1
|
Dumas L, Roussel C, Buffet P. Intra-erythrocytic vacuoles in asplenic patients: elusive genesis and original clearance of unique organelles. Front Physiol 2023; 14:1324463. [PMID: 38192744 PMCID: PMC10773617 DOI: 10.3389/fphys.2023.1324463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024] Open
Abstract
The spleen plays a dual role of immune response and the filtration of red blood cells (RBC), the latter function being performed within the unique microcirculatory architecture of the red pulp. The red pulp filters and eliminates senescent and pathological RBC and can expell intra-erythrocytic rigid bodies through the so-called pitting mechanism. The loss of splenic function increases the risk of infections, thromboembolism, and hematological malignancies. However, current diagnostic tests such as quantification of Howell-Jolly Bodies and splenic scintigraphy lack sensitivity or are logistically demanding. Although not widely available in medical practice, the quantification of RBC containing vacuoles, i.e., pocked RBC, is a highly sensitive and specific marker for hyposplenism. The peripheral blood of hypo/asplenic individuals contains up to 80% RBC with vacuoles, whereas these pocked RBC account for less than 4% of RBC in healthy subjects. Despite their value as a spleen function test, intraerythrocytic vacuoles have received relatively limited attention so far, and little is known about their origin, content, and clearance. We provide an overview of the current knowledge regarding possible origins and mechanisms of elimination, as well as the potential function of these unique and original organelles observed in otherwise "empty" mature RBC. We highlight the need for further research on pocked RBC, particularly regarding their potential function and specific markers for easy counting and sorting, which are prerequisites for functional studies and wider application in medical practice.
Collapse
Affiliation(s)
- Lucie Dumas
- Université Paris Cité and Université des Antilles, Inserm, Biologie Tissulaire du Globule Rouge, Paris, France
- Laboratoire d’Excellence GR-Ex, Paris, France
| | - Camille Roussel
- Université Paris Cité and Université des Antilles, Inserm, Biologie Tissulaire du Globule Rouge, Paris, France
- Laboratoire d’Excellence GR-Ex, Paris, France
- Laboratoire d’Hématologie, Hôpital Universitaire Necker Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Pierre Buffet
- Université Paris Cité and Université des Antilles, Inserm, Biologie Tissulaire du Globule Rouge, Paris, France
- Laboratoire d’Excellence GR-Ex, Paris, France
- Université Paris Cité, Service de Maladies Infectieuses et Tropicales Hôpital Universitaire Necker Enfants Malades, Assistance Publique–Hôpitaux de Paris (AP-HP), IHU Imagine, Paris, France
| |
Collapse
|
2
|
Qiang Y, Sissoko A, Liu ZL, Dong T, Zheng F, Kong F, Higgins JM, Karniadakis GE, Buffet PA, Suresh S, Dao M. Microfluidic study of retention and elimination of abnormal red blood cells by human spleen with implications for sickle cell disease. Proc Natl Acad Sci U S A 2023; 120:e2217607120. [PMID: 36730189 PMCID: PMC9963977 DOI: 10.1073/pnas.2217607120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023] Open
Abstract
The spleen clears altered red blood cells (RBCs) from circulation, contributing to the balance between RBC formation (erythropoiesis) and removal. The splenic RBC retention and elimination occur predominantly in open circulation where RBCs flow through macrophages and inter-endothelial slits (IESs). The mechanisms underlying and interconnecting these processes significantly impact clinical outcomes. In sickle cell disease (SCD), blockage of intrasplenic sickled RBCs is observed in infants splenectomized due to acute splenic sequestration crisis (ASSC). This life-threatening RBC pooling and organ swelling event is plausibly triggered or enhanced by intra-tissular hypoxia. We present an oxygen-mediated spleen-on-a-chip platform for in vitro investigations of the homeostatic balance in the spleen. To demonstrate and validate the benefits of this general microfluidic platform, we focus on SCD and study the effects of hypoxia on splenic RBC retention and elimination. We observe that RBC retention by IESs and RBC-macrophage adhesion are faster in blood samples from SCD patients than those from healthy subjects. This difference is markedly exacerbated under hypoxia. Moreover, the sickled RBCs under hypoxia show distinctly different phagocytosis processes from those non-sickled RBCs under hypoxia or normoxia. We find that reoxygenation significantly alleviates RBC retention at IESs, and leads to rapid unsickling and fragmentation of the ingested sickled RBCs inside macrophages. These results provide unique mechanistic insights into how the spleen maintains its homeostatic balance between splenic RBC retention and elimination, and shed light on how disruptions in this balance could lead to anemia, splenomegaly, and ASSC in SCD and possible clinical manifestations in other hematologic diseases.
Collapse
Affiliation(s)
- Yuhao Qiang
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA02139
| | - Abdoulaye Sissoko
- Université Paris Cité, INSERM, Biologie Intégrée du Globule Rouge,75015Paris, France
- Université des Antilles, Biologie Intégrée du Globule Rouge,75015Paris, France
- Laboratoire d'Excellence du Globule Rouge,75015Paris, France
| | - Zixiang L. Liu
- Division of Applied Mathematics, Brown University, Providence, RI02912
| | - Ting Dong
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA02139
| | - Fuyin Zheng
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA02139
- School of Biological Sciences, Nanyang Technological University,639798Singapore, Singapore
| | - Fang Kong
- School of Biological Sciences, Nanyang Technological University,639798Singapore, Singapore
| | - John M. Higgins
- Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
| | | | - Pierre A. Buffet
- Université Paris Cité, INSERM, Biologie Intégrée du Globule Rouge,75015Paris, France
- Université des Antilles, Biologie Intégrée du Globule Rouge,75015Paris, France
- Laboratoire d'Excellence du Globule Rouge,75015Paris, France
| | - Subra Suresh
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA02139
- Nanyang Technological University,639798Singapore, Singapore
| | - Ming Dao
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA02139
- School of Biological Sciences, Nanyang Technological University,639798Singapore, Singapore
| |
Collapse
|
3
|
Tennenbaum J, Volle G, Buffet P, Ranque B, Pouchot J, Arlet JB. [Splenic dysfunction in sickle cell disease: An update]. Rev Med Interne 2023:S0248-8663(23)00005-X. [PMID: 36710088 DOI: 10.1016/j.revmed.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 01/30/2023]
Abstract
The spleen filters blood cells and contributes to the immune defense. The red pulp clears the blood from altered red blood cells via its unique microcirculatory network ; while the white pulp is a secondary lymphoid organ, directly connected to the bloodstream, whose specificity is the defense against encapsulated bacteria through the production of "natural" IgM in the marginal zone. Various health conditions can cause acquired impairment of the splenic function (or hyposplenism) directly and/or through therapeutic splenectomy. Hypo/asplenia is complicated by an increased susceptibility to encapsulated germ infections, but an increased risk of thrombosis and pulmonary hypertension has also been reported after surgical splenectomy. Homozygous sickle cell disease is the most common disease associated with functional asplenia. The latter appears early in childhood likely through repeated ischemic alterations caused by the sickling of red blood cells. In addition, specific complications such as hypersplenism and acute splenic sequestration can occur and may be life-threatening. We provide here an update on the role and physiology of the spleen, which will allow a better understanding of the pathophysiology of spleen damage and its consequences in sickle cell disease.
Collapse
Affiliation(s)
- J Tennenbaum
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - G Volle
- Service de médecine interne, Hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - P Buffet
- Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France
| | - B Ranque
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France; Faculté de médecine Paris Cité, Paris, France
| | - J Pouchot
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Faculté de médecine Paris Cité, Paris, France
| | - J-B Arlet
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France; Faculté de médecine Paris Cité, Paris, France; Inserm U1163, CNRS 8254, Institut IMAGINE, Hôpital Necker, Assistance publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
4
|
Ladu AI, Satumari NA, Abba AM, Abulfathi FA, Jeffery C, Adekile A, Bates I. Evaluation of two red cell inclusion staining methods for assessing spleen function among sickle cell disease patients in North-East Nigeria. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001552. [PMID: 37200242 DOI: 10.1371/journal.pgph.0001552] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/23/2023] [Indexed: 05/20/2023]
Abstract
The loss of splenic function is associated with an increased risk of infection in sickle cell disease (SCD); however, spleen function is rarely documented among SCD patients in Africa, due partly to the non-availability of sophisticated techniques such as scintigraphy. Methods of assessing splenic function which may be achievable in resource-poor settings include counting red blood cells (RBC) containing Howell Jolly Bodies (HJB) and RBC containing silver-staining (argyrophilic) inclusions (AI) using a light microscope. We evaluated the presence of HJB-and AI-containing RBC as markers of splenic dysfunction among SCD patients in Nigeria. We prospectively enrolled children and adults with SCD in steady state attending outpatient clinics at a tertiary hospital in North-East Nigeria. The percentages of HJB-and AI-containing red cells were estimated from peripheral blood smears and compared to normal controls. There were 182 SCD patients and 102 healthy controls. Both AI- and HJB-containing red cells could be easily identified in the participants blood smears. SCD patients had a significantly higher proportion of red cells containing HJB (1.5%; IQR 0.7%-3.1%) compared to controls (0.3%; IQR 0.1%-0.5%) (P <0.0001). The AI red cell counts were also higher among the SCD patients (47.4%; IQR 34.5%-66.0%) than the control group (7.1%; IQR 5.1%-8.7%) (P < 0.0001). The intra-observer reliability for assessment of HJB- (r = 0.92; r2 = 0.86) and AI- containing red cells (r = 0.90; r2 = 0.82) was high. The estimated intra-observer agreement was better with the HJB count method (95% limits of agreement, -4.5% to 4.3%; P = 0.579).We have demonstrated the utility of light microscopy in the assessment of red cells containing-HJB and AI inclusions as indices of splenic dysfunction in Nigerian SCD patients. These methods can be easily applied in the routine evaluation and care of patients with SCD to identify those at high risk of infection and initiate appropriate preventive measures.
Collapse
Affiliation(s)
- Adama I Ladu
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Ngamarju A Satumari
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Maiduguri, Maiduguri, Borno state, Nigeria
| | - Aisha M Abba
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Fatima A Abulfathi
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Caroline Jeffery
- Department of Clinical Infection, Microbiology and Immunology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Adekunle Adekile
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Imelda Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|
5
|
Sabatini L, Chinali M, Franceschini A, Di Mauro M, Marchesani S, Fini F, Arcuri G, Lodi M, Palumbo G, Ceglie G. Echocardiographic Evaluation in Paediatric Sickle Cell Disease Patients: A Pilot Study. J Clin Med 2022; 12:jcm12010007. [PMID: 36614810 PMCID: PMC9821745 DOI: 10.3390/jcm12010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular involvement has a great impact on morbidity and mortality in sickle cell disease (SCD). Currently, few studies are available regarding the paediatric setting and, moreover, current guidelines for the echocardiogram screening program in the asymptomatic paediatric population are controversial. We performed a retrospective observational monocentric study on 64 SCD patients (37 male and 27 female, median age 10) at the Bambino Gesù Childrens' Hospital, who had undergone a routine transthoracic echocardiogram. In total, 46 (72%) patients had at least one cardiac abnormality. Left atrial dilatation (LAD) was present in 41 (65%) patients and left ventricular hypertrophy (LVH) was found in 29 (45%) patients. Patients with LAD showed lower median haemoglobin levels (p = 0.009), and a higher absolute reticulocyte count (p = 0.04). LVH was negatively correlated with the median haemoglobin value (p = 0.006) and positively with the reticulocyte count (p = 0.03). Moreover, we found that patients with cardiac anomalies had higher transfusion needs and a lower frequency of pain crises. In our setting, cardiac involvement has a high prevalence in the paediatric cohort and seems to be associated with specific laboratory findings, and with a specific clinical phenotype characterized by complications related to high haemodynamic load.
Collapse
Affiliation(s)
- Letizia Sabatini
- Department of Pediatrics, Bambino Gesù Children’s Hospital—IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-06-6859-2951
| | - Marcello Chinali
- Department of Pediatric Cardiology and Cardiovascular Surgery, Bambino Gesù Children’s Research Hospital—IRCSS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Alessio Franceschini
- Department of Pediatric Cardiology and Cardiovascular Surgery, Bambino Gesù Children’s Research Hospital—IRCSS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Margherita Di Mauro
- Department of Pediatrics, Bambino Gesù Children’s Hospital—IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Silvio Marchesani
- Department of Pediatrics, Bambino Gesù Children’s Hospital—IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Francesca Fini
- Department of Pediatrics, Bambino Gesù Children’s Hospital—IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Giorgia Arcuri
- Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Mariachiara Lodi
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital—IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Giuseppe Palumbo
- Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital—IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Giulia Ceglie
- Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital—IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| |
Collapse
|