Hydrodynamics of hemostasis in sickle-cell disease

Allosteric control of hemoglobin S fiber formation by oxygen and its relation to the pathophysiology of sickle cell disease

The pathology of sickle cell disease is caused by polymerization of the abnormal hemoglobin S upon deoxygenation in the tissues to form fibers in red cells, causing them to deform and occlude the circulation. Drugs that allosterically shift the quaternary equilibrium from the polymerizing T quaternary structure to the nonpolymerizing R quaternary structure are now being developed. Here we update our understanding on the allosteric control of fiber formation at equilibrium by showing how the simplest extension of the classic quaternary two-state allosteric model of Monod, Wyman, and Changeux to include tertiary conformational changes provides a better quantitative description. We also show that if fiber formation is at equilibrium in vivo, the vast majority of cells in most tissues would contain fibers, indicating that it is unlikely that the disease would be survivable once the nonpolymerizing fetal hemoglobin has been replaced by adult hemoglobin S at about 1 y after birth. Calculations of sickling times, based on a recently discovered universal relation between the delay time prior to fiber formation and supersaturation, show that in vivo fiber formation is very far from equilibrium. Our analysis indicates that patients survive because the delay period allows the majority of cells to escape the small vessels of the tissues before fibers form. The enormous sensitivity of the duration of the delay period to intracellular hemoglobin composition also explains why sickle trait, the heterozygous condition, and the compound heterozygous condition of hemoglobin S with pancellular hereditary persistence of fetal hemoglobin are both relatively benign conditions.

A physical approach to model occlusions in the retinal microvasculature

Blood occlusions in the retinal microvasculature contribute to the pathology of many disease states within the eye. These events can cause haemorrhaging and retinal detachment, leading to a loss of vision in the affected patient. Here, we present a physical approach to characterising the collective cell dynamics leading to plug formation, through the use of a bespoke microfluidic device, and through the derivation of a probabilistic model. Our microfluidic device is based on a filtration design that can tune the particle volume fraction of a flowing suspension within a conduit, with sizes similar to arterioles. This allows us to control and reproduce an occlusive event. The formation of the occlusion can be examined through the extracted motion of particles within the channel, which enables the assessment of individual and collective particle dynamics in the time leading to the clogging event. In particular, we observe that at the onset of the occlusion, particles form an arch bridging the channel walls. The data presented here inform the development of our mathematical model, which captures the essential factors promoting occlusions, and notably highlights the central role of adhesion in these processes. Both the physical and probabilistic models rely on significant approximations, and future investigation will seek to assess these approximations, including the deformability and complex flow profiles of the blood constituents. However, we anticipate that the general mechanisms of occlusion may be elucidated from these simple models. As microvascular flows in the eye can now be measured in vivo and non-invasively with single cell resolution, our model will also be compared to the pathophysiological characteristics of the human microcirculation.

Emerging point-of-care technologies for sickle cell disease screening and monitoring

INTRODUCTION

Sickle Cell Disease (SCD) affects 100,000 Americans and more than 14 million people globally, mostly in economically disadvantaged populations, and requires early diagnosis after birth and constant monitoring throughout the life-span of the patient. Areas covered: Early diagnosis of SCD still remains a challenge in preventing childhood mortality in the developing world due to requirements of skilled personnel and high-cost of currently available modalities. On the other hand, SCD monitoring presents insurmountable challenges due to heterogeneities among patient populations, as well as in the same individual longitudinally. Here, we describe emerging point-of-care micro/nano platform technologies for SCD screening and monitoring, and critically discuss current state of the art, potential challenges associated with these technologies, and future directions. Expert commentary: Recently developed microtechnologies offer simple, rapid, and affordable screening of SCD and have the potential to facilitate universal screening in resource-limited settings and developing countries. On the other hand, monitoring of SCD is more complicated compared to diagnosis and requires comprehensive validation of efficacy. Early use of novel microdevices for patient monitoring might come in especially handy in new clinical trial designs of emerging therapies.

Self-sustained lift and low friction via soft lubrication

Relative motion between soft wet solids arises in a number of applications in natural and artificial settings, and invariably couples elastic deformation fluid flow. We explore this in a minimal setting by considering a fluid-immersed negatively buoyant cylinder moving along a soft inclined wall. Our experiments show that there is an emergent robust steady-state sliding regime of the cylinder with an effective friction that is significantly reduced relative to that of rigid fluid-lubricated contacts. A simple scaling approach that couples the cylinder-induced flow to substrate deformation allows us to explain the elastohydrodynamic lift that underlies the self-sustained lubricated motion of the cylinder, consistent with recent theoretical predictions. Our results suggest an explanation for a range of effects such as reduced wear in animal joints and long-runout landslides, and can be couched as a design principle for low-friction interfaces.

Heterogeneous red blood cell adhesion and deformability in sickle cell disease

We present a microfluidic approach that allows simultaneous interrogation of RBC properties in physiological flow conditions at a single cell level. With this method, we studied healthy hemoglobin A (HbA) and homozygous sickle hemoglobin (HbS) containing RBCs using whole blood samples from twelve subjects. We report that HbS-containing RBCs are heterogeneous in terms of adhesion and deformability in flow.