Sickle cell disease (SCD) is an inherited disorder caused by a point mutation in the β-
globin gene, leading to the production of abnormally shaped red blood cells. Sickle cells are prone to
hemolysis and thereby release free
heme into plasma, causing oxidative stress and
inflammation that in turn result in damage to multiple organs. The
transcription factor Nrf2 (nuclear factor erythroid 2-related factor 2) is a master regulator of the
antioxidant cell-defense system. Here we show that constitutive Nrf2 activation by ablation of its negative regulator Keap1 (
kelch-like ECH-associated protein 1) significantly improves symptoms in SCD model mice. SCD mice exhibit severe liver damage and
lung inflammation associated with high expression levels of proinflammatory
cytokines and adhesion molecules compared with normal mice. Importantly, these symptoms subsided after Nrf2 activation. Although
hemolysis and stress erythropoiesis did not change substantially in the Nrf2-activated SCD mice, Nrf2 promoted the elimination of plasma
heme released by sickle cells'
hemolysis and thereby reduced oxidative stress and
inflammation, demonstrating that Nrf2 activation reduces organ damage and segregates
inflammation from prevention of
hemolysis in SCD mice. Furthermore, administration of the Nrf2 inducer
CDDO-Im (2-cyano-3, 12 dioxooleana-1, 9 diene-28-imidazolide) also relieved
inflammation and organ failure in SCD mice. These results support the contention that Nrf2 induction may be an important means to protect organs from the pathophysiology of sickle cell-induced damage.