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Zhang LG, Ma XJ, Li XY. Case report: Roxadustat overdose in an anemia patient of chronic kidney disease: insight beyond insignificant consequence. FRONTIERS IN NEPHROLOGY 2024; 4:1413496. [PMID: 39155928 PMCID: PMC11327132 DOI: 10.3389/fneph.2024.1413496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/08/2024] [Indexed: 08/20/2024]
Abstract
A 71-year-old man with a 20-year history of grade 3 hypertension experienced kidney dysfunction 2 years earlier. His serum creatinine (SCr) at the time was 140 μmol/L [with estimated glomerular filtration rate (eGFR) of 43.9 ml/min per 1.73m2], for which he received irbesartan since. At initial presentation, the spot urine dipstick protein was 1+, with an albumin-to-creatinine ratio of 230 mg/g (0-30) and normal urine sediments. The SCr was 176 μmol/L (eGFR = 32.8 ml/min per 1.73m2). The hemoglobulin (Hb) level decreased from 102 to 96 g/L despite oral ferrous succinate 100 mg twice daily starting 2 months ago. Roxadustat (ROXA) 50 mg (body weight, 70 kg) three times weekly was then prescribed. Unfortunately, the patient mistakenly took the drug at 50 mg three times a day (i.e., 1,050 mg instead of the intended 150 mg per week), which was 3.5 times the recommended starting dose for non-dialysis-dependent chronic kidney disease (CKD) patients (100 mg three times weekly for body weight >60 kg) and two times the highest drug manual-recommended weekly dose (2.5 mg/kg three times weekly) approved in the country. When the attending nephrologist discovered the misuse 1 month later, the patient reported no apparent discomfort, and his home blood pressure was in the range 110-130/60-80 mmHg. Repeat blood tests showed that the Hb increased from 96 to 163 g/L and the SCr from 199 to 201 μmol/L in a month. The serum alanine transaminase (ALT) remained within the normal range (from 12 U/L at baseline to 20 U/L), while the serum total and indirect bilirubin levels were slightly elevated. ROXA was withheld immediately. In 30 days, the serum bilirubin returned to baseline, but the Hb decreased from 163 to 140 g/L, and then to 108 g/L after 3 months. On the other hand, the SCr increased from 179 to 203 μmol/L. At 9 months after the initial dosing, when the SCr increased to 256 μmol/L and the Hb decreased to 94 g/L again, ROXA 50 mg three times weekly was reinitiated uneventfully. Herein, by introducing a case who erroneously consumed twice the highest recommended dose of ROXA for a month, but had apparently no obvious discomfort or unfavorable consequence, we attempt to provide a brief overview of the mechanism of action, characteristics, drug metabolism, and side effect profile associated with this agent.
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Affiliation(s)
| | | | - Xiang-Yang Li
- Department of Nephrology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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2
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Song J, Lanikova L, Kim SJ, Papadopoulos N, Meznarich J, Constantinescu SN, Parsegov B, Prchal JF, Prchal JT. Novel germline JAK2 R715T mutation causing PV-like erythrocytosis in 3 generations. Amelioration by Ropeg-Interferon. Am J Hematol 2024; 99:1220-1229. [PMID: 38629639 DOI: 10.1002/ajh.27311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 06/12/2024]
Abstract
Polycythemia vera (PV) is a clonal disorder arising from the acquired somatic mutations of the JAK2 gene, including JAK2V617F or several others in exon 12. A 38-year-old female had a stroke at age 32 and found to have elevated hemoglobin, normal leukocytes, normal platelets, and tested negative for JAK2V617F and exon 12 mutations. Next generation sequencing revealed a novel mutation: JAK2R715T in the pseudokinase domain (JH2) at 47.5%. Its presence in her nail DNA confirmed a germline origin. Her mother and her son similarly had erythrocytosis and a JAK2R715T mutation. Computer modeling indicated gain-of-function JAK2 activity. The propositus and her mother had polyclonal myelopoiesis, ruling out another somatic mutation-derived clonal hematopoiesis. Some erythroid progenitors of all three generations grew without erythropoietin, a hallmark of PV. The in vitro reporter assay confirmed increased activity of the JAK2R715T kinase. Similar to PV, the JAK2R715T native cells have increased STAT5 phosphorylation, augmented transcripts of prothrombotic and inflammatory genes, and decreased KLF2 transcripts. The propositus was not controlled by hydroxyurea, and JAK2 inhibitors were not tolerated; however, Ropeginterferon-alfa-2b (Ropeg-IFN-α) induced a remission. Ropeg-IFN-α treatment also reduced JAK2 activity in the propositus, her mother and JAK2V617F PV subjects. We report dominantly inherited erythrocytosis secondary to a novel germline JAK2R715T gain-of-function mutation with many but not all comparable molecular features to JAK2V617F PV. We also document a previously unreported inhibitory mechanism of JAK2 signaling by Ropeg-IFN-α.
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Affiliation(s)
- Jihyun Song
- Division of Hematology & Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Lucie Lanikova
- Department of Cell and Developmental Biology, Institute of Molecular Genetics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Soo Jin Kim
- Division of Hematology & Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Nicolas Papadopoulos
- Ludwig Institute for Cancer Research, Brussels, Belgium
- de Duve Institute, Brussels, Belgium
| | - Jessica Meznarich
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Stefan N Constantinescu
- Ludwig Institute for Cancer Research, Brussels, Belgium
- de Duve Institute, Brussels, Belgium
- Nuffield Department of Medicine, Oxford University, Oxford, UK
- WELBIO Department, WEL Research Institute, Wavre, Belgium
| | - Brynn Parsegov
- Division of Hematology & Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - Josef T Prchal
- Division of Hematology & Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
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3
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Arias CF, Valente-Leal N, Bertocchini F, Marques S, Acosta FJ, Fernandez-Arias C. A new role for erythropoietin in the homeostasis of red blood cells. Commun Biol 2024; 7:58. [PMID: 38191841 PMCID: PMC10774343 DOI: 10.1038/s42003-023-05758-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024] Open
Abstract
The regulation of red blood cell (RBC) homeostasis is widely assumed to rely on the control of cell production by erythropoietin (EPO) and the destruction of cells at a fixed, species-specific age. In this work, we show that such a regulatory mechanism would be a poor homeostatic solution to satisfy the changing needs of the body. Effective homeostatic control would require RBC lifespan to be variable and tightly regulated. We suggest that EPO may control RBC lifespan by determining CD47 expression in newly formed RBCs and SIRP-α expression in sinusoidal macrophages. EPO could also regulate the initiation and intensity of anti-RBC autoimmune responses that curtail RBC lifespan in some circumstances. These mechanisms would continuously modulate the rate of RBC destruction depending on oxygen availability. The control of RBC lifespan by EPO and autoimmunity emerges as a key mechanism in the homeostasis of RBCs.
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Affiliation(s)
- Clemente F Arias
- Centro de Investigaciones Biológicas (CSIC), Madrid, Spain.
- Grupo Interdisciplinar de Sistemas Complejos (GISC), Madrid, Spain.
| | - Nuno Valente-Leal
- Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
| | | | - Sofia Marques
- Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
| | - Francisco J Acosta
- Departamento de Ecología, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Fernandez-Arias
- Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal.
- Departamento de Immunología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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4
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Lechuga GC, Morel CM, De-Simone SG. Hematological alterations associated with long COVID-19. Front Physiol 2023; 14:1203472. [PMID: 37565145 PMCID: PMC10411895 DOI: 10.3389/fphys.2023.1203472] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Long COVID-19 is a condition characterized by persistent symptoms lasting beyond the acute phase of COVID-19. Long COVID-19 produces diverse symptomatology and can impact organs and systems, including the hematological system. Several studies have reported, in COVID-19 patients, hematological abnormalities. Most of these alterations are associated with a higher risk of severe disease and poor outcomes. This literature review identified studies reporting hematological parameters in individuals with Long COVID-19. Findings suggest that Long COVID-19 is associated with a range of sustained hematological alterations, including alterations in red blood cells, anemia, lymphopenia, and elevated levels of inflammatory markers such as ferritin, D-dimer, and IL-6. These alterations may contribute to a better understanding of the pathophysiology of Long COVID-19 and its associated symptoms. However, further research is needed to elucidate the underlying mechanisms and potential treatments for these hematological changes in individuals with Long COVID-19.
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Affiliation(s)
- Guilherme C. Lechuga
- Center for Technological Development in Health (CDTS)/ National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratory of Epidemiology and Molecular Systematics (LESM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratory of Cellular Ultrastructure, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Carlos M. Morel
- Center for Technological Development in Health (CDTS)/ National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Salvatore Giovanni De-Simone
- Center for Technological Development in Health (CDTS)/ National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratory of Epidemiology and Molecular Systematics (LESM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Post-Graduation Program in Science and Biotechnology, Department of Molecular and Cellular Biology, Biology Institute, Federal Fluminense University, Niterói, Brazil
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Zhou M, Liu X, Li L. Secondary polycythaemia from chronic hypoxia is a risk for cerebral thrombosis: a case report. BMC Neurol 2023; 23:225. [PMID: 37296428 DOI: 10.1186/s12883-023-03277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Secondary polycythemia is considered the usual complication of chronic hypoxia. It can theoretically increase the oxygen-carrying capacity, but this adaptive trait has a deleterious effect because the blood viscosity increases, which can induce significant morbidity and mortality, such as stroke and myocardial infarction. CASE PRESENTATION A 55-year-old man with a history of a congenitally small main pulmonary artery presented to the emergency department with sustained unsteady walking, dizziness and vertigo. Evaluation revealed elevated hemoglobin and superior posterior circulation cerebral artery thrombosis. The patient was treated with high flux inhalation of oxygen and anti-platelet aggregation. CONCLUSIONS The involvement of cerebral vessels has rarely been reported in chronic hypoxia cases. The present case is the first case of superior posterior circulation cerebral artery thrombosis due to chronic hypoxia in a patient with a congenitally small main pulmonary artery. This case demonstrates the importance of recognizing some chronic diseases that can lead to hypoxia and secondary polycythemia thereby leading to hypercoagulable state and subsequent thrombosis.
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Affiliation(s)
- Min Zhou
- Department of Neurology, Ningbo No. 2 Hospital, 41 Xi'bei Street, Ningbo, Zhejiang, China
| | - Xiaoxia Liu
- Department of Neurology, Ningbo No. 2 Hospital, 41 Xi'bei Street, Ningbo, Zhejiang, China
| | - Li Li
- Department of Neurology, Ningbo No. 2 Hospital, 41 Xi'bei Street, Ningbo, Zhejiang, China.
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Giraud-Billoud M, Campoy-Diaz AD, Dellagnola FA, Rodriguez C, Vega IA. Antioxidant Responses Induced by Short-Term Activity–Estivation–Arousal Cycle in Pomacea canaliculata. Front Physiol 2022; 13:805168. [PMID: 35185614 PMCID: PMC8847974 DOI: 10.3389/fphys.2022.805168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022] Open
Abstract
Long-term estivation (45 days) in the apple snail Pomacea canaliculata induces an increase of non-enzymatic antioxidants, such as uric acid and reduced glutathione (GSH), which constitutes an alternative to the adaptive physiological strategy of preparation for oxidative stress (POS). Here, we studied markers of oxidative stress damage, uric acid levels, and non-enzymatic antioxidant capacity, enzymatic antioxidant defenses, such as superoxide dismutase (SOD), catalase (CAT), and glutathione S-transferase (GST), and transcription factors expression [forkhead box protein O (FOXO), hypoxia-inducible factor-1 alpha (HIF1α), and nuclear factor erythroid 2-related factor 2 (Nrf2)] in control active animals, 7-day estivating and aroused snails, in digestive gland, gill, and lung tissue samples. In the digestive gland, SOD and CAT activities significantly increased after estivation and decreased during arousal. Meanwhile, GST activity decreased significantly during the activity–estivation–arousal cycle. Gill CAT activity increased significantly at 7 days of estivation, and it decreased during arousal. In the lung, the CAT activity level increased significantly during the cycle. FOXO upregulation was observed in the studied tissues, decreasing its expression only in the gill of aroused animals during the cycle. HIF1α and Nrf2 transcription factors decreased their expression during estivation in the gill, while in the lung and the digestive gland, both transcription factors did not show significant changes. Our results showed that the short-term estivation induced oxidative stress in different tissues of P. canaliculata thereby increasing overall antioxidant enzymes activity and highlighting the role of FOXO regulation as a possible underlying mechanism of the POS strategy.
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Affiliation(s)
- Maximiliano Giraud-Billoud
- IHEM, CONICET, Universidad Nacional de Cuyo, Mendoza, Argentina
- Facultad de Ciencias Médicas, Instituto de Fisiología, Universidad Nacional de Cuyo, Mendoza, Argentina
- Departamento de Ciencias Básicas, Escuela de Ciencias de la Salud-Medicina, Universidad Nacional de Villa Mercedes, San Luis, Argentina
- *Correspondence: Maximiliano Giraud-Billoud,
| | - Alejandra D. Campoy-Diaz
- IHEM, CONICET, Universidad Nacional de Cuyo, Mendoza, Argentina
- Facultad de Ciencias Médicas, Instituto de Fisiología, Universidad Nacional de Cuyo, Mendoza, Argentina
- Departamento de Ciencias Básicas, Escuela de Ciencias de la Salud-Medicina, Universidad Nacional de Villa Mercedes, San Luis, Argentina
| | - Federico A. Dellagnola
- IHEM, CONICET, Universidad Nacional de Cuyo, Mendoza, Argentina
- Facultad de Ciencias Médicas, Instituto de Fisiología, Universidad Nacional de Cuyo, Mendoza, Argentina
- Departamento de Biología, Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Cristian Rodriguez
- IHEM, CONICET, Universidad Nacional de Cuyo, Mendoza, Argentina
- Facultad de Ciencias Médicas, Instituto de Fisiología, Universidad Nacional de Cuyo, Mendoza, Argentina
- Departamento de Biología, Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Israel A. Vega
- IHEM, CONICET, Universidad Nacional de Cuyo, Mendoza, Argentina
- Facultad de Ciencias Médicas, Instituto de Fisiología, Universidad Nacional de Cuyo, Mendoza, Argentina
- Departamento de Biología, Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Cuyo, Mendoza, Argentina
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Affiliation(s)
| | - Risso Angela
- Department of Agriculture, Food, Environment, and Animal Sciences University of Udine Udine Italy
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8
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Song J, Christensen RD, Thiagarajan P, Prchal JT. Does neocytolysis exist after descent from high altitude? Acta Physiol (Oxf) 2021; 233:e13713. [PMID: 34228882 DOI: 10.1111/apha.13713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Jihyun Song
- Division of Hematology School of Medicine University of Utah Salt Lake City UT USA
| | | | - Perumal Thiagarajan
- Department of Pathology and Medicine Baylor College of Medicine and Center for Translational Research on Inflammatory DiseasesMichael E. DeBakey VA Medical Center Houston TX USA
| | - Josef T. Prchal
- Division of Hematology School of Medicine University of Utah Salt Lake City UT USA
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Mairbäurl H, Kaestner L, Yu Bogdanova A, Klein M, Minetti G. Of mice and men 1 : How to achieve a better life with lower total Hb mass after returning from hypoxia to normoxia. (response to Song and colleagues). Acta Physiol (Oxf) 2021; 233:e13720. [PMID: 34292651 DOI: 10.1111/apha.13720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Heimo Mairbäurl
- Translational Pneumology University Hospital Heidelberg Heidelberg Germany
| | - Lars Kaestner
- Experimental Physics Dynamics of Fluids Group Saarland University Saarbrücken Germany
- Theoretical Medicine and Biosciences Campus University HospitalSaarland University Saarbrücken Germany
| | - Anna Yu Bogdanova
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Marie Klein
- Medical Clinic VII Sports Medicine University Hospital Heidelberg Heidelberg Germany
| | - Giampaolo Minetti
- Department of Biology and Biotechology "L Spallanzani" Laboratories of Biochemistry University of Pavia Pavia Italy
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10
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Concise review: how do red blood cells born, live, and die? Ann Hematol 2021; 100:2425-2433. [PMID: 34342697 DOI: 10.1007/s00277-021-04575-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
The average life cycle of a human RBC is approximately 120 days. Generally, by this point, the cell is worn out and damaged. RBCs pass through both the spleen and liver, where specialised immune cells called macrophages are found. Macrophages recognise when an RBC is spent, and undergo a process called phagocytosis where they digest the cell. In this process, the iron in haemoglobin is recycled for use in new blood cells and the hem molecule is degraded, conjugated to bilirubin, and eliminated from the body. All the other cellular proteins are either recycled or eliminated. Historically, this process was thought to occur exclusively in the spleen, but recent studies have shown that it occurs in the bone marrow. The RBC has been analysed from many perspectives: cytological, haematological, and immunological, as well as from the focus of molecular biology, biophysics, and mathematics. Here we analyse how are red blood cells born and how they live and die in a brief overview of the whole process with special mention of the morphological aspects from bone marrow and spleen provided by transmission and scanning electron microscopy.
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11
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Rice L, Gunga H. Neocytolysis on descending the mountain and ascending into space. Acta Physiol (Oxf) 2021; 232:e13676. [PMID: 33998156 DOI: 10.1111/apha.13676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lawrence Rice
- Departments of Medicine (Hematology) and Cancer Center Houston Methodist HospitalWeill Cornell Medical College Houston TX USA
| | - Hanns‐Christian Gunga
- Charité – Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthInstitute of Physiology Berlin Germany
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Klein M, Kaestner L, Bogdanova AY, Minetti G, Rudloff S, Lundby C, Makhro A, Seiler E, Cromvoirt A, Fenk S, Simionato G, Hertz L, Recktenwald S, Schäfer L, Haider T, Fried S, Borsch C, Marti HH, Sander A, Mairbäurl H. Absence of neocytolysis in humans returning from a 3-week high-altitude sojourn. Acta Physiol (Oxf) 2021; 232:e13647. [PMID: 33729672 DOI: 10.1111/apha.13647] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 12/26/2022]
Abstract
AIMS Total haemoglobin mass (tot-Hb) increases during high-altitude acclimatization. Normalization of tot-Hb upon descent is thought to occur via neocytolysis, the selective destruction of newly formed erythrocytes. Because convincing experimental proof of neocytolysis is lacking, we performed a prospective study on erythrocyte survival after a stay at the Jungfraujoch Research Station (JFJRS; 3450 m). METHODS Newly formed erythrocytes of 12 male subjects (mean age 23.3 years) were age cohort labelled in normoxia (110 m) and during a 19-day high-altitude sojourn by ingestion of 13 C2- and 15 N-labelled glycine respectively. Elimination dynamics for erythrocytes produced in normoxia and at high altitude were measured by isotope ratio mass spectrometry of haem, by determining tot-Hb, reticulocyte counts, erythrocyte membrane protein 4.1a/4.1b ratio and by mathematical modelling. RESULTS Tot-Hb increased by 4.7% ± 2.7% at high altitude and returned to pre-altitude values within 11 days after descent. Elimination of 13 C- (normoxia) and 15 N- (high altitude) labelled erythrocytes was not different. Erythropoietin levels and counts of CD71-positive reticulocytes decreased rapidly after descent. The band 4.1a/4.1b ratio decreased at altitude and remained low for 3-4 days after descent and normalized slowly. There was no indication of haemolysis. CONCLUSION We confirm a rapid normalization of tot-Hb upon descent. Based on the lack of accelerated removal of age cohorts of erythrocytes labelled at high altitude, on patterns of changes in reticulocyte counts and of the band 4.1a/4.1b ratio and on modelling, this decrease did not occur via neocytolysis, but by a reduced rate of erythropoiesis along with normal clearance of senescent erythrocytes.
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Affiliation(s)
- Marie Klein
- Medical Clinic VII Sports Medicine University Hospital Heidelberg Heidelberg Germany
- Translational Pneumology University Hospital Heidelberg Heidelberg Germany
| | - Lars Kaestner
- Experimental Physics Dynamics of Fluids Group Saarland University Saarbrücken Germany
- Theoretical Medicine and Biosciences Campus University HospitalSaarland University Homburg Germany
| | - Anna Y. Bogdanova
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Giampaolo Minetti
- Department of Biology and Biotechnology "L Spallanzani" Laboratories of Biochemistry University of Pavia Pavia Italy
| | - Silvia Rudloff
- Analytical Platform Stable Isotopes, and Cell Biology Institute of Nutritional Sciences Justus Liebig University Giessen Giessen Germany
| | - Carsten Lundby
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research Rigshospitalet University of Copenhagen Hillerød Denmark
- Inland Norway University of Applied Sciences Lillehammer Norway
| | - Asya Makhro
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Elena Seiler
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Ankie Cromvoirt
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Simone Fenk
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Greta Simionato
- Experimental Physics Dynamics of Fluids Group Saarland University Saarbrücken Germany
- Theoretical Medicine and Biosciences Campus University HospitalSaarland University Homburg Germany
- Institute for Clinical and Experimental Surgery Saarland UniversityCampus University Hospital Homburg Germany
| | - Laura Hertz
- Experimental Physics Dynamics of Fluids Group Saarland University Saarbrücken Germany
| | - Steffen Recktenwald
- Experimental Physics Dynamics of Fluids Group Saarland University Saarbrücken Germany
| | - Larissa Schäfer
- Department of Anaesthesiology and Intensive Care Medicine University Hospital SalzburgParacelsus Medical University Salzburg Austria
| | - Thomas Haider
- Department of Cardiology University Hospital Zürich Zürich Switzerland
| | - Sebastian Fried
- Department of Anaesthesiology University Hospital Heidelberg Heidelberg Germany
| | - Christian Borsch
- Analytical Platform Stable Isotopes, and Cell Biology Institute of Nutritional Sciences Justus Liebig University Giessen Giessen Germany
| | - Hugo H. Marti
- Institute of Physiology and Pathophysiology University of Heidelberg Heidelberg Germany
| | - Anja Sander
- Institute of Medical Biometry and Informatics University Hospital Heidelberg Heidelberg Germany
| | - Heimo Mairbäurl
- Medical Clinic VII Sports Medicine University Hospital Heidelberg Heidelberg Germany
- Translational Pneumology University Hospital Heidelberg Heidelberg Germany
- Translational Lung Research Centre Heidelberg (TLRC) Part of the German Centre for Lung Research (DZL) Heidelberg Germany
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Parashar A, Jacob VD, Gideon DA, Manoj KM. Hemoglobin catalyzes ATP-synthesis in human erythrocytes: a murburn model. J Biomol Struct Dyn 2021; 40:8783-8795. [PMID: 33998971 DOI: 10.1080/07391102.2021.1925592] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Blood hemoglobin (Hb), known to transport oxygen, is the most abundant globular protein in humans. Erythrocytes have ∼10-3 M concentration of ATP in steady-state and we estimate that this high amounts cannot be formed from 10-4 - 10-7 M levels of precursors via substrate-level phosphorylation of glycolysis. To account for this discrepancy, we propose that Hb serves as a 'murzyme' (a redox enzyme working along the principles of murburn concept), catalyzing the synthesis of the major amounts of ATP found in erythrocytes. This proposal is along the lines of our earlier works demonstrating DROS (diffusible reactive oxygen species) mediated ATP-synthesis as a thermodynamically and kinetically viable mechanism for physiological oxidative phosphorylation. We support the new hypothesis for Hb with theoretical arguments, experimental findings of reputed peers and in silico explorations. Using in silico methods, we demonstrate that adenosine nucleotide and 2,3-bisphosphoglycerate (2,3-BPG) binding sites are located suitably on the monomer/tetramer, thereby availing facile access to the superoxide emanating from the heme center. Our proposal explains earlier reported in situ experimental findings/suggestions of 2,3-BPG and ADP binding at the same locus on Hb. The binding energy is in the order of 2,3-BPG > NADH > ATP > ADP > AMP and agrees with earlier reports, potentially explaining the bioenergetic physiology of erythrocytes. Also, the newly discovered site for 2,3-BPG shows lower affinity in fetal Hb (as compared to adults) explaining oxygen transfer from mother to embryo. The findings pose significant implications in routine physiology and pathologies like sickle cell anemia and thalassemia.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Abhinav Parashar
- Satyamjayatu: The Science & Ethics Foundation, Kulappully, India
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Thiagarajan P, Parker CJ, Prchal JT. How Do Red Blood Cells Die? Front Physiol 2021; 12:655393. [PMID: 33790808 PMCID: PMC8006275 DOI: 10.3389/fphys.2021.655393] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/24/2021] [Indexed: 12/24/2022] Open
Abstract
Normal human red blood cells have an average life span of about 120 days in the circulation after which they are engulfed by macrophages. This is an extremely efficient process as macrophages phagocytose about 5 million erythrocytes every second without any significant release of hemoglobin in the circulation. Despite large number of investigations, the precise molecular mechanism by which macrophages recognize senescent red blood cells for clearance remains elusive. Red cells undergo several physicochemical changes as they age in the circulation. Several of these changes have been proposed as a recognition tag for macrophages. Most prevalent hypotheses for red cell clearance mechanism(s) are expression of neoantigens on red cell surface, exposure phosphatidylserine and decreased deformability. While there is some correlation between these changes with aging their causal role for red cell clearance has not been established. Despite plethora of investigations, we still have incomplete understanding of the molecular details of red cell clearance. In this review, we have reviewed the recent data on clearance of senescent red cells. We anticipate recent progresses in in vivo red cell labeling and the explosion of modern proteomic techniques will, in near future, facilitate our understanding of red cell senescence and their destruction.
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Affiliation(s)
- Perumal Thiagarajan
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United States
| | - Charles J Parker
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Josef T Prchal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
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15
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Acute Cycling Exercise Induces Changes in Red Blood Cell Deformability and Membrane Lipid Remodeling. Int J Mol Sci 2021; 22:ijms22020896. [PMID: 33477427 PMCID: PMC7831009 DOI: 10.3390/ijms22020896] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 12/15/2022] Open
Abstract
Here we describe the effects of a controlled, 30 min, high-intensity cycling test on blood rheology and the metabolic profiles of red blood cells (RBCs) and plasma from well-trained males. RBCs demonstrated decreased deformability and trended toward increased generation of microparticles after the test. Meanwhile, metabolomics and lipidomics highlighted oxidative stress and activation of membrane lipid remodeling mechanisms in order to cope with altered properties of circulation resulting from physical exertion during the cycling test. Of note, intermediates from coenzyme A (CoA) synthesis for conjugation to fatty acyl chains, in parallel with reversible conversion of carnitine and acylcarnitines, emerged as metabolites that significantly correlate with RBC deformability and the generation of microparticles during exercise. Taken together, we propose that RBC membrane remodeling and repair plays an active role in the physiologic response to exercise by altering RBC properties.
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16
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Bahr TM, Henry E, Hulse W, Baer VL, Prchal JT, Bhutani VK, Christensen RD. Early Hyperbilirubinemia in Neonates with Down Syndrome. J Pediatr 2020; 219:140-145. [PMID: 32014279 DOI: 10.1016/j.jpeds.2019.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare total serum bilirubin (TSB) levels, phototherapy usage, and hospital readmission for jaundice among neonates with Down syndrome vs controls. STUDY DESIGN A retrospective cohort study using 15 years of multihospital data. We created control reference intervals (5th, median, and 95th percentiles) for initial TSB values hourly during the first days after birth, and determined the proportion of neonates with Down syndrome whose TSB exceeded the 95th percentile control interval. We determined the proportion with an initial TSB exceeding the upper control reference interval, the highest TSB recorded, the percentage of neonates receiving phototherapy, and the rate of hospital readmission for jaundice treatment. RESULTS We compared 357 neonates with Down syndrome with 377 368 controls. Compared with controls, those with Down syndrome had 4.7 times the risk (95% CI, 3.9-5.7; P < .0001) of an initial TSB exceeding the 95th percentile control interval (23.5% vs 5.0%), 8.9 times (95% CI, 8.1-9.8; P < .0001) the phototherapy usage (62.2% vs 7.0%), and 3.6 times (95% CI, 1.6-8.2; P = .0075) the readmission rate for jaundice (17.4 vs 4.8 per 1000 live births). CONCLUSIONS Neonates with Down syndrome have a substantial risk of early hyperbilirubinemia. The American Academy of Pediatrics currently advises obtaining an early screening complete blood count from neonates with Down syndrome. We submit that assessing their TSB is also advisable.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT.
| | - Erick Henry
- Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT
| | - Whitley Hulse
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT
| | - Vickie L Baer
- Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT
| | - Josef T Prchal
- Division of Hematology/Oncology, Department of Internal Medicine, University of Utah Health and Salt Lake City VA Hospital, Salt Lake City, UT
| | - Vinod K Bhutani
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucille Packard Children's Hospital, Stanford, CA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT; Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT; Division of Hematology-Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT
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17
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Gangaraju R, Song J, Kim SJ, Tashi T, Reeves BN, Sundar KM, Thiagarajan P, Prchal JT. Thrombotic, inflammatory, and HIF-regulated genes and thrombosis risk in polycythemia vera and essential thrombocythemia. Blood Adv 2020; 4:1115-1130. [PMID: 32203583 PMCID: PMC7094018 DOI: 10.1182/bloodadvances.2019001379] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/19/2020] [Indexed: 02/07/2023] Open
Abstract
Thrombosis is a major cause of morbidity and mortality in polycythemia vera (PV) and essential thrombocythemia (ET). The pathophysiology of thrombosis in these disorders remains unclear, and we hypothesized that upregulation of thrombotic, inflammatory, and hypoxia-inducible factor (HIF)-regulated genes may play a role in it. We performed unbiased RNA sequencing in granulocytes and platelets of PV patients and found differential expression of several thrombotic, inflammatory, and HIF-regulated genes. The expression of many of these genes positively correlated with JAK2 expression and JAK2V617F allelic burden. We then validated these findings by quantitative polymerase chain reaction analyses of selected gene transcripts in a larger number of PV and ET granulocytes and platelets (58 patients) and in 28 controls, and we compared these findings in patients with and without thrombosis. The study included 29 females and 29 males; of these, 28 had a history of thrombosis. We found that transcripts of several selected genes were upregulated in patients with PV or ET compared with controls. In granulocytes, the expression levels of F3, SELP, VEGFA, and SLC2A1 were significantly higher in patients with a history of thrombosis compared with those who did not have thrombosis. Patients with a history of thrombosis have significantly higher expression of IL1RAP (P < .05) in platelets compared with those without thrombosis. Our study confirms the presence of a thrombo-inflammatory state and augmented HIF activity in PV and ET and its role in thrombosis. These data may provide the background for targeted therapies in PV and ET.
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Affiliation(s)
- Radhika Gangaraju
- Division of Hematology-Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jihyun Song
- Division of Hematology, School of Medicine, University of Utah, Salt Lake City, UT
| | - Soo Jin Kim
- Division of Hematology, School of Medicine, University of Utah, Salt Lake City, UT
| | - Tsewang Tashi
- Division of Hematology, School of Medicine, University of Utah, Salt Lake City, UT
| | - Brandi N Reeves
- Division of Hematology-Oncology, University of North Carolina, Chapel Hill, NC
| | - Krishna M Sundar
- Division of Pulmonology, Critical Care and Sleep Medicine, School of Medicine, University of Utah, Salt Lake City, UT
| | - Perumal Thiagarajan
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Department of Medicine and Pathology, Baylor College of Medicine, Houston, TX; and
| | - Josef T Prchal
- Division of Hematology, School of Medicine, University of Utah, Salt Lake City, UT
- Veterans Administration Medical Center, Salt Lake City, UT
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18
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Song J, Tashi T, Prchal JT. Editorial Comment on: Inhibition of Suicidal Erythrocyte Death by Chronic Hypoxia by Tang et al. (From: Tang F, Feng L, Li R, Wang W, Liu H, Yang Q, Ge R-L. High Alt Med Biol 2019;20:112-119; DOI: 10.1089/ham.2017.0159). High Alt Med Biol 2019; 20:120-121. [PMID: 31233384 DOI: 10.1089/ham.2019.29017.stp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jihyun Song
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, Utah
| | - Tsewang Tashi
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, Utah
| | - Josef T Prchal
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, Utah
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19
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BDNF-mediated mitophagy alleviates high-glucose-induced brain microvascular endothelial cell injury. Apoptosis 2019; 24:511-528. [DOI: 10.1007/s10495-019-01535-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Kinoshita C, Aoyama K, Nakaki T. Neuroprotection afforded by circadian regulation of intracellular glutathione levels: A key role for miRNAs. Free Radic Biol Med 2018; 119:17-33. [PMID: 29198727 DOI: 10.1016/j.freeradbiomed.2017.11.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/21/2017] [Accepted: 11/27/2017] [Indexed: 01/17/2023]
Abstract
Circadian rhythms are approximately 24-h oscillations of physiological and behavioral processes that allow us to adapt to daily environmental cycles. Like many other biological functions, cellular redox status and antioxidative defense systems display circadian rhythmicity. In the central nervous system (CNS), glutathione (GSH) is a critical antioxidant because the CNS is extremely vulnerable to oxidative stress; oxidative stress, in turn, causes several fatal diseases, including neurodegenerative diseases. It has long been known that GSH level shows circadian rhythm, although the mechanism underlying GSH rhythm production has not been well-studied. Several lines of recent evidence indicate that the expression of antioxidant genes involved in GSH homeostasis as well as circadian clock genes are regulated by post-transcriptional regulator microRNA (miRNA), indicating that miRNA plays a key role in generating GSH rhythm. Interestingly, several reports have shown that alterations of miRNA expression as well as circadian rhythm have been known to link with various diseases related to oxidative stress. A growing body of evidence implicates a strong correlation between antioxidative defense, circadian rhythm and miRNA function, therefore, their dysfunctions could cause numerous diseases. It is hoped that continued elucidation of the antioxidative defense systems controlled by novel miRNA regulation under circadian control will advance the development of therapeutics for the diseases caused by oxidative stress.
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Affiliation(s)
- Chisato Kinoshita
- Department of Pharmacology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Koji Aoyama
- Department of Pharmacology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Toshio Nakaki
- Department of Pharmacology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
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21
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Mairbäurl H. Neocytolysis: How to Get Rid of the Extra Erythrocytes Formed by Stress Erythropoiesis Upon Descent From High Altitude. Front Physiol 2018; 9:345. [PMID: 29674976 PMCID: PMC5896414 DOI: 10.3389/fphys.2018.00345] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/20/2018] [Indexed: 01/18/2023] Open
Abstract
Neocytolysis is the selective destruction of those erythrocytes that had been formed during stress-erythropoiesis in hypoxia in order to increase the oxygen transport capacity of blood. Neocytolysis likely aims at decreasing this excess amount of erythrocytes and hemoglobin (Hb) when it is not required anymore and to decrease blood viscosity. Neocytolysis seems to occur upon descent from high altitude. Similar processes seem to occur in microgravity, and are also discussed to mediate the replacement of erythrocytes containing fetal hemoglobin (HbF) with those having adult hemoglobin (HbA) after birth. This review will focus on hypoxia at high altitude. Hemoglobin concentration and total hemoglobin in blood increase by 20-50% depending on the altitude (i.e., the degree of hypoxia) and the duration of the sojourn. Upon return to normoxia hemoglobin concentration, hematocrit, and reticulocyte counts decrease faster than expected from inhibition of stress-erythropoiesis and normal erythrocyte destruction rates. In parallel, an increase in haptoglobin, bilirubin, and ferritin is observed, which serve as indirect markers of hemolysis and hemoglobin-breakdown. At the same time markers of progressing erythrocyte senescence appear even on reticulocytes. Unexpectedly, reticulocytes from hypoxic mice show decreased levels of the hypoxia-inducible factor HIF-1α and decreased activity of the BCL2/adenovirus E1B 19 kDa protein-interacting protein 3 (BNIP3), which results in elevated mitochondrial activity in these cells. Furthermore, hypoxia increases the expression of miR-21, which inhibits the expression of catalase and thus decreases one of the most important mechanisms protecting against oxygen free radicals in erythrocytes. This unleashes a series of events which likely explain neocytolysis, because upon re-oxygenation systemic and mitochondrial oxygen radical formation increases and causes the selective destruction of those erythrocytes having impaired anti-oxidant capacity.
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Affiliation(s)
- Heimo Mairbäurl
- Medical Clinic VII, Sports Medicine, Translational Lung Research Center, German Center for Lung Research, University Hospital Heidelberg, Heidelberg, Germany
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22
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Sundar KM, Prchal JT. The Cornerstone of the Aberrant Pathophysiology of Obstructive Sleep Apnea: Tissue Responses to Chronic Sustained Versus Intermittent Hypoxia. Am J Respir Cell Mol Biol 2018; 56:419-420. [PMID: 28362150 DOI: 10.1165/rcmb.2017-0028ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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23
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Abstract
Hypoxia increases erythropoiesis by hypoxia-inducible factors (HIF), principally by HIF-2, which upregulates erythropoietin transcription. This results in an increase of red blood cell (RBC) production and delivery of more oxygen to tissues. Upon rapid return to normoxia, hypoxia-induced polycythemia is overcorrected by neocytolysis, a transient destruction of preferentially young RBCs bearing low catalase (downregulated by hypoxia-stimulated microRNA(miR)-21) caused by reactive oxygen species (ROS) from expanded mitochondria. In order to study molecular mechanism of neocytolysis, it is critical to differentiate life span of young and old RBCs and to measure the hematological changes before and after hypoxia treatment. Here we describe the methodological aspects of these measurements.
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24
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Siebenmann C, Robach P, Lundby C. Regulation of blood volume in lowlanders exposed to high altitude. J Appl Physiol (1985) 2017; 123:957-966. [PMID: 28572493 DOI: 10.1152/japplphysiol.00118.2017] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/18/2017] [Accepted: 05/31/2017] [Indexed: 12/21/2022] Open
Abstract
Humans ascending to high altitude (HA) experience a reduction in arterial oxyhemoglobin saturation and, as a result, arterial O2 content ([Formula: see text]). As HA exposure extends, this reduction in [Formula: see text] is counteracted by an increase in arterial hemoglobin concentration. Initially, hemoconcentration is exclusively related to a reduction in plasma volume (PV), whereas after several weeks a progressive expansion in total red blood cell volume (RCV) contributes, although often to a modest extent. Since the decrease in PV is more rapid and usually more pronounced than the expansion in RCV, at least during the first weeks of exposure, a reduction in circulating blood volume is common at HA. Although the regulation of hematological responses to HA has been investigated for decades, it remains incompletely understood. This is not only related to the large number of mechanisms that could be involved and the complexity of their interplay but also to the difficulty of conducting comprehensive experiments in the often secluded HA environment. In this review, we present our understanding of the kinetics, the mechanisms and the physiological relevance of the HA-induced reduction in PV and expansion in RCV.
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Affiliation(s)
- Christoph Siebenmann
- The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Paul Robach
- National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - Carsten Lundby
- The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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25
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Song J, Sundar K, Gangaraju R, Prchal JT. Regulation of erythropoiesis after normoxic return from chronic sustained and intermittent hypoxia. J Appl Physiol (1985) 2017; 123:1671-1675. [PMID: 28522758 DOI: 10.1152/japplphysiol.00119.2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hypoxia increases erythropoiesis mediated by hypoxia-inducible transcription factors (HIF), which regulate erythropoietin transcription. Neocytolysis is a physiological mechanism that corrects polycythemia from chronic sustained hypoxemia by transient, preferential destruction of young RBCs after normoxia is restored. We showed that neocytolysis is caused by excessive mitochondrial-derived reactive oxygen species in reticulocytes mediated by downregulation of HIF-controlled BNIP3L regulated mitophagy and a decrease in RBC antioxidant catalase (CAT) in hypoxia-produced erythrocytes. Decreased CAT results from hypoxia-induced miR-21 that downregulates CAT. This correlates with a transient acute decrease of HIF-1 at normoxic return that is associated with normalization of red cell mass.
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26
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Arias CF, Arias CF. How do red blood cells know when to die? ROYAL SOCIETY OPEN SCIENCE 2017; 4:160850. [PMID: 28484605 PMCID: PMC5414242 DOI: 10.1098/rsos.160850] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/01/2017] [Indexed: 05/19/2023]
Abstract
Human red blood cells (RBCs) are normally phagocytized by macrophages of splenic and hepatic sinusoids at 120 days of age. The destruction of RBCs is ultimately controlled by antagonist effects of phosphatidylserine (PS) and CD47 on the phagocytic activity of macrophages. In this work, we introduce a conceptual model that explains RBC lifespan as a consequence of the dynamics of these molecules. Specifically, we suggest that PS and CD47 define a molecular algorithm that sets the timing of RBC phagocytosis. We show that significant changes in RBC lifespan described in the literature can be explained as alternative outcomes of this algorithm when it is executed in different conditions of oxygen availability. The theoretical model introduced here provides a unified framework to understand a variety of empirical observations regarding RBC biology. It also highlights the role of RBC lifespan as a key element of RBC homeostasis.
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Affiliation(s)
- Clemente Fernandez Arias
- Departamento de Matemática Aplicada, Universidad Complutense de Madrid, Spain
- Grupo Interdisciplinar de Sistemas Complejos, Madrid, Spain
| | - Cristina Fernandez Arias
- HIV and Malaria Vaccine Program, Aaron Diamond AIDS Research Center, Affiliate of The Rockefeller University, New York, NY, USA
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27
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Fornari TA, Lanaro C, Albuquerque DM, Ferreira R, Costa FF. Featured Article: Modulation of fetal hemoglobin in hereditary persistence of fetal hemoglobin deletion type-2, compared to Sicilian δβ-thalassemia, by BCL11A and SOX6-targeting microRNAs. Exp Biol Med (Maywood) 2016; 242:267-274. [PMID: 27591578 DOI: 10.1177/1535370216668052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Hereditary persistence of fetal hemoglobin deletion type-2 (HPFH-2) and Sicilian-δβ-thalassemia are conditions described as large deletions of the human β-like globin cluster, with absent β-globin chains and a compensatory variable increase in γ-globin. HPFH, in general, may be distinguished from DB-Thalassemia by higher fetal hemoglobin (HbF) levels, absence of anemia and hypochromic and microcytic erythrocytes. MicroRNAs (miRNAs) regulate a range of cellular processes including erythropoiesis and regulation of transcription factors such as the BCL11A and SOX6 genes, which are related to the regulation of γ-globin expression. In this report, a possible association among the overexpression of miRNAs and the expression of the γ-globin gene was analyzed in these two conditions. Forty-nine differentially expressed miRNAs were identified by microarrays in CD34+-derived erythroid cells of two subjects heterozygous for Sicilian-δβ-thalassemia, 2 for HPFH-2 and 3 for controls after 13 days of culture. Some of these miRNAs may participate in γ-globin gene regulation and red blood cell function. The BCL11A gene was found to be potentially targeted by 12 miRNAs that were up-regulated in HPFH-2 or in DB-Thal. A down-regulation of BCL11A gene expression in HPFH-2 was verified by quantitative polymerase chain reaction. These data suggest an important action for miRNA that may partially explain the phenotypic differences between HPFH-2 and Sicilian δβ-thalassemia and the increased expression of γ-globin in these conditions.
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Affiliation(s)
- Thais A Fornari
- Hemocentro-UNICAMP - SP, Brazil, São Paulo 13083-878, Brazil
| | - Carolina Lanaro
- Hemocentro-UNICAMP - SP, Brazil, São Paulo 13083-878, Brazil
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Lang M, Wang X, Wang H, Dong J, Lan C, Hao J, Huang C, Li X, Yu M, Yang Y, Yang S, Ren H. Arsenic trioxide plus PX-478 achieves effective treatment in pancreatic ductal adenocarcinoma. Cancer Lett 2016; 378:87-96. [PMID: 27212442 DOI: 10.1016/j.canlet.2016.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 05/12/2016] [Accepted: 05/17/2016] [Indexed: 02/06/2023]
Abstract
Arsenic trioxide (ATO) has been selected as a promising treatment not only in leukemia but also in solid tumors. Previous studies showed that the cytotoxicity of ATO mainly depends on the induction of reactive oxygen species. However, ATO has only achieved a modest effect in pancreatic ductal adenocarcinoma, suggesting that the existing radical scavenging proteins, such as hypoxia inducible factor-1, attenuate the effect. The goal of this study is to investigate the effect of combination treatment of ATO plus PX-478 (hypoxia-inducible factor-1 inhibitor) and its underlying mechanism. Here, we showed that PX-478 robustly strengthened the anti-growth and pro-apoptosis effect of ATO on Panc-1 and BxPC-3 pancreatic cancer cells in vitro. Meanwhile, in vivo mouse xenograft models also showed the synergistic effect of ATO plus PX-478 compared with any single agent. Further studies showed that the anti-tumor effect of ATO plus PX-478 was derived from the reactive oxygen species-induced apoptosis. We next confirmed that Hypoxia-inducible factor-1 cleared reactive oxygen species by its downstream target, forkhead box O transcription factors, and this effect may justify the strategy of ATO plus PX-478 in the treatment of pancreatic cancer.
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Affiliation(s)
- Mingxiao Lang
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiuchao Wang
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hongwei Wang
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jie Dong
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Chungen Lan
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jihui Hao
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chongbiao Huang
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xin Li
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ming Yu
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yanhui Yang
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormones and Development (Ministry of Health), Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Shengyu Yang
- Department of Tumor Biology and Comprehensive Melanoma Research Center, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - He Ren
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
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Christensen RD, Henry E, Bennett ST, Yaish HM. Reference intervals for reticulocyte parameters of infants during their first 90 days after birth. J Perinatol 2016; 36:61-6. [PMID: 26513452 DOI: 10.1038/jp.2015.140] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/26/2015] [Accepted: 09/01/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The automated reticulocyte parameters (absolute reticulocyte count, immature reticulocyte fraction (IRF) and reticulocyte hemoglobin content (RET-He)) are of value in managing adults and older children with a variety of hematological disorders. However, the lack of reference intervals for these parameters in neonates and young infants has limited their application to that population. STUDY DESIGN During a span of 12 months (29 May 2014 to 5 May 2015), a convenience sample of reticulocyte parameters were run from clinically ordered complete blood counts (CBCs) of infants within the first 90 days after birth. Measuring the reticulocyte parameters as a research-only adjunct to the CBC did not require any additional blood or generate a patient charge, and the reticulocyte results were not reported to the provided and did not appear in the clinical records. Values from neonates who had a transfusion or a diagnosis of anemia were subsequently excluded from the reference data set. RESULTS Nine Intermountain Healthcare clinical laboratories contributed 8438 CBCs to the initial reticulocyte parameter database. From these, 1806 were excluded because of a transfusion or a diagnosis of anemia, leaving 6632 in the reference interval database. The parameters charted over the first 90 days after birth were: (1) blood hemoglobin concentration (g dl(-1)), (2) mean corpuscular volume (fL), (3) reticulocyte count (x10(3) per μl), (4) IRF (%) and (5) RET-He (pg). CONCLUSIONS The new reference interval charts can help clinicians identify abnormalities in the reticulocyte parameters. This information could be of value in identifying and following neonates with various hematological problems including hemolytic disorders, occult hemorrhage, or iron deficiency or other limitations of erythrocyte production.
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Affiliation(s)
- R D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.,Women and Newborn's Program, Intermountain Healthcare, Salt Lake City, UT, USA.,Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - E Henry
- Women and Newborn's Program, Intermountain Healthcare, Salt Lake City, UT, USA.,Institute for Healthcare Delivery Research, Salt Lake City, UT, USA
| | - S T Bennett
- Department of Pathology, Intermountain Medical Center, Murray, UT, USA
| | - H M Yaish
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Divoky V, Song J, Horvathova M, Kralova B, Votavova H, Prchal JT, Yoon D. Delayed hemoglobin switching and perinatal neocytolysis in mice with gain-of-function erythropoietin receptor. J Mol Med (Berl) 2015; 94:597-608. [PMID: 26706855 DOI: 10.1007/s00109-015-1375-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 11/18/2015] [Accepted: 11/24/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Mutations of the truncated cytoplasmic domain of human erythropoietin receptor (EPOR) result in gain-of-function of erythropoietin (EPO) signaling and a dominantly inherited polycythemia, primary familial and congenital polycythemia (PFCP). We interrogated the unexplained transient absence of perinatal polycythemia observed in PFCP patients using an animal model of PFCP to examine its erythropoiesis during embryonic, perinatal, and early postnatal periods. In this model, we replaced the murine EpoR gene (mEpoR) with the wild-type human EPOR (wtHEPOR) or mutant human EPOR gene (mtHEPOR) and previously reported that the gain-of-function mtHEPOR mice become polycythemic at 3~6 weeks of age, but not at birth, similar to the phenotype of PFCP patients. In contrast, wtHEPOR mice had sustained anemia. We report that the mtHEPOR fetuses are polycythemic, but their polycythemia is abrogated in the perinatal period and reappears again at 3 weeks after birth. mtHEPOR fetuses have a delayed switch from primitive to definitive erythropoiesis, augmented erythropoietin signaling, and prolonged Stat5 phosphorylation while the wtHEPOR fetuses are anemic. Our study demonstrates the in vivo effect of excessive EPO/EPOR signaling on developmental erythropoiesis switch and describes that fetal polycythemia in this PFCP model is followed by transient correction of polycythemia in perinatal life associated with low Epo levels and increased exposure of erythrocytes' phosphatidylserine. We suggest that neocytolysis contributes to the observed perinatal correction of polycythemia in mtHEPOR newborns as embryos leaving the hypoxic uterus are exposed to normoxia at birth. KEY MESSAGE Human gain-of-function EPOR (mtHEPOR) causes fetal polycythemia in knock-in mice. Wild-type human EPOR causes fetal anemia in knock-in mouse model. mtHEPOR mice have delayed switch from primitive to definitive erythropoiesis. Polycythemia of mtHEPOR mice is transiently corrected in perinatal life. mtHEPOR newborns have low Epo and increased exposure of erythrocytes' phosphatidylserine.
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Affiliation(s)
- Vladimir Divoky
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University, 775 15, Olomouc, Czech Republic
| | - Jihyun Song
- Hematology Division, Department of Medicine, University of Utah and VAH, Salt Lake City, UT, 84132, USA
| | - Monika Horvathova
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University, 775 15, Olomouc, Czech Republic
| | - Barbora Kralova
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University, 775 15, Olomouc, Czech Republic
| | - Hana Votavova
- Institute of Hematology and Blood Transfusion, 12820, Prague, Czech Republic
| | - Josef T Prchal
- Hematology Division, Department of Medicine, University of Utah and VAH, Salt Lake City, UT, 84132, USA.
| | - Donghoon Yoon
- Hematology Division, Department of Medicine, University of Utah and VAH, Salt Lake City, UT, 84132, USA
- Myeloma Institute University of Arkansas for Medical Science, Little Rock, AR, USA
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