Pharmacological Inhibition of Calpain-1 Prevents Red Cell Dehydration and Reduces Gardos Channel Activity in a Mouse Model of Sickle Cell Disease. Identification of Druggable Protease Target
Authors: De Franceschi Lucia , Mattè Alessandro , Brugnara Carlo , Siciliano Angela , Bertoldi Mariarita , Wieschhaus Adam , Chishti Athar H. 
Published: October 2019

Abstract
Abstract 852
Sickle cell disease (SCD) is a hereditary red cell disorder characterized by the presence of pathological HbS, which polymerizes upon deoxygenation promoting red blood cell (RBC) dehydration and sickling. In SCD, the dense RBCs play a crucial role in the pathogenesis of sickle cell related organ damage and clinical manifestations. Although progress has been made in pathogenesis of SCD, the treatment options for SCD have limited pharmacological tools for clinical practice. Calpains are ubiquitous calcium-activated cysteine proteases, causing controlled proteolysis of protein substrates with regulatory functions. RBCs express only calpain-1, whose physiological function remains poorly understood. Gene inactivation of mouse calpain-1 revealed differential regulation of RBC calcium pump and enhanced RBC hydration. To investigate the relevance of these findings in SCD, we used BDA-410, a novel orally active inhibitor of calpain-1. Using the sickle (SAD) mouse, a model for human sickle cell disease, BDA-410 was administrated at the dosage of 30 mg/K/d by gavage to wild-type (WT) and sickle cell (SAD) mice. Animals were divided into 4 groups of 6 mice each: two groups from each strain were treated with BDA-410 for 14 days along with vehicle controls. Mice at baseline, day 7, and day 14 of BDA-410 treatment were evaluated for hematological parameters including the RBC density profile with phthalate density curves, RBC cation content, and Ca2+ activated K+ channel (Gardos channel) activity. BDA-410 induced a significant increase in Hct in both WT and SAD mice with no significant changes in Hb levels and an associated increased in MCV. The red cell K+ content increased significantly in SAD RBCs at day 7 and 14 of inhibitor treatment as compared to untreated SAD mice; whereas no major changes were observed in the WT RBCs. The mean corpuscular Hb concentration (CHCM) decreased in both WT and SAD mice treated with BDA-410. A left-shift in the RBC density curves was observed in SAD mice; whereas this left-shift was limited to a sub-fraction of denser red cells in the WT mice. The activity of the Gardos channel was significantly reduced in BDA-410 treated SAD mice compared to the untreated SAD group, while no significant differences were observed in the WT mice. Since the membrane-association of Peroxiredoxin-2 (Prx2) is increased in SCD RBCs, and has been correlated with Gardos channel activity, we evaluated Prx2-membrane association. BDA-410 treatment induced a significant reduction in the amount of Prx2 translocated to the membrane in both WT and SAD mice. Moreover, when we exposed WT and SAD mice to hypoxia (8% oxygen) for 48 hours, followed by 2 hours of re-oxygenation to mimic sickle cell related vaso-occlusive events, BDA-410 treatment prevented the hypoxia induced K+ loss and RBC dehydration in SAD mice. Identification of RBC membrane substrates in the calpain-1 null mice suggests that proteolytic modification of clapain targets as calcium pump, Prx2, and the Gardos channel protein may underpin some of the protective effects of BDA-410 in SAD mice. These results suggest that the inhibition of calpain-1 may offer a new therapeutic strategy to ameliorate hematological phenotype of SCD.

Disclosures:
No relevant conflicts of interest to declare.