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Li W, Tsai AG, Intaglietta M, Tartakovsky DM. A model of anemic tissue perfusion after blood transfusion shows critical role of endothelial response to shear stress stimuli. J Appl Physiol (1985) 2021; 131:1815-1823. [PMID: 34647829 DOI: 10.1152/japplphysiol.00524.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although some of the cardiovascular responses to changes in hematocrit (Hct) are not fully quantified experimentally, available information is sufficient to build a mathematical model of the consequences of treating anemia by introducing RBCs into the circulation via blood transfusion. We present such a model, which describes how the treatment of normovolemic anemia with blood transfusion impacts oxygen (O2) delivery (DO2, the product of blood O2 content and arterial blood flow) by the microcirculation. Our analysis accounts for the differential response of the endothelium to the wall shear stress (WSS) stimulus, changes in nitric oxide (NO) production due to modification of blood viscosity caused by alterations of both hematocrit (Hct) and cell free layer thickness, as well as for their combined effects on microvascular blood flow and DO2. Our model shows that transfusions of 1- and 2-unit of blood have a minimal effect on DO2 if the microcirculation is unresponsive to the WSS stimulus for NO production that causes vasodilatation increasing blood flow and DO2. Conversely, in a fully WSS responsive organism, blood transfusion significantly enhances blood flow and DO2, because increased viscosity stimulates endothelial NO production causing vasodilatation. This finding suggests that evaluation of a patients' pretransfusion endothelial WSS responsiveness should be beneficial in determining the optimal transfusion requirements for treating patients with anemia.NEW & NOTEWORTHY Transfusion of 1 or 2 units of blood accounts for about 3/4 of the world blood consumption of 119 million units per year, whereas a current world demand deficit is on the order of 100 million units. Therefore, factors supporting the practice of transfusing 1 unit instead of 2 are of interest, given their potential to expand the number of interventions without increasing blood availability. Our mathematical model provides a physiological support for this practice.
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Affiliation(s)
- Weiyu Li
- Department of Energy Resources Engineering, Stanford University, Stanford, California
| | - Amy G Tsai
- Department of Bioengineering, University of California, San Diego, California
| | - Marcos Intaglietta
- Department of Bioengineering, University of California, San Diego, California
| | - Daniel M Tartakovsky
- Department of Energy Resources Engineering, Stanford University, Stanford, California
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Williams AT, Muller CR, Eaker AM, Belcher DA, Bolden-Rush C, Palmer AF, Cabrales P. Polymerized Hemoglobin With Increased Molecular Size Reduces Toxicity in Healthy Guinea Pigs. ACS APPLIED BIO MATERIALS 2020; 3:2976-2985. [DOI: 10.1021/acsabm.0c00039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alexander T. Williams
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Cynthia R. Muller
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Allyn M. Eaker
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Donald A. Belcher
- Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, United States
| | - Crystal Bolden-Rush
- Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, United States
| | - Andre F. Palmer
- Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, United States
| | - Pedro Cabrales
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
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Wang Y, Zhu K, Wang J, Yang L. Numerical simulation of heat induced flow-mediated dilation of blood vessels. J Therm Biol 2019; 84:323-330. [PMID: 31466770 DOI: 10.1016/j.jtherbio.2019.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022]
Abstract
Local heat can accelerate the blood circulation and induce the vasodilatation. Investigators reported that local heat causes an increase in skin blood flow consisting of two phases. The first is solely sensory neural, and the second is nitric oxide mediated. However, the mechanism underlying the skin blood flow response to local heating are complex and poorly understood. The mechanisms behind these two phases are deduced to be linked by flow-mediated dilation. In this study, the variation of the blood flow and the blood vessel diameter are monitored during local heating. According to the dynamic blood flow, the theoretical model of flow mediated dilation involving the key agents production and transportation was first used to study vasodilatation process during heating, and the variations of blood vessel was obtained. Finally, accurate distributions of the nitric oxide, calcium and myosin concentrations in the arterial wall were found during autoregulation. We evaluated the time course of the blood vessel changing and verified the fact that the second increase in blood flow is the result of flow dilation mediation. The effects of dilation of blood vessel were also analyzed.
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Affiliation(s)
- Yabo Wang
- Tianjin Key Laboratory of Refrigeration Technology, Tianjin University of Commerce, Tianjin, China.
| | - Kai Zhu
- Tianjin Key Laboratory of Refrigeration Technology, Tianjin University of Commerce, Tianjin, China
| | - Jinshan Wang
- Tianjin Key Laboratory of Refrigeration Technology, Tianjin University of Commerce, Tianjin, China
| | - Long Yang
- Tianjin First Central Hospital, Tianjin, 300192, China
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Belcher DA, Ju JA, Baek JH, Yalamanoglu A, Buehler PW, Gilkes DM, Palmer AF. The quaternary state of polymerized human hemoglobin regulates oxygenation of breast cancer solid tumors: A theoretical and experimental study. PLoS One 2018; 13:e0191275. [PMID: 29414985 PMCID: PMC5802857 DOI: 10.1371/journal.pone.0191275] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/02/2018] [Indexed: 11/19/2022] Open
Abstract
A major constraint in the treatment of cancer is inadequate oxygenation of the tumor mass, which can reduce chemotherapeutic efficacy. We hypothesize that polymerized human hemoglobin (PolyhHb) can be transfused into the systemic circulation to increase solid tumor oxygenation, and improve chemotherapeutic outcomes. By locking PolyhHb in the relaxed (R) quaternary state, oxygen (O2) offloading at low O2 tensions (<20 mm Hg) may be increased, while O2 offloading at high O2 tensions (>20 mm Hg) is facilitated with tense (T) state PolyhHb. Therefore, R-state PolyhHb may deliver significantly more O2 to hypoxic tissues. Biophysical parameters of T and R-state PolyhHb were used to populate a modified Krogh tissue cylinder model to assess O2 transport in a tumor. In general, we found that increasing the volume of transfused PolyhHb decreased the apparent viscosity of blood in the arteriole. In addition, we found that PolyhHb transfusion decreased the wall shear stress at large arteriole diameters (>20 μm), but increased wall shear stress for small arteriole diameters (<10 μm). Therefore, transfusion of PolyhHb may lead to elevated O2 delivery at low pO2. In addition, transfusion of R-state PolyhHb may be more effective than T-state PolyhHb for O2 delivery at similar transfusion volumes. Reduction in the apparent viscosity resulting from PolyhHb transfusion may result in significant changes in flow distributions throughout the tumor microcirculatory network. The difference in wall shear stress implies that PolyhHb may have a more significant effect in capillary beds through mechano-transduction. Periodic top-load transfusions of PolyhHb into mice bearing breast tumors confirmed the oxygenation potential of both PolyhHbs via reduced hypoxic volume, vascular density, tumor growth, and increased expression of hypoxia inducible genes. Tissue section analysis demonstrated primary PolyhHb clearance occurred in the liver and spleen indicating a minimal risk for renal damage.
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Affiliation(s)
- Donald A. Belcher
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH, United States of America
| | - Julia A. Ju
- Department of Chemical and Biomolecular Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - Jin Hyen Baek
- Division of Blood Components and Devices, Laboratory of Biochemistry and Vascular Biology, FDA/CBER, Silver Spring, MD, United States of America
| | - Ayla Yalamanoglu
- Division of Blood Components and Devices, Laboratory of Biochemistry and Vascular Biology, FDA/CBER, Silver Spring, MD, United States of America
| | - Paul W. Buehler
- Division of Blood Components and Devices, Laboratory of Biochemistry and Vascular Biology, FDA/CBER, Silver Spring, MD, United States of America
| | - Daniele M. Gilkes
- Department of Chemical and Biomolecular Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Andre F. Palmer
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH, United States of America
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Ortiz D, Barros M, Yan S, Cabrales P. Resuscitation from hemorrhagic shock using polymerized hemoglobin compared to blood. Am J Emerg Med 2013; 32:248-55. [PMID: 24418449 DOI: 10.1016/j.ajem.2013.11.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/06/2013] [Accepted: 11/27/2013] [Indexed: 11/30/2022] Open
Abstract
The development of an alternative to blood transfusion to treat severe hemorrhage remains a challenge, especially in far forward scenarios when blood is not available. Hemoglobin level (Hb)-based oxygen (O2) carriers (HBOCs) were developed to address this need. Hemopure (HBOC-201, bovine Hb glutamer-250; OPK Biotech, Cambridge, MA), one such HBOC, has been approved for clinical use in South Africa and Russia. At the time of its approval, however, few studies aimed to understand Hemopure's function, administration, and adverse effects compared to blood. We used intravital microscopy to study the microcirculation hemodynamics (arteriolar and venular diameters and blood flow and functional capillary density [FCD]) and oxygenation implications of Hemopure administration at different Hb concentrations-4, 8, and 12 gHb/dL-compared to fresh blood transfusion during resuscitation from hemorrhagic shock. Experiments were performed in unanesthetized hamsters instrumented with a skinfold window chamber, subjected to hemorrhage (50% of the blood volume), followed by 1-hour hypovolemic shock and fluid resuscitation (50% of the shed volume). Our results show that fluid resuscitation with Hemopure or blood restored systemic and microvascular parameters. Microcirculation O2 delivery was directly correlated with Hemopure concentration, although increased vasoconstriction was as well. Functional capillary density reflected the balance between enhanced O2 transport and reduced blood flow: 12 gHb/dL of Hemopure and blood decreased FCD compared to the lower concentrations of Hemopure (P < .05). The balance between O2 transport and tissue perfusion can provide superior resuscitation from hemorrhagic shock compared to blood transfusion by using a low Hb concentration of HBOCs relative to blood.
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Affiliation(s)
- Daniel Ortiz
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093-0412, USA.
| | - Marcelo Barros
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093-0412, USA.
| | - Su Yan
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093-0412, USA.
| | - Pedro Cabrales
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093-0412, USA.
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