Oxidative stress contributes to hemolysis in patients with hereditary spherocytosis and can be ameliorated by fermented papaya preparation

1 Hussam Ghoti, 2Eitan Fibach, 2Mutaz Dana, 3Mohammad Abu Shaban, 4Hiham Jeadi, 5Andrei Braester, 6Zipora Matas, 1Eliezer Rachmilewitz

(1) Department of Hematology, Edith Wolfson Medical Center, Holon, Israel
(2) Department of Hematology, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
(3) Department of Hematology, Nasser Pediatric Hospital, Gaza, Palestinian Authority
(4) Department of Hematology, European Hospital, Gaza, Palestinian Authority
(5) Western Galilee Hospital, Nahariya, Israel
(6) Department of Biochemistry, Edith Wolfson Medical Center, Holon, Israel

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In the present study, we questioned the role of oxidative stress in hereditary spherocytosis (HS), where red blood cells (RBC) have a shortened survival due to primary deficiency in membrane proteins. Using flow cytometry techniques, we showed that RBC derived from 17 HS patients of seven families generate more reactive oxygen species, membrane lipid peroxides, and less reduced glutathione than normal RBC.

Following in vitro incubation of HS-RBC from seven patients with a fermentation bioproduct of Carica papaya (fermented papaya preparation (FPP)) with known antioxidative properties, oxidative stress markers were significantly reduced.

Similar results were obtained following treatment with FPP for 3 months of 10 adult HS patients, as well as decreased tendency to undergo hemolysis. The hemoglobin levels increased by >1 g/dl, mean corpuscular hemoglobin concentration decreased by >1 g/dl, and the reticulocyte count decreased by 0.93%.

Concomitantly, lactic dehydrogenase decreased by 17% and indirect bilirubin by 50%. A significant decrease in malonyldialdehyde was also detected. These data indicate that oxidative stress plays an important role in the pathophysiology of HS which can be ameliorated by an antioxidant such as FPP. Additional clinical trials with FPP and other antioxidants are warranted.

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