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“compound 18” is an oral inducer of fetal hemoglobin (HbF) intended to treat anemias such as sickle cell disease and beta-thalassemia. The authors identified a weak hit (>10 uM) from a high-throughput phenotypic screen using human umbilical cord blood-derived erythroid progenitor cells. Optimization led to the azaspiro[3.3]heptane-containing compound 18, which demonstrated significant HbF induction in cynos without significant safety issues. The mechanism of action is unclear and will hopefully disclosed in the future.