Peritoneal accumulation of infused stroma-free hemoglobin. Potential toxicity of an oxygen-carrying substitute

Evidence that rehydrated, lyophilized red blood cells are sufficiently deformable for normal microcirculation transit

A method was developed for the preparation of rehydratable lyophilized red blood cells (RL RBCs) that hold promise as cell-based oxygen carriers for transfusion medicine. The maintenance of normal cellular deformability is essential for the successful development of cell-based oxygen delivery systems. Improper deformability of RBCs can lead to hemolysis if too fragile or microvascular occlusion if too rigid. We developed an aldehyde stabilization method that is based on the use of paraformaldehyde polymers that complement the function of spectrin as a structural unit with conformational flexibility. Three types of in vitro deformability studies (filter transit, pipette aspiration, and atomic force microscopy) and in vivo intravital microscopy were performed to characterize the deformability of RL RBCs. When considered with safety data from previously reported studies in dogs, the results of these studies indicate that paraformaldehyde-modified RL RBCs have visco-elastic deformability properties that are in the nonpathological range.

Human Hemoglobin Shares Bioactivities Ascribed to Human Tumor Necrosis Factor‐α

Hemoglobin mediated cytotoxicity and apoptosis has been evaluated in Tumor necrosis factor-alpha (TNF-alpha) sensitive cell line, U937 and compared with TNF-alpha. Both species of hemoglobin, Hemoglobin A2 and Hemoglobin A0 induced apoptosis and cytotoxicity in U937 cell as measured by flow cytometry and 3-(4,5-dihydro-6-(4-(3,4-dimethoxybenzooyl)-1-piperazinyl)-2(1H)-quinoline (MTT) assay respectively. Different concentration of Hemoglobin A0 (4 ng/mL to 4000 ng/mL) induced apoptosis ranging from 9% to 16% in U937 cells. 4000 ng/mL hemoglobin A0 showed maximal apoptotic cells. TNF-alpha showed 87% apoptotic U937 cells at concentration of 1 pg/mL. HbA0 displayed cytotoxicity in U937 cell line at higher concentration in comparison to TNF-alpha. 4000 ng/mL of hemoglobin A0 showed optimal cytotoxic response in U937 cells. A dose response curve was also observed with varying doses of hemoglobin A0. U937 cells pretreated with serum activated LPS for 1 hr and incubated with different concentration of hemoglobin or human TNF-alpha for 24 h reduced the cytotoxic effect on U937. Dexamethasone treatment of U937 cells helped in protecting the HbA0 and HbA2 mediated cytotoxicity and anti-TNF-alpha antibody neutralized the hemoglobin mediated apoptosis and cytotoxicity. It is therefore apparent that human hemoglobin shares some of the bioactivities previously ascribed to TNF-alpha. Sharing of bioactivities of TNF-alpha by hemoglobin is interesting and suggests that cell free hemoglobin can mimic TNF-alpha functionally.

Intravascular circulation and distribution of human 51Cr-DBBF stroma-free hemoglobin, 51Cr-plasma, 51Cr-saline, 59FE-plasma, and 125I-albumin in the mouse

Male B6C3HF1 mice were infused with human 51Cr-labeled DBBF (bis 3,5-dibromosalicyl fumarate) crosslinked stroma-free hemoglobin (SFH). In the first hour following SFH infusion, 11.2% of the infused radioactivity was found in the skin, 11.4% in muscle, 9.1% in the skeleton, and 5% in the liver. Twenty-four hours after infusion, 15.4% of the radioactivity was found in the skin, 10.3%, in the muscle, 16.6% in the skeleton, and 6.7% in the liver. The circulation and distribution of 51Cr-labeled DBBF-SFH were compared with levels of 51Cr labeled plasma, 51Cr in saline, 59Fe labeled plasma, and 125I albumin. The radioactivity in the blood was similar for 51Cr-DBBF-SFH, 51Cr-plasma, and 59Fe-plasma. During the 24-hour post-infusion period, extravascular distribution of the 51Cr-saline, 51Cr-plasma, and 125I albumin within the organs was similar to that of 51Cr-DBBF-SFH, with the highest levels being in skin, muscle, skeleton and liver, and no increase in the levels in the lung or spleen. The distribution of 59Fe compared to that of 51Cr-DBBF, 51Cr-plasma, 51Cr-saline, and 125I albumin can be explained by the fact that 59Fe is utilized in the production of new red blood cells.

Glutaraldehyde modification of recombinant human hemoglobin alters its hemodynamic properties

Many cell-free hemoglobin solutions designed as oxygen-carrying therapeutics produce a hypertensive effect in animals. The response is likely due to oxidation of nitric oxide by hemoglobin. Since the site of oxidation may lie outside the vascular compartment, we tested the hypothesis that polymerization of hemoglobin, rHb1.1, by glutaraldehyde would attenuate the hypertensive response. Two products of the cross-linking reaction were isolated, a glutaraldehyde-derivatized monomer (mono-glxrHb) and a glutaraldehyde cross-linked polymer (poly-glxrHb), and evaluated for their effects on systemic hemodynamics in conscious rats. Administration of rHb1.1 caused a mean arterial pressure elevation of approximately 20 mm Hg and an increase in total peripheral resistance of approximately 30%. Administration of mono-glxrHb induced changes in mean arterial pressure and vascular resistance that were significantly diminished relative to those observed with rHb1.1. Poly-glxrHb elicited a mean arterial pressure response that was further reduced compared with that obtained with mono-glxrHb and a change in vascular resistance that was the same as the response to mono-glxrHb. These results suggest that rHb peripheral vasoconstriction elicited by rHb1.1 is significantly attenuated by glutaraldehyde modification of the hemoglobin monomer and that the effect of glutaraldehyde polymerization is likely due to surface modification and/or intramolecular cross-linking, rather than an increase in molecular size.

Effects of a stroma-free hemoglobin and perfluorochemical combination on ultrastructure and function of the isolated rat kidney

Experimental perfusions of isolated rat kidneys were performed with flow rates adjusted to produce comparable glomerular filtration rates (GFR) in control and experimental groups. The experimental perfusate, consisting of Krebs-Ringer bicarbonate (KRB) containing 3.5% (uncrosslinked) stroma-free hemoglobin (SFH) plus 3.5% of the perfluorochemical (PFC) Fluosol-DA, was found to produce only 48% as much urine as the control perfusate consisting of KRB containing 7% dextran (without either SFH or PFC). Perfusion with the experimental SFH/PFC mixture was associated with mean fractional reabsorptions of sodium 3.3% greater and of potassium 5.1% lesser than perfusion with the control KRB (with dextran) solution (p < .05). The SFH/PFC mixture was localized histochemically to the capillaries and urinary spaces of glomeruli; and to the apical microvilli, basal laminae, and intracytoplasmic vacuoles of proximal renal tubular cells. Since the glomerular filtration rate was not a factor, decremental urine production appears to be associated with increased reabsorption of sodium, excretion of potassium, and proximal tubular uptake of the experimental SFH/PFC mixture by endocytosis.

Clearance of differentially labelled infused hemoglobin and polymerized hemoglobin from dog plasma and accumulation in urine and selected tissues

Pyridoxalated hemoglobin polymerized with glutaraldehyde has been proposed as a hemoglobin based blood substitute. The preparations contain significant amounts of unpolymerized hemoglobin. We have prepared polymerized pyridoxalated hemoglobin labelled with 14C by reductive methylation free of unpolymerized hemoglobin and pyridoxalated hemoglobin labelled with 3H by reductive methylation to compare the handling of the two forms after infusion into dogs. Four dogs were examined sequentially. After three hours, 52.4 +/- 8.9% of the 3H label had disappeared from plasma whereas 21.7 +/- 5.8 of the 14C label had disappeared. The decrease of both labels occurred in a very close to linear fashion over the time period examined. From radioactivity in collected urine, it was calculated that 30.7 +/- 6.3% of the 3H and 9.0 +/- 2.7 of the 14C that had been cleared from plasma appeared in urine. The ratio of the specific radioactivity in tissue to the specific radioactivity of plasma indicated that extravascular accumulation of 3H label from unpolymerized hemoglobin occurred in kidney, heart and liver, with the kidney cortex exhibiting a very high concentration of the label. The specific radioactivity of both 3H and 14C label in liver suggested the substantial involvement of the reticuloendothelial system in the removal of both unpolymerized and polymerized hemoglobin from the circulation.