A mathematical model for lactate transport to red blood cells

The oxygen dissociation curve of blood in COVID-19-An update

An impressive effect of the infection with SARS-Co-19 is the impairment of oxygen uptake due to lung injury. The reduced oxygen diffusion may potentially be counteracted by an increase in oxygen affinity of hemoglobin. However, hypoxia and anemia associated with COVID-19 usually decrease oxygen affinity due to a rise in [2,3-bisphosphoglycerate]. As such, COVID-19 related changes in the oxygen dissociation curve may be critical for oxygen uptake and supply, but are hard to predict. A Pubmed search lists 14 publications on oxygen affinity in COVID-19. While some investigations show no changes, three large studies found an increased affinity that was related to a good prognosis. Exact causes remain unknown. The cause of the associated anemia in COVID-19 is under discussion. Erythrocytes with structural alterations of membrane and cytoskeleton have been observed, and virus binding to Band 3 and also to ACE2 receptors in erythroblasts has been proposed. COVID-19 presentation is moderate in many subjects suffering from sickle cell disease. A possible explanation is that COVID-19 counteracts the unfavorable large right shift of the oxygen dissociation curve in these patients. Under discussion for therapy are mainly affinity-increasing drugs.

The oxygen dissociation curve of blood in COVID-19

COVID-19 hinders oxygen transport to the consuming tissues by at least two mechanisms: In the injured lung, saturation of hemoglobin is compromised, and in the tissues, an associated anemia reduces the volume of delivered oxygen. For the first problem, increased hemoglobin oxygen affinity [left shift of the oxygen dissociation curve (ODC)] is of advantage, for the second, however, the contrary is the case. Indeed a right shift of the ODC has been found in former studies for anemia caused by reduced cell production or hemolysis. This resulted from increased 2,3-bisphosphoglycerate (2,3-BPG) concentration. In three investigations in COVID-19, however, no change of hemoglobin affinity was detected in spite of probably high [2,3-BPG]. The most plausible cause for this finding is formation of methemoglobin (MetHb), which increases the oxygen affinity and thus apparently compensates for the 2,3-BPG effect. However, this "useful effect" is cancelled by the concomitant reduction of functional hemoglobin. In the largest study on COVID-19, even a clear left shift of the ODC was detected when calculated from measurements in fresh blood rather than after equilibration with gases outside the body. This additional "in vivo" left shift possibly results from various factors, e.g., concentration changes of Cl-, 2,3-BPG, ATP, lactate, nitrocompounds, glutathione, glutamate, because of time delay between blood sampling and end of equilibration, or enlarged distribution space including interstitial fluid and is useful for O2 uptake in the lungs. Under discussion for therapy are the affinity-increasing 5-hydroxymethyl-2-furfural (5-HMF), erythropoiesis-stimulating substances like erythropoietin, and methylene blue against MetHb formation.

Evaluation of a sport-specific field test to determine maximal lactate accumulation rate and sprint performance parameters in running

OBJECTIVES

The aim of this study was to examine the reliability of maximal lactate accumulation rate (V˙La_max) and sprint performance parameters in running and assess different approaches to determine alactic time interval (t_alac).

DESIGN

Sixteen competitive runners (female=5; male=11) performed three trials (T1, T2 and T3) of an all-out 100-m sprint test separated by 48h.

METHODS

Time to cover the 100m was determined by using a photoelectric light-barrier (t_100,LB) and a stop-watch (t_100,SW). Throughout the sprints, velocity was measured using a laser velocity guard (LAVEG) to estimate maximal velocity (v_max) and power (P_max). The t_alac was calculated as the time when power decreased by 3.5% (t_pmax-3.5%) and interpolated based on the sprint time (t_inter,LB and t_inter,SW). Reliability was assessed using intraclass correlation coefficient (ICC), typical error (TE) and smallest worthwhile change (SWC).

RESULTS

After initial familiarisation, t₁₀₀, t_inter, v_max, P_max and V˙La_max attained excellent reliability (ICC≥0.90), whereas t_pmax-3.5% attained moderate reliability (ICC=0.518). The reliability of V˙La_max was higher when t_inter,LB or t_inter,SW were used (ICC=0.960) compared to using t_pmax-3.5% (ICC=0.928). At T1, V˙La_max was significantly higher when stop-watch measurements were used. There was no difference between t_pmax-3.5% and the interpolated time intervals and the associated V˙La_max-estimates.

CONCLUSIONS

In running, V˙La_max and sprint performance parameters can easily and high-reliably be measured using this sport-specific field test. Interpolating t_alac results in similar and more reliable values of V˙La_max. To improve the reliability and accuracy of the stop-watch estimate, a familiarisation should be performed.

Influence of Whole-Body Electrostimulation on Human Red Blood Cell Deformability

Red blood cell-nitric oxide synthase (RBC-NOS)-dependent NO production is essential for the maintenance of RBC deformability, which is known to improve oxygen supply to the working tissue. Electrostimulation of the whole body (WB-EMS) has been shown to improve maximal strength, springiness, and jumping power of trained and untrained athletes. To examine whether these 2 parameters are associated, this study, for the first time, aimed to investigate the effects of an 18-week dynamic WB-EMS program on RBC deformability in addition to maximal strength performance (1 repetition maximum [1RM]) in elite soccer players. Fifteen test persons were assigned in either WB-EMS group (EG, n = 10) or training group (TG, n = 5). Next to their weekly training sessions, EG performed 3 × 10 squat jumps under the influence of WB-EMS twice per week between weeks 1 and 14 and once per week between weeks 14 and 18. Training group only performed 3 × 10 squat jumps. Performance was assessed by a maximal strength test on the leg press machine (1RM). Subjects were tested at baseline and after weeks 7, 14, and 18 with blood sampling before (Pre), 15-30 minutes after (Post), and 24 hours after (24-hour Post) the training. The results showed that maximal strength was significantly improved in EG (p < 0.01). Maximum RBC deformability (EImax) increased on EMS stimulus in EG while it remained unaffected in the TG. Acute increase in EImax at baseline was explained by an increase in RBC-NOS activation while chronic increase of deformability must be caused by different, yet unknown, mechanisms. EImax decreased between weeks 14 and 18 suggesting that 1 WB-EMS session per week is not sufficient to alter deformability (EImax). In contrast, the deformability at low shear stress (EI 3 Pa), comparable with conditions found in the microcirculation, significantly increased in EG until week 14, whereas in TG deformability only, increased until week 7 due to increasing training volume after the winter break. The results indicate that WB-EMS represents a useful and time-saving addition to conventional training sessions to improve RBC deformability and possibly oxygen supply to the working tissue and thus promoting general force components in high performance sport.

Metabolomics of AS-5 RBC supernatants following routine storage

BACKGROUND AND OBJECTIVES

The safety and efficacy of stored red blood cells (RBCs) transfusion has been long debated due to retrospective clinical evidence and laboratory results, indicating a potential correlation between increased morbidity and mortality following transfusion of RBC units stored longer than 14 days. We hypothesize that storage in Optisol additive solution-5 leads to a unique metabolomics profile in the supernatant of stored RBCs.

MATERIALS AND METHODS

Whole blood was drawn from five healthy donors, RBC units were manufactured, and prestorage leucoreduced by filtration. Samples were taken on days 1 and 42, the cells removed, and mass spectrometry-based metabolomics was performed.

RESULTS

The results confirmed the progressive impairment of RBC energy metabolism by day 42 with indirect markers of a parallel alteration of glutathione and NADPH homeostasis. Moreover, oxidized pro-inflammatory lipids accumulated by the end of storage.

CONCLUSION

The supernatants from stored RBCs may represent a burden to the transfused recipients from a metabolomics standpoint.