Ektacytometry of red blood cells

Dynamics of Deformation Properties of Erythrocytes in Wistar Rats during Postnatal Ontogeny

We performed a detailed analysis of changes in the profiles of osmotic deformability using the method of gradient ektacytometry. Changes in all determinants that form the deformation properties of red blood cells in Wistar rats in the juvenile period and before puberty were determined. The dynamics of the formation of the rheological properties of the blood after birth is characterized by a wave-like change in the studied determinants. The changes are explained by adaptive reactions to extrauterine life as a result of hematopoiesis activation and the transition of the red bone marrow to a new level of functioning with the predominant replacement of physiological reticulocytosis in newborns with mature erythrocytes. The most critical period is from 10 days to 1 month after birth. Starting from the second month, the deformation parameters of erythrocytes are stabilized.

Assessment of the Deformability and Velocity of Healthy and Artificially Impaired Red Blood Cells in Narrow Polydimethylsiloxane (PDMS) Microchannels

Malaria is one of the leading causes of death in underdeveloped regions. Thus, the development of rapid, efficient, and competitive diagnostic techniques is essential. This work reports a study of the deformability and velocity assessment of healthy and artificially impaired red blood cells (RBCs), with the purpose of potentially mimicking malaria effects, in narrow polydimethylsiloxane microchannels. To obtain impaired RBCs, their properties were modified by adding, to the RBCs, different concentrations of glucose, glutaraldehyde, or diamide, in order to increase the cells' rigidity. The effects of the RBCs' artificial stiffening were evaluated by combining image analysis techniques with microchannels with a contraction width of 8 µm, making it possible to measure the cells' deformability and velocity of both healthy and modified RBCs. The results showed that healthy RBCs naturally deform when they cross the contractions and rapidly recover their original shape. In contrast, for the modified samples with high concentration of chemicals, the same did not occur. Additionally, for all the tested modification methods, the results have shown a decrease in the RBCs' deformability and velocity as the cells' rigidity increases, when compared to the behavior of healthy RBCs samples. These results show the ability of the image analysis tools combined with microchannel contractions to obtain crucial information on the pathological blood phenomena in microcirculation. Particularly, it was possible to measure the deformability of the RBCs and their velocity, resulting in a velocity/deformability relation in the microchannel. This correlation shows great potential to relate the RBCs' behavior with the various stages of malaria, helping to establish the development of new diagnostic systems towards point-of-care devices.

Determination of red blood cell deformability using centrifugal force in a three-dimensional-printed mini-disk (3D-PMD)

Measuring red blood cell (RBC) deformability has become important for clinical disease diagnostics. Various methods for measuring RBC deformability have been developed; however, they require costly and large instruments, long measuring time, and skilled personnel. In this study, we present a three-dimensional-printed mini-disk (3D-PMD) for measuring RBC deformability to overcome the previous limitations. For a miniaturized and low-cost setup, the 3D-PMD was fabricated by a 3D printing technique, which had not yet been used for fabricating a lab-on-a-compact disk (LOCD). Using a 3D printing technique, a multi-layered fluidic channel on the mini CD could be fabricated easily. During rotation by a spinning motor, the difference of the length of compressed RBCs in the fluidic channel was measured and analysed as compressibility indices (CIs) of normal and glutaraldehyde-treated hardened RBCs. The rotation speed and time were decided as 3000 rpm and 30 min, respectively, at which the difference of CI values between normal and hardened RBCs was largest (CInormal-CIhardened = 0.195).

Laser trap ionization for identification of human erythrocytes with variable hemoglobin quantitation

An approach to an established technique that is potentially applicable for a more comprehensive understanding of the electrical properties of red blood cells (RBCs) is presented. Using a high-intensity gradient laser trap, RBCs can be singly trapped and consequentially ionized. The subsequent dynamics of the ionized cell allows one to calculate the charge developed and the ionization energy (IE) through a Newtonian-based analysis. RBCs with two different hemoglobin (Hb) types were ionized. The first sample was identified as carrying Hb HbAA (normal Hb) and the second one was identified as carrying HbAC (HbC trait). By analyzing the charge developed on each cell and several other related factors, we were able to discern a difference between the main Hb types contained within the individual RBC, independent of cell size. A relationship between the charge developed and the IE of the cell was also established based on the electrical properties of RBCs. Thus, we present this laser trapping technique as a study of the electrical properties of RBCs and as possible biomedical tool to be used for the differentiation of Hb types.

Rat red blood cell storage lesions in various additive solutions

BACKGROUND

Small rodent models are routinely used to evaluate the safety and efficacy of blood transfusions. Limited comprehensive literature exists about effect of different storage solutions in rat red blood cells (RBCs) characteristics. RBCs undergo time dependent biochemical and biophysical changes during storage known as hypothermic storage lesions (HSLs).

OBJECTIVE

This study evaluates the effects of RBC additive solutions (AS) during storage of rat RBCs.

METHODS

Blood was leukoreduced and stored as per manufacturer instructions at 4°C up to 42-days. Three solutions, CPDA-1; AS-1; and AS-7 (SOLX), were evaluated. Biochemical parameters measured included extracellular K+, pH, hemolysis, 2,3-diphosphoglycerate (2,3-DPG), oxygen affinity, ATP, and lactate. Mechanical properties measured included RBC deformability, elongation index (EI), RBC membrane shear elastic modulus (SEM), mean corpuscular volume (MCV), viscosity, and aggregability.

RESULTS

There were no differences in biochemical or mechanical parameters at baseline or after one week of storage. However, after two weeks, AS-7 preserved biochemical and mechanical properties as compared to CPDA-1 and AS-1. Changes were observed to be significant after 14-days of storage. AS-7 prevented extracellular K+ increase, reduced acidosis, showed lower hemolysis, preserved ATP and 2,3-DPG levels (consequently oxygen affinity), and reduced lactate. AS-7, when compared to CPDA-1 and AS-1, prevented the reduction in RBC deformability and was found to preserve the EI at multiple shear stresses, the membrane SEM, the aggregability and viscosity.

DISCUSSION

Rat RBCs stored with AS-7 presented reduced changes in biochemical and mechanical parameters, when compared with rat RBCs stored in CPDA-1 and AS-1, after as early as two weeks of storage.

Dynamic fatigue measurement of human erythrocytes using dielectrophoresis

Erythrocytes must undergo severe deformation to pass through narrow capillaries and submicronic splenic slits for several hundred thousand times in their normal lifespan. Studies of erythrocyte biomechanics have been mainly focused on cell deformability and rheology measured from a single application of stress and mostly under a static or quasi-static state using classical biomechanical techniques, such as optical tweezers and micropipette aspiration. Dynamic behavior of erythrocytes in response to cyclic stresses that contributes to the membrane failure in blood circulation is not fully understood. This paper presents a new experimental method for dynamic fatigue analysis of erythrocytes, using amplitude modulated electrokinetic force field in a microfluidic platform. We demonstrate the capability of this new technique using a low cycle fatigue analysis of normal human erythrocytes and ATP-depleted erythrocytes. Cyclic tensile stresses are generated to induce repeated uniaxial stretching and extensional recovery of single erythrocytes. Results of morphological and biomechanical parameters of individually tracked erythrocytes show strong correlations with the number of the loading cycles. Under a same strength of electric field, after 180 stress cycles, for normal erythrocytes, maximum stretch ratio decreases from 3.80 to 2.86, characteristic time of cellular extensional recovery increases from 0.16s to 0.37s, membrane shear viscosity increases from 1.0(µN/m)s to 1.6(µN/m)s. Membrane deformation in a small number of erythrocytes becomes irreversible after large deformation for about 200 cyclic loads. ATP-depleted cells show similar trends in decreased deformation and increased characteristic time with the loading cycles. These results show proof of concept of the new microfluidics technique for dynamic fatigue analysis of human erythrocytes.

STATEMENT OF SIGNIFICANCE

Red blood cells (RBCs) experience a tremendous number of deformation in blood circulation before losing their mechanical deformability and eventually being degraded in the reticuloendothelial system. Prior efforts in RBC biomechanics have mostly focused on a single-application of stress, or quasi-static loading through physical contact to deform cell membranes, thus with limited capabilities in probing cellular dynamic responses to cyclic stresses. We present a unique electrokinetic microfluidic system for the study of dynamic fatigue behavior of RBCs subjected to cyclic loads. Our work shows quantitatively how the cyclic stretching loads cause membrane mechanical degradation and irreversibly deformed cells. This new technique can be useful to identify biomechanical markers for prediction of the mechanical stability and residual lifespan of circulating RBCs.

Increases in core temperature counterbalance effects of haemoconcentration on blood viscosity during prolonged exercise in the heat

NEW FINDINGS

What is the central question of this study? The purpose of the present study was to determine the effects of exercise-induced haemoconcentration and hyperthermia on blood viscosity. What is the main finding and its importance? Exercise-induced haemoconcentration, increased plasma viscosity and increased blood aggregation, all of which increased blood viscosity, were counterbalanced by increased red blood cell (RBC) deformability (e.g. RBC membrane shear elastic modulus and elongation index) caused by the hyperthermia. Thus, blood viscosity remained unchanged following prolonged moderate-intensity exercise in the heat. Previous studies have reported that blood viscosity is significantly increased following exercise. However, these studies measured both pre- and postexercise blood viscosity at 37 °C even though core and blood temperatures would be expected to have increased during the exercise. Consequently, the effect of exercise-induced hyperthermia on mitigating change in blood viscosity may have been missed. The purpose of this study was to isolate the effects of exercise-induced haemoconcentration and hyperthermia and to determine their combined effects on blood viscosity. Nine subjects performed 2 h of moderate-intensity exercise in the heat (37 °C, 40% relative humidity), which resulted in significant increases from pre-exercise values for rectal temperature (from 37.11 ± 0.35 to 38.76 ± 0.13 °C), haemoconcentration (haematocrit increased from 43.6 ± 3.6 to 45.6 ± 3.5%) and dehydration (change in body weight = -3.6 ± 0.7%). Exercise-induced haemoconcentration significantly (P < 0.05) increased blood viscosity by 9% (from 3.97 to 4.33 cP at 300 s(-1)), whereas exercise-induced hyperthermia significantly decreased blood viscosity by 7% (from 3.97 to 3.69 cP at 300 s(-1)). When both factors were considered together, there was no overall change in blood viscosity (from 3.97 to 4.03 cP at 300 s(-1)). The effects of exercise-induced haemoconcentration, increased plasma viscosity and increased red blood cell aggregation, all of which increased blood viscosity, were counterbalanced by increased red blood cell deformability (e.g. red blood cell membrane shear elastic modulus and elongation index) caused by the hyperthermia. Thus, blood viscosity remained unchanged following prolonged moderate-intensity exercise in the heat.

Renitrosylation of banked human red blood cells improves deformability and reduces adhesivity

BACKGROUND

Transfusion of red blood cells (RBCs) is a frequent health care practice. However, unfavorable consequences may occur from transfusions of stored RBCs and are associated with RBC changes during storage. Loss of S-nitrosohemoglobin (SNO-Hb) and other S-nitrosothiols (SNOs) during storage is implicated as a detriment to transfusion efficacy. It was hypothesized that restoring SNOs within banked RBCs would improve RBC functions relevant to successful transfusion outcomes, namely, increased deformability and decreased adhesivity.

STUDY DESIGN AND METHODS

Stored human RBCs were incubated with nitric oxide (NO) donors PROLI/NO and DEA/NO (disodium 1-[2-(carboxylato)-pyrrolidin-1-yl]diazen-1-ium-1,2-diolate and diethylammonium (Z)-1-(N,N-diethylamino)diazen-1-ium-1,2-diolate) under varying experimental conditions (e.g., aerobic/anaerobic incubation, NO donor to RBC ratio). SNO restoration was evaluated in vitro and in vivo as a means to improve RBC function after storage.

RESULTS

Incubation of RBCs with the NO donors resulted in 10-fold greater levels of SNO-Hb versus untreated control or sham RBCs, with significantly higher Hb-bound NO yields from an NO dose delivered by DEA/NO. RBC incubation with DEA/NO at a stoichiometry of 1:62.5 NO:Hb significantly increased RBC deformabilty and reduced adhesion to cultured endothelial cells. RBC incubation with DEA/NO also increased S-nitrosylation of RBC cytoskeletal and membrane proteins, including the β-spectrin chain. Renitrosylation attenuated both RBC sequestration in the lung and the mild blood oxygen saturation impairments seen with banked RBCs in a mouse model of transfusion.

CONCLUSIONS

RBC renitrosylation using NO donors has promise for correcting deficient properties (e.g., adhesivity, rigidity, and SNO loss) of banked RBCs and in turn improving transfusion outcomes.

Reduced red blood cell deformability over time is associated with a poor outcome in septic patients

BACKGROUND

To investigate changes in red blood cell (RBC) rheology over time in critically ill patients with sepsis and their relationship with outcome.

METHODS

In this prospective, non-interventional study, RBC rheology was assessed using the Laser-assisted Optical Rotational Cell Analyzer in a convenience sample of intensive care unit (ICU) patients with (n=64) and without (n=160) sepsis. Results were compared to measures in healthy volunteers (n=20). RBC rheology was also assessed on days 1 and 3 of the ICU stay in 32 of the non-septic and 19 of the septic patients. RBC deformability was determined by the elongation index (EI) in relation to the shear stress (0.3 to 50Pa) applied to the RBC membrane. An aggregation index (AI) was assessed simultaneously with the same device.

RESULTS

The ICU mortality rate of the septic patients was 31%. RBC deformability was already reduced in septic patients at ICU admission, an effect that persisted during the study period and worsened in the non-survivors for the large majority of shear stresses studied (e.g., EI for 50Pa of shear stress was 0.527±0.064 in non-survivors vs. 0.566±0.034 in survivors, p<0.05). These changes were not observed in non-septic patients. The AI was more elevated in septic than in non-septic patients at ICU admission, but had no prognostic value.

CONCLUSIONS

Alterations in RBC rheology, including reduced deformability and increased aggregation, occur early in septic patients and reductions in RBC deformability over time are associated with a poor outcome.

Deformability analysis of sickle blood using ektacytometry

Sickle cell disease (SCD) is characterized by decreased erythrocyte deformability, microvessel occlusion and severe painful infarctions of different organs. Ektacytometry of SCD red blood cells (RBC) is made difficult by the presence of rigid, poorly-deformable irreversibly sickled cells (ISC) that do not align with the fluid shear field and distort the elliptical diffraction pattern seen with normal RBC. In operation, the computer software fits an outline to the diffraction pattern, then reports an elongation index (EI) at each shear stress based on the length and width of the fitted ellipse: EI=(length-width)/(length+width). Using a commercial ektacytometer (LORCA, Mechatronics Instruments, The Netherlands) we have approached the problem of ellipse fitting in two ways: (1) altering the height of the diffraction image on a computer monitor using an aperture within the camera lens; (2) altering the light intensity level (gray level) used by the software to fit the image to an elliptical shape. Neither of these methods affected deformability results (elongation index-shear stress relations) for normal RBC but did markedly affect results for SCD erythrocytes: (1) decreasing image height by 15% and 30% increased EI at moderate to high stresses; (2) progressively increasing the light level increased EI over a wide range of stresses. Fitting data obtained at different image heights using the Lineweaver-Burke routine yielded percentage ISC results in good agreement with microscopic cell counting. We suggest that these two relatively simple approaches allow minimizing artifacts due to the presence of rigid discs or ISC and also suggest the need for additional studies to evaluate the physiological relevance of deformability data obtained via these methods.

Effects of ethanol on red blood cell rheological behavior

Consumption of red wine is associated with a decreased risk of several cardiovascular diseases (e.g., coronary artery disease, stroke), but unfortunately literature reports regarding ethanol's effects on hemorheological parameters are not concordant. In the present study, red blood cell (RBC) deformability was tested via laser ektacytometry (LORCA, 0.3-30 Pa) using two approaches: 1) addition of ethanol to whole blood at 0.25%-2% followed by incubation and testing in ethanol-free LORCA medium; 2) addition of ethanol to the LORCA medium at 0.25%-6% then testing untreated native RBC in these media. The effects of ethanol on deformability for oxidatively stressed RBC were investigated as were changes of RBC aggregation (Myrenne Aggregometer) for cells in autologous plasma or 3% 70 kDa dextran. Significant dose-related increases of RBC deformability were observed at 0.25% (p < 0.05) and higher concentrations only if ethanol was in the LORCA medium; no changes occurred for cells previously incubated with ethanol then tested in ethanol-free medium. The impaired deformability of cells pre-exposed to oxidative stress was improved only if ethanol was in the LORCA medium. RBC aggregation decreased with concentration at 0.25% and higher for cells in both autologous plasma and dextran 70. Our results indicate that ethanol reversibly improves erythrocyte deformability and irreversibly decreases erythrocyte aggregation; the relevance of these results to the health benefits of moderate wine consumption require further investigation.

The effect of alcohols on red blood cell mechanical properties and membrane fluidity depends on their molecular size

The role of membrane fluidity in determining red blood cell (RBC) deformability has been suggested by a number of studies. The present investigation evaluated alterations of RBC membrane fluidity, deformability and stability in the presence of four linear alcohols (methanol, ethanol, propanol and butanol) using ektacytometry and electron paramagnetic resonance (EPR) spectroscopy. All alcohols had a biphasic effect on deformability such that it increased then decreased with increasing concentration; the critical concentration for reversal was an inverse function of molecular size. EPR results showed biphasic changes of near-surface fluidity (i.e., increase then decrease) and a decreased fluidity of the lipid core; rank order of effectiveness was butanol > propanol > ethanol > methanol, with a significant correlation between near-surface fluidity and deformability (r = 0.697; p<0.01). The presence of alcohol enhanced the impairment of RBC deformability caused by subjecting cells to 100 Pa shear stress for 300 s, with significant differences from control being observed at higher concentrations of all four alcohols. The level of hemolysis was dependent on molecular size and concentration, whereas echinocytic shape transformation (i.e., biconcave disc to crenated morphology) was observed only for ethanol and propanol. These results are in accordance with available data obtained on model membranes. They document the presence of mechanical links between RBC deformability and near-surface membrane fluidity, chain length-dependence of the ability of alcohols to alter RBC mechanical behavior, and the biphasic response of RBC deformability and near-surface membrane fluidity to increasing alcohol concentrations.

Analysis of light scattering by red blood cells in ektacytometry using global pattern fitting

Ektacytometry measures the shape of red blood cells under shear stress by analyzing the diffraction pattern of laser light passing through a thin layer of suspended cells. Here we model the diffraction pattern using a combination of Bessel and anomalous scattering functions, and employ a global pattern-fitting technique over nine different shear stresses to determine the separate mechanical properties of normal and non-deformable cells. This technique is capable of yielding the correct elongation index of the normal cells over a range of shear stresses even when they are mixed with as much as 50% non-deformable cells. Additionally, the relative concentrations of normal and non-deformable cells can be determined.

Thrombosis preventive potential of chicory coffee consumption: a clinical study

The protective effects of plant polyphenol intake on cardiovascular morbidity and mortality are widely acknowledged. Caffeine-free chicory coffee is a rich source of plant phenolics, including caffeic acid, which inhibits in vitro platelet aggregation, and also phenylpyruvate tautomerase enzymatic activity of the proinflammatory cytokine, macrophage migration inhibitory factor (MIF). To assess whether chicory coffee consumption might confer cardiovascular benefits a clinical intervention study was performed with 27 healthy volunteers, who consumed 300 mL chicory coffee every day for 1 week. The dietary intervention produced variable effects on platelet aggregation, depending on the inducer used for the aggregation test. Whole blood and plasma viscosity were both significantly decreased, along with serum MIF levels, after 1 week of chicory coffee consumption. Moreover, significant improvements were seen in red blood cell deformability. No changes in hematocrit, fibrinogen level or red blood cell counts were detected. The full spectrum of these effects is unlikely to be attributable to a single compound present in chicory coffee, nevertheless, the phenolics, including caffeic acid, are expected to play a substantial role. In conclusion, our study offers an encouraging starting-point to delineate the antithrombotic and antiinflammatory effects of phenolic compounds found in chicory coffee.

Early alterations of red blood cell rheology in critically ill patients

OBJECTIVE

To investigate red blood cell rheology in a large intensive care unit population on admission, and to assess the possible influence of comorbidities on the rheology.

DESIGN

: Prospective study.

SETTING

Medico-surgical intensive care unit with 31 beds.

SUBJECTS

All intensive care unit admissions during a 5-month period and 20 healthy volunteers.

INTERVENTIONS

Blood sampling.

MEASUREMENTS AND MAIN RESULTS

A total of 196 intensive care patients (160 without and 36 with sepsis) and 20 healthy volunteers were studied. Red blood cell rheology (deformability and aggregation) was assessed ex vivo using the laser-assisted optical rotational cell analyzer (LORCA; Mechatronics Instruments BV, AN Zwaag, Netherlands) within the first 24 hrs after intensive care unit admission. Red blood cell deformability was determined by the elongation index in relation to the shear stress (0.3 to 50 Pa) applied on the red blood cell membrane surface. Aggregation was assessed by the aggregation index. Septic patients were more likely to have anemia, coagulation abnormalities, and comorbidities than were nonseptic patients. Red blood cell deformability was significantly altered in septic compared to nonseptic patients and volunteers for the majority of shear stress rates studied. The aggregation index was greater in septic patients than in volunteers (67.9% [54.7-73.5] vs. 61.8% [58.2-68.4]; p < .05). Only sepsis and hematologic disease influenced the elongation index (both p < .01). Other comorbidities, like cancer, diabetes mellitus, cirrhosis, and terminal renal failure, had no effect on the elongation index. Aggregation index was related to the degree of organ failure (Sequential Organ Failure Assessment score), the red blood cell count, and fibrinogen concentrations.

CONCLUSIONS

Early alterations of red blood cell rheology are common in intensive care unit patients, especially in those with sepsis. Comorbidities (other than hematologic diseases) do not significantly influence these abnormalities. These alterations could contribute to the microcirculatory alterations observed in critically ill patients.

Direct measurement of the impact of impaired erythrocyte deformability on microvascular network perfusion in a microfluidic device

The ability of red blood cells (RBCs, erythrocytes) to deform and pass through capillaries is essential for continual flow of blood in the microvasculature, which ensures an adequate supply of oxygen and nutrients, prompt removal of metabolic waste products, transport of drugs and hormones, and traffic of circulating cells to and from all living tissues. This paper presents a novel tool for evaluating the impact of impaired deformability of RBCs on the flow of blood in the microvasculature by directly measuring perfusion of a test microchannel network with dimensions and topology similar to the real microcirculation. The measurement of microchannel network perfusion is compared with RBC filtration -- a conventional assay of RBC deformability. In contrast to RBC filterability, network perfusion depends linearly on RBC deformability modulated by graded exposure to glutaraldehyde, showing a higher sensitivity to small changes of deformability. The direct measurement of microchannel network perfusion represents a new concept for the field of blood rheology and should prove beneficial for basic science and clinical applications.

Altered erythrocyte endothelial adherence and membrane phospholipid asymmetry in hereditary hydrocytosis

The risk for thrombosis is increased in patients with hereditary hydrocytosis, an uncommon variant of hereditary stomatocytosis. Erythrocytes from 2 patients with hydrocytosis were studied to gain insight into the mechanism of thrombosis in this disorder. Erythrocytes demonstrated abnormal osmotic scan ektacytometry and decreased erythrocyte filtration rates. There was also a mild increase in adherence of erythrocytes to endothelial monolayers in a micropipette assay. Adhesion of erythrocytes to the subendothelial matrix proteins thrombospondin and laminin, however, was not significantly increased. Percentages of hydrocytosis erythrocytes and reticulocytes with phosphatidylserine exposed on the outer surfaces were increased in both patients compared with healthy controls, indicating altered membrane phospholipid asymmetry. Increased phosphatidylserine exposure accelerating thrombin-forming processes has been proposed as a mechanism for thrombosis in sickle cell disease and beta-thalassemia and may play a similar role in hereditary hydrocytosis.

Cell interactions with polyelectrolyte multilayer films

The short-term interactions of chondrosarcoma cells with polyelectrolyte multilayer films built up by the alternate adsorption of poly(L-lysine) (PLL) and poly(L-glutamic acid) (PGA) was studied in the presence and in the absence of serum. The films and their interaction with serum proteins were first characterized by means of optical waveguide lightmode spectroscopy, quartz crystal microbalance, and zeta potential measurements. In a serum-containing medium, the detachment forces measured by the micropipet technique were about eight times smaller on PGA-ending than on PLL-ending films. For these latter ones, the adhesion force decreased when the film thickness increased. In a serum-free medium, the differences between the negative- and positive-ending films were enhanced: adhesion forces on PLL-ending films were 40-100% higher, whereas no cellular adherence was found on PGA-terminating films. PGA-ending films were found to prevent the adsorption of serum proteins, whereas important protein adsorption was always observed on PLL-ending films. These results show how cell interactions with polyelectrolyte films can be tuned by the type of the outermost layer, the presence of proteins, and the number of layers in the film.

Headpiece domain of dematin is required for the stability of the erythrocyte membrane

Dematin is an actin-binding and bundling protein of the erythrocyte membrane skeleton. Dematin is localized to the spectrin-actin junctions, and its actin-bundling activity is regulated by phosphorylation of cAMP-dependent protein kinase. The carboxyl terminus of dematin is homologous to the "headpiece" domain of villin, an actin-bundling protein of the microvillus cytoskeleton. The headpiece domain contains an actin-binding site, a cAMP-kinase phosphorylation site, plays an essential role in dematin self-assembly, and bundles F-actin in vitro. By using homologous recombination in mouse embryonic stem cells, the headpiece domain of dematin was deleted to evaluate its function in vivo. Dematin headpiece null mice were viable and born at the expected Mendelian ratio. Hematological evaluation revealed evidence of compensated anemia and spherocytosis in the dematin headpiece null mice. The headpiece null erythrocytes were osmotically fragile, and ektacytometry/micropore filtration measurements demonstrated reduced deformability and filterability. In vitro membrane stability measurements indicated significantly greater membrane fragmentation of the dematin headpiece null erythrocytes. Finally, biochemical characterization, including the vesicle/cytoskeleton dissociation, spectrin self-association, and chemical crosslinking measurements, revealed a weakened membrane skeleton evidenced by reduced association of spectrin and actin to the plasma membrane. Together, these results provide evidence for the physiological significance of dematin and demonstrate a role for the headpiece domain in the maintenance of structural integrity and mechanical properties of erythrocytes in vivo.

Regulation of the glycophorin C-protein 4.1 membrane-to-skeleton bridge and evaluation of its contribution to erythrocyte membrane stability

The band 3-ankyrin-spectrin bridge and the glycophorin C-protein 4.1-spectrin/actin bridge constitute the two major tethers between the erythrocyte membrane and its spectrin skeleton. Although a structural requirement for the band 3-ankyrin bridge is well established, the contribution of the glycophorin C-protein 4.1 bridge to red cell function remains to be defined. In order to explore this latter bridge further, we have identified and/or characterized five stimuli that sever the linkage in intact erythrocytes and have examined the impact of this rupture on membrane mechanical properties. We report here that elevation of cytosolic 2,3-bisphosphoglycerate, an increase in intracellular Ca(2+), removal of cell O(2), a decrease in intracellular pH, and activation of erythrocyte protein kinase C all promote dissociation of protein 4.1 from glycophorin C, leading to reduced retention of glycophorin C in detergent-extracted spectrin/actin skeletons. Significantly, where mechanical studies could be performed, we also observe that rupture of the membrane-to-skeleton bridge has little or no impact on the mechanical properties of the cell, as assayed by ektacytometry and nickel mesh filtration. We, therefore, suggest that, although regulation of the glycophorin C-protein 4.1-spectrin/actin bridge likely occurs physiologically, the role of the tether and the associated regulatory changes remain to be established.

Increased erythrocyte deformability in fetal erythropoiesis and in erythrocytes deficient in glucose-6-phosphate dehydrogenase and other glycolytic enzymes

Erythrocyte deformability was determined in more than 500 clinical samples, and was found to be elevated in conditions in which fetal-like red cells are produced: aplastic anemia (3/3 cases), myelodysplastic syndromes, polycythemias, sickle cell anemia during treatment with hydroxyurea, paroxysmal nocturnal hemoglobinuria, and recovery from B12 deficiency. Elevated deformability was observed in neonatal erythrocytes, and during recovery from transient erythroblastopenia of childhood, when fetal-like red cells are known to be produced. Increased deformability appears to be a feature of fetal and fetal-like red cells. Forty-eight cases of enzymatically verified glucose-6-phosphate (G-6-PD) deficiency were also examined. Thirty out of 32 G-6-PD(A-) individuals, including both heterozygotes and hemizygotes, exhibited increased deformability during the steady state. In contrast, G-6-PD(Med) hemizygotes had normal deformability. Increased deformability was also found in G-6-PD(Huron) (n=3), G-6-PD(Wayne) (n=4), triose phosphate isomerase deficiency (n=2), and pyruvate kinase deficiency (n=2). An elevated osmoscan was found in more than 90% of female G-6-PD heterozygotes, affording a simple screening test for heterozygotes. Deformability remained high during hemolytic episodes, when older enzyme deficient cells are removed from the circulation. In four cases of G-6-PD deficiency with normal deformability, evidence for co-existing hereditary spherocytosis was found. The combination of conditions with opposing effects on deformability resulted in nearly normal deformability. Because increased red cell deformability is a feature of fetal erythrocytes, these results suggest that the red cells in many cases of glycolytic enzyme deficiency are fetal-like.

Rheologic properties of mammalian erythrocytes: relationship to transport ATPases

Rheologic properties of erythrocytes and activities of their Ca(2+)-ATPase and Na+, K(+)-ATPase were analyzed together with standard erythrocyte values in seven mammalian species (man, rat, mouse, rabbit, hamster, guinea pig and dog). The number of erythrocytes in the blood of animals investigated correlated inversely with the mean cell volume (MCV) (r = -0.936, P = 0.002) and the mean cell hemoglobin content (MCH) (r = -0.923, P = 0.003). MCV and MCH also showed a high direct correlation with each other (r = 0.907, P = 0.005). The maximal erythrocyte deformability (DImax) measured with ektacytometry was inversely proportional to the MCV and MCH (r = -0.854, P = 0.014, and r = -0.940, P < 0.002, respectively). The MCV was also linearly related with the Na+, K(+)-ATPase activity (r = -0.791, P = 0.034). The major parameters of osmoscan (O' and Omax) and their derivatives (O'-Omin, Omax-Omin) were shown to be in a direct correlation with each other and with the activity of Na+, K(+)-ATPase in the whole erythrocytes except for the rabbit Na+, K(+)-ATPase. The activity of Ca(2+)-ATPase in the whole erythrocytes significantly correlated only with the O' and O'-Omin values. Thus, the activities of transport ATPases in mammalian red cells seem to be adjusted to the level required to maintain particular rheologic properties of the cells of one or other species.

Red blood cell deformability in sepsis

The microcirculatory disturbances in sepsis have prompted micropore bulk-filtration studies of red blood cell (RBC) mechanical behavior (i.e., deformability). However, these prior reports may not solely reflect RBC behavior because of possible white blood cell (WBC) occlusion of the filter pores. The present study was designed to examine RBC mechanical alterations in human and experimental sepsis using techniques that are not affected by WBC artifacts. RBC were obtained from adult patients with sepsis and from healthy control donors. RBC were also obtained from Swiss-albino rats in which experimental sepsis was induced via cecal ligation-puncture. Red cell mechanical behavior was tested using a computerized micropore filtration system (CTA) and a laser-diffraction shearing device (LORCA); the latter provides the extent of RBC deformation at various stresses and the time constant for RBC shape recovery. Salient findings include: (1) for human RBC, significantly decreased deformability at fluid shear stresses < 5 Pa (LORCA) yet no differences from control with the CTA; (2) for rat RBC in experimental sepsis, significant decreases of deformability and shape-recovery time constant (LORCA) but no differences with the CTA. We conclude that RBC deformability is reduced in sepsis but that micropore bulk-filtration methods may not be appropriate for detecting these changes.

Erythrocyte aggregation tendency and cellular properties in horse, human, and rat: a comparative study

Horse blood has a higher tendency to form red blood cell (RBC) aggregates compared with human blood, with this enhanced aggregation previously attributed to differences in plasma factors. Our results confirm this observation and further indicate that washed horse RBC also have a significantly higher aggregation tendency in dextran 70 solutions (i.e., horse RBC have a higher "aggregability"). In contrast, the aggregation tendency of rat RBC, both in autologous plasma and in dextran 70, is significantly less compared with human and horse RBC. Other rheological findings for horse and rat RBC include smaller changes in RBC deformation indexes over the same shear stress range and a lower RBC shape recovery time constant. Rat RBC also had higher two-phase aqueous polymer partition coefficients, suggesting a higher surface charge. Membrane protein analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed marked differences: 1) band 4.2 protein was lacking in horse RBC membranes, and 2) carbohydrate groups have different distributions in human, rat, and horse RBC, as indicated by different patterns in periodic acid-Schiff-stained protein bands. Our results clearly indicate significant differences in RBC aggregability among the three species and indicate that cellular factors contribute importantly to these differences. Furthermore, they suggest that systematic studies of blood and RBC from different species should provide insight into the mechanism(s) of RBC aggregation.

Osmotic scan ektacytometry in clinical diagnosis

PURPOSE

The use of red blood cell deformability measurements in the diagnosis of hemolytic anemia is reviewed.

PATIENTS AND METHODS

Results from 500 individuals are discussed. Erythrocytes were characterized by the automated measurement of cell deformability as the tonicity of the medium is varied (osmotic scan ektacytometry).

RESULTS

The measurement yields a reliable identification of hemolytic anemias caused by deficiencies or abnormalities in erythrocyte structural proteins. In addition, it can, with good reliability, signal the presence of a glycolytic enzyme deficiency. The scan is complete in 15 min, and can therefore give a rapid indication of the type of hemolytic anemia. The osmotic scans of other hemolytic anemias are also discussed.

CONCLUSION

The analysis of red blood cell deformability can offer a valuable addition to diagnostic methods in hemolytic anemia.

Effect of beraprost, a stable prostacyclin analogue, on red blood cell deformability impairment in the presence of hypercholesterolemia in rabbits

We evaluated the effects of orally administered beraprost, a stable prostacyclin analogue, on the rheological behavior of red blood cells (RBC) in the presence of hypercholesterolemia. Rabbits fed a cholesterolrich diet were administered various doses of beraprost or pravastatin. We evaluated rheological behavior of RBC by assessing RBC deformability, using a positive-pressure filtration method. The maximum pressure generated by passing a suspension of RBC through a membrane filter was used as an index of RBC deformability. After animals were fed cholesterol for 16 weeks, the maximum pressure increased significantly from 172 +/- 15 mm Hg at baseline to 261 +/- 18 mm Hg (p < 0.01, n = 24). The reduction in RBC deformability associated with hypercholesterolemia improved dose dependently during 1-h incubation with various doses of beraprost. In ex vivo study, beraprost markedly restored RBC deformability 3 h after its oral administration to 218 +/- 17 mm Hg (n = 9) at a low dose and to 215 +/- 20 mm Hg (n = 9) at a high dose. The effect persisted for at least 2 h. Pravastatin failed to reduce the increased maximum pressure. Findings suggest that beraprost treatment may improve the microcirculation by restoring RBC deformability in the presence of hypercholesterolemia.

Bepridil as an antisickling agent: membrane internalization and cell rigidity

The calcium channel antagonist, bepridil, beta-(2-methylpropoxy)methyl-N-phenyl-N-(phenylmethyl)-1-pyrrol idineethanamine monochloride monohydrate, inhibits the sickling of deoxygenated sickle (SS) erythrocytes, as determined by light microscopy. The anti-sickling effect was seen only in dilute suspensions of red cells. In concentrated erythrocyte suspensions, sickling was not inhibited and measurements of hematocrit and cell density were unchanged by bepridil. The determination of cell volume in dilute suspensions was complicated by bepridil's tendency to aggregate, but rapid measurements by electronic sizing also indicated no increase in cell volume, up to a bepridil concentration of 200 microM. Ektacytometry of dilute sickle cell suspensions suggested an explanation for the anti-sickling action of bepridil. Osmotic scan ektacytometry disclosed that bepridil initially increased the surface area of the red cell, as shown by a shift in the low osmolality minimum. This change was complete in 10 sec, the shortest time that could be measured. Subsequently, at concentrations that were observed to inhibit the sickling of deoxygenated sickle cells (100 microM or greater), red cells underwent a loss in surface area that was complete in 1 min. There was a concomitant loss of cell deformability. Light and scanning electron microscopy has previously shown that bepridil is a stomatocytic agent. Using transmission electron microscopy, we verified that the loss of surface area was a consequence of endocytosis, presumably as the end stage of the stomatocytic transformation induced by bepridil. Bepridil did not inhibit intracellular hemoglobin S polymerization even at 200 microM, as shown by oxygen scan ektacytometry. Bepridil thus appears to inhibit the sickling of deoxygenated SS cells by inducing endocytosis and lowering cell deformability. This mechanism may explain the anti-sickling effect of other basic amphiphiles, such as chlorpromazine.

DIDS inhibition of deformation-induced cation flux in human erythrocytes

The permeability of human erythrocytes to sodium, potassium and calcium increases when the cells are deformed by shear. We now report that the anion-exchange inhibitor DIDS (4,4'-diisothiocyanostilbene-2,2'-disulfonic acid) inhibited 55-60% of the deformation-induced flux with an apparent K1/2 of 1 microM. Covalently bound DIDS was also effective. In cells partially derivatized at 0 degrees C (pH 7.4), anion exchange and the deformation flux were inhibited in parallel, implying that lysine a is the site of inhibition for both fluxes. Ektacytometry showed that DIDS does not inhibit by lowering the cell's ability to deform. Crosslinking of lysines in Band 3 was not required for inhibition of the stress flux, as demonstrated by electrophoretic analysis of chymotrypsin-cleaved Band 3 after DIDS treatment. Chymotrypsin cleavage itself did not affect the cation flux rates. DNDS, an anion exchange inhibitor that binds to the chloride site on Band 3 but is unable to derivatize lysine a, is an ineffective inhibitor of the deformation flux. Other high-affinity inhibitors of anion exchange were also relatively ineffective against the deformation flux, and anion exchange itself was unchanged by shear. These results suggest that 55-60% of the deformation-induced cation movement traverses a route that includes Band 3, but is distinct from the pathway utilized by anion exchange. Chloride-dependent cation pathways do not participate in the stress induced cation flux, since complete exchange of intracellular chloride for sulfate had no effect on the rates. Deformation of erythrocytes by laminar shear appears to increase the non-specific cation permeability.

The clinical importance of erythrocyte deformability, a hemorrheological parameter

Hemorheology, the science of the flow behavior of blood, has become increasingly important in clinical situations. The rheology of blood is dependent on its viscosity, which in turn is influenced by plasma viscosity, hematocrit, erythrocyte aggregation, and erythrocyte deformability. In recent years it has become apparent that the shape and elasticity of erythrocytes may be important in explaining the etiology of certain pathological situations. Thus, clinicians have become increasingly interested in hemorheology in general and erythrocyte deformability in particular. In the course of time, many clinical studies have been performed, but no concise review has thus far been published. This article encompasses a review of the clinically based literature on this subject.

Microviscosity of human erythrocytes studied using hypophosphite two-spin order relaxation

A new 31P NMR method is used to probe the cytoplasmic viscosity of human erythrocytes. The method is based on observing two-spin order relaxation of the 31P atom of the hypophosphite ion. This method is superior to our previous method, using the longitudinal relaxation time of the ion, because random field effects such as intermolecular dipole-dipole relaxation can be separated from intramolecular relaxation. This allows a more accurate determination of the effective reorientational correlation time from the measured intramolecular relaxation because it is now unaffected by random field effects. The new method also provides a means by which to estimate the random field effects. Both two-spin order and proton-decoupled T1 measurements were conducted on hypophosphite in water solutions at various temperatures, glycerol solutions of various viscosities, and in erythrocyte samples of various cell volumes. The results show that the effective reorientational correlation time of the hypophosphite ion varies from 7.2 to 15.2 ps in the cytoplasm of cells ranging in volume from 102 to 56 fl cells.

A large erythroid spectrin beta-chain variant

A large variant of erythrocyte beta-spectrin was found in a child presenting with hereditary elliptocytosis and anaemia. This polypeptide was phosphorylated, cross-reacted with normal beta-spectrin in immunoblotting and formed a dimer with alpha-spectrin that co-purified with normal alpha beta dimer. The molecular weight was estimated to be 330 kD by SDS gel electrophoresis, which is 84 kD (35%) larger than the normal beta-chain. This variant has been tentatively named spectrin Detroit (beta Detroit). Tryptic digests demonstrated a coexisting alpha-spectrin variant Sp alpha I/65 in the propositus, his father and a paternal uncle. Anaemia and elliptocytosis was associated with Sp alpha I/65 rather than beta Detroit, since other family members with beta Detroit in whom alpha-spectrin was normal had no morphological or clinical abnormalities. Family members were identified who had normal alpha-spectrin but were heterozygotic for the large beta-spectrin. Their erythrocyte membranes were more rigid and fragile than normal. The fragility is probably a consequence of both weaker dimer association and spectrin deficiency. Variant spectrin dimers (alpha beta Detroit) had a reduced self-association constants. Binding to ankyrin was normal. Instability of beta Detroit during erythropoiesis is suggested by the fact that it comprises only 25% of the beta-spectrin in beta Detroit heterozygote erythrocytes, and total spectrin was reduced by 20%. Although beta Detroit has some functional defects, this 84 kDa insert in erythrocyte spectrin is compatible with nearly normal function.

Erythrocyte cation permeability induced by mechanical stress: a model for sickle cell cation loss

Human red blood cells were subjected to mechanical shearing in a Couette viscometer at 37 degrees C, using polyvinylpyrrolidone to increase the medium viscosity. At stresses greater than 300 dyn/cm2, movement of both Na and K down their concentration gradients was observed. The net rate of both monovalent cation fluxes appeared to be linear with applied stress in the range of 300-910 dyn/cm2. The applied shear forces caused no fragmentation of the cells. Observed hemolysis was slight. The observed cation fluxes are not a result of hemolysis because the amount of K released by the hemolyzed cells is quantitatively inadequate to account for the net K efflux, and there is a net uptake of Na by the stressed erythrocytes, which cannot be a consequence of hemolysis. The rates of net Na uptake and K efflux were nearly equal (ratio = 0.93 +/- 0.40, n = 6). The stress-induced permeabilities were reversible when shearing was halted. This work demonstrates the existence of cation permeability inducible in the red cell membrane by mechanical deformation, which may be a model for the sickling-induced monovalent cation exchange observed in deoxygenated sickle cells.