EXPERIMENTAL AND CLINICAL OBSERVATIONS ON INCREASED MECHANICAL FRAGILITY OF ERYTHROCYTES

Individual red blood cell nitric oxide production in sickle cell anemia: Nitric oxide production is increased and sickle shaped cells have unique morphologic change compared to discoid cells

Sickle cell anemia (SCA) is characterized by decreased red blood cell (RBC) deformability due to polymerization of deoxygenated hemoglobin, leading to abnormal mechanical properties of RBC, increased cellular adhesion, and microcirculatory obstruction. Prior work has demonstrated that NO• influences RBC hydration and deformability and is produced at a basal rate that increases under shear stress in normal RBC. Nevertheless, the origin and physiological relevance of nitric oxide (NO•) production and scavenging in RBC remains unclear. We aimed to assess the basal and shear-mediated production of NO• in RBC from SCA patients and control (CTRL) subjects. RBCs loaded with a fluorescent NO• detector, DAF-FM (4-Amino-5-methylamino- 2',7'-difluorofluorescein diacetate), were imaged in microflow channels over 30-min without shear stress, followed by a 30-min period under 0.5Pa shear stress. We utilized non-specific nitric oxide synthase (NOS) blockade and carbon monoxide (CO) saturation of hemoglobin to assess the contribution of NOS and hemoglobin, respectively, to NO• production. Quantification of DAF-FM fluorescence intensity in individual RBC showed an increase in NO• in SCA RBC at the start of the basal period; however, both SCA and CTRL RBC increased NO• by a similar quantity under shear. A subpopulation of sickle-shaped RBC exhibited lower basal NO• production compared to discoid RBC from SCA group, and under shear became more circular in the direction of shear when compared to discoid RBC from SCA and CTRL, which elongated. Both CO and NOS inhibition caused a decrease in basal NO• production. Shear-mediated NO• production was decreased by CO in all RBC, but was decreased by NOS blockade only in SCA. In conclusion, total NO• production is increased and shear-mediated NO• production is preserved in SCA RBC in a NOS-dependent manner. Sickle shaped RBC with inclusions have higher NO• production and they become more circular rather than elongated with shear.

The effects of drugs on erythrocytes in vitro: Heinz body formation, glutathione peroxidase inhibition and changes in mechanical fragility

1 The relationship between mechanical fragility, glutathione peroxidase inhibition and Heinz body formation, in erythrocytes exposed to oxidant drugs in vitro, has been investigated. All drugs tested caused Heinz body formation, and with the exception of acetyl salicylic acid and salicylic acid, also caused increased erythrocyte mechanical fragility. 2 There was a direct relationship between mechanical fragility and drug concentration. Mechanical fragility increased in parallel with Heinz body formation, with primaquine, gentisic acid, ascorbic acid and potassium chlorate. In contrast Heinz body formation occurred at drug concentrations which did not cause a marked increase in mechanical fragility in the case of menadione, acetyl phenylhydrazine and phenylhydrazine. 3 The degree of inhibition of glutathione peroxidase was directly related to increased mechanical fragility with menadione, gentisic acid and potassium chlorate. However other substances causing increased mechanical fragility resulted in little or no loss of glutathione peroxidase activity. 4 The results show that there is no constant relationship between mechanical fragility caused by drugs, the formation of Heinz bodies and the inhibition of glutathione peroxidase. The factors contributing to oxidant drug-induced haemolysis appear to be variable and depend upon the drug concerned.

Effects of a single sickling event on the mechanical fragility of sickle cell trait erythrocytes

Hemolysis contributes to the pathology associated with sickle cell disease. However, the mechanism of hemolysis or relative contribution of sickling due to hemoglobin (Hb) polymerization vs. oxidative damage remains unknown. Earlier studies aimed at deciphering the relative importance of these two mechanisms have been complicated by the fact that sickle red cells (SS) have already been affected by multiple rounds of sickling and oxidative damage before they are collected. In our study, we examine the mechanical fragility of sickle cell trait cells, which do not sickle in vivo, but can be made to do so in vitro. Thus, our novel approach explores the effects of sickle Hb polymerization on cells that have never been sickled before. We find that the mechanical fragility of these cells increases dramatically after a single sickling event, suggesting that a substantial amount of hemolysis in vivo probably occurs in polymer-containing cells.

Age as effecting the osmotic and mechanical fragility of dog erythrocytes tagged with radioactive iron

Radioactive iron was administered to three normal dogs, two of which had previously been bled, in order to tag a group of erythrocytes of approximately known age. The osmotic fragility of the newly formed tagged cells was significantly greater than that of the general cell population during the first few days after injection of the iron, while the mechanical fragility of the young cells was less than that of the general red cell population. As the cells aged and approached the end of their life span, their susceptibility to destruction by trauma inflicted by rolling glass beads exceeded that of the general cell population. The osmotic behavior of the old cells was not distinctive. The increased mechanical fragility of senescent cells suggests that the life span of erythrocytes may be limited at least in part by changes within the cell which render it more susceptible to destruction by mechanical wear and tear in the circulation. It is emphasized, however, that the trauma produced by rolling glass beads may be quite unlike that inflicted upon red cells in vivo. A decrease in circulating radioactive iron was observed in each experiment soon after the mechanical fragility of the tagged cells began to exceed that of the total cell population. The lowest point on the curve representing circulating radioiron was noted at 119, 119, and 122 days respectively after injection of iron in the three experiments. Estimates of the life span of dog erythrocytes obtained in this way agree with those provided by other methods.

Tissue hemolysins as lysin-inhibitor complexes

1. Lytic substances are enzymatically produced at 37°C. from tissue slices or homogenates (mouse liver, kidney, etc.) and appear in the medium in which the tissue fragments are suspended. Their concentration increases with the time during which the tissue is kept at 37°C. (preincubation), and is accompanied by pH changes, so that the lytic activity as finally measured is a function of both the time of preincubation and of the pH. The optimum pH for lysin production is above 7.0, but the lysins, once produced, hemolyze red cells more rapidly at low pH's than at high ones. The enzyme system which produces the lysins is inactivated by heating to 100°C. for 5 minutes. Sodium iodoacetate and fluoride interfere with lysin production principally by reducing the concomitant pH shift; KCN accelerates the production of lytic material in mouse liver homogenates. 2. Comparison of the lytic activity of the supernatant fluid of a preincubated homogenate with the much greater lytic activity of the substances which can be extracted from the same supernatant fluid by alcohol and ether points to these extractable substances existing in the supernatant fluid as lysin-inhibitor complexes of relatively low lytic activity. These complexes are formed enzymatically during preincubation from non-lytic complexes in the tissue. The latter may be lipoproteins, and the highly lytic ether-extractable substances may be fatty acids or their soaps. 3. The diffusibility of the lysin-inhibitor complexes is small. 4. Lytic substances which are ether-insoluble can be extracted with alcohol from tissues as well as from serum. These "lysolecithin-like" substances exist in the supernatant fluids of homogenates as lysin-inhibitor complexes. 5. Lysis of mouse red cells by substances contained in mouse tissue (liver and kidney) is often accompanied by the formation of methemoglobin and choleglobin. Mouse red cells containing choleglobin are abnormally fragile both osmotically and mechanically, and it is possible that a process involving the production of choleglobin, accompanied or followed by globin denaturation, is one which contributes towards the hemolysis which occurs in systems containing tissue slices or homogenates.

Biological and environmental factors affecting ultrasound-induced hemolysis in vitro: medium tonicity

Whole human anticoagulated blood in vitro underwent controlled plasma replacement with either isotonic (0.9%) or hypotonic (0.5%) saline to 1. restore the blood to its original volume (which resulted in different hematocrits) or 2. bring the blood to a singular hematocrit (40%). The hypotonic cell MCVs were, on average, considerably larger than their isotonic counterpart by a ratio of 1.4:1. The blood samples were then subjected to two tests, one of mechanical fragility, the other to ultrasound (US)-induced hemolysis. The US exposure metrics were: 1.0-MHz center frequency, 200-micros pulse duration, 20-ms interpulse interval, exposure durations of 10 to 30 s in the presence of Albunex, as a control on blood gas nucleation, and exposure vessel rotation at 200 rpm. In all instances, the hypotonic blood displayed higher levels of hemolysis than the corresponding isotonic treatment. The highest ratio of US-induced hemolysis for the hypotonic:isotonic regimens was 2.2. In some instances, the ratio was somewhat less but appeared to be related to differences in whole blood viscosities among the regimens or other factors. The data supported the a priori hypothesis that hypotonicity will result in an increased tension on the cell membrane and render it more susceptible to shear-induced hemolysis, including exposure to US under conditions known to foster the occurrence of inertial cavitation. There was no temperature increase during the insonations of the blood.

Biological and environmental factors affecting ultrasound-induced hemolysis in vitro: 3. Antioxidant (Trolox) inclusion

This project tested the hypothesis that human erythrocytes pretreated with Trolox (a water-soluble analog of vitamin E) would be more susceptible to ultrasound (US)-induced hemolysis by a cavitational mechanism because of an increased fragility of the erythrocyte membrane over that without Trolox supplementation. Samples of whole human blood from apparently healthy donors (hematocrit approximately 40%) in vitro were supplemented or not supplemented with Trolox at various concentrations, ranging from 1.8 to 0.0018 mg/mL plasma. Mechanical fragility tests indicated the Trolox-treated blood in vitro exhibited greater hemolysis than untreated blood in vitro (p < 0.001). US exposures at comparable acoustic amplitude, pulse length and duty factor in the presence of the US contrast agent Albunex yielded differing results; at 1 MHz, the Trolox-supplemented blood had significantly greater hemolysis in vitro than non-Trolox-supplemented blood; at 3 MHz, there was a substantial reduction in hemolysis relative to that obtained at 1 MHz, and no statistically significant difference between the Trolox-supplemented and -unsupplemented blood. There was also essentially no support for an alternative hypothesis that the Trolox was functioning primarily as a pro-oxidant. These collective experimental results support the hypothesis and suggest duality in the functionality of membranous antioxidant inclusions or associations; they may foster protection against oxidative damage, yet render the cell less capable of withstanding mechanical stress.

Characteristics of rat platelets and relative contributions of platelets and blood coagulation to haemostasis

In order to understand some of the haemostatic mechanisms in rats for the interpretation of toxicological data, basic haemostatic parameters with a special emphasis on platelet functions were first measured in vitro. The results of reactions of rat platelets to many aggregating agents suggest that only ADP may be a consistently significant aggregator. The search for physiologic aggregators revealed ADP to be available from erythrocytes. Adhesion reaction also required ADP. Collagen was not considered to be essential for either reaction. Aggregation and adhesion were probably both reversible in flowing blood, while irreversible thrombi were formed in blood at rest ex vivo. Blood coagulation parameters determined revealed that the intrinsic pathway may be more important than the extrinsic one. The rate of intrinsic coagulation reaction was rapid, and plasma coagulation appeared to be of primary importance while the influence of platelet aggregation was minor. A simple model of rat haemostatic mechanism is proposed based on these results. Additionally, to define the relative contribution of platelets versus other cellular and plasma coagulation in vivo, rats were administered antiplatelet drugs (ticlopidine, suprofen and clopidogrel) and an anticoagulant (warfarin) intraperitoneally. Bleeding times (BTs) were significantly increased in all treated groups. ADP-induced platelet aggregations were significantly depressed by the administration of the three antiplatelet drugs, while kaolon-activated partial thromboplastin time and prothrombin time were greatly increased in the warfarin-treated rats. The increase in BT may be due to the inhibition of platelet activity or blood coagulation defect in rats given antiplatelet drugs or warfarin, respectively. These results suggest that platelets play a key role in haemostasis in the rat. Two possible explanations of the disparity between in vitro and in vivo results may be that functional tests used here are not adequate to cover the properties of rat platelets or that mechanisms leading to the formation of platelet thrombi in rats are ADP-dependent adhesion and ADP-induced aggregation.

Increased fragility of erythrocytes from amyotrophic lateral sclerosis (ALS) patients provoked by mechanical stress

Erythrocytes from patients with amyotrophic lateral sclerosis (ALS) and controls were suspended in an electrolyte-substrate medium and subjected to mechanical stress by centrifugation under standardized conditions. Subsequent spectrophotometric analysis of the medium disclosed a significantly higher degree of haemolysis in samples from ALS-patients than from controls. The observation gives further evidence for the existence of an abnormality of the red cells in the disease. The nature and possible significance of this abnormality in relation to the pathogenesis of ALS is as yet unknown, but notably there was no significant correlation between the degree of cell abnormality as manifested by haemolysis and the duration of the disease in the individual patient.

The fragility of normal and abnormal erythrocytes in a controlled hydrodynamic shear field

Fresh human erythrocytes (suspended in a compatible isotonic viscous saline medium containing plasma) were disrupted by the uniform shear stresses generated in the laminar flow field of a conventional cone and plate viscometer. A range of normal fragilities was established and blood samples from patients having certain well-defined haematological abnormalities were found to be partially or completely outside these limits. The present technique is sensitive enough to distinguish between young and old cell fractions isolated from the same original population and also appears to be able to resolve discrete sub-populations having different mechanical fragilities within unfractionated samples from certain patients (e.g. macrocytosis). This technique provides additional information which could aid or facilitate diagnosis and might eventually form the basis of a routine screening test in clinical haematology.

The destruction of red cells by antibodies in man. I. Observations of the sequestration and lysis of red cells altered by immune mechanisms

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