Red cell metabolism in iron-deficiency anemia

Importance of Microminerals for Maintaining Antioxidant Function After COVID-19-induced Oxidative Stress

Background

COVID-19 is caused by the Severe Acute Respiratory Distress Syndrome Coronavirus 2. Since the antioxidant mechanisms such as glutathione peroxidase or superoxide dismutase are downregulated during infection by the virus, there is an imbalance in the oxidant-antioxidant system. In this study we aimed to identify the effect of COVID-19 on the antioxidant defense mechanism by comparing the concentrations of antioxidants and microminerals in COVID-19 patients and healthy controls.

Methods

This cross-sectional analytical study involved 200 patients at Kasturba Hospital, Manipal University. The serum concentrations of antioxidants and minerals were determined to establish the impact of COVID-19 on antioxidants mechanism and nutrient status in COVID-19 patients.

Results

The serum concentrations of GPX (10.36 ± 2.70 ≥ 5.82 ± 1.64 mKAT/L, p < 0.0001) and copper (2192.5 ± 449.8 ≥ 782.15 ± 106.5 µg/dL, p < 0.0001) were significantly greater, and zinc (34.78 ± 4.5 ≤ 81.07 ± 10.13 µg/dL, p < 0.0001) was significantly less, in the study group than in controls. The Pearson correlation between serum SOD and zinc was significant (r = 0.491, p < 0.0001) indicating the importance of zinc in maintaining and improving SOD activity. No significant correlations were observed between copper and SOD (r = -0.089) or iron and CAT (r = -0.027).

Conclusion

Our study demonstrated the expected increase in oxidant-radical production during COVID-19 by estimating the altered concentrations of antioxidants and the minerals required to neutralize the elevated ROS. This finding is not novel but adds to the existing literature, which recommends nutritional supplementation of microminerals and antioxidants.

Sodium Pump Activity in Uremic Erythrocytes: A Microcalorimetric Study

Erythrocyte thermogenesis was studied by flow microcalorimetry in 25 healthy subjects and 27 uremic patients. The heat production (HP) from cells in plasma, decrease in HP induced by ouabain (a specific sodium pump inhibitor) and index of rate response to ouabain action were measured. HP was higher in uremic patients than controls. Sodium pump inhibition with ouabain induced the same decrease in HP in the two groups. The index of rate response to ouabain action was lower in uremic patients than in controls. The difference in total HP may be due to a different age distribution of erythrocytes. Mean sodium pump activity was identical in the two groups, but some patients had lower activity than controls. Ouabain seems to act more slowly in many patients than in controls, perhaps because of hindered binding of the inhibitor.

Effect of Oral Iron on Markers of Oxidative Stress and Antioxidant Status in Children with Iron Deficiency Anaemia

INTRODUCTION

Conflicting reports are available on the relationship of Iron Deficiency Anaemia (IDA) and iron therapy with oxidative stress.

AIM

To study the levels of markers of oxidative stress and anti-oxidant status in children with IDA and to assess the effect of iron therapy on the same.

MATERIALS AND METHODS

This prospective, single centre, hospital based study was a sub-study of a randomized controlled trial conducted in the Department of Paediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh in collaboration with the Department of Biochemistry (of the same institution) between October 2009 to February 2011. The sub-study was conducted in two parts: in the first part, levels of a biomarker of oxidative stress {Malondialdehyde (MDA)} and anti-oxidant enzymes {Superoxide Dismutase (SOD), Catalase (CAT), Glutathione Peroxidase (GPx)} were assessed and compared between 67 children with IDA and 31 non-anaemic controls; in the second part, the effect of oral iron (6mg/kg/day) for eight weeks on these markers was studied in a subset of 35 children with IDA. The Bivariate correlations procedure was used to compute pair wise associations for a set of variables. T-tests (Independent samples t-test/Paired sample t-test) and Non-parametric tests (Mann-Whitney test/Wilcoxon signed-rank test) were applied as applicable for normally and non-normally distributed data, respectively.

RESULTS

Levels of anti-oxidant enzymes were significantly lower (p<0.001) in children with IDA as compared to controls, viz., SOD {median, 8.63 (IQR, 8.60-8.66) vs. 9.46 (IQR, 9.14-9.62) units/mg protein}, CAT {median, 8.49 (IQR, 8.46-8.50) vs. 9.10 (IQR, 9.04-9.14) μmol H₂O₂/min/mg protein} and GPx {median, 49.19 (IQR, 48.99-49.60) vs. 56.94(IQR, 56.80-57.14) mol NADPH oxidized /min/ mg protein}. Whereas, levels of MDA were significantly higher (p<0.001) in IDA group {median, 1.50 (IQR, 1.48-1.52) vs. 1.24 (IQR, 1.20-1.27) moles/ml of serum}. Levels of Haemoglobin (Hb) and markers of iron status (serum iron, transferrin saturation and ferritin) had a very strong, highly significant positive correlation (p<0.001) with levels of anti-oxidant enzymes (SOD, CAT, and GPx) but a very strong, highly significant negative correlation (p<0.001) with MDA. Total Iron Binding Capacity (TIBC) on the other hand, had a strong, highly significant (p<0.001) negative correlation with SOD, CAT, and GPx but a strong, highly significant positive correlation (p<0.001) with MDA. After eight weeks of daily iron therapy, a highly significant rise (p<0.001) from baseline was observed in levels of SOD, CAT, and GPx in subjects with IDA. On the other hand, MDA levels declined significantly (p<0.001).

CONCLUSION

Lipid peroxidation is increased and anti-oxidant defenses lowered in IDA. These changes, however, may be mitigated effectively with oral iron therapy.

Se bioavailability and glutathione peroxidase activity in iron deficient rats

Little information is available on the relationship of Se deposit in target organs and GPx activity in iron deficiency anemia. As red blood cells (RBCs) play a crucial role on Se metabolism and during Fe deficiency anemia a lower count of RBCs is featured, we aimed to investigate the influence of this pathology on Se bioavailability and the relationship with antioxidant status. 20 male Wistar rats were randomly divided into two groups, a control group receiving AIN-93G diet with normal Fe content (45mg/kg diet) and the Fe-deficient group receiving AIN-93G diet with low Fe content (5mg/kg diet) for 40 days. Both diets were prepared with an adequate Se content (0.180mg/kg diet). The digestive and metabolic utilization of Se, the distribution in target organ, the GPx activity and TBARS production were measured after receiving the diets. Se retention increased (P<0.001) in the anemic group, fact that contributes to keep the enzymatic antioxidant activity of GPx in normal levels and the tendency observed is that stored Se increased in the organs, especially in kidney (P<0.01), however, a lower Se deposit was found in sternum of anemic rats (P<0.001). The lower count of RBCs featured in this pathology (P<0.001) causes a decrease of Se concentration in sternum meanwhile the increase in kidney deposit is a consequence of the lower urinary losses (P<0.001).

Red-cell metabolism in patients with iron deficiency

18 components of metabolism were determined in the red cells of iron-deficient patients and data were expressed per 10(12) red cells to avoid the complicating effects of hypochromia and microcytosis. Glucose consumption, AMP and ATP, glycolytic intermediates except 2,3-bisphosphoglycerate (2,3-DPG) and phosphoenolpyruvate (PEP), red-cell Na+ and the net passive leakage of Na+ and K+ at 4 degrees C were all normal. Creatine, 6-phospho-D-gluconate: NADP oxidoreductase (6PGD) activity and fresh red-cell K+ were raised, suggestive of a young cell population. However, ATP: D-fructose-6-phosphate 1-phosphotransferase (PFK) activity and ADP were low. An elevated 2,3-DPG level was attributable to the anaemia present but the somewhat raised PEP level is unexplained. It is concluded that red cells in iron deficiency show some characteristics of a young cell population; in other respects they appear normal, but in containing a low PFK activity they are abnormal.

Erythrocyte membrane lipid peroxidation in iron deficiency anemia

Erythrocytes from normal subjects and from cases of iron deficiency anemia were exposed to hydrogen peroxide and the extent of membrane lipid peroxidation studied. Significantly less peroxidation was observed in intact anemic erythrocytes compared to normal. However, when isolated membrane lipids were subjected to peroxidation, there was no significant difference between the two groups. It is unlikely that lipid peroxidation per se plays a major role in the reported decrease in red cell life-span in iron deficiency.

Human beta-mercaptopyruvate sulfurtransferase: distribution in cellular compartments of blood and activity in erythrocytes from patients with hematological disorders

The distribution of mercaptopyruvate sulfurtransferase (EC 2.8.1.2) in human blood cell compartments has been studied. Almost all of the enzyme activity in whole blood was confined to erythrocytes, but the activity per litre cell volume was higher in platelets than in erythrocytes. Leukocytes contained very low concentrations of the sulfurtransferase and plasma was devoid of activity. The enzyme activity of blood hemolysates from normal subjects and patients with various erythrocyte disorders was also determined. Significantly higher sulfur transferase activity was found in male subjects in comparison with females. The enzyme activity per litre erythrocytes was increased in blood from patients with iron deficiency anemia, whereas less clear-cut differences with respect to normals were found in other diseases studied.

The relationship between GSH, GSSG and non-GSH thiol in GSH-deficient erythrocytes from Finnish landrace and Tasmanian merino sheep

1. Two automated colorimetric methods have been developed for assaying the GSH and total thiol in protein-free extracts of erythrocytes. They employ as chromogens 5,5'-dithiobis-(2-nitrobenzoate) (DTNB) and alloxan. 2. The concentrations of GSH, GSSG and total non-protein thiol have been estimated in high and low GSH erythrocytes from Finnish Landrace and Tasmanian Merino sheep. 3. In both breeds of sheep low GSH cells were found to have low concentrations of total non-protein thiol and GSSG as well as of GSH. 4. Nevertheless high and low GSH cells have similar values for the oxidation-reduction potential of the GSH : GSSG couple.

Red cell glutathione in anaemia

Erythrocyte reduced glutathione (GSH) has been measured in 17 normal subjects and in 70 patients with anaemia of various causes; the red cells of most of the anaemic patients contained abnormally high levels of GSH. In the group of cases of untreated megaloblastic anaemia in which the haemoglobin concentration was less than 8.0 g. per 100 ml., there was an inverse relationship between the erythrocyte GSH level and the haemoglobin concentration. During initial therapy in megaloblastic anaemia, as the haemoglobin concentration increased, the GSH level decreased towards normal; the time taken for the GSH level to reach a value 2 standard deviations above the normal mean was inversely related to the initial haemoglobin concentration. In the red cells of patients with anaemia there was no correlation between the GSH level and the activity of glutathione peroxidase. The significance of these findings is discussed.