Potential Benefits of Metformin Use in Sickle Cell Anemia

Abstract

Sickle cell anemia (SCA) is one of the most important genetic disorders known to mankind. Even with the impressive advances in medical science, effective treatment and cure remain challenging. Currently available treatments including hydroxyurea, which is the only FDA approved drug for SCA, and hemopoietic stem cell transplantation all have significant limitations, so the search for new therapeutic options continues. Metformin, the traditional antidiabetic drug has recently gained novel attention from accumulating molecular evidence suggesting its pleiotropic effects and new potential applications. Our study of these new understandings of the pharmacodynamics and pleiotropic effects leads us to propose that the drug may be of potential therapeutic benefit in SCA. Our arguments are premised on a logical correlation of the interconnected pathophysiologic mechanisms in SCA with current information on the molecular pharmacodynamics of metformin. We reviewed existing evidence and deduced the diverse effects of metformin of relevant therapeutic significance in SCA, including enhancement of nitric oxide bioavailability, induction of fetal hemoglobin synthesis, attenuation of the inflammatory phenotype and beneficial effects in ischemia/reperfusion injury. Collectively, these considerations lead us to infer that there is reasonable evidence to support potential therapeutic adaptation of metformin in SCA.




J Hematol. 2016;5(2):41-48
doi: http://dx.doi.org/10.14740/jh275w