Comprhensive Sickle Cell Center Program Project

描述（由申请人提供）： 镰状细胞病（SCD）的根本挑战是点突变如何改变单个循环细胞中单个蛋白质中的单个氨基酸，导致具有多变表现的疾病以及复杂和不可预测的临床症状。Marian安德森综合镰状细胞中心一直在使用生命的最初几年，这是患有SCD的婴儿表现出高水平HbF的生理关键时期，以纵向评估HbF和与SCD病理生理学相关的其他生物学参数之间是否存在潜在的重要关系，并且已经证明了HbF、液相凝血和粘附标志物之间的重要关系。 这项针对婴儿和儿童（3个月至4岁）的前瞻性、纵向研究的拟定延续将提供关于特定生物标志物重要性的关键新信息，因为它们与微血管闭塞现象的病理生理学相关。 此外，这些纵向研究将随着婴儿的生长而产生“生物足迹”，提供对婴儿和幼儿中粘附、内皮、血小板、白色细胞和止血活化的变化的时间顺序的独特观察，因为HbF的保护作用下降，并且受试者开始经历HbS聚合的展开的全身作用，包括贫血和疼痛。 一个额外的临床项目不仅提供了这些婴儿和幼儿所经历的疼痛的基本信息，以使生物和生理相关性，它还建议使用创新的新技术，以促进家庭，研究人员和临床工作人员之间的临床和研究沟通。 这些技术的实用性将进一步证明在父母介导的疼痛管理协议的幼儿SCD的发展和评价。 PS阳性镰状红细胞的内皮细胞受体的检查将作为该中心的基础科学研究，并将当前中心研究人员获得的新信息与该中心新研究人员协助的创新分子生物学研究相结合。这种细致的临床护理和研究的独特结合在合作网络协议中得到了强调，该协议提出了一项临床试验，使用统计技术和从该中心以前的疼痛研究中开发的初步数据，比较了SC疾病中的羟基脲与羟基脲和静脉切开术，以及详细的实验室研究，以帮助了解这种鲜为人知的镰状综合征的病理生理学。支持这些研究的是一个临床核心的专门工作人员，也支持该中心不断增长的患者群体，其中现在包括成人和儿科患者在费城，和一个虚拟中心在路易斯维尔大学在肯塔基州。该中心是一个病人服务核心，重点是通过宾夕法尼亚州和肯塔基州的教育和社区外展活动，将我们最先进的研究和病人护理转化为实践。

DESCRIPTION (provided by applicant): The fundamental challenge of sickle cell disease (SCD) is how a point mutation, which changes a single amino acid in a single protein, in a single circulating cell, causes a disease with protean manifestations, and complex and unpredictable clinical symptoms. The Marian Anderson Comprehensive Sickle Cell Center has been using the first few years of life, a physiologically crucial period when infants with SCD manifest high levels of HbF, to longitudinally evaluate whether potentially important relationships exist between HbF and other biologic parameters related to SCD pathophysiology, and has demonstrated important relationships between HbF, fluid phase coagulation and adhesion markers. The proposed continuation of this prospective, longitudinal study of infants and children (3 months to 4 yrs) will provide critical new information on the importance of specific biologic markers as they relate to the pathophysiology of the microvessel occlusive phenomenon. In addition, these longitudinal studies will create a "biologic footprint" as the infant grows, providing a unique look at the temporal sequence of changes in adherence, endothelial, platelet, white cell and hemostatic activation in the infant and young child as the protective effects of HbF decline, and the subject begins to experience the unfolding systemic effects of HbS polymerization including anemia and pain. An additional clinical project not only provides the fundamental information on the pain experienced by these infants and young children needed to make the biologic and physiologic correlates, it also proposes using innovative new technologies to facilitate clinical and research communication between families, investigators, and clinical staff. The utility of these technologies will be further demonstrated in the development and evaluation of a parent-mediated pain management protocol for young children with SCD. An examination of endothelial cell receptors for PS-positive sickle erythrocytes will serve as the Center's basic science study and combines new information obtained by current Center investigators with innovative molecular biology studies assisted by investigators new to the Center. This unique blend of meticulous clinical care and research is highlighted in the collaborative network protocol which proposes a clinical trial comparing hydroxyurea to hydroxyurea and phlebotomy in SC disease using statistical techniques and preliminary data developed from the Center's previous pain studies, and detailed laboratory studies to help understand the pathophysiology of this poorly understood sickle syndrome. Supporting these studies is a clinical core of dedicated staff that also supports the Center's growing patient population, which now includes adult and pediatric patients in Philadelphia, and a virtual Center at the University of Louisville in Kentucky. Rounding out the Center is a patient services core with a focus on translating our state-of-the-art research and patient care into practice through education and community outreach in Pennsylvania and Kentucky.