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Anastasiadi AT, Arvaniti VZ, Hudson KE, Kriebardis AG, Stathopoulos C, D’Alessandro A, Spitalnik SL, Tzounakas VL. Exploring unconventional attributes of red blood cells and their potential applications in biomedicine. Protein Cell 2024; 15:315-330. [PMID: 38270470 PMCID: PMC11074998 DOI: 10.1093/procel/pwae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Affiliation(s)
- Alkmini T Anastasiadi
- Department of Biochemistry, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Vasiliki-Zoi Arvaniti
- Department of Biochemistry, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Krystalyn E Hudson
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York City, NY 10032, USA
| | - Anastasios G Kriebardis
- Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, School of Health & Caring Sciences, University of West Attica (UniWA), 12243 Egaleo, Greece
| | | | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, 13001 Aurora, CO, USA
| | - Steven L Spitalnik
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York City, NY 10032, USA
| | - Vassilis L Tzounakas
- Department of Biochemistry, School of Medicine, University of Patras, 26504 Patras, Greece
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Xie KH, Liu LL, Liang YR, Su CY, Li H, Liu RN, Chen QQ, He JS, Ruan YK, He WK. Red cell distribution width: a novel predictive biomarker for stroke risk after transient ischaemic attack. Ann Med 2022; 54:1167-1177. [PMID: 35471128 PMCID: PMC9045760 DOI: 10.1080/07853890.2022.2059558] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Predicting the prognosis of transient ischaemic attack (TIA) is difficult for many frontline clinicians. The purpose of this study was to determine whether subsequent stroke in TIA patients can be predicted via red blood cell distribution width (RDW). MATERIAL AND METHODS A total of 360 consecutive patients with new-onset TIA in our stroke centre, were enrolled over the period studied. The patients were divided into three groups: 103 TIA patients, 206 ischaemic stroke (IS) patients and 51 patients with haemorrhagic stroke (HS) within 7 days after TIA. Complete blood count, biochemical parameters and brain imaging were performed on all patients. RESULTS The mean RDW values of patients with IS and HS after TIA were significantly higher than patients with TIA (13.35 ± 1.59 vs 12.84 ± 1.19, 13.32 ± 1.08 vs 12.84 ± 1.19, respectively, all p ≤ .001). In a multivariate model, RDW was independently associated with stroke after TIA (IS: odds ratio (OR) = 2.52, 95% confidence interval (CI) = 1.46-3.35, p = .002; HS: OR = 1.511, 95% CI = 1.101-2.074, p = .011). Compared to ABCD2 scores, the diagnostic power of RDW in the differentiation of patients with IS after TIA was better (area under curve (AUC): 0.731 vs 0.613, p = .015). When an RDW cut-off value of 13.95% was accepted for differentiating patients with IS from TIA, the sensitivity and specificity were 73.7% and 74.3%, respectively. However, the AUC for the ability of the RDW to predict HS was 0.653 (95% CI = 0.589-0.716; p < .001). CONCLUSIONS The early determination of RDW is a promising, rapid, easy and inexpensive biomarker to predict the subsequent stroke in TIA patients, especially for IS. KEY MESSAGESThe most important result of our study is to show that (1) the higher RDW, the earlier the stroke onset and (2) RDW ≥13.95% has a 2.52-fold risk of ischaemic stroke in TIA patients, and RDW ≥12.85% has a 1.51-fold risk of haemorrhagic stroke.As an economic and accessible hematological marker, baseline RDW may serve as a useful biomarker for risk stratification in TIA patients.
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Affiliation(s)
- Ke-Hang Xie
- Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, China
| | - Ling-Ling Liu
- Department of Nephrology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Yun-Ru Liang
- Reproductive Endocrine Center, Yangjiang Hospital of Traditional Chinese Medicine, Yangjiang, China
| | - Chu-Yin Su
- Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, China
| | - Hua Li
- Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, China
| | - Run-Ni Liu
- Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, China
| | - Qing-Qing Chen
- Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, China
| | - Jia-Sheng He
- Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, China
| | - Yong-Kun Ruan
- Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, China
| | - Wang-Kai He
- Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, China
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3
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Rong N, Zhao P, Yang J, Fan QL, Zhang Q, Han ZG, Cai J, Zhu DS. The U-Shaped Association Between Serum Uric Acid and Red Blood Cell Distribution Width in Acute Ischemic Stroke. Front Physiol 2021; 12:631369. [PMID: 34413783 PMCID: PMC8369338 DOI: 10.3389/fphys.2021.631369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The U-shaped association between serum uric acid (SUA) and the functional outcome has been found in acute ischemic stroke (AIS). However, it is unclear if SUA is associated with red blood cell morphology in AIS. This study aimed to determine the relationship between SUA and red blood cell distribution width (RDW) in patients with AIS. Methods: A cross-sectional study including 438 consecutive patients with AIS was conducted. SUA and RDW, biochemical parameters that reflect the heterogeneity of red blood cell volume, were evaluated on admission. We evaluated the association between SUA and RDW through linear curve fitting analyses and two-piecewise regression analyses. Results: The association between SUA levels and RDW followed a U-shape in all patients. In females, the values of RDW significantly decreased with the increment of SUA (per mg/dl: β, -1.45; 95% CI: -2.15 to -0.75; p < 0.001) in patients with SUA <3.86 mg/dl and increased with the increment of SUA (per mg/dl: β, 0.60; 95% CI: 0.22-0.97; p = 0.002) in patients with SUA ≥ 3.86 mg/dl. Similar results were observed in males with the turning point of SUA = 4.82 mg/dl. After adjusting for potential confounders, a U-shaped association between SUA and RDW was maintained in females, but no statistical significance was maintained in patients with SUA ≥ 4.82 mg/dl in males (p = 0.206). Conclusion: In the sample of patients with AIS, we found a U-shaped relationship between SUA levels and RDW, with the turning point of SUA (3.96 mg/dl in females and 4.82 mg/dl in males) by the threshold effect analysis.
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Affiliation(s)
- Ning Rong
- Department of Neurology, Baoshan Branch, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,School of Clinical Medicine, Dali University, Dali, China
| | - Pei Zhao
- Department of Neurology, Baoshan Branch, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jin Yang
- Department of Neurology, Baoshan Branch, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qing-Lei Fan
- Department of Neurology, Baoshan Branch, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qiang Zhang
- School of Clinical Medicine, Dali University, Dali, China
| | - Zhi-Gang Han
- Department of Radiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jian Cai
- Department of Neurology, Baoshan Branch, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - De-Sheng Zhu
- Department of Neurology, Baoshan Branch, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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4
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Pecchiari M, Pontikis K, Alevrakis E, Vasileiadis I, Kompoti M, Koutsoukou A. Cardiovascular Responses During Sepsis. Compr Physiol 2021; 11:1605-1652. [PMID: 33792902 DOI: 10.1002/cphy.c190044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sepsis is the life-threatening organ dysfunction arising from a dysregulated host response to infection. Although the specific mechanisms leading to organ dysfunction are still debated, impaired tissue oxygenation appears to play a major role, and concomitant hemodynamic alterations are invariably present. The hemodynamic phenotype of affected individuals is highly variable for reasons that have been partially elucidated. Indeed, each patient's circulatory condition is shaped by the complex interplay between the medical history, the volemic status, the interval from disease onset, the pathogen, the site of infection, and the attempted resuscitation. Moreover, the same hemodynamic pattern can be generated by different combinations of various pathophysiological processes, so the presence of a given hemodynamic pattern cannot be directly related to a unique cluster of alterations. Research based on endotoxin administration to healthy volunteers and animal models compensate, to an extent, for the scarcity of clinical studies on the evolution of sepsis hemodynamics. Their results, however, cannot be directly extrapolated to the clinical setting, due to fundamental differences between the septic patient, the healthy volunteer, and the experimental model. Numerous microcirculatory derangements might exist in the septic host, even in the presence of a preserved macrocirculation. This dissociation between the macro- and the microcirculation might account for the limited success of therapeutic interventions targeting typical hemodynamic parameters, such as arterial and cardiac filling pressures, and cardiac output. Finally, physiological studies point to an early contribution of cardiac dysfunction to the septic phenotype, however, our defective diagnostic tools preclude its clinical recognition. © 2021 American Physiological Society. Compr Physiol 11:1605-1652, 2021.
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Affiliation(s)
- Matteo Pecchiari
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Konstantinos Pontikis
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Emmanouil Alevrakis
- 4th Department of Pulmonary Medicine, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Ioannis Vasileiadis
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Maria Kompoti
- Intensive Care Unit, Thriassio General Hospital of Eleusis, Magoula, Greece
| | - Antonia Koutsoukou
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
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Pereira-Neves A, Rocha-Neves J, Fragão-Marques M, Duarte-Gamas L, Jácome F, Coelho A, Cerqueira A, Andrade JP, Mansilha A. Red blood cell distribution width is associated with hypoperfusion in carotid endarterectomy under regional anesthesia. Surgery 2021; 169:1536-1543. [PMID: 33610341 DOI: 10.1016/j.surg.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A subset of patients submitted to carotid endarterectomy under regional anesthesia develop intraoperative neurologic deficit during carotid artery crossclamping related to critical cerebral perfusion, which may be owing to low flow or embolic phenomena. This subgroup is deemed prone to worse outcomes, which highlights its clinical relevance. The main aim of this study was to identify clinical and hematological predictors for intraoperative neurologic deficit. The secondary aim was to evaluate the perioperative prognostic value of postcarotid artery crossclamping manifestations of cerebral ischemia. METHODS Between January 2012 to January 2020, patients submitted to carotid endarterectomy under regional anesthesia in a tertiary referral center who presented intraoperative neurologic deficit were prospectively and consecutively included. This group constituted 8% of the total carotid endarterectomy performed in the center during this timeframe. The control group of patients was the subsequent patient submitted to carotid endarterectomy without intraoperative neurologic deficit in a 1:1 ratio. Blood samples were collected before surgery (<2 weeks). Propensity score matching was used to identify well-matched pairs of patients. RESULTS A total of 180 patients were included, with 90 (50% of the cohort and 8% of total carotid endarterectomies) presenting intraoperative neurologic deficit associated to clamping. Mean age was 71.4 ± 9.27 years in the study group and 68.8 ± 8.36 years in the control group. The clinical variables presenting significance after multivariate analysis include: age (adjusted odds ratio: 1.04, 5-95% confidence interval, [1.003-1.078]; P = .034), obesity (adjusted odds ratio: 3.537 [1.445-8.658]; P = .006), lower ipsilateral carotid stenosis grade (adjusted odds ratio: 0.725 [0.525-0.997]; P = .049), and higher contralateral carotid stenosis grade (adjusted odds ratio: 1.266 [1.057-1.516]; P = .010). Red cell distribution width coefficient of variation demonstrated statistical significance in predicting intraoperative neurologic deficit with an adjusted odds ratio of 1.394 (1.076-1.805); P = .012. The 30-day stroke rate was significantly higher in the intraoperative neurologic deficit group, with an adjusted odds ratio of 5.13 (5-95% confidence interval [1.058-24.87]; P = .042) after propensity score matching. Postoperative complications (Clavien-Dindo ≥2) were also associated with intraoperative neurologic deficit (after propensity score matching adjusted odds ratio of 2.748 [5-95% confidence interval, 0.976-7.741]; P = .051). CONCLUSION In this study, increased red cell distribution width coefficient of variation demonstrated value to predict intraoperative neurologic deficit. Additionally, age, obesity, a lower degree of ipsilateral carotid stenosis, and a higher degree of contralateral carotid stenosis also demonstrated ability to predict intraoperative neurologic deficit. Moreover, intraoperative neurologic deficit was an independent risk factor for 30-day stroke and postoperative complications Clavien-Dindo ≥2.
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Affiliation(s)
- António Pereira-Neves
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal.
| | - João Rocha-Neves
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Mariana Fragão-Marques
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular R & D Unit, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Filipa Jácome
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Andreia Coelho
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Alfredo Cerqueira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José P Andrade
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Armando Mansilha
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
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Arbell D, Bin-Nun A, Zugayar D, Eventov-Friedman S, Chepel N, Srebnik N, Hamerman C, Wexler TLR, Barshtein G, Yedgar S. Deformability of cord blood vs. newborns' red blood cells: implication for blood transfusion. J Matern Fetal Neonatal Med 2021; 35:3270-3275. [PMID: 33541145 DOI: 10.1080/14767058.2020.1818203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM About 50% of premature neonates (PN) are treated with transfusion of packed red blood cells (PRBC) collected from adult donors, which has been suggested to potentially provoke PN pathologies, characterized as blood circulation disorders. RBC have properties that are key determinants of blood circulation, primarily the cell deformability. In previous studies we have shown that transfusion of RBC with reduced deformability impaired the transfusion outcome. Although RBC of PN (PN-RBC) are larger, and their microvessels are narrower than those of adults, their blood circulation is very efficient, pointing to the possibility that the deformability of adults' PRBC is inferior to that of PN-RBC, and that treating PN with PRBC transfusion might, therefore, introduce a risk to the recipients. This would infer that PN should be given RBC with high deformability. However, since using PN-RBC is not feasible, the use of cord blood RBC (CB-RBC) is a sound alternative, assuming that the deformability of CB-RBC is comparable to that of PN-RBC.The present study is aimed at testing this hypothesis. METHODS We compared the deformability of (1) RBC of PN vs. the PRBC they received, and (2) PN-RBC vs. their autologous CB-RBC. RESULTS 1. The deformability of the transfused PRBC is indeed inferior to that of PN-RBC. 2. The deformability of CB-RBC is equivalent to that of PN-RBC. CONCLUSION This study supports the notion that treating PN with transfusion of adults' PRBC has the potential to introduce a circulatory risk to the recipients, while CB-RBC, with their superior deformability, provides a safer and more effective PN-specific transfusion therapy.
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Affiliation(s)
- Dan Arbell
- Department of Pediatric Surgery, Hadassah University Hospital, Jerusalem, Israel
| | - Alona Bin-Nun
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Diaa Zugayar
- Department of Pediatric Surgery, Hadassah University Hospital, Jerusalem, Israel
| | | | - Natalia Chepel
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Naama Srebnik
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Cathy Hamerman
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tanja L R Wexler
- Faculty of Medicine, Department of Biochemistry, Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Gregory Barshtein
- Faculty of Medicine, Department of Biochemistry, Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Saul Yedgar
- Faculty of Medicine, Department of Biochemistry, Hadassah Medical School, Hebrew University, Jerusalem, Israel
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Gurung S, Dubansky B, Virgen CA, Verbeck GF, Murphy DW. Effects of crude oil vapors on the cardiovascular flow of embryonic Gulf killifish. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 751:141627. [PMID: 33181982 DOI: 10.1016/j.scitotenv.2020.141627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 06/11/2023]
Abstract
Direct contact with toxicants in crude oil during embryogenesis causes cardiovascular defects, but the effects of exposure to airborne volatile organic compounds released from spilled oil are not well understood. The effects of crude oil-derived airborne toxicants on peripheral blood flow were examined in Gulf killifish (Fundulus grandis) since this model completes embryogenesis in the air. Particle image velocimetry was used to measure in vivo blood flow in intersegmental arteries of control and oil-exposed embryos. Significant effects in oil-exposed embryos included increased pulse rate, reduced mean blood flow speed and volumetric flow rate, and decreased pulsatility, demonstrating that normal-appearing oil-exposed embryos retain underlying cardiovascular defects. Further, hematocrit moderately increased in oil-exposed embryos. This study highlights the potential for fine-scale physiological measurement techniques to better understand the sub-lethal effects of oil exposure and demonstrates the efficacy of Gulf killifish as a unique teleost model for aerial toxicant exposure studies.
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Affiliation(s)
- Sanjib Gurung
- Department of Mechanical Engineering, University of South Florida, Tampa, FL 33620, United States
| | - Benjamin Dubansky
- Department of Biological Sciences, University of North Texas, Denton, TX 76203, United States
| | - Camila A Virgen
- Department of Chemistry, University of North Texas, Denton, TX 76203, United States
| | - Guido F Verbeck
- Department of Chemistry, University of North Texas, Denton, TX 76203, United States
| | - David W Murphy
- Department of Mechanical Engineering, University of South Florida, Tampa, FL 33620, United States.
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Abstract
Red Blood Cells (RBCs) have been increasingly recognized to play important roles in hemostasis and the mechanisms by which they do so continue to be elucidated. First and foremost, RBC biomechanics are the principal determinant of viscosity and flow dynamics of blood, which strongly influence all features of hemostasis. Of note, morphologic pathology, such as that found in sickle cell disease, leads to increased risk of thrombotic disease. RBC surface interactions govern signaling between platelets and RBCs and also aid in the conversion of prothrombin to thrombin. Additionally, RBCs generate microparticles which have been shown to reduce clotting time. Finally, blood clot structure and maturation are dependent on the inclusion of RBCs in forming thrombi. Here, we review the above mechanisms of RBC contribution to hemostasis.
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Affiliation(s)
- Andrea H Gillespie
- Division of Pediatric Hematology and Oncology, Oregon Health and Sciences University, Portland, OR, United States
| | - Allan Doctor
- Division of Pediatric Critical Care Medicine, The Center for Blood Oxygen Transport and Hemostasis, University of Maryland School of Medicine, Baltimore, MD, United States
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9
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Bogdanova A, Kaestner L, Simionato G, Wickrema A, Makhro A. Heterogeneity of Red Blood Cells: Causes and Consequences. Front Physiol 2020; 11:392. [PMID: 32457644 PMCID: PMC7221019 DOI: 10.3389/fphys.2020.00392] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/02/2020] [Indexed: 12/21/2022] Open
Abstract
Mean values of hematological parameters are currently used in the clinical laboratory settings to characterize red blood cell properties. Those include red blood cell indices, osmotic fragility test, eosin 5-maleimide (EMA) test, and deformability assessment using ektacytometry to name a few. Diagnosis of hereditary red blood cell disorders is complemented by identification of mutations in distinct genes that are recognized "molecular causes of disease." The power of these measurements is clinically well-established. However, the evidence is growing that the available information is not enough to understand the determinants of severity of diseases and heterogeneity in manifestation of pathologies such as hereditary hemolytic anemias. This review focuses on an alternative approach to assess red blood cell properties based on heterogeneity of red blood cells and characterization of fractions of cells with similar properties such as density, hydration, membrane loss, redox state, Ca2+ levels, and morphology. Methodological approaches to detect variance of red blood cell properties will be presented. Causes of red blood cell heterogeneity include cell age, environmental stress as well as shear and metabolic stress, and multiple other factors. Heterogeneity of red blood cell properties is also promoted by pathological conditions that are not limited to the red blood cells disorders, but inflammatory state, metabolic diseases and cancer. Therapeutic interventions such as splenectomy and transfusion as well as drug administration also impact the variance in red blood cell properties. Based on the overview of the studies in this area, the possible applications of heterogeneity in red blood cell properties as prognostic and diagnostic marker commenting on the power and selectivity of such markers are discussed.
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Affiliation(s)
- Anna Bogdanova
- Red Blood Cell Research Group, Vetsuisse Faculty, The Zurich Center for Integrative Human Physiology (ZHIP), Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland
| | - Lars Kaestner
- Experimental Physics, Dynamics of Fluids, Faculty of Natural Sciences and Technology, Saarland University, Saarbrücken, Germany
- Theoretical Medicine and Biosciences, Medical Faculty, Saarland University, Homburg, Germany
| | - Greta Simionato
- Experimental Physics, Dynamics of Fluids, Faculty of Natural Sciences and Technology, Saarland University, Saarbrücken, Germany
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg, Germany
| | - Amittha Wickrema
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Asya Makhro
- Red Blood Cell Research Group, Vetsuisse Faculty, The Zurich Center for Integrative Human Physiology (ZHIP), Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland
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10
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Nader E, Romana M, Connes P. The Red Blood Cell-Inflammation Vicious Circle in Sickle Cell Disease. Front Immunol 2020; 11:454. [PMID: 32231672 PMCID: PMC7082402 DOI: 10.3389/fimmu.2020.00454] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/27/2020] [Indexed: 12/31/2022] Open
Abstract
Sickle cell disease (SCD) is a genetic disease caused by a single mutation in the β-globin gene, leading to the production of an abnormal hemoglobin called hemoglobin S (HbS), which polymerizes under deoxygenation, and induces the sickling of red blood cells (RBCs). Sickled RBCs are very fragile and rigid, and patients consequently become anemic and develop frequent and recurrent vaso-occlusive crises. However, it is now evident that SCD is not only a RBC rheological disease. Accumulating evidence shows that SCD is also characterized by the presence of chronic inflammation and oxidative stress, participating in the development of chronic vasculopathy and several chronic complications. The accumulation of hemoglobin and heme in the plasma, as a consequence of enhanced intravascular hemolysis, decreases nitric oxide bioavailability and enhances the production of reactive oxygen species (ROS). Heme and hemoglobin also represent erythrocytic danger-associated molecular pattern molecules (eDAMPs), which may activate endothelial inflammation through TLR-4 signaling and promote the development of complications, such as acute chest syndrome. It is also suspected that heme may activate the innate immune complement system and stimulate neutrophils to release neutrophil extracellular traps. A large amount of microparticles (MPs) from various cellular origins (platelets, RBCs, white blood cells, endothelial cells) is also released into the plasma of SCD patients and participate in the inflammation and oxidative stress in SCD. In turn, this pro-inflammatory and oxidative stress environment further alters the RBC properties. Increased pro-inflammatory cytokine concentrations promote the activation of RBC NADPH oxidase and, thus, raise the production of intra-erythrocyte ROS. Such enhanced oxidative stress causes deleterious damage to the RBC membrane and further alters the deformability of the cells, modifying their aggregation properties. These RBC rheological alterations have been shown to be associated to specific SCD complications, such as leg ulcers, priapism, and glomerulopathy. Moreover, RBCs positive for the Duffy antigen receptor for chemokines may be very sensitive to various inflammatory molecules that promote RBC dehydration and increase RBC adhesiveness to the vascular wall. In summary, SCD is characterized by a vicious circle between abnormal RBC rheology and inflammation, which modulates the clinical severity of patients.
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Affiliation(s)
- Elie Nader
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Marc Romana
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France.,Université des Antilles, UMR_S1134, BIGR, Pointe-à-Pitre, France.,Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
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11
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Prognostic Relationship Between Peripheral Red Cell Distribution Width and Acute Cerebral Infarction in Patients with rtPA Thrombolysis. Neurotox Res 2020; 38:211-218. [PMID: 32162280 DOI: 10.1007/s12640-020-00186-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/20/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022]
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12
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Biran R, Hadayer N, Ramot Y, Zlotogorski A, Yedgar S, Barshtein G. Phototherapy decreases red blood cell deformability in patients with psoriasis. Clin Hemorheol Microcirc 2020; 73:489-496. [DOI: 10.3233/ch-180424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Roni Biran
- Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Noa Hadayer
- Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Yuval Ramot
- Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Abraham Zlotogorski
- Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Saul Yedgar
- Department of Biochemistry, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Gregory Barshtein
- Department of Biochemistry, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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13
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Lu M, Rab MA, Shevkoplyas SS, Sheehan VA. Blood rheology biomarkers in sickle cell disease. Exp Biol Med (Maywood) 2020; 245:155-165. [PMID: 31948290 DOI: 10.1177/1535370219900494] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sickle cell disease (SCD) is the most common inherited blood disorder, affecting approximately 100,000 patients in the U.S. and millions more worldwide. Patients with SCD experience a wide range of clinical complications, including frequent pain crises, stroke, and early mortality, all originating from a single-point mutation in the β-globin subunit. The RBC changes resulting from the sickle mutation lead to a host of rheological abnormalities that diminish microvascular blood flow, and produce severe anemia due to RBC hemolysis, and ischemia from vaso-occlusion initiated by sticky, rigid sickle RBCs. While the pathophysiology and mechanisms of SCD have been investigated for many years, therapies to treat the disease are limited. In addition to RBC transfusion, there are only two US Food and Drug Administration (FDA)-approved drugs to ameliorate SCD complications: hydroxyurea (HU) and L-glutamine (Endari™). The only curative therapy currently available is allogeneic hematopoietic stem cell transplantation (HSCT), which is generally reserved for individuals with a matched related donor, comprising only 10–15% of the total SCD population. Potentially curative advanced gene therapy approaches for SCD are under investigation in ongoing clinical trials. The ultimate goal of any curative treatment should be to repair the hemorheological abnormalities caused by SCD, and thus normalize blood flow and prevent clinical complications. Our mini-review highlights a set of key hemorheological biomarkers (and the current and emerging technologies used to measure them) that may be used to guide the development of novel curative and palliative therapies for SCD, and functionally assess outcomes. Impact statement Severe impairment of blood rheology is the hallmark of SCD pathophysiology, and one of the key factors predisposing SCD patients to pain crises, organ damage, and early mortality. As novel therapies emerge to treat or cure SCD, it is crucial that these treatments are functionally evaluated for their effect on blood rheology. This review describes a comprehensive panel of rheological biomarkers, their clinical uses, and the technologies used to obtain them. The described technologies can produce highly sensitive measurements of the ability of current treatments to improve blood rheology of SCD patients. The goal of curative therapies should be to achieve blood rheology biomarkers measurements in the range of sickle cell trait individuals (HbAS). The use of the panel of rheological biomarkers proposed in this review could significantly accelerate the development, optimization, and clinical translation of novel therapies for SCD.
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Affiliation(s)
- Madeleine Lu
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA
| | - Minke Ae Rab
- Laboratory of Clinical Chemistry & Hematology, University Medical Center Utrecht, Utrecht University, Utrecht 3584, The Netherlands
| | - Sergey S Shevkoplyas
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA
| | - Vivien A Sheehan
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX 77030, USA
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14
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Diebel LN, Liberati DM. Red blood cell storage and adhesion to vascular endothelium under normal or stress conditions: An in vitro microfluidic study. J Trauma Acute Care Surg 2019; 86:943-951. [PMID: 31124891 DOI: 10.1097/ta.0000000000002239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Observational studies have identified an association between duration of red blood cell (RBC) storage and adverse outcomes in trauma. Hemorrhagic shock (HS) leads to impaired tissue perfusion which is associated with endothelial cell glycocalyx (eGC) shedding. Adhesion of stored RBC to the vascular endothelium has been shown to lead to impaired perfusion in the microcirculation and contribute to organ failure and poor outcome. The role of either or both of the EC and RBC glycocalyx in this process is unknown and was studied in an in vitro model. METHODS Human umbilical vein endothelial cells were perfused in a microfluidic device with RBC solutions from fresh, less than 14-day or longer than 21-day storage. In some experiments, the HS microenvironment was simulated by hypoxia-reoxygenation (H/R) and epinephrine (Epi) in the perfusion experiments. Measurements obtained included endothelial cell (EC) and RBC glycocalyx and RBC adherence to human umbilical vein endothelial cell monolayers at variable shear rates. RESULTS Endothelial cell glycocalyx and RBC glycocalyx dimensions were reduced by H/R and Epi and storage duration respectively. Red blood cell adherence to the endothelium was increased by H/R + Epi treatment and duration of RBC storage. CONCLUSION Our data may help explain some of the remaining discrepancies regarding the impact of RBC storage duration on outcomes in the trauma population. Consideration of the integrity of the EC and RBC glycocalyx may guide future transfusion strategies in the trauma population. The microfluidic device system platform may offer a high throughput modality to study emerging therapies to mitigate adverse consequence of RBC storage duration on the perfused endothelium in the trauma setting.
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Affiliation(s)
- Lawrence N Diebel
- From the Michael and Marian Ilitch Department of Surgery (L.N.D., D.M.L.), Wayne State University, Detroit, Michigan
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15
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Barshtein G, Arbell D, Yedgar S. Hemodynamic Functionality of Transfused Red Blood Cells in the Microcirculation of Blood Recipients. Front Physiol 2018; 9:41. [PMID: 29441026 PMCID: PMC5797635 DOI: 10.3389/fphys.2018.00041] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/11/2018] [Indexed: 01/23/2023] Open
Abstract
The primary goal of red blood cell (RBC) transfusion is to supply oxygen to tissues and organs. However, due to a growing number of studies that have reported negative transfusion outcomes, including reduced blood perfusion, there is rising concern about the risks in blood transfusion. RBC are characterized by unique flow-affecting properties, specifically adherence to blood vessel wall endothelium, cell deformability, and self-aggregability, which define their hemodynamic functionality (HF), namely their potential to affect blood circulation. The role of the HF of RBC in blood circulation, particularly the microcirculation, has been documented in numerous studies with animal models. These studies indicate that the HF of transfused RBC (TRBC) plays an important role in the transfusion outcome. However, studies with animal models must be interpreted with reservations, as animal physiology may not reflect human physiology. To test this concept in humans, we have directly examined the effect of the HF of TRBC, as expressed by their deformability and adherence to vascular endothelium, on the transfusion-induced effect on the skin blood flow and hemoglobin increment in β-thalassemia major patients. The results demonstrated, for the first time in humans, that the TRBC HF is a potent effector of the transfusion outcome, expressed by the transfusion-induced increase in the recipients' hemoglobin level, and the change in the skin blood flow, indicating a link between the microcirculation and the survival of TRBC in the recipients' vascular system. The implication of these findings for blood transfusion practice and to vascular function in blood recipients is discussed.
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Affiliation(s)
- Gregory Barshtein
- Department of Biochemistry, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dan Arbell
- Department of Pediatric Surgery, Hadassah University Hospital, Jerusalem, Israel
| | - Saul Yedgar
- Department of Biochemistry, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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16
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McNamee AP, Tansley GD, Sabapathy S, Simmonds MJ. Biphasic impairment of erythrocyte deformability in response to repeated, short duration exposures of supraphysiological, subhaemolytic shear stress. Biorheology 2017; 53:137-149. [PMID: 27662271 DOI: 10.3233/bir-15108] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Despite current generation mechanical assist devices being designed to limit shear stresses and minimise damage to formed elements in blood, severe secondary complications suggestive of impaired rheological functioning are still observed. At present, the precise interactions between the magnitude-duration of shear stress exposure and the deformability of red blood cells (RBC) remain largely undescribed for repeated subhaemolytic shear stress duty-cycles of less than 15 s. Given that the time taken for blood to traverse mechanical devices (e.g., Bio Pump) typically ranges from 1.85-3.08 s, the present study examined the influence of repeated, short duration, supraphysiological shear stress exposure on RBC function. METHODS RBC were exposed to shear stress duty-cycles of 64 Pa × 3 s or 88 Pa × 2 s, for 10 repeated bouts, in an annular Couette shearing system and ektacytometer. Laser diffractometry was used to measure RBC deformability before and after application of each duty-cycle. Free haemoglobin concentration and RBC morphology was also examined following shear exposure to determine cell viability. RESULTS Initial exposure to shear stress duty-cycles decreased RBC deformability and increased RBC sensitivity to mechanical damage. Interestingly, the pattern of change in these variables reversed and returned to baseline values within two successive duty-cycle exposures. Significant improvements in RBC deformability were then observed by the 9th repeated exposure to 64 Pa × 3 s. CONCLUSIONS Repeat applications of short duration supraphysiological, subhaemolytic shear stress induces a biphasic RBC deformability response that appears to progressively improve initially impaired RBC populations.
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Affiliation(s)
- Antony P McNamee
- School of Allied Health Sciences, Griffith University, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Geoff D Tansley
- School of Engineering, Griffith University, Queensland, Australia
| | - Surendran Sabapathy
- School of Allied Health Sciences, Griffith University, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Michael J Simmonds
- School of Allied Health Sciences, Griffith University, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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17
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Red blood cells: Supercarriers for drugs, biologicals, and nanoparticles and inspiration for advanced delivery systems. Adv Drug Deliv Rev 2016; 106:88-103. [PMID: 26941164 DOI: 10.1016/j.addr.2016.02.007] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 12/19/2022]
Abstract
Red blood cells (RBCs) constitute a unique drug delivery system as a biologic or hybrid carrier capable of greatly enhancing pharmacokinetics, altering pharmacodynamics (for example, by changing margination within the intravascular space), and modulating immune responses to appended cargoes. Strategies for RBC drug delivery systems include internal and surface loading, and the latter can be performed both ex vivo and in vivo. A relatively new avenue for RBC drug delivery is their application as a carrier for nanoparticles. Efforts are also being made to incorporate features of RBCs in nanocarriers to mimic their most useful aspects, such as long circulation and stealth features. RBCs have also recently been explored as carriers for the delivery of antigens for modulation of immune response. Therefore, RBC-based drug delivery systems represent supercarriers for a diverse array of biomedical interventions, and this is reflected by several industrial and academic efforts that are poised to enter the clinical realm.
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18
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Barshtein G, Pries AR, Goldschmidt N, Zukerman A, Orbach A, Zelig O, Arbell D, Yedgar S. Deformability of transfused red blood cells is a potent determinant of transfusion-induced change in recipient's blood flow. Microcirculation 2016; 23:479-486. [DOI: 10.1111/micc.12296] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/06/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Gregory Barshtein
- Department of Biochemistry; Hebrew University Faculty of Medicine; Jerusalem Israel
| | | | - Neta Goldschmidt
- Department of Hematology; Hadassah University Hospital; Jerusalem Israel
| | - Ayelet Zukerman
- Department of Biochemistry; Hebrew University Faculty of Medicine; Jerusalem Israel
| | - Ariel Orbach
- Department of Biochemistry; Hebrew University Faculty of Medicine; Jerusalem Israel
| | - Orly Zelig
- Blood Bank; Hadassah-Hebrew University Hospital; Jerusalem Israel
| | - Dan Arbell
- Department of Pediatric Surgery; Hadassah- Hebrew University Hospital; Jerusalem Israel
| | - Saul Yedgar
- Department of Biochemistry; Hebrew University Faculty of Medicine; Jerusalem Israel
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19
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Schmidt AE, Refaai MA, Blumberg N. Past, present and forecast of transfusion medicine: What has changed and what is expected to change? Presse Med 2016; 45:e253-72. [PMID: 27474234 DOI: 10.1016/j.lpm.2016.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Blood transfusion is the second most used medical procedures in health care systems worldwide. Over the last few decades, significant changes have been evolved in transfusion medicine practices. These changes were mainly needed to increase safety, efficacy, and availability of blood products as well as reduce recipients' unnecessary exposure to allogeneic blood. Blood products collection, processing, and storage as well as transfusion practices throughout all patient populations were the main stream of these changes. Health care systems across the world have adopted some or most of these changes to reduce transfusion risks, to improve overall patients' outcome, and to reduce health care costs. In this article, we are going to present and discuss some of these recent modifications and their impact on patients' safety.
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Affiliation(s)
- Amy E Schmidt
- University of Rochester medical center, department of pathology and laboratory medicine, 14642 Rochester, NY, USA
| | - Majed A Refaai
- University of Rochester medical center, department of pathology and laboratory medicine, 14642 Rochester, NY, USA
| | - Neil Blumberg
- University of Rochester medical center, department of pathology and laboratory medicine, 14642 Rochester, NY, USA.
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20
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Villa CH, Muzykantov VR, Cines DB. The emerging role for red blood cells in haemostasis: opportunity for intervention. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- C. H. Villa
- Department of Pathology and Laboratory Medicine; The Perelman School of Medicine, University of Pennsylvania; Philadelphia PA USA
| | - V. R. Muzykantov
- Department of Pharmacology and Center for Targeted Therapeutics and Translational Nanomedicine of the Institute for Translational Medicine and Therapeutics; The Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - D. B. Cines
- Department of Pathology and Laboratory Medicine; The Perelman School of Medicine, University of Pennsylvania; Philadelphia PA USA
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21
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Riccio DA, Zhu H, Foster MW, Huang B, Hofmann CL, Palmer GM, McMahon TJ. Renitrosylation of banked human red blood cells improves deformability and reduces adhesivity. Transfusion 2015; 55:2452-63. [PMID: 26098062 DOI: 10.1111/trf.13189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Daniel A Riccio
- Department of Medicine, Durham Veterans Affairs and Duke University Medical Centers, Durham, North Carolina
| | - Hongmei Zhu
- Department of Medicine, Durham Veterans Affairs and Duke University Medical Centers, Durham, North Carolina
| | - Matthew W Foster
- Department of Medicine, Durham Veterans Affairs and Duke University Medical Centers, Durham, North Carolina
| | - Brendan Huang
- Department of Medicine, Durham Veterans Affairs and Duke University Medical Centers, Durham, North Carolina
| | | | - Gregory M Palmer
- Department of Radiation Oncology, Durham Veterans Affairs and Duke University Medical Centers, Durham, North Carolina
| | - Tim J McMahon
- Department of Medicine, Durham Veterans Affairs and Duke University Medical Centers, Durham, North Carolina
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22
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Cahn A, Livshits L, Srulevich A, Raz I, Yedgar S, Barshtein G. Diabetic foot disease is associated with reduced erythrocyte deformability. Int Wound J 2015; 13:500-4. [PMID: 26018868 DOI: 10.1111/iwj.12466] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 01/13/2023] Open
Abstract
The pathogenesis of diabetic foot disease is multifactorial and encompasses microvascular and macrovascular pathologies. Abnormal blood rheology may also play a part in its development. Using a cell flow analyser (CFA), we examined the association between erythrocyte deformability and diabetic foot disease. Erythrocytes from diabetic patients with no known microvascular complications (n = 11) and patients suffering from a diabetic foot ulcer (n = 11) were isolated and their average elongation ratio (ER) as well as the ER distribution curve were measured. Average ER was decreased in the diabetic foot patients compared with the patients with diabetes and no complications (1·64 ± 0·07 versus 1·71 ± 0·1; P = 0·036). A significant rise in the percentage of minimally deformable red blood cells RBCs in diabetic foot patients compared with the patients with no complications was observed (37·89% ± 8·12% versus 30·61% ± 10·17%; P = 0·039) accompanied by a significant decrease in the percentage of highly deformable RBCs (12·47% ± 4·43% versus 17·49% ± 8·17% P = 0·046). Reduced erythrocyte deformability may slow capillary flow in the microvasculature and prolong wound healing in diabetic foot patients. Conversely, it may be the low-grade inflammatory state imposed by diabetic foot disease that reduces erythrocyte deformability. Further study of the rheological changes associated with diabetic foot disease may enhance our understanding of its pathogenesis and aid in the study of novel therapeutic approaches.
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Affiliation(s)
- Avivit Cahn
- The Diabetes Research Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Department of Endocrinology & Metabolism Service, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Leonid Livshits
- The Diabetes Research Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ariel Srulevich
- The Diabetes Research Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Itamar Raz
- The Diabetes Research Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Shaul Yedgar
- Department of Biochemistry, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Gregory Barshtein
- Department of Biochemistry, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Henkelman S, Noorman F, Badloe JF, Lagerberg JWM. Utilization and quality of cryopreserved red blood cells in transfusion medicine. Vox Sang 2014; 108:103-12. [PMID: 25471135 DOI: 10.1111/vox.12218] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023]
Abstract
Cryopreserved (frozen) red blood cells have been used in transfusion medicine since the Vietnam war. The main method to freeze the red blood cells is by usage of glycerol. Although the usage of cryopreserved red blood cells was promising due to the prolonged storage time and the limited cellular deterioration at subzero temperatures, its usage have been hampered due to the more complex and labour intensive procedure and the limited shelf life of thawed products. Since the FDA approval of a closed (de) glycerolization procedure in 2002, allowing a prolonged postthaw storage of red blood cells up to 21 days at 2-6°C, cryopreserved red blood cells have become a more utilized blood product. Currently, cryopreserved red blood cells are mainly used in military operations and to stock red blood cells with rare phenotypes. Yet, cryopreserved red blood cells could also be useful to replenish temporary blood shortages, to prolong storage time before autologous transfusion and for IgA-deficient patients. This review describes the main methods to cryopreserve red blood cells, explores the quality of this blood product and highlights clinical settings in which cryopreserved red blood cells are or could be utilized.
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Affiliation(s)
- S Henkelman
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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24
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Barshtein G, Gural A, Manny N, Zelig O, Yedgar S, Arbell D. Storage-induced damage to red blood cell mechanical properties can be only partially reversed by rejuvenation. Transfus Med Hemother 2014; 41:197-204. [PMID: 25053933 DOI: 10.1159/000357986] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 04/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The storage of red blood cells (RBC) is associated with impairment of their properties that can induce a circulatory risk to recipients. In a preceding study (2009), we reported that post-storage rejuvenation (RJ) of stored RBC (St-RBC) efficiently reduced the storage-induced RBC/endothelial cell interaction, while only partially reversing the level of intracellular Ca(2+), reactive oxygen species, and surface phosphatidylserine. In the present study, we examined the RJ effectiveness in repairing St-RBC mechanical properties. METHODS RBC, stored in CPDA-1 without pre-storage leukoreduction, were subjected to post-storage RJ, and the deformability, osmotic fragility (OF), and mechanical fragility (MF) of the rejuvenated St-RBC (St-RBCRj) were compared to those of untreated St-RBC and of freshly-collected RBC (F-RBC). RESULTS 5-week storage considerably increased OF and MF, and reduced the deformability of St-RBC. All alterations were only partially (40-70%) reversed by RJ, depending on the extent of the damage: the greater the damage, the lesser the relative effect of RJ. CONCLUSION The findings of the present and preceding studies suggest that different St-RBC properties are differentially reversed by RJ, implying that some of the changes occur during storage and are irreversible.
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Affiliation(s)
| | | | | | | | - Saul Yedgar
- Department of Biochemistry, Faculty of Medicine, Hebrew University
| | - Dan Arbell
- Department of Pediatric Surgery, Hadassah University Hospital, Jerusalem, Israel
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25
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Yang Y, Koo S, Heng LT, Meiselman HJ, Neu B. Non-adsorbing macromolecules promote endothelial adhesion of erythrocytes with reduced sialic acids. Biochim Biophys Acta Gen Subj 2014; 1840:288-93. [DOI: 10.1016/j.bbagen.2013.09.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/30/2013] [Accepted: 09/20/2013] [Indexed: 12/19/2022]
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Abstract
OBJECTIVE Blood loss and transfusion are frequent among patients undergoing liver surgery. Concerns have been raised about the safety and efficacy of transfusing stored blood. The influence of transfusing fresh vs. stored blood on the liver has not been studied to date. We tested the hypothesis that transfusion of stored, but not fresh blood, adversely affects liver outcome in vivo following acute hemorrhage. Additionally, possible mechanisms linking adverse liver outcome with increased storage duration were evaluated. DESIGN Prospective, controlled, animal study. SETTING University research laboratory. SUBJECTS Adult male Sprague-Dawley rats INTERVENTIONS Anesthetized rats were randomized to control, hemorrhagic and shock group (acute bleeding; HSG), or hemorrhagic and blood resuscitation groups (BR) (with fresh blood [BR-d0], blood stored for 4 [BR-d4] or 7 [BR-d7] days, or packed RBCs stored for 7 days [packed RBC-d7]). MEASUREMENTS AND MAIN RESULTS Administration of blood or packed RBC stored for 7 days exacerbated liver injury as reflected by liver necrosis and enhanced apoptosis (p < 0.001). Functional MRI analysis of the liver demonstrated significant improvement in liver perfusion with fresh blood (% change in functional MRI signal intensity due to hyperoxia was 16% ± 3% in BR-d0 vs. 4% ± 3% in hemorrhagic group, p < 0.001) but not with stored blood (12% ± 2% and 9% ± 5% for BR-d4 and BR-d7, respectively). Analysis of stored blood showed reduction in RBC deformability at 7 days of storage, reflecting a five-fold increase in the number of undeformable cells. CONCLUSION Liver injury is exacerbated by the transfusion of stored blood, primarily due to the change in the rheological properties of RBC. This data call for clinical studies in patients undergoing liver resection or transplantation.
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27
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Karger R, Lukow C, Kretschmer V. Deformability of Red Blood Cells and Correlation with ATP Content during Storage as Leukocyte-Depleted Whole Blood. ACTA ACUST UNITED AC 2012; 39:277-282. [PMID: 22969698 DOI: 10.1159/000339809] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 02/27/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND: Storage duration of red cells has been associated with increased morbidity and mortality following transfusion. This association has been attributed to the loss of deformability of stored red cells leading to deterioration of microvascular perfusion. ATP content is considered a critical determinant of the deformability of stored red cells. METHODS: ATP content and deformability were determined after storage for up to 49 days in 40 leukocyte-depleted whole blood units. Red cell deformability was determined using a laser-assisted optical rotational cell analyzer (LORCA( (®) )) employing shear stress (SS) ranging from 0.3 to 30 Pa. Deformability was expressed as the elongation index (EI). EI was correlated with ATP content. RESULTS: ATP content decreased from 3.5 to 1.7 ?mol/g hemoglobin. EI increased from 0.03 to 0.05 at an SS of 0.3 Pa, and decreased from 0.62 to 0.59 at an SS of 30 Pa. Correlation coefficient (r) of ATP vs. EI at 0.3 Pa ranged from -0.17 to +0.15 during storage. At 30 Pa, r ranged from -0.03 to +0.45. Correlation increased with storage irrespective of SS, and increased with SS irrespective of storage. CONCLUSIONS: ATP content is not a valid surrogate marker for red cell deformability and may not reflect in vivo survival of stored red cells.
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Affiliation(s)
- Ralf Karger
- Institut für Transfusionsmedizin und Hämostaseologie, Klinikum der Philipps-Universität Marburg, Germany
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Kim J, Kim YD, Song TJ, Park JH, Lee HS, Nam CM, Nam HS, Heo JH. Red blood cell distribution width is associated with poor clinical outcome in acute cerebral infarction. Thromb Haemost 2012; 108:349-56. [PMID: 22739700 DOI: 10.1160/th12-03-0165] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 05/14/2012] [Indexed: 12/17/2022]
Abstract
Increased red blood cell distribution width (RDW), which is a marker of anisocytosis, is associated with mortality and cardiovascular events in the general population and in patients with heart failure or coronary heart disease. We investigated whether RDW in acute cerebral infarction is predictive of functional outcome and mortality. A total of 847 consecutive patients with first-ever acute cerebral infarction who presented to the emergency department within seven days of symptom onset were enrolled in this study. We investigated the association of RDW with poor functional outcome (modified Rankin Scale >2) and all-cause mortality at three months, as well as survival time for one year after stroke onset. Multivariate logistic regression revealed that higher RDW was independently associated with poor functional outcome (adjusted odds ratio [OR], 1.222 per 1% increment in RDW, 95% confidence interval [CI] 1.059-1.409, p=0.006) and all-cause death (adjusted OR, 1.395 per 1% increment in RDW, 95% CI 1.168-1.665, p<0.001) at three months after stroke onset. RDW was an independent predictor of survival in multivariate Cox-proportional regression model (adjusted hazard ratio, 1.328 per 1% increment in RDW, 95%CI 1.178-1.498, p<0.001). The addition of RDW to a survival model significantly increased predictability for survival across the entire follow-up period (weighted average of the area-under the curves, 0.858 vs. 0.841, p<0.05). In conclusion, higher RDW measured in cases of acute stage cerebral infarction was associated with poor functional outcome and mortality. RDW may be used as a biomarker for the prediction of long-term outcomes in patients with acute cerebral infarction.
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Affiliation(s)
- Jinkwon Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Connes P. Hemorheology and exercise: effects of warm environments and potential consequences for sickle cell trait carriers. Scand J Med Sci Sports 2011; 20 Suppl 3:48-52. [PMID: 21029190 DOI: 10.1111/j.1600-0838.2010.01208.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The relationship between blood rheology and hemodynamics is complex, and the following review presents several aspects of exercise hemorheology, with the focus on both cycling and running as exercise. The scientific literature assessing the effects of warm environment on exercise hemorheology is presented and the potential consequences for a specific population, sickle cell trait carriers, are discussed.
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Affiliation(s)
- Philippe Connes
- Laboratoire ACTES, Département de Physiologie, Université des Antilles et de la Guyane, Campus de Fouillole, Guadeloupe, French West Indies.
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Henkelman S, Lagerberg JW, Graaff R, Rakhorst G, Van Oeveren W. The effects of cryopreservation on red blood cell rheologic properties. Transfusion 2010; 50:2393-401. [DOI: 10.1111/j.1537-2995.2010.02730.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Plasma Factor in Red Blood Cells Adhesion to Endothelial Cells: Humans and Rats. Cell Biochem Biophys 2010; 58:157-61. [DOI: 10.1007/s12013-010-9102-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koshkaryev A, Barshtein G, Yedgar S. Vitamin E induces phosphatidylserine externalization and red cell adhesion to endothelial cells. Cell Biochem Biophys 2010; 56:109-14. [PMID: 20020330 DOI: 10.1007/s12013-009-9074-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Red blood cell (RBC) adhesion to vessel wall endothelium is a potent catalyst of vascular occlusion and occurs in oxidative stress states such as hemoglobinopathies and cardiovascular conditions. These are often treated with vitamin E (VitE), a "classic" antioxidant. In this study, we examined the effects of VitE on RBC adhesion to vascular endothelial cells (EC), and on translocation of phosphatidylserine (PS) to RBC surface, known as a potent mediator of RBC/EC adhesion, facilitating thrombus formation. Treatment of RBC with VitE strongly induces (up to sevenfold) PS externalization and enhances (up to 20-fold) their adherence to EC. The VitE hydrophilic analogue-Trolox-does not incorporate into cell membranes. Trolox did not exhibit any of these effects, implying that the VitE effect is due to its known ability to incorporate into cell membranes. The membrane-incorporated VitE significantly reduced the level of reactive oxygen species in H(2)O(2)-treated RBC, demonstrating that VitE elevates RBC/EC adhesion despite acting as an anti-oxidant. This study demonstrates for the first time that contrary to the common view of VitE as a beneficial supplement, VitE may introduce a circulatory risk by inducing flow-disturbing RBC adherence to blood vessel wall and the pro-thrombotic PS exposure.
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Affiliation(s)
- Alexander Koshkaryev
- Department of Biochemistry, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Henkelman S, Dijkstra-Tiekstra MJ, de Wildt-Eggen J, Graaff R, Rakhorst G, van Oeveren W. Is red blood cell rheology preserved during routine blood bank storage? Transfusion 2009; 50:941-8. [PMID: 20003060 DOI: 10.1111/j.1537-2995.2009.02521.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Red blood cell (RBC) units stored for more than 2 weeks at 4 degrees C are currently considered of impaired quality. This opinion has primarily been based on altered RBC rheologic properties (i.e., enhanced aggregability, reduced deformability, and elevated endothelial cell interaction), during prolonged storage of nonleukoreduced RBC units. In this study, the rheologic properties and cell variables of leukoreduced RBC units, during routine blood bank storage in saline-adenine-glucose-mannitol, were investigated. STUDY DESIGN AND METHODS Ten leukoreduced RBC units were stored at the blood bank for 7 weeks at 4 degrees C. RBCs were tested weekly for aggregability, deformability, and other relevant variables. RESULTS RBC aggregability was significantly reduced after the first week of storage but recovered during the following weeks. After 7 weeks aggregability was slightly, but significantly, reduced (46.9 + or - 2.4-44.3 + or - 2.2 aggregation index). During storage the osmotic fragility was not significantly enhanced (0.47 + or - 0.01% phosphate-buffered saline) and the deformability at shear stress of 3.9 Pa was not significantly reduced (0.36 + or - 0.01 elongation index [EI]). The deformability at 50 Pa was reduced (0.58 + or - 0.01-0.54 + or - 0.01 EI) but remained within reference values (0.53 + or - 0.04). During 5 weeks of storage, adenosine triphosphate was reduced by 54% whereas mean cell volume, pH, and mean cell hemoglobin concentration were minimally affected. CONCLUSIONS RBC biochemical and physical alterations during storage minimally affected the RBC ability to aggregate and deform, even after prolonged storage. The rheologic properties of leukoreduced RBC units were well preserved during 7 weeks of routine blood bank storage.
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Affiliation(s)
- Sandra Henkelman
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Koshkaryev A, Zelig O, Manny N, Yedgar S, Barshtein G. Rejuvenation treatment of stored red blood cells reverses storage-induced adhesion to vascular endothelial cells. Transfusion 2009; 49:2136-43. [PMID: 19538542 DOI: 10.1111/j.1537-2995.2009.02251.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Blood banking procedures are associated with elevated adherence of red blood cells (RBCs) to blood vessel wall endothelial cells (ECs), which can introduce a circulatory risk to recipients. This study was undertaken to examine the possibility of repairing this damage by a poststorage "rejuvenation" procedure before transfusion. STUDY DESIGN AND METHODS Stored RBCs were treated with rejuvenation solution (Rejuvesol, enCyte Systems, Inc.), and their adhesion to cultured human microvascular ECs was determined as a function of shear stress using a cell flow properties analyzer. The adherence of rejuvenation-treated stored RBCs (stRBCs) was compared to that of untreated stRBCs and of freshly donated RBCs. RESULTS Strong elevation of stRBC/EC adhesion was induced by cold storage and it correlated with translocation of phosphatidylserine (PS) to the RBC surface, a known mediator of RBC/EC adhesion. The role of RBC surface PS in stRBC/EC interaction was confirmed by the suppression of adhesion after the blocking of the stRBC surface PS with annexin V. Concomitantly, RBC storage elevated intracellular levels of reactive oxygen species (ROS) and Ca(2+), the latter known to facilitate PS externalization. Poststorage rejuvenation treatment of stRBCs reversed all the above changes (ROS, Ca(2+), PS), along with complete suppression of the enhanced RBC/EC adhesion, restoring it to that of normal, freshly collected RBCs. CONCLUSION Poststorage RBC rejuvenation treatment is effective in reversing the storage-induced RBC/EC interaction. This provides further documentation for the potential clinical benefit of poststorage rejuvenation.
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Affiliation(s)
- Alexander Koshkaryev
- Department of Biochemistry, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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