant differences were observed for all parameters&#44; except for medium corpuscular hemoglobin &#40;MCH&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Data from oxidative stress parameters are illustrated in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; comparing patients with sickle cell disease with healthy children&#46; Statistically significant differences were observed for methemoglobin&#44; TBARS&#44; percentage of hemolysis&#44; G6-PD activity&#44; and reactive oxygen species &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Normal erythrocytes suffer oxidative stress due to the production of reactive oxygen species that results from oxygen metabolism&#46; However&#44; this is efficiently repaired by the highly powerful antioxidant systems of the cell without any problematic effect&#46; Oxidative stress occurs as a result of an imbalance between reactive oxygen species production and antioxidant defenses&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In sickle cell disease&#44; oxidative stress may result from high levels of meta hemoglobin S&#44; which is less stable than meta hemoglobin A&#44; leading to intravascular hemolysis&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> ischemia-reperfusion injury&#44; chronic inflammation&#44; and higher auto-oxidation of sickle hemoglobin&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a> Many potential antioxidants are of interest in relation to sickle cell disease&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> and several studies have demonstrated significant increases in stress markers and differing behavior in antioxidant defense systems in patients with sickle cell disease when compared to those in healthy subjects&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The present results for blood counts confirm several features of sickle cell disease that are already known&#44; such as the hemolytic anemia&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> evidenced by low levels of hemoglobin<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> and increased levels of white blood cells and platelets&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">As previously demonstrated&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> methemoglobin levels are increased in individuals with sickle cell disease&#46; There is an electron transfer in the bonding interaction between the heme and the oxygen &#40;O<span class="elsevierStyleInf">2</span>&#41; in oxygenated hemoglobin&#46; When hemoglobin deoxygenates&#44; the heme iron normally remains in the ferrous state&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> In this exchange&#44; alterations wherein hemoglobin autoxidizes result in methemoglobin&#44; with the heme iron in ferric state&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> Alterations in erythrocyte function or structure can lead to an enhanced flow of methemoglobin that can lead to oxidative stress&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The increased intra- and extra-erythrocytic oxidative stress induces lipid peroxidation and membrane instability&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> TBARS is one of the existing biomarkers&#44; and this evaluation is an indirect quantification of lipid peroxidation processes&#44; which makes it a good indicator of pro-oxidant stimuli&#46; In accordance with results reported previously&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;20&#44;22</span></a> the present study observed significantly higher levels of TBARS in patients with sickle cell disease than in the controls&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Rigid and deformed sickle erythrocytes have a shortened lifespan and undergo both intravascular and extravascular hemolysis&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> Higher percentages of hemolysis in erythrocyte from children with sickle cell disease than in the control group were observed&#44; both in basal suspensions of erythrocytes and in suspensions incubated with an oxidizing agent&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">G6-PD is an important enzyme related to the antioxidant defense in erythrocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Higher activity of this enzyme in patients with sickle cell disease was found than in the control group&#46; It was previously reported that erythrocytes from patients with sickle cell disease have an increased percentage of reticulocytes&#44; while the activity of G6-PD in reticulocytes is normal&#44; but declines exponentially as the red cells age&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Sickle cells spontaneously generate approximately two times more reactive oxygen species than normal red blood cells&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> In accordance with the findings of George et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> elevated levels of reactive oxygen species in sickle erythrocytes were also demonstrated&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Reduced glutathione &#40;GSH&#41; is present at high concentrations in erythrocytes and acts by itself or <span class="elsevierStyleItalic">via</span> glutathione peroxidase as a major reducing source to maintain cell integrity&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> The measurements of GSH and its oxidized form glutathione disulfide &#40;GSSG&#41; have been considered useful indicators of <span class="elsevierStyleItalic">in vivo</span> oxidative stress&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> The majority of studies of adults with sickle cell disease reported some deficits of endogenous synthesis of GSH&#44; probably due to its consumption by increased oxidant production&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26&#44;28</span></a> Although Rusanova et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> showed high levels of GSH in pediatric patients with sickle cell disease&#44; the present study found no difference in GSH levels between children with sickle cell disease and the control group&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Superoxide dismutase can convert superoxide to hydrogen peroxide&#44; and catalase can remove excess hydrogen peroxide&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> According to Silva et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> the increased pro-oxidant generation in sickle cell disease results in an antioxidant deficiency&#46; However&#44; there are some discrepancies between studies on superoxide dismutase and catalase levels in this disease&#44; with some studies observing increased activity and others observing decreased levels&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> An increase in these enzymes activity potentially constitutes a defense mechanism in response to increased oxidative stress&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> or might be a consequence of increased reticulocyte content in blood samples from patients with sickle cell disease&#46; However&#44; a decrease in enzyme levels was related to disease severity in patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20&#44;22</span></a> These seemingly contradictory findings could be due to differences in the extent of oxidative stress&#44; disease severity&#44; enzyme polymorphism&#44; and the enzyme co-factor&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> The present results showed no difference between the activities of these enzymes in children with sickle cell disease and those in healthy children&#44; according with Cho et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> with regard to catalase&#46; These results may be due to large individual variability found among patients&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In light of evidence suggesting that an excess of oxidative stress has implications in sickle cell disease pathophysiology&#44; the assessment of oxidative stress parameters in these patients may provide useful information regarding the use of current medications and may lead to the development of new therapeutic strategies&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;19&#44;20</span></a> Monitoring the oxidative stress involves the observation of different parameters associated with pro-oxidant and antioxidant biomarkers&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> However&#44; the use of an isolated biomarker and the measurement of individual antioxidants are not likely to be useful indexes of oxidative status&#46; The oxidant&#8211;antioxidant balance involves biochemical reactions that require the evaluation of many endpoints&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The present study evaluated eight oxidative stress markers&#44; including pro-oxidant and antioxidant parameters&#46; The results indicate the presence of a hyperoxidative status in children with sickle cell disease&#44; which can be observed by their high levels of methemoglobin&#44; TBARS&#44; hemolysis&#44; reactive oxygen species&#44; and G6-PD activity&#46; Simple techniques were used to determine these parameters using small volumes of blood&#46; These parameters that appeared altered in children with sickle cell disease can be useful in the evaluation of disease progression and treatment&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicts of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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            1 => array:2 [
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            2 => array:2 [
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          "titulo" => "Introduction"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Chemicals"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Blood samples"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Hematologic parameters"
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            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Methemoglobin concentration"
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            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Reduced glutathione determination"
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              "identificador" => "sec0040"
              "titulo" => "Lipid peroxidation"
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            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Measurement of hemolysis"
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            7 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Activity of glucose6-phosphate dehydrogenase &#40;G6-PD&#41;"
            ]
            8 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Superoxide dismutase activity"
            ]
            9 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Catalase activity"
            ]
            10 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Intracellular reactive oxygen species"
            ]
            11 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Statistical analyses"
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        6 => array:2 [
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          "titulo" => "Results"
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          "titulo" => "Discussion"
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    "fechaRecibido" => "2015-07-06"
    "fechaAceptado" => "2015-10-16"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec706078"
          "palabras" => array:3 [
            0 => "Oxidative stress"
            1 => "Sickle cell disease"
            2 => "Children"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec706077"
          "palabras" => array:3 [
            0 => "Estresse oxidativo"
            1 => "Doen&#231;a falciforme"
            2 => "Crian&#231;as"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine eight parameters of oxidative stress markers in erythrocytes from children with sickle cell disease and compare with the same parameters in erythrocytes from healthy children&#44; since oxidative stress plays an important role in the pathophysiology of sickle cell disease and because this disease is a serious public health problem in many countries&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Blood samples were obtained from 45 children with sickle cell disease &#40;21 males and 24 females with a mean age of 9 years&#59; range&#58; 3&#8211;13 years&#41; and 280 blood samples were obtained from children without hemoglobinopathies &#40;137 males and 143 females with a mean age of 10 years&#59; range&#58; 8&#8211;11 years&#41;&#44; as a control group&#46; All blood samples were analyzed for methemoglobin&#44; reduced glutathione&#44; thiobarbituric acid reactive substances&#44; percentage of hemolysis&#44; reactive oxygen species&#44; and activity of the enzymes glucose 6-phosphate dehydrogenase&#44; superoxide dismutase&#44; and catalase&#46; Data were analyzed using Student&#39;s <span class="elsevierStyleItalic">t</span>-test and were expressed as the mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; A <span class="elsevierStyleItalic">p</span>-value of &#60;0&#46;05 was considered significant&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Significant differences were observed between children with sickle cell disease and the control group for the parameters methemoglobin&#44; thiobarbituric acid reactive substances&#44; hemolysis&#44; glucose 6-phosphate dehydrogenase activity&#44; and reactive oxygen species&#44; with higher levels in the patients than in the controls&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Oxidative stress parameters in children&#39;s erythrocytes were determined using simple laboratory methods with small volumes of blood&#59; these biomarkers can be useful to evaluate disease progression and outcomes in patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar par&#226;metros de estresse oxidativo em eritr&#243;citos de crian&#231;as com doen&#231;a falciforme e compar&#225;-los com os mesmos par&#226;metros em eritr&#243;citos de crian&#231;as saud&#225;veis&#44; pois o estresse oxidativo desempenha um importante papel na fisiopatologia da doen&#231;a falciforme&#44; considerada um s&#233;rio problema de sa&#250;de p&#250;blica em muitos pa&#237;ses&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram obtidas amostras de sangue de 45 crian&#231;as com doen&#231;a falciforme &#40;21 meninos e 24 meninas com m&#233;dia de 9 anos&#44; varia&#231;&#227;o de 3 a 13 anos&#41; e 280 amostras de sangue de crian&#231;as sem hemoglobinopatias &#40;137 meninos e 143 meninas com m&#233;dia de 10 anos&#44; varia&#231;&#227;o de 8 a 11 anos&#41;&#44; como grupo controle&#46; Em todas as amostras foram determinados meta-hemoglobina&#44; glutationa reduzida&#44; subst&#226;ncias reativas ao &#225;cido tiobarbit&#250;rico&#44; porcentagem de hem&#243;lise&#44; esp&#233;cies reativas de oxig&#234;nio e atividade das enzimas glucose6-fosfato desidrogenase&#44; super&#243;xido dismutase e catalase&#46; Os dados foram analisados com o teste <span class="elsevierStyleItalic">t</span> de Student e foram expressos como m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desvio padr&#227;o&#46; Um valor de <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado significativo&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram observadas diferen&#231;as significativas entre as crian&#231;as com doen&#231;a falciforme e o grupo controle para os par&#226;metros meta-hemoglobina&#44; subst&#226;ncias reativas ao &#225;cido tiobarbit&#250;rico&#44; porcentagem de hem&#243;lise&#44; esp&#233;cies reativas de oxig&#234;nio e atividade da enzima glucose6-fosfato desidrogenase&#44; com n&#237;veis aumentados nos pacientes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Foi poss&#237;vel determinar par&#226;metros de estresse oxidativo em eritr&#243;citos de crian&#231;as&#44; com t&#233;cnicas laboratoriais simples e pequenos volumes de sangue&#46; Esses biomarcadores podem ser &#250;teis na avalia&#231;&#227;o da progress&#227;o e dos resultados de tratamentos da doen&#231;a&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
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            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Hermann PB&#44; Pianovski MA&#44; Henneberg R&#44; Nascimento AJ&#44; Leonart MS&#46; Erythrocyte oxidative stress markers in children with sickle cell disease&#46; J Pediatr &#40;Rio J&#41;&#46; 2016&#59;92&#58;394&#8211;9&#46;</p>"
      ]
    ]
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">RBC&#44; red blood cells&#59; MCV&#44; medium corpuscular volume&#59; MCH&#44; medium corpuscular hemoglobin&#59; MCHC&#44; medium corpuscular hemoglobin concentration&#59; WBC&#44; white blood cells&#59; PLA&#44; platelets&#59; CV&#44; Pearson&#39;s coefficient of variation &#40;&#37;&#41;&#46; Data are presented as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEMO 50<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEMO 100<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEMO 150<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1832&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>647&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6 10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;6 10<span class="elsevierStyleSup">4</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;9&#183;10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;5&#183;10<span class="elsevierStyleSup">4</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1468&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>296&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2427&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1110&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2015.10.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	5	3	8
2024 October	18	19	37
2024 September	29	40	69
2024 August	31	35	66
2024 July	30	38	68
2024 June	21	19	40
2024 May	21	12	33
2024 April	24	27	51
2024 March	35	21	56
2024 February	29	27	56
2024 January	17	24	41
2023 December	14	23	37
2023 November	18	34	52
2023 October	27	33	60
2023 September	21	37	58
2023 August	15	11	26
2023 July	19	11	30
2023 June	13	13	26
2023 May	21	14	35
2023 April	13	3	16
2023 March	34	17	51
2023 February	18	13	31
2023 January	15	17	32
2022 December	39	25	64
2022 November	31	27	58
2022 October	38	30	68
2022 September	23	42	65
2022 August	19	28	47
2022 July	19	32	51
2022 June	16	25	41
2022 May	15	32	47
2022 April	38	32	70
2022 March	25	28	53
2022 February	13	18	31
2022 January	9	18	27
2021 December	17	22	39
2021 November	8	11	19
2021 October	13	19	32
2021 September	4	5	9
2021 August	8	10	18
2021 July	2	2	4
2021 June	4	10	14
2021 May	12	16	28
2021 April	5	13	18
2021 March	5	11	16
2021 February	6	5	11
2021 January	6	10	16
2020 December	8	5	13
2020 November	10	10	20
2020 October	7	4	11
2020 September	12	14	26
2020 August	6	3	9
2020 July	4	14	18
2020 June	5	6	11
2020 May	7	2	9
2020 April	5	9	14
2020 March	3	9	12
2020 February	10	13	23
2020 January	16	19	35
2019 December	7	10	17
2019 November	1	16	17
2019 October	9	12	21
2019 September	7	14	21
2019 August	7	11	18
2019 July	10	6	16
2019 June	11	14	25
2019 May	10	11	21
2019 April	15	13	28
2019 March	11	4	15
2019 February	9	8	17
2019 January	5	2	7
2018 December	12	9	21
2018 November	37	6	43
2018 October	205	16	221
2018 September	106	8	114
2018 August	28	7	35
2018 July	10	2	12
2018 June	5	4	9
2018 May	24	6	30
2018 April	5	1	6
2018 March	9	3	12
2018 February	6	1	7
2018 January	8	5	13
2017 December	2	2	4
2017 November	6	1	7
2017 October	11	5	16
2017 September	7	2	9
2017 August	1	2	3
2017 July	2	0	2
2017 June	8	3	11
2017 May	5	2	7
2017 April	7	4	11
2017 March	6	6	12
2017 February	6	6	12
2017 January	11	3	14
2016 December	10	13	23
2016 November	5	12	17
2016 October	14	17	31
2016 September	25	9	34
2016 August	55	16	71
2016 July	13	8	21
2016 June	9	10	19
2016 May	17	14	31

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