Life-long hydroxyurea treatment decreases chronic sickle cell disease pain

Chronic sickle cell disease (SCD) pain mechanisms remain critically understudied, even though more than 50% of patients develop this symptom as their disease progresses. Despite high face validity, there are critical gaps in transgenic SCD mouse model characterization and implementation that must be addressed in order to increase the translational relevance of these animals. First, it is unclear when the chronic pain phenotype first develops in these mice. Second, there are no studies that have measured chronic pain in animals following standard-of-care drug regimens. Herein, we address both of these gaps by performing reflexive pain behavior tests in hydroxyurea-treated Townes HbSS and HbAA mice from postnatal day 10 to 6 months of age. Hydroxyurea (HU), a compound that increases circulating levels of fetal hemoglobin (HbF), is a life-long therapy prescribed to individuals with SCD beginning as early as age 9 months. Here, we demonstrate that chronic mechanical hypersensitivity develops in Townes HbSS mice between P21-P28, a time frame that follows the HbF-to-HbS switch. When initiated at birth, HU treatment limits the extent of chronic mechanical pain development in HbSS mice. HU analgesic effects can be attributed to decreased innate immune tone in the periphery; life-long HU treatment decreases circulating monocyte counts in HbSS mice and reverses sensitization of TRPA1, a lipopolysaccharide receptor, in HbSS nociceptors. In conclusion, these studies provide additional support for early implementation of HU in SCD disease management, and furthermore, identify the LPS-TRPA1 signaling axis as a novel analgesic target for chronic SCD pain.