Abstract
Sickle cell disease (SCD) patients often exhibit a dyslipidemic sub-phenotype. Paraoxonase 1 (PON 1) is a serum glycoprotein associated with the high-density lipoproteins cholesterol (HDL-C), and variability in PON1 activity depends on the PON1 genotypes. We investigated the influence of PON1c.192Q > R and PON1c.55L > M polymorphisms on PON1 activity and laboratory parameters and the association between PON1 activity and clinical manifestations in SCD patients. We recruited 350 individuals, including 154 SCD patients and 196 healthy volunteers, which comprised the control group. Laboratory parameters and molecular analyses were investigated from the participants' blood samples. We have found increased PON1 activity in SCD individuals compared to the control group. In addition, carriers of the variant genotype of each polymorphism presented lower PON1 activity. SCD individuals carrying the variant genotype of PON1c.55L > M polymorphism had lower platelet and reticulocyte counts, C-reactive protein, and aspartate aminotransferase levels; in addition to higher creatinine levels. SCD individuals carrying the variant genotype of PON1c.192Q > R polymorphism had lower triglyceride, VLDL-c, and indirect bilirubin levels. Furthermore, we observed an association between PON1 activity history of stroke and splenectomy. The present study confirmed the association between PON1c.192Q > R and PON1c.55L > M polymorphisms and PON1 activity, in addition to demonstrate their effects on markers of dislipidemia, hemolysis and inflammation, in SCD individuals. Moreover, data suggest PON1 activity as a potential biomarker related to stroke and splenectomy.
Similar content being viewed by others
Introduction
Sickle cell disease (SCD) is a genetic disorder characterized by the presence of hemoglobin S (HbS). The most frequent forms are homozygous (HbSS, sickle cell anemia) or heterozygous (HbSC, or HbSβ-thalassemia). The sickle red blood cell has complex interactions with endothelial cells, leukocytes, platelets, and plasma constituents, leading to vaso-occlusion, which is responsible for most of the clinical features and complications of the disease1,2,3. Hemoglobin S is vulnerable to slow oxidation followed by oxygen release4,5,6, resulting in chronic cycles of vascular ischemia–reperfusion and tissue injury. This direct tissue ischemia and factors such as plasma hemoglobin-induced endothelial dysfunction, free radical generation, and cytokine activation produce a characteristic chronic inflammatory state2,7. Previous studies suggest a dyslipidemic subphenotype in SCD that is characterized by reductions in total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) and increases in VLDL-C and triglycerides. These lipid alterations were also associated with biomarkers of hemolysis and endothelial dysfunction8,9. Abnormal lipid homeostasis has also been suggested to change during a vaso-occlusive crisis10,11,12.
Paraoxonase-1 (PON1) is an aryldialkylphosphatase glycoprotein synthesized by the liver that circulates in the serum in association with apoA-I of the HDL-C. PON genes are located at chromosome 7q21–22 and contain three members: PON1, PON2, and PON3, and the variability of PON activity has been associated with polymorphisms in these genes13,14,15. The PON1 gene demonstrated its crucial role in lipid metabolism, cardiovascular disease, and atherosclerosis16. Two polymorphisms were identified in the coding region of the PON1 gene, the first where methionine replaces leucine at position 55 (PON1 55 M/L) and the second where arginine replaces glutamine at position 192 (PON1 192 R/Q). The frequency of PON1 polymorphisms varies among human populations17. The PON2 has two polymorphisms: the 148 G/R, where glycine replaces arginine, and the 311 C/S, where cysteine substitutes serine17,18.
HDL-C is a relevant cardiovascular risk factor and a fraction of total cholesterol, which consists of a group of particles originally obtained by plasma ultracentrifugation19,20. The main apolipoproteins of HDL-C are apoA-I and apoA-II. However, others, such as apoA-IV, apoA-V, apoC-I, apoC-II, apoC-III, apoD, and apoE, may be present19,21.
According to reports, PON1 possesses antioxidant and anti-inflammatory properties, as well as the ability to hydrolyze oxidized lipids in LDL-C, atherosclerotic lesions, and macrophages, preventing the initiation and progression of the atherosclerotic lesion22,23,24. The HDL has an anti-atherogenic function and some protective actions, including antioxidant protection, mediation of cholesterol efflux, inhibition of cell adhesion molecule expression and leukocyte activation, induction of nitric oxide (NO) production, regulation of blood coagulation, and platelet activity25. LDL-C oxidation is considered the main event involved in atherosclerosis initiation26,27. Oxidized LDL-C (oxLDL-C) acts as a chemotactic factor for monocytes, contributes to endothelial cell cytotoxicity, platelet activation, smooth muscle cell (SMC) migration, and proliferation, and antagonizes NO vasodilator effects26.
Knowing that PON1 has a crucial role in lipid metabolism and has antioxidant and anti-inflammatory properties, we aimed to investigate the influence of PON1c.192Q > R and PON1c.55L > M polymorphisms on PON1 activity and laboratory parameters and the association between PON1 activity and clinical manifestations in SCD patients.
Methods
Subjects and controls
The present case–control study involved 154 SCD pediatric patients. We included 101 (67.8%) individuals with sickle cell anemia (HbSS) with a mean age of 8.657 ± 0.388 and 45 (44.6%) females; 47 (31.5%) with HbSC disease, with a mean age of 10.787 ± 0.621 and 23 (48.9%) of female, and one (0.7%) four years old infant with Sβ-thalassemia. Patients attended the outpatient clinic of the Hematology and Hemotherapy Foundation of Bahia (HEMOBA). The study also included 196 healthy individuals of pediatric age that matched cases by age, gender, and African ethnic origin as a control group and were selected from individuals that attended the Clinical Laboratory College of Pharmaceutical Sciences at the Federal University of Bahia. The control group had a mean age of 9.310 (± 0.248) with 97 (49.5%) females, and all had an AA hemoglobin profile.
Ethics
The present study was approved by the Institutional Review Board of the Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz Bahia, Brazil), and complies with the Declaration of Helsinki 1964 and its subsequent amendments. Additionally, all patient’s legal guardians provided a signed informed consent form.
Laboratory methods
Hematological analyses were carried out using an electronic cell counter, CELL—DYN 3700 (Santa Clara, USA). Reticulocyte count was performed after blue brilliant cresyl dye staining, and hemoglobin (Hb) profile, as well as HbF levels, were investigated by high-performance liquid chromatography using an HPLC/Variant-II hemoglobin testing system (Bio-Rad, Hercules, California, USA).
Biochemical parameters were assessed from serum by spectrophotometric methods using an immunochemistry assay (A25 system, BIOSYSTEMS SA, Barcelona, Spain). C-reactive protein (CRP), anti-streptolysin-O (ASLO), and alpha 1- antitrypsin (A1AT) were assessed by immunochemistry (Immage® 800system, Beckman Coulter, Fullerton, CA). Serum ferritin was measured by immunoassay using an Access® 2 Immunoassay system X2 (Beckman Coulter, Fullerton, CA).
PON1 activity
PON1 activity was measured by adding serum preincubated with 5 µmol/L de serine to 1 mL of tris–HCl buffer (100 mmol/L, pH 8.0) containing 2 mmol/L CaCl2 and 5.5 mmol/L paraoxon (O,O-diethyl-O-nitrophenyl phosphate; Sigma Chemical Co., UK)28. The rate of production of p-nitrophenol (nmol min-1 ml-1 serum) was determined at 25 °C, with a spectrophotometer (SpectraMax, USA) at 405 nm.
PON1 polymorphisms
Molecular analyses were carried out on genomic DNA extracted from peripheral blood leukocytes using the Flexigen 250 kit (Qiagen, Hilden, Germany) following the manufacturer's guidelines. Specific primers were used to identify R192Q and M55L mutations to PON1.
Primers of position 192 were as follows: 5′TAT.TGT.TGC.TGT.GGG.ACC.TGA.G3′ and 5′CAC.GCT.AAA.CCC.AAA.TAC.ATC.TC3′ for 99 bp DNA; of position 55 were 5′GAA.GAG.TGA.TGT.ATA.GCC.CCA.G3′ and 5′TTT.AAT.CCA.GAG.CTA.ATG.AAA.GCC3′ for 170 bp. The PCR products were digested with AlwI to R192Q and CviAII to M55L.
Statistical analysis
Data were expressed as mean ± standard deviation or number or percentage where appropriate. The distribution analysis of quantitative variables was investigated using the Kolmogorov–Smirnov test. An unpaired t-test was used to compare the mean values between the two groups when the distribution within these groups was normal, while Mann–Whitney was used for non-normal distribution. All analyses were performed using the Statistical Package for the Social Sciences (SPSS) v. 20.0 software (IBM, Armonk, New York, USA) and GraphPad Prism v. 6.0 (GraphPad Software, San Diego, California, USA), with p < 0.05 considered statistically significant.
Results
Laboratory characterization
Laboratory parameters, including hematologic, biochemical, and inflammatory biomarkers, of SCD individuals and the control group, are summarized in Table 1.
PON1c.192Q > R and PON1c.55L > M frequencies
Table 2 shows the frequency of PON1c.192Q > R and PON1c.55L > M variants in SCD patients and controls. The frequency of the variant PON1c.192R allele was 0.38 and 0.45 in SCD patients and controls, respectively. Regarding the variant PON1c.55 M, the allelic frequency was 0.09 and 0.15 in SCD patients and controls, respectively.
PON1 activity in SCD and control group
SCD patients showed significantly higher PON1 activity compared to the control group (Fig. 1). Analysis of PON1 activity between SCD and control group, according to the genotypes, showed interesting results. SCD patients with the heterozygote PON1c.192QR genotype exhibited an increase in PON1 activity compared to the control group with the same genotype (p = 0.027). Regarding the PON1c.55L > M polymorphism, SCD patients with the wild-type PON1c.55LL genotype presented an increase in PON1 activity in comparison with the individuals of control group carriers of the same genotype (p = 0.002) (Table 3).
Moreover, the variant (LM + MM) genotype of the PON1c.55L > M polymorphism was associated with a significant decrease in PON1 activity in both SCD and control groups (Fig. 2A,C, respectively). The variant (QR + RR) genotype of the PON1c.192Q > R was also associated with a significant decrease in PON1 activity in the SCD group (Fig. 2B). Noteworthy, no significant association was found between this genotype and PON1 activity in the control group (Fig. 2D).
Association of laboratory parameters and PON1 polymorphism
We also investigated the association of laboratory parameters in SCD with PON1 polymorphisms. The variant (LM + MM) genotype was associated with significant decreases in platelet and reticulocyte counts, CRP, and AST levels, as well as a significant increase in creatinine levels (Fig. 3A–E). In addition, we found significant associations between the variant (QR + RR) genotype and lower triglycerides, VLDL-c, and indirect bilirubin levels (Fig. 3F–H).
Evaluation of clinical manifestations and PON1 activity
We have found that SCD individuals with previous stroke history had lower PON1 activity, while those who underwent splenectomy exhibited higher PON1 activity (Fig. 4).
Discussion
SCD is a group of genetic diseases characterized by the presence of hemoglobin S. Under low oxygen conditions, hemoglobin S forms long polymers, which leads to red blood cell sickling. This event is central to vaso-occlusion, resulting in ischemia, pain, vaso-occlusive crises, and hemolysis1,2,29. SCD patients show heterogeneous clinical manifestations with serious complications related to vaso-occlusive crises, such as splenic sequestration, acute chest syndrome, ischemic stroke, priapism, and leg ulcers1,30. As expected, our data demonstrated statistically significant differences in hematological, biochemical, and inflammatory biomarkers when comparing SCD and the control group.
Analysis of PON1 activity demonstrated a higher level of enzymatic activity in SCD patients compared with the control group, which was corroborated by previous data31. A previous study showed that SCA patients had lower PON1 activity than controls32. The findings of Reichert et al. (2019) also suggest that SCA patients exhibit reduced PON1 activity compared to controls, although no statistical difference was found33. This discrepancy may be due to intrinsic characteristics related to patients and individuals included in the studies and/or the methodology used to access PON1 activity, as well as the studies’ sample size.
Allelic frequency analysis of the PON1c.55L > M and PON1c.192Q > R polymorphisms identified higher frequencies of the PON1c.55L (91% in SCD patients and 85% in controls) and PON1c.192Q (62% in SCD patients and 55% in controls) alleles. The frequencies observed in patients corroborate the findings of a previous study33. A study performed on Caucasians from Europe and America identified that 12%, 43%, and 45% of the individuals had QQ, QR, and RR genotypes, respectively34. The L allele appears to be prevalent among Japanese and Chinese (91–94%) and Caucasians (67–74%)34. The study of Amazonian Amerindian tribes from Brazil identified higher frequencies for L and R alleles (97% and 73%, respectively)35. The differences observed in frequencies may be explained by the geographical origin of the individuals included in the studies and the mixed character of the Brazilian population.
Reports suggest that PON1 polymorphisms may influence enzymatic activity, which has been associated with conditions such as atherosclerotic coronary disease15,35,36. The PON1c.55L > M and PON1c.192Q > R polymorphisms investigated in the present study are known to affect the hydrolytic activity associated with lipid peroxidation. PON1c.55 M allele is associated with decreases in enzyme activity while PON1c.192R leads to an increase in its activity36,37. Reichert et al. also observed a significant association between higher PON activity and the variant PON1c.192RR genotype in patients with SCD. Contrarily, in the present study, within the SCD group, the variant PON1c.192R was associated with a reduction in enzyme activity. This discrepancy related to PON1c.192Q > R and PON activity may be explained by inherent characteristics of the individuals of the different study populations and needs to be elucidated. Moreover, SCD patients with the heterozygote PON1c.192QR genotype exhibited a significant increase in PON1 activity compared to the control group with the same genotype. SCD patients with the wild-type PON1c.55LL genotype presented a significant increase in PON1 activity compared with the individuals in the control group who carried the same genotype. Reichert et al. observed a significant decrease in PON1 activity when comparing SCA patients with heterozygote PON1c.55LM to control carriers of the same genotype33. The authors also found significant decreases in PON1 activity between SCA patients and the controls carrying the PON1c.192QQ and PON1c.192QR genotypes. Our data also demonstrated that carriers of the variant (LM + MM) genotype had lower PON1 activity than those with the wild-type LL genotype. Likewise, those with the variant (QR + RR) genotype had decreased PON1 activity compared to the wild-type QQ genotype. These findings suggest that the variant alleles may be potential risks for SCD patients.
Regarding association analyses, we observed that SCD patients with the variant (LM + MM) genotype had significant decreases in platelet and reticulocyte counts, which may be explained by the establishment of oxidative stress related to a reduction in PON1 activity presented by these patients. Indeed, it is known that the oxidative stress and decreased antioxidant capacity observed in coronary artery disease may lead to changes in platelet function38. The variant (LM + MM) genotype was also associated with significant decreases in CRP and AST levels, as well as a significant increase in creatinine levels, while SCD patients with the variant (QR + RR) genotype exhibited lower indirect bilirubin levels. These alterations may be due to kidney dysfunction related to impairment in PON antioxidant function.
PON is commonly related to lipid metabolism39. It is known that PON1 circulates in the bloodstream linked to apo A-I in HDL27,40, a fraction of serum lipoproteins that have an inverse relationship with total cholesterol and is responsible for the reverse transport of cholesterol circulating in the liver25. This mechanism is mainly involved in protection against the development of coronary disease through potentially anti-atherogenic effects. In this process, HDL inhibits monocyte chemotaxis, adherence of leukocytes, LDL oxidation, and platelet activation. The antioxidant effect of HDL on LDL was attributed to the antioxidant content of lipoproteins and the presence of PON25. It was shown that PON could inhibit HDL oxidation22. A previous report demonstrated a positive correlation between PON1 activity and HDL-C levels in SCA patients33. In the present study, the data did not show any significant association between the investigated polymorphisms and HDL levels. However, SCD patients with the variant (QR + RR) genotype exhibited lower VLDL-c and triglyceride levels.
The VLDL-C is a subclass of lipoprotein synthesized in the liver and responsible for transporting endogenous products (cholesterol, cholesterol esters, triglycerides, and phospholipids) in circulation, which receive the apolipoprotein E and C2 in the capillaries in contact with the lipoprotein lipase (LPL). The action of LPL is the removal of triglycerides from VLDL-c, which turns into LDL-c. The levels of VLDL have been associated with an accelerated rate of atherosclerosis and an increase in the number of diseases and metabolic states25.
Regarding analyses between clinical manifestations and PON1 activity in SCD patients, we observed a significant decrease in PON1 activity in those with previous stroke history or who did not undergo splenectomy. El-Ghamrawy et al. did not observe any association between PON1 activity and clinical manifestations in SCD individuals41. Despite the discrepancy, our data suggest the involvement of PON1 in organ injury, as it was previously reported that an impairment in antioxidant function related to PON2 deficiency could lead to vascular inflammation and abnormalities in blood coagulation42.
Conclusion
Data showed that lipid metabolism is an essential component of vascular homeostasis. The PON appears to prevent the accumulation of lipoperoxide in LDL-C and thus prevent the propagation of lipid peroxidation because of the action of free radicals on oxidized LDL. In SCD patients, the presence of polymorphisms in the PON1 gene, which alters its activity, may be associated with worsening clinical symptoms in these individuals. Further studies are needed to confirm the polymorphism of the PON1 gene as a risk factor for patients with SCD, taking into account the diverse genetic background of the population.
Data availability
The datasets supporting the conclusions of this article are included in the article.
Abbreviations
- Hb:
-
Hemoglobin
- HBA:
-
Globin-α genes
- HbF:
-
Hemoglobin fetal
- HDL-C:
-
High-density lipoprotein cholesterol
- Ht:
-
Hematocrit
- LDH:
-
Lactate dehydrogenase
- LDL-C:
-
Low-density lipoprotein cholesterol
- MCH:
-
Mean corpuscular hemoglobin
- MCV:
-
Mean cell volume
- RBC:
-
Red blood cell
- SCA:
-
Sickle cell anemia
- SCD:
-
Sickle cell disease
- VLDL-C:
-
Very low-density lipoprotein cholesterol
- PON 1:
-
Paraoxonase 1
- NO:
-
Nitric oxide
- oxLDL-C:
-
Oxidized LDL-C
- SMC:
-
Smooth muscle cell
- LPL:
-
Lipoprotein Lipase
References
Pinto, V. M., Balocco, M., Quintino, S. & Forni, G. L. Sickle cell disease: A review for the internist. Intern. Emerg. Med. 14(7), 1051–1064 (2019).
Kato, G. J. et al. Sickle cell disease. Nat. Rev. Dis. Primers. 4(1), 1–22 (2018).
Piel, F. B., Steinberg, M. H. & Rees, D. C. Sickle cell disease. N. Engl. J. Med. 376(16), 1561–1573 (2017).
Alayash, A. I. Oxidative pathways in the sickle cell and beyond. Blood Cells Mol. Dis. 70, 78–86 (2018).
Chaves, M. A. F., Leonart, M. S. S. & do Nascimento, A. J. Oxidative process in erythrocytes of individuals with hemoglobin S. Hematology 13(3), 187–192 (2008).
Rifkind, J. M., Mohanty, J. G. & Nagababu, E. The pathophysiology of extracellular hemoglobin associated with enhanced oxidative reactions. Front. Physiol. https://doi.org/10.3389/fphys.2014.00500 (2015).
Belcher, J. D., Beckman, J. D., Balla, G., Balla, J. & Vercellotti, G. Heme degradation and vascular injury. Antioxid. Redox. Signal. 12(2), 233–248 (2010).
Seixas, M. O. et al. Levels of high-density lipoprotein cholesterol (HDL-C) among children with steady-state sickle cell disease. Lipids Health Dis. 9, 91 (2010).
Aleluia, M. M. et al. Association of classical markers and establishment of the dyslipidemic sub-phenotype of sickle cell anemia. Lipids Health Dis. 16(1), 74 (2017).
Yalcinkaya, A., Unal, S. & Oztas, Y. Altered HDL particle in sickle cell disease: Decreased cholesterol content is associated with hemolysis, whereas decreased Apolipoprotein A1 is linked to inflammation. Lipids Health Dis. 18(1), 225 (2019).
Akinlade, K. S. et al. Defective lipid metabolism in sickle cell anaemia subjects in vaso-occlusive crisis. Niger Med. J. 55(5), 428–431 (2014).
de Guarda, C. C. et al. Investigation of Lipid profile and clinical manifestations in SCA children. Dis. Mark. 2020, e8842362 (2020).
Mackness, M. & Mackness, B. Human paraoxonase-1 (PON1): Gene structure and expression, promiscuous activities and multiple physiological roles. Gene 567(1), 12–21 (2015).
Mackness, M. I., Arrol, S., Abbott, C. & Durrington, P. N. Protection of low-density lipoprotein against oxidative modification by high-density lipoprotein associated paraoxonase. Atherosclerosis 104(1–2), 129–135 (1993).
Moreno-Godínez, M. E. et al. Genotypes of common polymorphisms in the PON1 gene associated with paraoxonase activity as cardiovascular risk factor. Arch. Med. Res. 49(7), 486–496 (2018).
Grzegorzewska, A. E. et al. Paraoxonase 1 concerning dyslipidaemia, cardiovascular diseases, and mortality in haemodialysis patients. Sci. Rep. 11(1), 6773 (2021).
Mochizuki, H. et al. Human PON2 gene at 7q21.3: Cloning, multiple mRNA forms, and missense polymorphisms in the coding sequence. Gene 213(1–2), 149–157 (1998).
Ren, H., Tan, S. L., Liu, M. Z., Banh, H. L. & Luo, J. Q. Association of PON2 gene polymorphisms (Ser311Cys and Ala148Gly) with the risk of developing type 2 diabetes mellitus in the chinese population. Front. Endocrinol. https://doi.org/10.3389/fendo.2018.00495 (2018).
Lima, E. S. & Couto, R. D. Estrutura, metabolismo e funções fisiológicas da lipoproteína de alta densidade. J. Bras. Patol Med. Lab. 42, 169–178 (2006).
Lund-Katz, S., Liu, L., Thuahnai, S. T. & Phillips, M. C. High density lipoprotein structure. Front. Biosci. 8, d1044-1054 (2003).
Phillips, M. C. New insights into the determination of HDL structure by apolipoproteins1. J. Lipid Res. 54(8), 2034–2048 (2013).
Aviram, M. et al. Human Serum paraoxonases (PON1) Q and R selectively decrease lipid peroxides in human coronary and carotid atherosclerotic lesions. Circulation 101(21), 2510–2517 (2000).
Fuhrman, B., Volkova, N. & Aviram, M. Oxidative stress increases the expression of the CD36 scavenger receptor and the cellular uptake of oxidized low-density lipoprotein in macrophages from atherosclerotic mice: Protective role of antioxidants and of paraoxonase. Atherosclerosis 161(2), 307–316 (2002).
Humbert, R. et al. The molecular basis of the human serum paraoxonase activity polymorphism. Nat. Genet. 3(1), 73–76 (1993).
Nofer, J. R. et al. HDL and arteriosclerosis: Beyond reverse cholesterol transport. Atherosclerosis 161(1), 1–16 (2002).
Chisolm, G. M. & Steinberg, D. The oxidative modification hypothesis of atherogenesis: An overview. Free Radic. Biol. Med. 28(12), 1815–1826 (2000).
Iuliano, L. The oxidant stress hypothesis of atherogenesis. Lipids 36(Suppl), S41-44 (2001).
Abbott, C. A., Mackness, M. I., Kumar, S., Boulton, A. J. & Durrington, P. N. Serum paraoxonase activity, concentration, and phenotype distribution in diabetes mellitus and its relationship to serum lipids and lipoproteins. ATVB. 15(11), 1812–1818 (1995).
Weatherall, D. J. & Provan, A. B. Red cells I: Inherited anaemias. Lancet 355(9210), 1169–1175 (2000).
Lyra, I. M. et al. Caracterização clínica, hematológica e molecular de crianças portadoras da anemia falciforme em duas diferentes cidades do Brasil. Cad Saúde Pública. 21, 1287–1290 (2005).
Ji, X. et al. The mechanism of proinflammatory HDL generation in sickle cell disease is linked to cell-free hemoglobin via haptoglobin. PLoS ONE 11(10), e0164264 (2016).
El-Ghamrawy, M. K. et al. Oxidant-antioxidant status in Egyptian children with sickle cell anemia: A single center based study. Jornal de Pediatria. 90(3), 286–292 (2014).
Reichert, C. O. et al. Paraoxonases (PON) 1, 2, and 3 Polymorphisms and PON-1 Activities in Patients with Sickle Cell Disease. Antioxidants. 8(8), 252 (2019).
Szabó, I., Róna, K., Czinner, A. & Gachályi, B. Human paraoxonase polymorphism: Hungarian population studies in children and adults. Int. J. Clin. Pharmacol. Ther. Toxicol. 29(6), 238–241 (1991).
dos Santos, N. P. C., Ribeiro-dos-Santos, Â. K. & Santos, S. E. Frequency of the Q192R and L55M polymorphisms of the human serum paraoxonase gene (PON1) in ten Amazonian Amerindian tribes. Genet. Mol. Biol. 28, 36–39 (2005).
Mackness, B., Mackness, M. I., Arrol, S., Turkie, W. & Durrington, P. N. Effect of the human serum paraoxonase 55 and 192 genetic polymorphisms on the protection by high density lipoprotein against low density lipoprotein oxidative modification. FEBS Lett. 423(1), 57–60 (1998).
Mendonça, M. I. et al. Polimorfismos do Gene da Paraoxonase Humana e Risco de Doença Coronária. Hum. Paraoxonase Gene Polymorphisms Coronary Artery Dis. Risk. 27(12), 1539–1555 (2008).
Freedman, J. E. Oxidative stress and platelets. Arterioscler Thromb Vasc Biol. 28(3), s11-16 (2008).
Heinecke, J. W. & Lusis, A. J. Paraoxonase-gene polymorphisms associated with coronary heart disease: Support for the oxidative damage hypothesis?. Am. J. Hum. Genet. 62(1), 20–24 (1998).
Mackness, M. I., Mackness, B., Durrington, P. N., Connelly, P. W. & Hegele, R. A. Paraoxonase: Biochemistry, genetics and relationship to plasma lipoproteins. Curr. Opin. Lipidol. 7(2), 69–76 (1996).
El-Ghamrawy, M. K. et al. Oxidant-antioxidant status in Egyptian children with sickle cell anemia: A single center based study. J. Pediatr. (Rio J). 90, 286–292 (2014).
Ebert, J. et al. Paraoxonase-2 regulates coagulation activation through endothelial tissue factor. Blood 131(19), 2161–2172 (2018).
Acknowledgements
We are thankful to all patients and their families who agreed to participate in the study.
Author information
Authors and Affiliations
Contributions
J.F.M. collected the samples, performed the assays, and wrote the paper. M.O.S.C., E.V.A., and C.C.S. helped with the laboratory analyses. F.M.S., T.N.P., and A.A.N.D. helped with PON1 activity measurement. L.C.R., I.M.L., and V.M.L.N. assisted the patients. C.C.G., R.P.S., S.P.C., S.C.M.A.Y., R.M.O., C.S.A. L.M.F., C.V.B.F, and M.S.G. critically revised the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Menezes, J.F., Carvalho, M.O.S., Rocha, L.C. et al. Role of paraoxonase 1 activity and PON1 gene polymorphisms in sickle cell disease. Sci Rep 13, 7215 (2023). https://doi.org/10.1038/s41598-023-34396-1
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-023-34396-1
Comments
By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate.