Bile salts and cholesterol in the pathogenesis of target cells in obstructive jaundice

Potential of Three Ethnomedicinal Plants as Antisickling Agents

Sickle cell disease (SCD) is a genetic blood disorder that affects the shape and transportation of red blood cells (RBCs) in blood vessels, leading to various clinical complications. Many drugs that are available for treating the disease are insufficiently effective, toxic, or too expensive. Therefore, there is a pressing need for safe, effective, and inexpensive therapeutic agents from indigenous plants used in ethnomedicines. The potential of aqueous extracts of Cajanus cajan leaf and seed, Zanthoxylum zanthoxyloides leaf, and Carica papaya leaf in sickle cell disease management was investigated in vitro using freshly prepared 2% sodium metabisulfite for sickling induction. The results indicated that the percentage of sickled cells, which was initially 91.6% in the control, was reduced to 29.3%, 41.7%, 32.8%, 38.2%, 47.6%, in the presence of hydroxyurea, C. cajan seed, C. cajan leaf, Z. zanthoxyloides leaf, and C. papaya leaf extracts, respectively, where the rate of polymerization inhibition was 6.5, 5.9, 8.0, 6.6, and 6.0 (×10^-2) accordingly. It was also found that the RBC resistance to hemolysis was increased in the presence of the tested agents as indicated by the reduction of the percentage of hemolyzed cells from 100% to 0%. The phytochemical screening results indicated the presence of important phytochemicals including tannins, saponins, alkaloids, flavonoids, and glycosides in all the plant extracts. Finally, gas chromatography-mass spectrometry analysis showed the presence of important secondary metabolites in the plants. These results suggest that the plant extracts have some potential to be used as alternative antisickling therapy to hydroxyurea in SCD management.

The effects of L-carnitine on some hematological parameters in rats fed a cholesterol-rich diet

We evaluated the effects of L-carnitine on the hematological characteristics of rats fed a cholesterol-rich diet. Healthy male Wistar Albino rats were assigned to four equal groups. During the 40 day experiment, group 1 was fed standard rat pellets, group 2 was fed standard rat pellets containing 7.5 % cholesterol powder, group 3 was fed standard rat pellets and water that contained 75 mg/l L-carnitine, and group 4 was fed standard rat pellets that contained 7.5% cholesterol and water that contained 75 mg/l L-carnitine. Blood samples were analyzed for red (RBC) and white (WBC) blood cells, hemoglobin, hematocrit, granulocytes, lymphocytes, monocytes, mean cell volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) using an automated cell counter. The RBC count in the group that received the 7.5% cholesterol diet was decreased significantly compared to the other groups. The hematocrit of the cholesterol group was lower than for the L-carnitine + cholesterol and L-carnitine groups. The MCV in the cholesterol group was significantly higher than the control group. The MCH in the cholesterol group was higher than for the other groups. There was no significant difference among the groups with regard to hemoglobin, MCHC, WBCs and leukocyte types. L-carnitine appears to have beneficial effects on erythrocyte stability, erythropoiesis and hyperlipidemia.

Surface area loss and increased sphericity account for the splenic entrapment of subpopulations of Plasmodium falciparum ring-infected erythrocytes

Ex vivo perfusion of human spleens revealed innate retention of numerous cultured Plasmodium falciparum ring-infected red blood cells (ring-iRBCs). Ring-iRBC retention was confirmed by a microsphiltration device, a microbead-based technology that mimics the mechanical filtering function of the human spleen. However, the cellular alterations underpinning this retention remain unclear. Here, we use ImageStream technology to analyze infected RBCs’ morphology and cell dimensions before and after fractionation with microsphiltration. Compared to fresh normal RBCs, the mean cell membrane surface area loss of trophozoite-iRBCs, ring-iRBCs and uninfected co-cultured RBCs (uRBCs) was 14.2% (range: 8.3–21.9%), 9.6% (7.3–12.2%) and 3.7% (0–8.4), respectively. Microsphilters retained 100%, ∼50% and 4% of trophozoite-iRBCs, ring-iRBCs and uRBCs, respectively. Retained ring-iRBCs display reduced surface area values (estimated mean, range: 17%, 15–18%), similar to the previously shown threshold of surface-deficient RBCs retention in the human spleen (surface area loss: >18%). By contrast, ring-iRBCs that successfully traversed microsphilters had minimal surface area loss and normal sphericity, suggesting that these parameters are determinants of their retention. To confirm this hypothesis, fresh normal RBCs were exposed to lysophosphatidylcholine to induce a controlled loss of surface area. This resulted in a dose-dependent retention in microsphilters, with complete retention occurring for RBCs displaying >14% surface area loss. Taken together, these data demonstrate that surface area loss and resultant increased sphericity drive ring-iRBC retention in microsphilters, and contribute to splenic entrapment of a subpopulation of ring-iRBCs. These findings trigger more interest in malaria research fields, including modeling of infection kinetics, estimation of parasite load, and analysis of risk factors for severe clinical forms. The determination of the threshold of splenic retention of ring-iRBCs has significant implications for diagnosis (spleen functionality) and drug treatment (screening of adjuvant therapy targeting ring-iRBCs).

Surface area loss and increased sphericity account for the splenic entrapment of subpopulations of Plasmodium falciparum ring-infected erythrocytes

Ex vivo perfusion of human spleens revealed innate retention of numerous cultured Plasmodium falciparum ring-infected red blood cells (ring-iRBCs). Ring-iRBC retention was confirmed by a microsphiltration device, a microbead-based technology that mimics the mechanical filtering function of the human spleen. However, the cellular alterations underpinning this retention remain unclear. Here, we use ImageStream technology to analyze infected RBCs' morphology and cell dimensions before and after fractionation with microsphiltration. Compared to fresh normal RBCs, the mean cell membrane surface area loss of trophozoite-iRBCs, ring-iRBCs and uninfected co-cultured RBCs (uRBCs) was 14.2% (range: 8.3-21.9%), 9.6% (7.3-12.2%) and 3.7% (0-8.4), respectively. Microsphilters retained 100%, ∼50% and 4% of trophozoite-iRBCs, ring-iRBCs and uRBCs, respectively. Retained ring-iRBCs display reduced surface area values (estimated mean, range: 17%, 15-18%), similar to the previously shown threshold of surface-deficient RBCs retention in the human spleen (surface area loss: >18%). By contrast, ring-iRBCs that successfully traversed microsphilters had minimal surface area loss and normal sphericity, suggesting that these parameters are determinants of their retention. To confirm this hypothesis, fresh normal RBCs were exposed to lysophosphatidylcholine to induce a controlled loss of surface area. This resulted in a dose-dependent retention in microsphilters, with complete retention occurring for RBCs displaying >14% surface area loss. Taken together, these data demonstrate that surface area loss and resultant increased sphericity drive ring-iRBC retention in microsphilters, and contribute to splenic entrapment of a subpopulation of ring-iRBCs. These findings trigger more interest in malaria research fields, including modeling of infection kinetics, estimation of parasite load, and analysis of risk factors for severe clinical forms. The determination of the threshold of splenic retention of ring-iRBCs has significant implications for diagnosis (spleen functionality) and drug treatment (screening of adjuvant therapy targeting ring-iRBCs).

Quantitative assessment of sensing and sequestration of spherocytic erythrocytes by the human spleen

Splenic sequestration of RBCs with reduced surface area and cellular deformability has long been recognized as contributing to pathogenesis of several RBC disorders, including hereditary spherocytosis. However, the quantitative relationship between the extent of surface area loss and splenic entrapment remains to be defined. To address this issue, in the present study, we perfused ex vivo normal human spleens with RBCs displaying various degrees of surface area loss and monitored the kinetics of their splenic retention. Treatment with increasing concentrations of lysophosphatidylcholine resulted in a dose-dependent reduction of RBC surface area at constant volume, increased osmotic fragility, and decreased deformability. The degree of splenic retention of treated RBCs increased with increasing surface area loss. RBCs with a > 18% average surface area loss (> 27% reduced surface area-to-volume ratio) were rapidly and completely entrapped in the spleen. Surface-deficient RBCs appeared to undergo volume loss after repeated passages through the spleen and escape from splenic retention. The results of the present study for the first time define the critical extent of surface area loss leading to splenic entrapment and identify an adaptive volume regulation mechanism that allows spherocytic RBCs to prolong their life span in circulation. These results have significant implications for understanding the clinical heterogeneity of RBC membrane disorders.

Some factors affecting the cultivationin vitroof the erythrocytic stages ofPlasmodium knowlesi

A study was made of some of the factors which affect the growth ofPlasmodium knowlesiin blood diluted in the Harvard medium. Some slight enhancement of growth and re-invasion of new host cells was obtained whenP. knowlesiwas incubated in low oxygen tensions. Some growth but no re-invasion was obtained under anaerobic conditions. High oxygen tensions were also inhibitory.

The lipids present in the plasma are important for the growth ofP. knowlesi in vitro.Stearic acid and cholesterol are required by the parasite but do not account for all the growth promoting properties of plasma. A requirement for vitamin B12was also demonstrated.

I should like to thank Dr F. Hawking and Dr J. Williamson for their advice and for reading through the manuscript, Mr T. J. Scott-Finnigan for technical assistance, Dr K. Mervyn (Glaxo Research Ltd.) for samples of vitamin B12analogues and the Hachmeister Company (Pittsburgh) for a sample of TEM 4T. This work received financial assistance from the World Health Organization.

Red cell osmotic fragility studies in hemoglobin C-β thalassemia: osmotically resistant microspherocytes

Typically certain features of red cell morphology predict the results of osmotic fragility testing. Microspherocytes generally have increased and target cells decreased fragility. Blood smears in homozygous hemoglobin C disease show an interesting admixture of microspherocytes and target cells. Yet osmotic fragility studies generally show only reduced fragility and no population of fragile cells to correspond with the spherocytes. The present study demonstrates that the red cells of patients with hemoglobin C-beta thalassemia share many characteristics with hemoglobin C red cells, including the decreased osmotic fragility of all cells despite the presence of both spherocytes and target cells. These paradoxically osmotically resistant spherocytes probably arise because of cellular dehydration due to a K-Cl transport system which may be activated by binding of hemoglobin C to the red cell membrane.

High concentrations of conjugated bile acids inhibit bacterial growth of Clostridium perfringens and induce its extracellular cholylglycine hydrolase

To investigate the effects of conjugated bile acid on bacterial growth and cholylglycine hydrolase activity, Clostridium perfringens from human feces was exposed to varying concentrations of taurine- or glycine-conjugated chenodeoxycholic acid. Extracellular enzyme activity was determined by deconjugation of radiolabeled taurocholic acid and viable cells were counted after anaerobic culture at 37 degrees C for 24 h. Viable cells were decreased with more than 1.0 mg of conjugated chenodeoxycholic acid per mL and there were no viable cells with 10.0 mg of bile acid per mL. Although total enzyme activity was decreased according to the bile acid concentration, enzyme activity per bacterium was increased between 1.0 and 4.0 mg/mL. There were no statistically significant differences between the types of conjugation. It was concluded that conjugated bile acids may exert inhibitory effect on bacterial growth and extracellular cholylglycine hydrolase activity in Clostridium perfringens. However, under the physiologic condition in the human intestine, conjugated bile acid might induce production of extracellular cholyglycine hydrolase per bacterium.

Decreased erythrocyte osmotic fragility during canine leptospirosis

Erythrocyte osmotic fragility (EOF) was carried out in nineteen dogs naturally infected by Leptospira interrogans serovar icterohaemorrhagiae/copenhagi. A decreased EOF was observed, suggesting a modification of erythrocyte components secondary to disturbances that occur during canine leptospirosis, such as renal damage and hepatic disease.

Changes in lipid composition of erythrocyte membranes with administration of S-adenosyl-L-methionine in chronic liver disease

This study was undertaken to determine whether S-adenosyl-L-methionine (SAMe) changes the lipid composition and fluidity of erythrocyte membranes in chronic liver disease. SAMe was administered intravenously at a daily dose of 600 mg for 2 weeks to 10 patients; 6 patients with cirrhosis and four with primary biliary cirrhosis. The elevated free cholesterol to phospholipid molar (C/PL) ratio of the erythrocyte membranes of the patients (0.857 +/- 0.018) significantly decreased after the administration of SAMe (1 week, 0.823 +/- 0.021; 2 weeks, 0.823 +/- 0.013). In all of the four patients whose erythrocyte membrane fluidity was measured, fluidity improved with the administration of SAMe and correlated with the C/PL ratio of the membranes. These results suggest that SAMe decreases the C/PL ratio of erythrocyte membranes and thus improves membrane fluidity in chronic liver disease.

Excess of red cell membrane proteins in hereditary high-phosphatidylcholine hemolytic anemia

Previous descriptions of hereditary high-phosphatidylcholine hemolytic anemia (HPCHA) have highlighted the association of increased erythrocyte membrane phosphatidylcholine with abnormal membrane cation permeability. We studied the function and composition of erythrocyte membranes from three individuals with HPCHA to characterize further the membrane abnormalities in this disorder. Despite significant macrocytosis, HPCHA red cells were dehydrated and showed an increased surface area to volume ratio compared to normal red cells. The passive efflux of K+ from HPCHA erythrocytes was increased fourfold at 37 degrees C. Total membrane phospholipid was increased 7-42%, largely due to excess phosphatidylcholine, which made up 35.8-37.2% of total phospholipid. Membrane cholesterol:phospholipid ratios were in the normal range. It appears that the excess phosphatidylcholine was not acquired during circulation, since plasma lipids were normal and all subpopulations of density-separated HPCHA erythrocytes were similarly abnormal. The ratio of total protein to phospholipid in white ghosts was increased, indicating that membrane protein was increased to an even greater extent than membrane lipids. No abnormal membrane proteins were identified by Coomassie or periodic acid Schiff (PAS) staining. Quantitation of the major membrane proteins indicated that the total protein excess in HPCHA membranes was due to a proportional increase in all major proteins. We conclude that HPCHA erythrocytes have excess membrane proteins and hypothesize that the changes in lipid composition and cation permeability are secondary to underlying protein abnormalities, which remain to be defined.

Influence of hypercholesterolemia on morphological and rheological characteristics of erythrocytes

The changes in shape and rheological parameters of erythrocytes in cholesterol-fed rabbits (fed with normal diet plus 0.5% cholesterol for a duration of 1 year) and in vitro cholesterol enrichment of erythrocytes in cholesterol enriched plasma were studied. This process affects the shape of erythrocytes. In rabbits the actual shape change begins after 6 weeks of cholesterol feeding. The shape changes in rabbits and in vitro cholesterol-enrichment are similar. The extent of shape changes depends on the amount of cholesterol incorporated into the membrane. The rheological parameters such as blood viscosity, osmotic fragility and deformability are measured. The whole blood viscosity is increased and deformability decreased. The cells become osmotically more fragile in cholesterol-fed rabbits but are resistant to osmotic lysis in in vitro cholesterol enrichment. The altered lipid composition may be responsible for the observed changes in these parameters.

Single locus (rol) control of extreme resistance to red cell osmotic lysis: intrinsic mode of gene action

Previous work has indicated that inbred mouse strains C57BL/6 and DBA/2 produce red cells differing in their sensitivity to osmotic lysis and that the trait is under multigene control. A recombinant inbred strain (BXD-31), produced from C57BL/6 and DBA/2, has red cells manifesting resistance to osmotic lysis far greater than that of either progenitor. We demonstrate here that the fragility difference between BXD-31 and DBA/2 is the consequence of allelic variation at a single autosomal locus, termed rol. The resistance allele (rol') is almost completely recessive to the sensitive one (rols). Results of bone marrow chimera analyses indicate that (1) the mode of rol gene action is by a direct influence on the properties of the red cells rather than an indirect influence on their extracellular milieu, and (2) rol does not affect erythrocyte production and turnover. The fragility difference caused by rol variation is likely to involve the erythrocyte membrane or underlying cytoskeleton, since various red cell properties sensitive to ion metabolism differences are unaffected by the gene.

Red blood cell membrane microviscosity correlates with posttransfusion survival

The cholesterol/phospholipid and sphingomyelin/phospholipid ratios of red blood cells stored for 42 days were unchanged after storage. However, the total phospholipid concentration in the red cells decreased suggesting a loss of red cell membrane during storage. The 24 h survival of the stored red cells was assessed by the Cr technique in homologous donors. A decrease in fluorescence polarization of diphenylhexatriene incorporated into the membrane was observed following storage which correlated with survival. Thus, molecular defects in the lipid bilayer are associated with long-term storage of red blood cells.

Calcium enhances the hemolytic action of bile salts

The lysis of human erythrocytes by bile salts in buffer containing isotonic saline was dramatically enhanced by the addition of 5-10 mM calcium chloride. All bile acids tested showed this effect, with a marked increase in lysis occurring at 0.75 mM for deoxycholate, 1 mM for chenodeoxycholate, 2.5 mM for ursodeoxycholate and 5.5 mM with cholate in the presence of 10 mM calcium chloride. The effect appeared to be specific for calcium; strontium chloride and magnesium chloride gave no stimulatory effect. The increased lysis of the erythrocytes in the presence of 1 mM deoxycholate and 1-10 mM calcium chloride was not associated with increased uptake of the bile salt by the cells (measured with [14C]deoxycholate). Using erythrocytes previously labelled with [3H]cholesterol, there was no evidence of an enhanced removal of that membrane component in the presence of calcium and deoxycholate, compared to deoxycholate alone. The sensitivity of the cells to the effect of calcium in the presence of 1 mM deoxycholate increased with the length of time of their storage at 4 degrees C. The sensitivity returned to that of fresh cells after incubation at 37 degrees C with 30 mM adenosine plus 25 mM glucose, but this treatment did not further diminish the lysis. Lysis in the presence of 10 mM calcium chloride and 1 mM deoxycholate was partially blocked by increasing the KCl concentration at the expense of NaCl. The maximum effect occurred with a buffer comprising 100 mM KCl/50 mM NaCl. A more dramatic reduction in the lysis followed the incorporation of the calcium chelator, quin2, into the cells. The lysis induced by 1 mM deoxycholate in the presence of calcium was reduced by 80% in quin-2-loaded cells compared to controls. The data suggest that bile acids can promote the influx of calcium into erythrocytes, leading to lysis as a result of the efflux of intracellular potassium and/or the uptake of sodium from the incubation medium. The data further suggest that cellular effects may occur at lower bile acid concentrations than that thought to be required for detergent damage.

Alcohol and the blood

Pathologic effects of ethanol on hematopoietic tissue can result directly from alcohol ingestion or from secondary nutritional deficiencies or hepatic disease. The clinician will often confront an array of overlapping syndromes in the alcoholic patient which involve abnormalities of erythrocytes, leukocytes, and platelets.

Epimerization versus dehydroxylation of the 7 alpha-hydroxyl- group of primary bile acids: competitive studies with Clostridium absonum and 7 alpha-dehydroxylating bacteria (Eubacterium sp.)

Primary bile acids, chenodeoxycholic (3 alpha,7 alpha-dihydroxy-5 beta-cholan-24-oic) and cholic (3 alpha,7 alpha,12 alpha-trihydroxy-5 beta-cholan-24-oic) were included in cultures of (a) Clostridium absonum alone (b) a mixture of C. absonum and a 7-dehydroxylating organism, Eubacterium sp. (c) a mixture of C. absonum and fecal bacteria, and (d) fecal bacteria alone. C. absonum, when added to Eubacterium sp. cultures totally prevented lithocholic acid formation when the substrate was chenodeoxycholic acid and halved deoxycholic acid formation when the substrate was cholic acid. As expected, formation of 7 beta-hydroxy- and 7-keto-bile acids took precedence over formation of 7 alpha-dehydroxylated bile acids. However, the addition of C. absonum to mixed fecal cultures containing chenodeoxycholic acid did not alter production of lithocholic (3 alpha-hydroxy-5 beta-cholan-24-oic) acid; instead it enhanced formation of ursodeoxycholic acid (3 alpha,7 beta-dihydroxy-5 beta-cholan-24-oic acid) at the expense of 7-keto-lithocholic acid (3 alpha-hydroxyl-7-oxo-5 beta-cholan-24-oic acid). Similarly, the addition of C. absonum to mixed fecal cultures containing cholic acid promoted production of ursocholic acid (3 alpha,7 beta,12 alpha-trihydroxy-5 beta-cholan-24-oic acid) which did not take place when C. absonum was not added. Surprisingly, deoxycholic acid formation was somewhat enhanced when C. absonum was added to fecal cultures. These studies suggest that successful introduction of "foreign" 7 alpha-epimerizing organisms into animal or human intestines may influence bile acid metabolism in vivo.

Role of phospholipids in the DDT-induced efflux of potassium in human erythrocytes

Incubation of human erythrocytes for 1-2 h at 37 degrees C in a suspension of dipalmitoylphosphatidylcholine (DDPC) liposomes results in a phospholipid enrichment of erythrocyte membranes by 45-55% and a depletion of cholesterol by 19-24%. The enrichment by DPPC was time and concentration dependent. By contrast, dioleoylphosphatidylcholine (DOPC) liposomes were less effective in enriching the membranes with phospholipid and in depleting the membranes of cholesterol. Concomitantly, the DDT-induced efflux of K+ was reduced in the case of DPPC-enriched erythrocytes but enhanced in DOPC-enriched erythrocytes. These results suggest that DDT partitions more readily into the unsaturated than the saturated phospholipids of the erythrocyte membrane. It is concluded that the extent to which DDT affects the flux of K+ across the membrane is dependent on the fluidity of the lipid phase. We also report here a rapid method for cholesterol depletion of red blood cells in comparison to previously reported methods.

Mechanism of increased osmotic resistance of red cells in workers exposed to lead

In order to clarify the mechanism of the increased osmotic resistance of red blood cells in lead workers 19 men employed in a lead refining factory and 18 control male workers employed in railway construction were examined for red cell count, haematocrit, MCV, blood and urine lead concentrations, urine coproporphyrin and delta-aminolevulinic acid, osmotic resistance of red cells, lecithin-cholesterol acyltransferase (LCAT) activity in serum, and cholesterol content and cholesterol-to-phospholipid ratio of the red cell membrane. The results were: (1) The osmotic resistance of the red cells (p less than 0.05), cholesterol content of the red cell membrane, blood and urine lead, urine coproporphyrin, and urine delta-ALA concentrations (p less than 0.01) were higher in the lead workers than in the controls. (2) In the lead workers close relationships were observed between the osmotic resistance and the blood lead concentration (r = -0.515, p less than 0.05), osmotic resistance and LCAT activity (r = 0.596, p less than 0.01), and osmotic resistance and cholesterol of the red cell membrane (r = -0.492, p less than 0.05).

Abnormalities of erythrocyte stromal lipids in atresia of the intrahepatic bile ducts

Detailed analysis of plasma and erythrocytes lipid composition of patient with intrahepatic biliary atresia is presented. Abnormalities have been outlined and are characterized as following: (1) an increase of total cholesterol compounds and total phospholipids in serum; (2) an increase of free cholesterol and lecithin up to 50 per cent of total phosphatides in red cells; (3) the fatty-acids pattern isolated from total phospholipids of red cells shows a rise of palmitic and palmitoleic acids and a decrease of stearic and longer-chain fatty acids; (4) in PC and PE of red cells, there is an overall tendency for the degree of unsaturation of long-chain fatty acids to increase. In addition to these lipid changes, it was demonstrated by polyacrylamide-gel electrophoresis that the composition of membrane proteins was normal. It is of particular interest to establish whether these abnormalities are either induced by complex metabolic pathways and exchange processes between the lipids of circulating erythrocytes and the altered lipids of serum environment or are the direct result of modified hepatic cellular or enzymatic function.

Alterations of lipids of the erythrocyte membranes in workers exposed to lead

Changes in lipids (cholesterol and phospholipids) of the erythrocyte membrane were studied and several laboratory examinations were performed with 25 male workers employed in a scrap lead refining factory using as controls 38 male railway construction workers. The examinations included measurements of erythrocyte count, hematocrit, mean corpuscular volume (MCV), blood and urine lead concentrations, urine coproporphyrin and delta-aminolevulinic acid, membrane cholesterol (CHO) and phospholipids (PL), total and free CHO in plasma, and lecithin cholesterol acyltransferase (LCAT) activity in plasma. The results were: 1) Membrane CHO (P less than 0.01) and CHO: PL ratio (P less than 0.05) of lead workers were higher than those of the controls. But no significant difference was observed in membrane PL between both groups. 2) Membrane phosphatidyl choline was higher (P less than 0.05) and lysophosphatidyl choline was lower (P less than 0.05) in lead workers compared with controls. But no significant difference was observed in membrane sphingomyelin, phosphatidyl serine, and phosphatidyl ethanolamine between both groups. 3) Free CHO in plasma was higher (P less than 0.05) in lead workers compared with controls. But no significant difference was observed in total CHO in plasma, erythrocyte count, hematocrit, MCV, and LCAT activity between both groups.

Relationships between osmotic fragility of red blood cells and various hematologic data in workers exposed to lead

This paper describes relationships between osmotic fragility (OF) of red blood cells and various hematologic data in 32 male workers exposed to lead and 30 controls. The examination included measurements of OF determined by the coil planet centrifuge system, red blood cell (RBC) count, hematocrit, hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), water of RBC, sodium and potassium of RBC, blood and urine lead, urine coproporphyrin, and urine delta-aminolevulinic acid. The results were: 1) OF was lower in lead workers at all three hemolytic points compared with the controls (P less than 0.05). 2) A difference in hemolysis pattern between the two groups was observed (P less than 0.05). 3) A close relationship was observed in both groups between OF and MCV (P less than 0.05), although the results were contrasting. Also a close relationship was observed in lead workers between OF and hematocrit, OF and hemoglobin, OF and MCH, and OF and intracellular potassium (P less than 0.05) but not in the controls. In the controls a close relationship was found between OF and RBC (P less than 0.05) but this was not observed in the lead workers. No significant relationship was observed in either group between OF and MCHC, OF and intracellular sodium, and OF and intracellular water. 4) No difference in RBC, hematocrit, hemoglobin, MCV, MCH, MCHC, and intracellular water, sodium and potassium was observed between both groups.

Red cell fragmentation in the dog: an editorial review

Red blood cell fragments in blood smears from dogs are described morphologically and pathogenetically. Categories include microangiopathic fragmentation, spherocytic fragmentation. Heinz body fragmentation, metabolic fragmentation associated with systemic disease, and artifactual fragmentation. Microangiopathic fragmentation is associated with direct physical damage to normal circulating red blood cells as they pass through abnormal capillary beds. Spherocytic fragmentation is a common feature of immune-mediated hemolytic anemia and results from the removal of portions of antibody-coated erythrocyte plasma membranes by phagocytes of the reticuloendothelial system. Heinz body fragmentation occurs when rigid particles of oxidized hemoglobin are torn from affected red cells as they circulate through the spleen. Metabolic fragmentation is an ill-defined syndrome most commonly associated with cholesterol loading of red cell membranes caused by lipid metabolism abnormalities. Resulting spiculated red cells are more susceptible to traumatic disruption. All the types of red cell fragmentation described in dogs have been observed and documented in man.

Studies on osmotic fragility of red blood cells determined with a coil planet centrifuge for workers occupationally exposed to lead

In order to clarify the relationship between lead exposure level and osmotic fragility of red blood cells determined by the coil planet centrifuge method, several clinical laboratory examinations were performed on 27 male workers employed in a scrap lead refining factory using as controls 40 male workers employed in railway construction. The examinations included measurement of red blood cell and reticulocyte counts, hematocrit, MCV, blood and urine lead concentrations, urine coproporphyrin, and urine delta-aminolevulinic acid. The results were: 1. Osmotic fragility of red blood cells was lower in lead workers at all three hemolytic points compared with the controls. Significant difference was observed in hemolysis of the maximum point (P less than 0.05). 2. The red blood cell and reticulocyte counts, hematocrit value and MCV of the lead workers were not significantly different from those of the controls. Values for blood and urine lead, coproporphyrin, and delta-aminolevulinic acid of the lead workers were much higher than those of the controls (P less than 0.01). 3. In lead workers, close relationships between the osmotic fragility and these laboratory findings were observed: blood lead, r = -0.572, P less than 0.01; coproporphyrin, r = -0.608, P less than 0.01; delta-aminolevulinic acid, r = -0.559, P less than 0.01; urine lead, r = -0.453, P less than 0.05.

Erythrocyte osmotic fragility in various liver diseases--application of coil planet centrifuge system

A change in erythrocyte osmotic fragility was observed on various liver diseases by means of the coil planet centrifuge (CPC) system, and the relationship between changes in it and in serum lipids was studied. According to the CPC classification of hemolytic patterns of L, M, T and R, the frequency of appearance of T and R increased in liver cirrhosis and primary hepatoma. Hemolytic start and end points both changed considerably in primary hepatoma, acute hepatitis and liver cirrhosis. Change of hemolytic end point which shifted to the hypotonic side is more prominent than that of hemolytic start point. The hemolytic end point showed an inverse correlation to serum alkaline phosphatase and LAP, and correlation to pseudocholinesterase and albumin. Among the relations of red cell fragility and lipids of the lipoprotein fractions, free cholesterol and the ratio of free cholesterol to phospholipid in high density lipoprotein were both in remarkable inverse correlation to the hemolytic end point. Free cholesterol in high density lipoprotein was concluded one of the most important determinants of erythrocyte osmotic fragility.

Spin label studies of erythrocytes with abnormal lipid composition: comparison of red cells in a hereditary hemolytic syndrome and lecithin: cholesterol acyltransferase deficiency

Erythrocytes from patients with familial lecithin : cholesterol acyltransferase (LCAT) deficiency have been shown to exhibit an increase in membrane fluidity which is surprisingly small in view of the extensive alterations both in membrane lipid composition (namely, an elevation in cholesterol and phosphatidylcholine contents as well as a decrease in phosphatidylethanolamine) and in the functional properties of these cells. In the hope of deriving some information concerning the interrelationship between the structural and functional abnormalities, we have used the spin probe 5-doxyl stearic acid to investigate the temperature-dependent fluidity properties of red cells from two patients with a hereditary hemolytic syndrome (HHS) whose red cells are also characterized by qualitatively similar alterations in phosphatidylcholine and phosphatidylethanolamine but, unlike those in LCAT deficiency, have relatively normal levels of membrane cholesterol. A small increase in membrane fluidity of HHS erythrocytes equivalent to that previously observed in LCAT deficiency was found, indicating that membrane cholesterol level does not exert an important modulatory influence on membrane fluidity in these cells. It is concluded that while the distinct patterns of structural and functional erythrocyte alterations in these two disorders cannot be explained on the basis of differences in bulk membrane fluidity, the marginally increased fluidity may underlie the abnormalities in osmotic fragility and membrane p-nitrophenylphosphatase activity which are shared in common by both types of modified red cells.

Changes in shape of erythrocytes in rabbits on atherogenic diet and onion extracts

The effects of administration of cholesterol alone and of cholesterol and fresh whole onion extract, on the shape of erythrocytes, were studied in albino rabbits. In animals on a cholesterol-enriched diet, the erythrocytes changed shape and showed an increased tendency to aggregate, whereas they retained their normal appearance in animals on cholesterol and onion extract, and did not differ from those of normal control rabbits.

The erythrocyte membrane disturbances in protein-energy malnutrition: nature and mechanisms

In protein-energy malnutrition (PEM), as observed in Kivu, the RBC have an increased ratio of surface area to volume which is demonstrated by the presence of target cells on light microscopy and cup cells with scanning electron microscopy. The osmotic fragility is decreased. These abnormalities can be attributed to the accumulation of cholesterol and phosphatidylcholine (PC) in the RBC membrane. The molar ratio of cholesterol to phospholipids is moderately increased. Several findings suggest that the cholesterol and PC build-up results from disturbed exchanges in these lipids between the RBC and the plasma lipoproteins. Firstly, the osmotic fragility of a patient's RBC gradually becomes normal when the cells are transfused into a healthy recipient. Secondly, the cholesterol flux between the RBC and the plasma LDL seems to be low. Thirdly, the increase in RBC PC cannot be explained by a diminished fatty acids transport between the deep RBC PC pool and the RBC phosphatidylethanolamine (PE) pool. Finally complex disturbances of the plasma lipoproteins are obvious. It is improbable that the cholesterol and PC build-up accounts for the premature RBC destruction which has been described in Kivu PEM. However, the observation of an increased fatty acid turnover in RBC PC and PE, as well as other data previously obtained in Kivu PEM, lead to the conclusion that membrane peroxidation may be a major cause of the shortened erythrocyte life-span in this syndrome.

Rheological and functional impairments in cholesterol-loaded human erythrocytes

Decreased deformability, slightly increased suspension viscosity and retarded oxygen egrees were observed in cholesterol-loaded, human erythrocytes. These functional changes resulted from the decreased membrane fluidity induced by cholesterol.

Congenital persistent proximal type renal tubular acidosis in two brothers

Two brothers showed severe and persistent hyperchloraemic metabolic acidosis (capillary blood pH 7.07--7.15) due to a low renal bicarbonate threshold at 11 mmol/l. The maximal tubular capacity for bicarbonate reabsorption was reduced to about half the normal. A high dose of acetazolamide (25 mg/kg) lowered the tubular bicarbonate reabsorption substantially, indicating the presence of carbonic anhydrase. Both the glomerular filtration rate, the renal blood flow and the renal concentrating capacity were slightly reduced. The clinical characteristics were: growth retardation, mental retardation, nystagmus, corneal opacities, cataract, glaucoma and enamel defects of the permanent teeth. Serum thyroxine was pathological low without clinical signs of hypothyreosis. The erythrocytes showed an increased osmotic resistance. Autopsy of the younger brother, who died 4 1/2 years old, revealed thyroid and thymus weights of 25% of the normal. The kidney tubular cells were swollen with vacuoles. The glomeruli had a normal appearance.

Abnormalities of erythrocyte membranes in biliary atresia: ultrastructure and lipid composition

Biochemical and ultrastructural studies of red blood cell membranes from seven patients with congenital biliary atresia have been performed. Scanning electron microscopic observations revealed that more than half of these cells were of abnormal shapes, such as target, spur and cup-formed cells. By freeze-fracture electron microscopy, membrane particle-free smooth areas were noted in the fracture faces. In addition, the number of membrane-associated particles was 20% less than those in control subjects. The lipid analysis of red blood cells showed a significant increase in phospholipid and a marked increase in cholesterol content. The increase of phospholipid content was primarily caused by the increase of lecithin. The acyl chain analysis of erythrocyte lecithin demonstrated an increase in palmitic, palmitoleic and oleic acid, and a decrease in stearic and linoleic acid. These observations are similar to those of acquired biliary obstruction. The fluidity of erythrocyte membrane lipid, studied by a fluorescence technique using fluorescent probe 1,6-diphenyl-1,3,5-hexatriene (DPH), was found to be less in an individual with congenital biliary atresia than in the control subject.

Investigation of poikilocytic normochromic normocytic anemia. 1. Round and elongated forms

Occasional nonspecific poikilocytes are found in most normal blood smears, but dominance of one or more forms of poikilocytes usually is indicative of a specific anemia or disease in an organ or organ system. For example, stomatocytes are most commonly associated with acute alcoholism, while teardrop cells classically reflect "spent" polycythemia vera or myelofibrosis. The clinical significance of the various round poikilocytes (spherocytes, stomatocytes, target cells) and elongated poikilocytes (ovalocytes and elliptocytes, teardrop cells, sickle cells) is discussed.

Investigation of macrocytic anemia

The three most common causes of macrocytosis--vitamin B12 or folate deficiency, liver disease, and reticulocytosis--usually can be differentiated on the basis of red cell indexes and morphologic findings. Bone marrow studies are not indicated. In reticulocytosis, the mean corpuscular volume (MCV) rarely exceeds ll0 cu mu and a reticulocyte count quickly establishes the diagnosis. In liver disease, macrocytosis is also mild and uniform. The RBCs are round. In megaloblastic anemia, the MCV may exceed 150 cu mu. The RBCs vary considerably in size and shape. The macrocytes tend to be oval. Serum vitamin B12 determination remains the best test for unmasking vitamin B12 deficiency. It should be ordered in conjunction with serum and red cell folate determinations in the course of investigating a macrocytic anemia. When vitamin B12 deficiency has been established, a Schilling test or plasma uptake test is indicated to pinpoint the cause.

Membrane lipid composition of red blood cells in liver disease: regression of spur cell anaemia after infusion of polyunsaturated phosphatidylcholine

The morphology of red blood cells was studied in 30 patients with severe liver cirrhosis, in 10 patients with extrahepatic jaundice, and in 10 control subjects. In all the patients with extrahepatic jaundice more than 30% of red blood cells were target cells with increased resistance to osmotic lysis. In 12 patients with liver cirrhosis more than 30% of red blood cells were spur cells. The cholesterol: phospholipids (C/PL) molar ratio was 0.89 in target cells, 1.33 in spur cells, and 0.74 in normal red blood cells. The red blood cell membrane cholesterol and phospholipids exchanged with plasma lipoproteins, the lipid composition of which was studied in eight patients with spur cells; the free cholesterol: phospholipid (FC/PL) molar ratio was 0.33 (0.16 in the controls) in high density lipoproteins (HDL) and 1.40 (0.82 in the controls) in low density lipoproteins (LDL); in these patients the polyunsaturated fatty acid content was low in both phospholipids and cholesterol esters of lipoproteins. The irregular folds of the spur cells regressed when polyunsaturated lecithin was infused (2 g daily for five days) in eight patients with spur cell anaemia; the infusions decreased both C/PL ratio in RC to 0.88 and the concentration of unconjugated bilirubin (104.3 to 82.0 mumol/l (6.1 to 4.8 mg%)), whereas the activity of the plasma lecithin:cholesterol acyltransferase (LCAT) increased from 31.2 to 54.4 mumol/l/h. Polyunsaturated fatty acid content of RC lecithin increased after the infusion as it did in HDL, the FC/PL ratio of which decreased to 0.23.

Mechanism for lipid abnormalities of erythrocyte membranes in biliary obstruction: lecithin content and its fatty acyl composition

The lipid compositions of erythrocyte membranes, plasma and bile of 16 patients with biliary obstruction were analysed to obtain information regarding the origin of excess lecithin which is usually found in the erythrocyte membranes in obstructive jaundice. Phospholipids and free cholesterol were found to be increased proportionally to the degree of biliary obstruction with an elevation in the free cholesterol/phospholipid ratio in the red cell membranes. The increase in phospholipid content is primarily due to lecithin. There was a highly significant alteration in the fatty acid composition of lecithin of erythrocyte membranes, plasma and bile from patients with severe jaundice. Red cell membrane lecithin amounted to more than 40% of the total phospholipid in these patients. Interestingly, the fatty acid composition of lecithin showed a similar pattern in erythrocyte membranes, plasma and bile. In addition, the fatty acyl chain composition of lecithin in lipoprotein-X was very similar to that of the red cell membrane. Freeze-fracture electron microscopy showed an alteration in membrane morphology and a reduced number of membrane-associated particles in the fractured faces. From these findings, we suggest that the lecithin of lipoprotein-X is derived from abnormal bile lecithin, which is incorporated into erythrocyte membranes by fusion with lipoprotein-X. On the other hand, the fatty acid composition of bile lecithin from patients with mild jaundice, whose erythrocyte membrane lecithin amounted to less than 31% of total phospholipid, was not different from that of normal individuals. However, in sharp contrast to the bile content, the fatty acid composition of erythrocyte membranes and plasma in these same patients showed a similar but small change compared to that of patients with severe biliary obstruction. The red cells of patients with mild jaundice were almost normal, biconcave disc-shaped, as observed by scanning electron microscopy and no abnormalities in the distribution or number of membrane particles were detected by freeze-fracturing. We propose that the abnormal lecithin content of erythrocyte membranes in patients with mild jaundice can be explained by the gradual exchange of lecithin between red blood cells and plasma lipoprotein.

Relationship of the constituents of bile to biliary peritonitis in the rat

The local action of bile salts has been associated with a wide variety of gastrointestinal diseases. This paper describes an animal model to determine which of the major solid components of bile are responsible for peritoneal destruction in biliary peritonitis. In the rat, bile salts within the peritoneal cavity cause peritonitis but cholesterol and lecithin are without deleterious effect.

Influence of increased membrane cholesterol on membrane fluidity and cell function in human red blood cells

Cholesterol and phospholipid are the two major lipids of the red cell membrane. Cholesterol is insoluble in water but is solubilized by phospholipids both in membranes and in plasma lipoproteins. Morever, cholesterol exchanges between membranes and lipoproteins. An equilibrium partition is established based on the amount of cholesterol relative to phospholipid (C/PL) in these two compartments. Increases in the C/PL of red cell membranes have been studied under three conditions: First, spontaneous increases in vivo have been observed in the spur red cells of patients with severe liver disease; second, similar red cell changes in vivo have been induced by the administration of cholesterol-enriched diets to rodents and dogs; third, increases in membrane cholesterol have been induced in vitro by enriching the C/PL of the lipoprotein environment with cholesterol-phospholipid dispersions (liposomes) having a C/PL of greater than 1.0. In each case, there is a close relationship between the C/PL of the plasma environment and the C/PL of the red cell membrane. In vivo, the C/PL mole ratio of red cell membranes ranges from a normal value of 0.09--1.0 to values which approach but do not reach 2.0. In vitro, this ratio approaches 3.0. Cholesterol enrichment of red cell membranes directly influences membrane lipid fluidity, as assessed by the rotational diffusion of hydrophobic fluorescent probes such as diphenyl hexatriene (DPH). A close correlation exists between increases in red cell membrane C/PL and decreases in membrane fluidity over the range of membrane C/PL from 1.0 to 2.0; however, little further change in fluidity occurs when membrane C/PL is increased to 2.0--3.0. Cholesterol enrichment of red cell membranes is associated with the transformation of cell contour to one which is redundant and folded, and this is associated with a decrease in red cell filterability in vitro. Circulation in vivo in the presence of the spleen further modifies cell shape to a spiny, irregular (spur) form, and the survival of cholesterol-rich red cells is decreased in the presence of the spleen. Although active Na-K transport is not influenced by cholesterol enrichment of human red cells, several carrier-mediated transport pathways are inhibited. We have demonstrated this effect for the cotransport of Na + K and similar results have been obtained by others in studies of organic acid transport and the transport of small neutral molecules such as erythritol and glycerol. Thus, red cell membrane C/PL is sensitive to the C/PL of the plasma environment. Increasing membrane C/PL causes a decrease in membrane fluidity, and these changes are associated with a reduction in membrane permeability, a distortion of cell contour and filterability and a shortening of the survival of red cells in vivo.

The dispersion of cholesterol with phospholipids and glycolipids

Of the polar lipids studied (phospholipids and glycolipids), only phosphatidylcholine and sphingomyelin can disperse in water with up to 2 mol cholesterol/mol polar lipid. However, mixtures of phosphatidylethanolamine with small amounts of phosphatidylcholine and mixed lipids from mitochondria and myelin will also form sterol-rich dispersions. Steroids in which the 3beta-OH group is replaced by an oxo function do not form such steroid-rich dispersions. Electron microscopy and optical rotatory dispersion (ORD) show that sterols disperse with cerebrosides and gangliosides to form cylindrical structures with the regions around C atoms 3 and 7 of the sterol in less polar environments than those they occupy in phospholipid liposomes. It is proposed that choline-containing phospholipids facilitate entry of sterol molecules into the outer leaflet of cell surface membranes but that the phospholipid composition itself will not give rise to an asymmetric distribution of sterol in membranes with a high cholesterol content.