Cilostazol as a repurposed therapeutic agent in sickle cell disease

ABSTRACT Sickle cell disease is a multisystem hemoglobinopathycharacterized by vaso-occlusion , chronic hemolysis ,endothelial dysfunction ,inflammation , and progressive organ damage. Despite advances in disease modifying therapies such as hydroxyurea and monoclonal antibodies targeting adhesion pathways , many patients continue to experience recurrent vaso-occlusive crises. Cilostazol, a phosphodiesterase-3 inhibitor , increase intracellular cyclic adenosine monophosphate resulting in vasodilation, inhibition of platelet aggregation , improvement of endothelial function , and modulation of blood rheology . emerging mechanistic evidence suggests that cilostazol ma address multiple pathological components of sickle cell disease simultaneously, particulary microvascular dysfunction , platelet hyperactivation, and impaired perfusion . The review synthesizes current mechanistic knowledge and proposes cilostazol as a potential repurposed therapeutic agent in sickle cell disease , highlighting biological plausibility and future research directions