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Blood, 15 August 2001, Vol. 98, No. 4, pp. 966-971

CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS

The nonexpression of CD36 on reticulocytes and mature red blood cells does not modify the clinical course of patients with sickle cell anemia

Ketty Lee, Pierre Gane, Françoise Roudot-Thoraval, Bertand Godeau, Dora Bachir, Françoise Bernaudin, Jean-Pierre Cartron, Frédéric Galactéros, and Philippe Bierling

From the EFS-Ile de France, Laboratoire d'immunologie leuco-plaquettaire; the Unité d'évaluation-études; the Service de médecine interne; and the Unité de génétique médicale, Hôpital Henri Mondor, AP-HP, Créteil; the Service de pédiatrie, center hospitalier intercommunal de Créteil; and INSERM U76, INTS, Paris, France.

It is thought that an increase in the adhesion of circulating reticulocytes to the vascular endothelium may initiate the vascular occlusion underlying the painful crises and organ failures typical of sickle cell disease (SCD). At least 2 receptors, usually present on reticulocytes, seem to be involved in this adhesion process: glycoprotein CD36 (glycoprotein IV) and integrin alpha 4beta 1 (very late activation antigen-4). Recently, a high frequency of the platelet CD36-deficient phenotype was reported in black Africans. The frequency of this deficiency was similar in subjects with and without SCD. The role of CD36 in vaso-occlusion was then investigated by comparing the clinical course in 2 groups of black Africans homozygous for hemoglobin S, with and without CD36 deficiency, but similar in age, sex, geographical origin, number of alpha -globin genes, and beta -globin gene haplotype. Flow cytometry showed that CD36 was absent from the circulating red blood cells and reticulocytes of platelet CD36-deficient individuals but present on those from patients with normal platelet CD36 expression, and that alpha 4beta 1 integrin levels were similar on the reticulocytes of the 2 groups. Neither clinical severity, as evaluated by the frequency and characteristics of vaso-occlusive events, nor biological data differed significantly in the 2 groups of patients. Finally, although CD36 has been suggested to play a critical role in the pathogenesis of vaso-occlusion, this study, despite including only a small number of patients, supports the idea that the modulation of expression of a single type of adhesion molecule is insufficient to counteract the pathological process leading to vaso-occlusion in SCD patients.

© 2001 by The American Society of Hematology.
 

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