Can we use biomarkers to identify those at risk of acute pain from sickle cell disease?

ABSTRACT

Introduction

Acute pain episodes, also known as vaso-occlusive crises (VOC), are a major symptom of sickle cell disease (SCD) and lead to frequent hospitalizations. The diagnosis of VOC can be challenging, particularly in adults with SCD, 50% of whom have chronic pain. Several potential biomarkers have been proposed for identifying individuals with VOC, including elevation above the baseline of various vascular growth factors, cytokines, and other markers of inflammation. However, none have been validated to date.

Areas covered

We summarize prospective biomarkers for the diagnosis of acute pain in SCD, and how they may be involved in the pathophysiology of a VOC. Previous and current strategies for biomarker discovery, including the use of omics techniques, are discussed.

Expert opinion

Implementing a multi-omics-based approach will facilitate the discovery of objective and validated biomarkers for acute pain.

KEYWORDS:

• Acute pain
• sickle cell disease
• vaso-occlusive crisis
• pain biomarkers
• Pain

Article highlights

• This review summarizes candidate biomarkers proposed for diagnosing acute pain episodes in SCD.

• Prospective biomarkers for VOC discovered with the single biomarker approach include adhesion molecules, vascular growth factors, inflammatory mediators, and cytokines.

• Recently, genomics and transcriptomics studies have revealed genetic variants and gene expression changes respectively, that are linked to an increased risk of acute pain.

• However, most of the studies performed to date have been at a single center or institution, included small sample sizes, and/or have not collected longitudinal data.

• Multi-omics and multi-center studies that include longitudinal analyses will support the discovery and validation of reliable biomarkers to identify patients at risk of acute pain and define endpoints for clinical trials.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by NHLBI funding, grant # 1 R01 HL164583-01.