Sickle cell disease (SCD) is a common disorder among African-Americans and other minority populations that is characterized by chronic anemia and episodic """"""""vaso-occlusive"""""""" crises. Acute pulmonary disease, descriptively termed """"""""acute chest syndrome"""""""" (ACS), is one of these events. ACS is a common cause of hospitalization for affected individuals, and it is the most common cause of death clue to SCD. Despite the significance of ACS, its treatment is supportive and often inadequate. Glucocorticoids inhibit several ostensible steps in the pathogenesis of ACS. Specifically, steroids attenuate the inflammatory process, inhibit the enzyme sPLA2, and prevent cytokine-induced expression of adhesion molecules by endothelial cells. A pilot study showed that the glucocorticoid dexamethasone had therapeutic benefit for ACS. This proposal describes a clinical investigation to test rigorously the efficacy of dexamethasone for ACS.
The specific aims of this project are to show that dexamethasone safely decreases the morbidity of ACS using objective measures and to determine whether dexamethasone therapy prevents adverse subacute effects on pulmonary function.
These aims are achieved by a prospective, randomized, double-blind, placebo-controlled clinical trial. Subjects will receive standard supportive therapy for ACS, and they will be randomly assigned to receive either oral dexamethasone or placebo. Efficacy will be assessed by comparing the effect of therapy on the length of hospitalization, the duration of supplemental oxygen therapy, the number of transfusion events, a quantitative measure of opioid use, and the duration of fever. Effect of treatment on pulmonary function and radiographic resolution will be compared one month after discharge. Subjects will also be monitored for potential adverse effects of the study medication. The Southwestern Comprehensive Sickle Cell Center has the expertise and resources to conduct this proposed inter-center investigation, and it will generate the highest quality of clinical evidence to improve the care of individuals with SCD and ACS.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
5U54HL070588-05
Application #
7409089
Study Section
Special Emphasis Panel (ZHL1)
Project Start
2007-04-01
Project End
2008-03-31
Budget Start
2007-04-01
Budget End
2008-03-31
Support Year
5
Fiscal Year
2007
Total Cost
$202,213
Indirect Cost
Name
University of Texas Sw Medical Center Dallas
Department
Type
DUNS #
800771545
City
Dallas
State
TX
Country
United States
Zip Code
75390
Becker, Amy M; Goldberg, Jordan H; Henson, Michael et al. (2014) Blood pressure abnormalities in children with sickle cell anemia. Pediatr Blood Cancer 61:518-22
Vetter, Courtney L; Buchanan, George R; Quinn, Charles T (2014) Burden of diagnostic radiation exposure in children with sickle cell disease. Pediatr Blood Cancer 61:1322-4
McCavit, Timothy L; Xuan, Lei; Zhang, Song et al. (2013) National trends in incidence rates of hospitalization for stroke in children with sickle cell disease. Pediatr Blood Cancer 60:823-7
Becker, Amy M (2011) Sickle cell nephropathy: challenging the conventional wisdom. Pediatr Nephrol 26:2099-109
Neelam, Sudha; Kakhniashvili, David G; Wilkens, Stephan et al. (2011) Functional 20S proteasomes in mature human red blood cells. Exp Biol Med (Maywood) 236:580-91
McCavit, Timothy L; Lin, Hua; Zhang, Song et al. (2011) Hospital volume, hospital teaching status, patient socioeconomic status, and outcomes in patients hospitalized with sickle cell disease. Am J Hematol 86:377-80
Dale, Juanita Conkin; Cochran, Cindy J; Roy, Lonnie et al. (2011) Health-related quality of life in children and adolescents with sickle cell disease. J Pediatr Health Care 25:208-15
McCavit, Timothy L; Quinn, Charles T; Techasaensiri, Chonnamet et al. (2011) Increase in invasive Streptococcus pneumoniae infections in children with sickle cell disease since pneumococcal conjugate vaccine licensure. J Pediatr 158:505-7
Quinn, Charles T; Stuart, Marie J; Kesler, Karen et al. (2011) Tapered oral dexamethasone for the acute chest syndrome of sickle cell disease. Br J Haematol 155:263-7
Ghatpande, Swati S; Choudhary, Pankaj K; Quinn, Charles T et al. (2010) In vivo pharmaco-proteomic analysis of hydroxyurea induced changes in the sickle red blood cell membrane proteome. J Proteomics 73:619-26

Showing the most recent 10 out of 43 publications