1
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Fay ME, Oshinowo O, Iffrig E, Fibben KS, Caruso C, Hansen S, Musick JO, Valdez JM, Azer SS, Mannino RG, Choi H, Zhang DY, Williams EK, Evans EN, Kanne CK, Kemp ML, Sheehan VA, Carden MA, Bennett CM, Wood DK, Lam WA. iCLOTS: open-source, artificial intelligence-enabled software for analyses of blood cells in microfluidic and microscopy-based assays. Nat Commun 2023; 14:5022. [PMID: 37596311 PMCID: PMC10439163 DOI: 10.1038/s41467-023-40522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 07/28/2023] [Indexed: 08/20/2023] Open
Abstract
While microscopy-based cellular assays, including microfluidics, have significantly advanced over the last several decades, there has not been concurrent development of widely-accessible techniques to analyze time-dependent microscopy data incorporating phenomena such as fluid flow and dynamic cell adhesion. As such, experimentalists typically rely on error-prone and time-consuming manual analysis, resulting in lost resolution and missed opportunities for innovative metrics. We present a user-adaptable toolkit packaged into the open-source, standalone Interactive Cellular assay Labeled Observation and Tracking Software (iCLOTS). We benchmark cell adhesion, single-cell tracking, velocity profile, and multiscale microfluidic-centric applications with blood samples, the prototypical biofluid specimen. Moreover, machine learning algorithms characterize previously imperceptible data groupings from numerical outputs. Free to download/use, iCLOTS addresses a need for a field stymied by a lack of analytical tools for innovative, physiologically-relevant assays of any design, democratizing use of well-validated algorithms for all end-user biomedical researchers who would benefit from advanced computational methods.
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Affiliation(s)
- Meredith E Fay
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Oluwamayokun Oshinowo
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Elizabeth Iffrig
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA, USA
| | - Kirby S Fibben
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Christina Caruso
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Scott Hansen
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Jamie O Musick
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - José M Valdez
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Sally S Azer
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Robert G Mannino
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Hyoann Choi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Dan Y Zhang
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Evelyn K Williams
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Erica N Evans
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Celeste K Kanne
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Melissa L Kemp
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Vivien A Sheehan
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Marcus A Carden
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Carolyn M Bennett
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - David K Wood
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Wilbur A Lam
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA.
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA.
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2
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Sandor B, Csiszar B, Galos G, Funke S, Kevey DK, Meggyes M, Szereday L, Toth K. The Influence of Early Onset Preeclampsia on Perinatal Red Blood Cell Characteristics of Neonates. Int J Mol Sci 2023; 24:ijms24108496. [PMID: 37239851 DOI: 10.3390/ijms24108496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Preeclampsia is the leading cause of complicated neonatal adaptation. The present investigation aimed to study the hemorheological factors during the early perinatal period (cord blood, 24 and 72 h after delivery) in newborns of early-onset preeclamptic mothers (n = 13) and healthy neonates (n = 17). Hematocrit, plasma, and whole blood viscosity (WBV), red blood cell (RBC) aggregation, and deformability were investigated. There were no significant differences in hematocrit. WBV was significantly lower in preterm neonates at birth than in the term 24 and 72 h samples. Plasma viscosity was significantly lower in preterm neonates' cord blood than in healthy controls. RBC aggregation parameters were significantly lower in preterm newborns' cord blood than in term neonates' cord blood 24 and 72 h samples. RBC elongation indices were significantly lower in the term group than in preterm neonates 72 h' sample at the high and middle shear stress range. Changes in the hemorheological parameters, especially RBC aggregation properties, refer to better microcirculation of preterm neonates at birth, which could be an adaptation mechanism to the impaired uteroplacental microcirculation in preeclampsia.
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Affiliation(s)
- Barbara Sandor
- 1st Department of Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Beata Csiszar
- Department of Anaesthesiology and Intensive Therapy, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Gergely Galos
- 1st Department of Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Simone Funke
- Department of Obstetrics and Gynaecology, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Dora Kinga Kevey
- Department of Obstetrics and Gynaecology, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Matyas Meggyes
- Department of Medical Microbiology and Immunology, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Laszlo Szereday
- Department of Medical Microbiology and Immunology, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Kalman Toth
- 1st Department of Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
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3
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A mathematical model of fibrinogen-mediated erythrocyte-erythrocyte adhesion. Commun Biol 2023; 6:192. [PMID: 36801914 PMCID: PMC9938206 DOI: 10.1038/s42003-023-04560-4] [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: 08/26/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
Erythrocytes are deformable cells that undergo progressive biophysical and biochemical changes affecting the normal blood flow. Fibrinogen, one of the most abundant plasma proteins, is a primary determinant for changes in haemorheological properties, and a major independent risk factor for cardiovascular diseases. In this study, the adhesion between human erythrocytes is measured by atomic force microscopy (AFM) and its effect observed by micropipette aspiration technique, in the absence and presence of fibrinogen. These experimental data are then used in the development of a mathematical model to examine the biomedical relevant interaction between two erythrocytes. Our designed mathematical model is able to explore the erythrocyte-erythrocyte adhesion forces and changes in erythrocyte morphology. AFM erythrocyte-erythrocyte adhesion data show that the work and detachment force necessary to overcome the adhesion between two erythrocytes increase in the presence of fibrinogen. The changes in erythrocyte morphology, the strong cell-cell adhesion and the slow separation of the two cells are successfully followed in the mathematical simulation. Erythrocyte-erythrocyte adhesion forces and energies are quantified and matched with experimental data. The changes observed on erythrocyte-erythrocyte interactions may give important insights about the pathophysiological relevance of fibrinogen and erythrocyte aggregation in hindering microcirculatory blood flow.
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4
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Sublingual Microcirculation Specificity of Sickle Cell Patients: Morphology of the Microvascular Bed, Blood Rheology, and Local Hemodynamics. Int J Mol Sci 2023; 24:ijms24043621. [PMID: 36835032 PMCID: PMC9967909 DOI: 10.3390/ijms24043621] [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: 01/12/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
Patients with sickle cell disease (SCD) have poorly deformable red blood cells (RBC) that may impede blood flow into microcirculation. Very few studies have been able to directly visualize microcirculation in humans with SCD. Sublingual video microscopy was performed in eight healthy (HbAA genotype) and four sickle cell individuals (HbSS genotype). Their hematocrit, blood viscosity, red blood cell deformability, and aggregation were individually determined through blood sample collections. Their microcirculation morphology (vessel density and diameter) and microcirculation hemodynamics (local velocity, local viscosity, and local red blood cell deformability) were investigated. The De Backer score was higher (15.9 mm-1) in HbSS individuals compared to HbAA individuals (11.1 mm-1). RBC deformability, derived from their local hemodynamic condition, was lower in HbSS individuals compared to HbAA individuals for vessels < 20 μm. Despite the presence of more rigid RBCs in HbSS individuals, their lower hematocrit caused their viscosity to be lower in microcirculation compared to that of HbAA individuals. The shear stress for all the vessel diameters was not different between HbSS and HbAA individuals. The local velocity and shear rates tended to be higher in HbSS individuals than in HbAA individuals, notably so in the smallest vessels, which could limit RBC entrapment into microcirculation. Our study offered a novel approach to studying the pathophysiological mechanisms of SCD with new biological/physiological markers that could be useful for characterizing the disease activity.
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5
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Kang YJ. Contributions of Red Blood Cell Sedimentation in a Driving Syringe to Blood Flow in Capillary Channels. MICROMACHINES 2022; 13:mi13060909. [PMID: 35744523 PMCID: PMC9229591 DOI: 10.3390/mi13060909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 12/18/2022]
Abstract
The erythrocyte sedimentation rate (ESR), which has been commonly used to detect physiological and pathological diseases in clinical settings, has been quantified using an interface in a vertical tube. However, previous methods do not provide biophysical information on blood during the ESR test. Therefore, it is necessary to quantify the individual contributions in terms of viscosity and pressure. In this study, to quantify RBC sedimentation, the image intensity (Ib) and interface (β) were obtained by analyzing the blood flow in the microfluidic channels. Based on threshold image intensity, the corresponding interfaces of RBCs (Ib > 0.15) and diluent (Ib < 0.15) were employed to obtain the viscosities (µb, µ0) and junction pressures (Pb, P0). Two coefficients (CH1, CH2) obtained from the empirical formulas (µb = µ0 [1 + CH1], Pb = P0 [1 + CH2]) were calculated to quantify RBC sedimentation. The present method was then adopted to detect differences in RBC sedimentation for various suspended blood samples (healthy RBCs suspended in dextran solutions or plasma). Based on the experimental results, four parameters (µ0, P0, CH1, and CH2) are considered to be effective for quantifying the contributions of the hematocrit and diluent. Two coefficients exhibited more consistent trends than the conventional ESR method. In conclusion, the proposed method can effectively detect RBC sedimentation.
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Affiliation(s)
- Yang Jun Kang
- Department of Mechanical Engineering, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea
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6
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Kim YK, Lee JM. Change of RBC Deformability During Hematopoietic Stem Cell Transplantation. J Pediatr Hematol Oncol 2022; 44:e329-e333. [PMID: 34486554 DOI: 10.1097/mph.0000000000002295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
The red blood cell (RBC) deformability test is the measurement of the ability of RBCs to adapt their shape to the flow conditions. The major determinants of RBC deformability include cell shape, composition of the cell membrane and cytoskeleton, and internal viscosity (mean cell hemoglobin concentration). RBC deformability is primarily regulated by the composition and arrangement of the cell membrane. In cancer patients, chemotherapy and hematopoietic stem transplantation (HSCT) affect the bone marrow microenvironment, which may alter RBC production and deformability. We aimed to evaluate the change in RBC deformability during HSCT. Blood samples were obtained from patients who underwent HSCT. Eleven children were enrolled in this study. RBC deformability was measured with a microfluidic ektacytometer (RheoScan-D, RheoMeditech, Seoul, Korea). All analyses were completed within 24 hours after blood collection. The elongation index of the erythrocytes was measured. The elongation index of RBCs gradually increased from day 5 to day 30 after HSCT. RBC deformability may reflect the bone marrow microenvironment of the patient during HSCT. Further studies investigating the correlation between RBC deformability and the prognosis of HSCT are needed.
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Affiliation(s)
- Yu Kyung Kim
- Department of Clinical Pathology, School of Medicine, Kyungpook National University
| | - Jae Min Lee
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Republic of Korea
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7
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Nardo-Marino A, Petersen J, Brewin JN, Birgens H, Williams TN, Kurtzhals JAL, Rees DC, Glenthøj A. Oxygen gradient ektacytometry does not predict pain in children with sickle cell anaemia. Br J Haematol 2021; 197:609-617. [PMID: 34859420 PMCID: PMC7613550 DOI: 10.1111/bjh.17975] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/15/2021] [Indexed: 01/29/2023]
Abstract
The loss of red blood cell (RBC) deformability in sickle cell anaemia (SCA) is considered the primary factor responsible for episodes of acute pain and downstream progressive organ dysfunction. Oxygen gradient ektacytometry (Oxygenscan) is a recently commercialised functional assay that aims to describe the deformability of RBCs in SCA at differing oxygen tensions. So far, the Oxygenscan has been evaluated only by a small number of research groups and the validity and clinical value of Oxygenscan-derived biomarkers have not yet been fully established. In this study we examined RBC deformability measured with the Oxygenscan in 91 children with SCA at King's College Hospital in London. We found a significant correlation between Oxygenscan-derived biomarkers and well-recognised modifiers of disease severity in SCA: haemoglobin F and co-inherited α-thalassaemia. We failed, however, to find any independent predictive value of the Oxygenscan in the clinical outcome measure of pain, as well as other important parameters such as hydroxycarbamide treatment. Although the Oxygenscan remains an intriguing tool for basic research, our results question whether it provides any additional information in predicting the clinical course in children with SCA, beyond measuring known markers of disease severity.
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Affiliation(s)
- Amina Nardo-Marino
- Department of Haematology, Centre for Haemoglobinopathies, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.,Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark.,Department of Haematological Medicine, King's College Hospital, London, United Kingdom.,School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Jesper Petersen
- Department of Haematology, Centre for Haemoglobinopathies, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - John N Brewin
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom.,School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Henrik Birgens
- Department of Haematology, Centre for Haemoglobinopathies, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Thomas N Williams
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Medicine, Imperial College London, London, United Kingdom
| | - Jørgen A L Kurtzhals
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - David C Rees
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom.,School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Andreas Glenthøj
- Department of Haematology, Centre for Haemoglobinopathies, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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8
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Csiszar B, Galos G, Funke S, Kevey DK, Meggyes M, Szereday L, Kenyeres P, Toth K, Sandor B. Peripartum Investigation of Red Blood Cell Properties in Women Diagnosed with Early-Onset Preeclampsia. Cells 2021; 10:cells10102714. [PMID: 34685694 PMCID: PMC8534376 DOI: 10.3390/cells10102714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 01/25/2023] Open
Abstract
We investigated peripartum maternal red blood cell (RBC) properties in early-onset preeclampsia (PE). Repeated blood samples were taken prospectively for hemorheological measurements at PE diagnosis (n = 13) or during 26-34 weeks of gestation in healthy pregnancies (n = 24), then at delivery, and 72 h postpartum. RBC aggregation was characterized by M index (infrared light transmission between the aggregated RBCs in stasis) and aggregation index (AI-laser backscattering from the RBC aggregates). We observed significantly elevated RBC aggregation (M index = 9.8 vs. 8.5; AI = 72.9% vs. 67.5%; p < 0.001) and reduced RBC deformability in PE (p < 0.05). A positive linear relationship was observed between AI and gestational age at birth in PE by regression analysis (R2 = 0.554; p = 0.006). ROC analysis of AI showed an AUC of 0.84 (0.68-0.99) (p = 0.001) for PE and indicated a cutoff of 69.4% (sensitivity = 83.3%; specificity = 62.5%), while M values showed an AUC of 0.75 (0.58-0.92) (p = 0.019) and indicated a cutoff of 8.39 (sensitivity = 90.9% and specificity = 50%). The predicted probabilities from the combination of AI and M variables showed increased AUC = 0.90 (0.79-1.00) (p < 0.001). Our results established impaired microcirculation in early-onset PE manifesting as deteriorated maternal RBC properties. The longer the pathologic pregnancy persists, the more pronounced the maternal erythrocyte aggregation. AI and M index could help in the prognostication of early-onset PE, but further investigations are warranted to confirm the prognostic role before the onset of symptoms.
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Affiliation(s)
- Beata Csiszar
- Department of Anaesthesiology and Intensive Therapy, Medical School, University of Pécs, H-7624 Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary; (G.G.); (M.M.); (L.S.); (P.K.); (K.T.); (B.S.)
- Correspondence:
| | - Gergely Galos
- Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary; (G.G.); (M.M.); (L.S.); (P.K.); (K.T.); (B.S.)
- 1st Department of Medicine, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Simone Funke
- Department of Obstetrics and Gynaecology, Medical School, University of Pécs, H-7624 Pécs, Hungary; (S.F.); (D.K.K.)
| | - Dora Kinga Kevey
- Department of Obstetrics and Gynaecology, Medical School, University of Pécs, H-7624 Pécs, Hungary; (S.F.); (D.K.K.)
| | - Matyas Meggyes
- Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary; (G.G.); (M.M.); (L.S.); (P.K.); (K.T.); (B.S.)
- Department of Medical Microbiology and Immunology, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Laszlo Szereday
- Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary; (G.G.); (M.M.); (L.S.); (P.K.); (K.T.); (B.S.)
- Department of Medical Microbiology and Immunology, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Peter Kenyeres
- Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary; (G.G.); (M.M.); (L.S.); (P.K.); (K.T.); (B.S.)
- 1st Department of Medicine, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Kalman Toth
- Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary; (G.G.); (M.M.); (L.S.); (P.K.); (K.T.); (B.S.)
- 1st Department of Medicine, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Barbara Sandor
- Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary; (G.G.); (M.M.); (L.S.); (P.K.); (K.T.); (B.S.)
- 1st Department of Medicine, Medical School, University of Pécs, H-7624 Pécs, Hungary
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9
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Kuck L, McNamee AP, Simmonds MJ. Impact of small fractions of abnormal erythrocytes on blood rheology. Microvasc Res 2021; 139:104261. [PMID: 34624306 DOI: 10.1016/j.mvr.2021.104261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022]
Abstract
Red blood cell (RBC) populations are inherently heterogeneous, given mature RBC lack the transcriptional machinery to re-synthesize proteins affected during in vivo aging. Clearance of older, less functional cells thus aids in maintaining consistent hemorheological properties. Scenarios occur, however, where portions of mechanically impaired RBC are re-introduced into blood (e.g., damaged from circulatory support, blood transfusion) and may alter whole blood fluid behavior. Given such perturbations are associated with poor clinical outcomes, determining the tolerable level of abnormal RBC in blood is valuable. Thus, the current study aimed to define the critical threshold of blood fluid properties to re-infused physically-impaired RBC. Cell mechanics of RBC were impaired through membrane cross-linking (glutaraldehyde) or intracellular oxidation (phenazine methosulfate). Mechanically impaired RBC were progressively re-introduced into the native cell population. Negative alterations of cellular deformability and high shear blood viscosity were observed following additions of only 1-5% rigidified RBC. Low-shear blood viscosity was conversely decreased following addition of glutaraldehyde-treated cells; high-resolution microscopy of these mixed cell populations revealed decreased capacity to form reversible aggregates and decreased aggregate size. Mixed RBC populations, when exposed to supraphysiological shear, presented with compounded mechanical impairment. Collectively, key determinants of blood flow behavior are sensitive to mechanical perturbations in RBC, even when only 1-5% of the cell population is affected. Given this fraction is well-below the volume of rigidified RBC introduced during circulatory support or transfusion practice, it is plausible that some adverse events following surgery and/or transfusion may be related to impaired blood fluidity.
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Affiliation(s)
- Lennart Kuck
- Biorheology Research Laboratory, Menzies Health Institute Queensland, QLD, Australia
| | - Antony P McNamee
- Biorheology Research Laboratory, Menzies Health Institute Queensland, QLD, Australia
| | - Michael J Simmonds
- Biorheology Research Laboratory, Menzies Health Institute Queensland, QLD, Australia.
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10
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Turgut A, Yalçin Ö. Applications of deep learning to the assessment of red blood cell deformability. Biorheology 2021; 58:51-60. [PMID: 34219708 DOI: 10.3233/bir-201016] [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: 11/15/2022]
Abstract
BACKGROUND Measurement of abnormal Red Blood Cell (RBC) deformability is a main indicator of Sickle Cell Anemia (SCA) and requires standardized quantification methods. Ektacytometry is commonly used to estimate the fraction of Sickled Cells (SCs) by measuring the deformability of RBCs from laser diffraction patterns under varying shear stress. In addition to estimations from model comparisons, use of maximum Elongation Index differences (ΔEImax) at different laser intensity levels was recently proposed for the estimation of SC fractions. OBJECTIVE Implement a convolutional neural network to accurately estimate rigid-cell fraction and RBC concentration from laser diffraction patterns without using a theoretical model and eliminating the ektacytometer dependency for deformability measurements. METHODS RBCs were collected from control patients. Rigid-cell fraction experiments were performed using varying concentrations of glutaraldehyde. Serial dilutions were used for varying the concentration of RBC. A convolutional neural network was constructed using Python and TensorFlow. RESULTS AND CONCLUSIONS Measurements and model predictions show that a linear relationship between ΔEImax and rigid-cell fraction exists only for rigid-cell fractions less than 0.2. The proposed neural network architecture can be used successfully for both RBC concentration and rigid-cell fraction estimations without a need for a theoretical model.
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Affiliation(s)
- Alper Turgut
- School of Medicine, University of Virginia, VA, Charlottesville, USA
| | - Özlem Yalçin
- School of Medicine, Koç University, Istanbul, Turkey
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Briole A, Podgorski T, Abou B. Molecular rotors as intracellular probes of red blood cell stiffness. SOFT MATTER 2021; 17:4525-4537. [PMID: 33949619 DOI: 10.1039/d1sm00321f] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The deformability of red blood cells is an essential parameter that controls the rheology of blood as well as its circulation in the body. Characterizing the rigidity of the cells and their heterogeneity in a blood sample is thus a key point in the understanding of occlusive phenomena, particularly in the case of erythrocytic diseases in which healthy cells coexist with pathological cells. However, measuring intracellular rheology in small biological compartments requires the development of specific techniques. We propose a technique based on molecular rotors - viscosity-sensitive fluorescent probes - to evaluate the above key point. DASPI molecular rotor has been identified with spectral fluorescence properties decoupled from those of hemoglobin, the main component of the cytosol. After validation of the rotor as a viscosity probe in model fluids, we showed by confocal microscopy that, in addition to binding to the membrane, the rotor penetrates spontaneously and uniformly into red blood cells. Experiments on red blood cells whose rigidity is varied with temperature, show that molecular rotors can detect variations in their overall rigidity. A simple model allowed us to separate the contribution of the cytosol from that of the membrane, allowing a qualitative determination of the variation of cytosol viscosity with temperature, consistent with independent measurements of the viscosity of hemoglobin solutions. Our experiments show that the rotor can be used to study the intracellular rheology of red blood cells at the cellular level, as well as the heterogeneity of this stiffness in a blood sample. This opens up new possibilities for biomedical applications, diagnosis and disease monitoring.
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Affiliation(s)
- Alice Briole
- Laboratoire Matière et Systèmes Complexes, UMR 7057 CNRS - Université de Paris, 75013 Paris, France.
| | - Thomas Podgorski
- Laboratoire Rhéologie et Procédés, UMR 5520 CNRS-UGA-G.INP - Domaine Universitaire, BP 53 38041 Grenoble Cedex 9, France.
| | - Bérengère Abou
- Laboratoire Matière et Systèmes Complexes, UMR 7057 CNRS - Université de Paris, 75013 Paris, France.
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12
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Gutierrez M, Shamoun M, Seu KG, Tanski T, Kalfa TA, Eniola-Adefeso O. Characterizing bulk rigidity of rigid red blood cell populations in sickle-cell disease patients. Sci Rep 2021; 11:7909. [PMID: 33846383 PMCID: PMC8041827 DOI: 10.1038/s41598-021-86582-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 03/11/2021] [Indexed: 01/25/2023] Open
Abstract
In this work, we utilized a parameterization model of ektacytometry to quantify the bulk rigidity of the rigid red blood cell (RBC) population in sickle cell disease (SCD) patients. Current ektacytometry techniques implement laser diffraction viscometry to estimate the RBC deformability in a whole blood sample. However, the diffraction measurement is an average of all cells present in the measured sample. By coupling an existing parameterization model of ektacytometry to an artificially rigid RBC model, we formulated an innovative system for estimating the average rigidity of the rigid RBC population in SCD blood. We demonstrated that this method could more accurately determine the bulk stiffness of the rigid RBC populations. This information could potentially help develop the ektacytometry technique as a tool for assessing disease severity in SCD patients, offering novel insights into the disease pathology and treatment.
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Affiliation(s)
- Mario Gutierrez
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Mark Shamoun
- Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Katie Giger Seu
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tyler Tanski
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Theodosia A Kalfa
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Omolola Eniola-Adefeso
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.
- Macromolecular Science and Engineering Program, University of Michigan, Ann Arbor, MI, 48109, USA.
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13
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Ugurel E, Kisakurek ZB, Aksu Y, Goksel E, Cilek N, Yalcin O. Calcium/protein kinase C signaling mechanisms in shear-induced mechanical responses of red blood cells. Microvasc Res 2021; 135:104124. [PMID: 33359148 DOI: 10.1016/j.mvr.2020.104124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022]
Abstract
Red blood cell (RBC) deformability has vital importance for microcirculation in the body, as RBCs travel in narrow capillaries under shear stress. Deformability can be defined as a remarkable cell ability to change shape in response to an external force which allows the cell to pass through the narrowest blood capillaries. Previous studies showed that RBC deformability could be regulated by Ca2+/protein kinase C (PKC) signaling mechanisms due to the phosphorylative changes in RBC membrane proteins by kinases and phosphatases. We investigated the roles of Ca2+/PKC signaling pathway on RBC mechanical responses and impaired RBC deformability under continuous shear stress (SS). A protein kinase C inhibitor Chelerythrine, a tyrosine phosphatase inhibitor Calpeptin, and a calcium channel blocker Verapamil were applied into human blood samples in 1 micromolar concentration. Samples with drugs were treated with or without 3 mM Ca2+. A shear stress at 5 Pa level was applied to each sample continuously for 300 s. RBC deformability was measured by a laser-assisted optical rotational cell analyzer (LORRCA) and was calculated as the change in elongation index (EI) of RBC upon a range of shear stress (SS, 0.3-50 Pa). RBC mechanical stress responses were evaluated before and after continuous SS through the parameterization of EI-SS curves. The drug administrations did not produce any significant alterations in RBC mechanical responses when they were applied alone. However, the application of the drugs together with Ca2+ substantially increased RBC deformability compared to calcium alone. Verapamil significantly improved Ca2+-induced impairments of deformability both before and after 5 Pa SS exposure (p < 0.0001). Calpeptin and Chelerythrine significantly ameliorated impaired deformability only after continuous SS (p < 0.05). Shear-induced improvements of deformability were conserved by the drug administrations although shear-induced deformability was impaired when the drugs were applied with calcium. The blocking of Ca2+ channel by Verapamil improved impaired RBC mechanical responses independent of the SS effect. The inhibition of tyrosine phosphatase and protein kinase C by Calpeptin and Chelerythrine, respectively, exhibited ameliorating effects on calcium-impaired deformability with the contribution of shear stress. The modulation of Ca2+/PKC signaling pathway could regulate the mechanical stress responses of RBCs when cells are under continuous SS exposure. Shear-induced improvements in the mechanical properties of RBCs by this signaling mechanism could facilitate RBC flow in the microcirculation of pathophysiological disorders, wherein Ca2+ homeostasis is disturbed and RBC deformability is reduced.
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Affiliation(s)
- Elif Ugurel
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey; Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | | | - Yasemin Aksu
- School of Medicine, Koç University, Istanbul, Turkey
| | - Evrim Goksel
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey; Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | - Neslihan Cilek
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey; Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | - Ozlem Yalcin
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey; Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey; School of Medicine, Koç University, Istanbul, Turkey.
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14
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McNamee AP, Fitzpatrick T, Tansley GD, Simmonds MJ. Sublethal Supraphysiological Shear Stress Alters Erythrocyte Dynamics in Subsequent Low-Shear Flows. Biophys J 2020; 119:2179-2189. [PMID: 33130119 DOI: 10.1016/j.bpj.2020.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/24/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022] Open
Abstract
Blood is a non-Newtonian, shear-thinning fluid owing to the physical properties and behaviors of red blood cells (RBCs). Under increased shear flow, pre-existing clusters of cells disaggregate, orientate with flow, and deform. These essential processes enhance fluidity of blood, although accumulating evidence suggests that sublethal blood trauma-induced by supraphysiological shear exposure-paradoxically increases the deformability of RBCs when examined under low-shear conditions, despite obvious decrement of cellular deformation at moderate-to-higher shear stresses. Some propose that rather than actual enhancement of cell mechanics, these observations are "pseudoimprovements" and possibly reflect altered flow and/or cell orientation, leading to methodological artifacts, although direct evidence is lacking. This study thus sought to explore RBC mechanical responses in shear flow using purpose-built laser diffractometry in tandem with direct optical visualization to address this problem. Freshly collected RBCs were exposed to a mechanical stimulus known to drastically alter cell deformability (i.e., prior shear exposure (PSE) to 100 Pa × 300 s). Samples were subsequently transferred to a custom-built slit-flow chamber that combined laser diffractometry with direct cell visualization. Cell suspensions were sheared in a stepwise manner (between 0.3 and 5.0 Pa), with each step being maintained for 15 s. Deformability and cell orientation indices were recorded for small-scatter Fraunhofer diffraction patterns and also visualized RBCs. PSE RBCs had significantly decreased visualized and laser-derived deformability at any given shear stress ≥1 Pa. Novel, to our knowledge, observations demonstrated that PSE RBCs had increased heterogeneity of direct visualized orientation with flow vector at any shear, which may be due to greater vorticity and thus instability in 5-Pa flow compared with unsheared control. These findings indicate that shear exposure and stress-strain history can alter subsequent RBC behavior in physiologically relevant low-shear flows. These findings may yield insight into microvascular disorders in recipients of mechanical circulatory support and individuals with hematological diseases that alter physical properties of blood.
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Affiliation(s)
- Antony P McNamee
- Biorheology Research Laboratory, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Tom Fitzpatrick
- School of Environment and Science, Griffith University, Gold Coast, Queensland, Australia
| | - Geoff D Tansley
- School of Engineering and Built Environment, Griffith University, Gold Coast, Queensland, Australia
| | - Michael J Simmonds
- Biorheology Research Laboratory, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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15
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Kumar A, Schmidt BR, Sanchez ZAC, Yazar F, Davis RW, Ramasubramanian AK, Saha AK. Automated Motion Tracking and Data Extraction for Red Blood Cell Biomechanics. ACTA ACUST UNITED AC 2020; 93:e75. [PMID: 32391975 DOI: 10.1002/cpcy.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Red blood cell biomechanics can provide us with a deeper understanding of macroscopic physiology and have the potential of being used for diagnostic purposes. In diseases like sickle cell anemia and malaria, reduced red blood cell deformability can be used as a biomarker, leading to further assays and diagnoses. A microfluidic system is useful for studying these biomechanical properties. We can observe detailed red blood cell mechanical behavior as they flow through microcapillaries using high-speed imaging and microscopy. Microfluidic devices are advantageous over traditional methods because they can serve as high-throughput tests. However, to rapidly analyze thousands of cells, there is a need for powerful image processing tools and software automation. We describe a workflow process using Image-Pro to identify and track red blood cells in a video, take measurements, and export the data for use in statistical analysis tools. The information in this protocol can be applied to large-scale blood studies where entire cell populations need to be analyzed from many cohorts of donors. © 2020 The Authors. Basic Protocol 1: Enhancing raw video for motion tracking Basic Protocol 2: Extracting motion tracking data from enhanced video.
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Affiliation(s)
- Arun Kumar
- Department of Biomedical Engineering, San José State University, San José, California
| | - Brendan R Schmidt
- Department of Chemical and Materials Engineering, San José State University, San José, California
| | | | - Feyza Yazar
- Department of Biomedical Engineering, San José State University, San José, California
| | - Ronald W Davis
- Department of Biochemistry, Stanford University, Stanford, California
| | - Anand K Ramasubramanian
- Department of Chemical and Materials Engineering, San José State University, San José, California
| | - Amit K Saha
- Department of Biochemistry, Stanford University, Stanford, California
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16
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Valadão Cardoso A. An experimental erythrocyte rigidity index (Ri) and its correlations with Transcranial Doppler velocities (TAMMV), Gosling Pulsatility Index PI, hematocrit, hemoglobin concentration and red cell distribution width (RDW). PLoS One 2020; 15:e0229105. [PMID: 32084188 PMCID: PMC7034921 DOI: 10.1371/journal.pone.0229105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022] Open
Abstract
Brain artery velocities (Time-Averaged Maximum Mean Velocity, TAMMV) by Transcranial Doppler (TCD), hematocrit, hemoglobin, Red blood cell (RBC) Distribution Width (RDW) and RBC rigidity index (Ri), when reported together with their correlations, provide a accurate and useful diagnostic picture than blood viscosity measurements alone. Additionally, our study included a sixth parameter provided by TCD, the Gosling Pulsatility Index PI, which is an indicator of CBF (Cerebral Blood Flow) resistance. All these parameters are routine in Hematology except for values of Ri. The rigidity (Ri) of the RBC is the main rheological characteristic of the blood of Sickle Cell Anemia (SCA) patients and several pathologies. However, its quantification depends on many commercial and experimental techniques, none disseminated and predominant around the World. The difference in absorbance values of the blood, during the process of sedimentation in a microwell of a Microplate Reader, is a straightforward way of semi-quantifying the RBC rigidity Ri, since the fraction of irreversibly sickled red blood cells does not form rouleaux. Erythrocyte Rigidity Index (Ri) was calculated using initial absorbance Ainitial (6 s) and final Afinal (540 s), Ri = 1 / (Ai-Af). The Ri of 119 patients (2–17 y / o, M & F) SCA, SCC (Sickle Cell/hemoglobin C), SCD (Sickle Cell/hemoglobin D), Sβ0thal (Sickle Cell/hemoglobin Beta Zero Thalassemia) and 71 blood donors (20–65 y / o, M & F) were measured in our laboratory while the five parameters (TAMMV and PI by TCD, Hct, Hb and RDW) were obtained from medical records. The in vitro addition of hydroxyurea (HU, 50mg /dl, n = 51 patients, and n = 8 healthy donors) in the samples decreased the rouleaux adhesion strength of both donor and patients’ blood samples, leading to extraordinarily high Ri values. The correlation between the studied parameters was especially significant for the direct relationships between Ri, TAMMV, and PI.
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Affiliation(s)
- Antonio Valadão Cardoso
- Rheology Laboratory, Materials Engineering Post-Graduation Program REDEMAT-UEMG/DESP-ED, State University of Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- * E-mail:
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17
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Farrell AT, Panepinto J, Carroll CP, Darbari DS, Desai AA, King AA, Adams RJ, Barber TD, Brandow AM, DeBaun MR, Donahue MJ, Gupta K, Hankins JS, Kameka M, Kirkham FJ, Luksenburg H, Miller S, Oneal PA, Rees DC, Setse R, Sheehan VA, Strouse J, Stucky CL, Werner EM, Wood JC, Zempsky WT. End points for sickle cell disease clinical trials: patient-reported outcomes, pain, and the brain. Blood Adv 2019; 3:3982-4001. [PMID: 31809538 PMCID: PMC6963237 DOI: 10.1182/bloodadvances.2019000882] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
To address the global burden of sickle cell disease (SCD) and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to: patient-reported outcomes (PROs), pain (non-PROs), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the PROs, pain, and brain panels, as well as relevant findings and recommendations from the biomarkers panel. The panels identify end points, where there were supporting data, to use in clinical trials of SCD. In addition, the panels discuss where further research is needed to support the development and validation of additional clinical trial end points.
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Affiliation(s)
| | - Julie Panepinto
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Ankit A Desai
- Krannert Institute of Cardiology, Indiana University, Bloomington, IN
| | - Allison A King
- Division of Hematology and Oncology in Pediatrics and Medicine, Washington University School of Medicine, St. Louis, MO
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | | | - Amanda M Brandow
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Michael R DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences
- Department of Neurology, and
- Department of Psychiatry, School of Medicine, Vanderbilt University, Nashville, TN
| | - Kalpna Gupta
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Michelle Kameka
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and
- Biomedical Research Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Harvey Luksenburg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - David C Rees
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Vivien A Sheehan
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - John Strouse
- Division of Hematology, Department of Medicine, and
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Cheryl L Stucky
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Ellen M Werner
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - John C Wood
- Children's Hospital Los Angeles, Los Angeles, CA; and
| | - William T Zempsky
- Department of Pediatrics, Connecticut Children's/School of Medicine, University of Connecticut, Hartford, CT
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Detterich JA, Kato R, Bush A, Chalacheva P, Ponce D, De Zoysa M, Shah P, Khoo MC, Meiselman HJ, Coates TD, Wood JC. Sickle cell microvascular paradox-oxygen supply-demand mismatch. Am J Hematol 2019; 94:678-688. [PMID: 30916797 DOI: 10.1002/ajh.25476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
We have previously demonstrated that sickle cell disease (SCD) patients maintain normal global systemic and cerebral oxygen delivery by increasing cardiac output. However, ischemic end-organ injury remains common suggesting that tissue oxygen delivery may be impaired by microvascular dysregulation or damage. To test this hypothesis, we performed fingertip laser Doppler flowmetry measurements at the base of the nailbed and regional oxygen saturation (rSO2 ) on the dorsal surface of the same hand. This was done during flow mediated dilation (FMD) studies in 26 chronically transfused SCD, 75 non-transfused SCD, and 18 control subjects. Chronically transfused SCD patients were studied prior to and following a single transfusion and there was no acute change in rSO2 or perfusion. Laser Doppler estimates of resting perfusion were 76% higher in non-transfused and 110% higher in transfused SCD patients, compared to control subjects. In contrast, rSO2 was 12 saturation points lower in non-transfused SCD patients, but normal in the transfused SCD patients. During cuff occlusion, rSO2 declined at the same rate in all subjects suggesting similar intrinsic oxygen consumption rates. Upon cuff release, laser doppler post occlusive hyperemia was blunted in SCD patients in proportion to their resting perfusion values. Transfusion therapy did not improve the hyperemia response. FMD was impaired in SCD subjects but partially ameliorated in transfused SCD subjects. Taken together, non-transfused SCD subjects demonstrate impaired conduit artery FMD, impaired microcirculatory post-occlusive hyperemia, and resting hypoxia in the hand despite compensated oxygen delivery, suggesting impaired oxygen supply-demand matching. Transfusion improves FMD and oxygen supply-demand matching but not microcirculation hyperemic response.
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Affiliation(s)
- Jon A. Detterich
- Division of Cardiology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
- Department of Physiology and NeuroscienceUniversity of Southern California Keck School of Medicine Los Angeles California
| | - Roberta Kato
- Division of Pediatric PulmonologyChildren's Hospital Los Angeles Los Angeles California
| | - Adam Bush
- Department of Biomedical EngineeringUniversity of Southern California Viterbi School of Engineering
| | - Patjanaporn Chalacheva
- Department of Biomedical EngineeringUniversity of Southern California Viterbi School of Engineering
| | - Derek Ponce
- Division of Cardiology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
| | - Madushka De Zoysa
- Division of Cardiology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
| | - Payal Shah
- Division of Hematology Oncology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
| | - Michael C. Khoo
- Department of Biomedical EngineeringUniversity of Southern California Viterbi School of Engineering
| | - Herbert J. Meiselman
- Department of Physiology and NeuroscienceUniversity of Southern California Keck School of Medicine Los Angeles California
| | - Thomas D. Coates
- Division of Hematology Oncology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
| | - John C. Wood
- Division of Cardiology, Children's Hospital Los AngelesUniversity of Southern California Keck School of Medicine Los Angeles California
- Department of Biomedical EngineeringUniversity of Southern California Viterbi School of Engineering
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Guruprasad P, Mannino RG, Caruso C, Zhang H, Josephson CD, Roback JD, Lam WA. Integrated automated particle tracking microfluidic enables high-throughput cell deformability cytometry for red cell disorders. Am J Hematol 2019; 94:189-199. [PMID: 30417938 DOI: 10.1002/ajh.25345] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 12/17/2022]
Abstract
Investigating individual red blood cells (RBCs) is critical to understanding hematologic diseases, as pathology often originates at the single-cell level. Many RBC disorders manifest in altered biophysical properties, such as deformability of RBCs. Due to limitations in current biophysical assays, there exists a need for high-throughput analysis of RBC deformability with single-cell resolution. To that end, we present a method that pairs a simple in vitro artificial microvasculature network system with an innovative MATLAB-based automated particle tracking program, allowing for high-throughput, single-cell deformability index (sDI) measurements of entire RBC populations. We apply our technology to quantify the sDI of RBCs from healthy volunteers, Sickle cell disease (SCD) patients, a transfusion-dependent beta thalassemia major patient, and in stored packed RBCs (pRBCs) that undergo storage lesion over 4 weeks. Moreover, our system can also measure cell size for each RBC, thereby enabling 2D analysis of cell deformability vs cell size with single cell resolution akin to flow cytometry. Our results demonstrate the clear existence of distinct biophysical RBC subpopulations with high interpatient variability in SCD as indicated by large magnitude skewness and kurtosis values of distribution, the "shifting" of sDI vs RBC size curves over transfusion cycles in beta thalassemia, and the appearance of low sDI RBC subpopulations within 4 days of pRBC storage. Overall, our system offers an inexpensive, convenient, and high-throughput method to gauge single RBC deformability and size for any RBC population and has the potential to aid in disease monitoring and transfusion guidelines for various RBC disorders.
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Affiliation(s)
- Puneeth Guruprasad
- Wallace H. Coulter Department of Biomedical Engineering; Georgia Institute of Technology and Emory University; Atlanta Georgia
| | - Robert G. Mannino
- Wallace H. Coulter Department of Biomedical Engineering; Georgia Institute of Technology and Emory University; Atlanta Georgia
- Aflac Cancer and Blood Disorder Center of Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Christina Caruso
- Aflac Cancer and Blood Disorder Center of Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | | | - Cassandra D. Josephson
- Department of Pathology and Laboratory Medicine; Emory University School of Medicine, Center for Transfusion and Cellular Therapies; Atlanta Georgia
| | - John D. Roback
- Department of Pathology and Laboratory Medicine; Emory University School of Medicine, Center for Transfusion and Cellular Therapies; Atlanta Georgia
| | - Wilbur A. Lam
- Wallace H. Coulter Department of Biomedical Engineering; Georgia Institute of Technology and Emory University; Atlanta Georgia
- Aflac Cancer and Blood Disorder Center of Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
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20
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Simmonds MJ, Suriany S, Ponce D, Detterich JA. Red blood cell mechanical sensitivity improves in patients with sickle cell disease undergoing chronic transfusion after prolonged, subhemolytic shear exposure. Transfusion 2018; 58:2788-2796. [PMID: 30325033 DOI: 10.1111/trf.14901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a genetically inherited hemoglobinopathy in which deoxygenated hemoglobin S polymerizes, leading to stiff red blood cells (RBCs) and inefficient microcirculatory blood flow. Transfusion therapy acts as primary and secondary prevention of ischemic stroke in SCD. Whether blood transfusion alters the mechanical sensitivity (MS) of RBCs to prolonged subhemolytic shear stress (shear) is unknown. We hypothesized that individuals with SCD undergoing chronic blood transfusion would have improved sensitivity to shear, compared with patients not undergoing transfusion therapy. STUDY DESIGN AND METHODS Blood suspensions from individuals with SCD not receiving (n = 15) and receiving (n = 15) chronic simple transfusion were conditioned to shear (1, 4, 16, 32, and 64 Pa) for various durations (1, 4, 16, 32, and 64 sec), and then deformability of RBCs was immediately measured. Healthy young controls (n = 15) were included for reference. A surface mesh was interpolated using the data to determine the effect of blood transfusion on MS of RBCs. RESULTS There was impaired RBC deformability to prolonged supraphysiologic shear in both SCD groups; however, MS improved in transfused patients when exposed to prolonged physiologic shear. Furthermore, in the transfused patients with SCD, the threshold above which subhemolytic damage occurs was similar to controls. CONCLUSION We found that chronic transfusion therapy normalizes the MS threshold above which RBC subhemolytic damage occurs after prolonged shear exposure in SCD. An important and novel finding in transfused patients with SCD was the improvement in RBC deformability in response to prolonged shear exposure over the physiologic range.
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Affiliation(s)
- Michael J Simmonds
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Silvie Suriany
- Division of Hematology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Derek Ponce
- Division of Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jon A Detterich
- Division of Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA.,Department of Physiology and Biophysics, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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21
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Lizarralde Iragorri MA, El Hoss S, Brousse V, Lefevre SD, Dussiot M, Xu T, Ferreira AR, Lamarre Y, Silva Pinto AC, Kashima S, Lapouméroulie C, Covas DT, Le Van Kim C, Colin Y, Elion J, Français O, Le Pioufle B, El Nemer W. A microfluidic approach to study the effect of mechanical stress on erythrocytes in sickle cell disease. LAB ON A CHIP 2018; 18:2975-2984. [PMID: 30168832 DOI: 10.1039/c8lc00637g] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The human red blood cell is a biconcave disc of 6-8 × 2 μm that is highly elastic. This capacity to deform enables it to stretch while circulating through narrow capillaries to ensure its main function of gas exchange. Red cell shape and deformability are altered in membrane disorders because of defects in skeletal or membrane proteins affecting protein-protein interactions. Red cell properties are also altered in other pathologies such as sickle cell disease. Sickle cell disease is a genetic hereditary disorder caused by a single point mutation in the β-globin gene generating sickle haemoglobin (HbS). Hypoxia drives HbS polymerisation that is responsible for red cell sickling and reduced deformability. The main clinical features of sickle cell disease are vaso-occlusive crises and haemolytic anaemia. Foetal haemoglobin (HbF) inhibits HbS polymerisation and positively impacts red cell survival in the circulation but the mechanism through which it exerts this action is not fully characterized. In this study, we designed a microfluidic biochip mimicking the dimensions of human capillaries to measure the impact of repeated mechanical stress on the survival of red cells at the single cell scale under controlled pressure. We show that mechanical stress is a critical parameter underlying intravascular haemolysis in sickle cell disease and that high intracellular levels of HbF protect against lysis. The biochip is a promising tool to address red cell deformability in pathological situations and to screen for molecules positively impacting this parameter in order to improve red cell survival in the circulation.
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Affiliation(s)
- Maria Alejandra Lizarralde Iragorri
- Biologie Intégrée du Globule Rouge UMR_S1134, Inserm, Univ. Paris Diderot, Sorbonne Paris Cité, Univ. de la Réunion, Univ. des Antilles, INTS, 6 rue Alexandre Cabanel, 75015 Paris, France.
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22
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Duez J, Carucci M, Garcia-Barbazan I, Corral M, Perez O, Presa JL, Henry B, Roussel C, Ndour PA, Rosa NB, Sanz L, Gamo FJ, Buffet P. High-throughput microsphiltration to assess red blood cell deformability and screen for malaria transmission–blocking drugs. Nat Protoc 2018; 13:1362-1376. [DOI: 10.1038/nprot.2018.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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23
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Kuck L, Grau M, Simmonds MJ. Recovery time course of erythrocyte deformability following exposure to shear is dependent upon conditioning shear stress. Biorheology 2018; 54:141-152. [DOI: 10.3233/bir-17151] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lennart Kuck
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Marijke Grau
- Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Michael J. Simmonds
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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24
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Parrow NL, Violet PC, Tu H, Nichols J, Pittman CA, Fitzhugh C, Fleming RE, Mohandas N, Tisdale JF, Levine M. Measuring Deformability and Red Cell Heterogeneity in Blood by Ektacytometry. J Vis Exp 2018. [PMID: 29364234 DOI: 10.3791/56910] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Decreased red cell deformability is characteristic of several disorders. In some cases, the extent of defective deformability can predict severity of disease or occurrence of serious complications. Ektacytometry uses laser diffraction viscometry to measure the deformability of red blood cells subject to either increasing shear stress or an osmotic gradient at a constant value of applied shear stress. However, direct deformability measurements are difficult to interpret when measuring heterogenous blood that is characterized by the presence of both rigid and deformable red cells. This is due to the inability of rigid cells to properly align in response to shear stress and results in a distorted diffraction pattern marked by an exaggerated decrease in apparent deformability. Measurement of the degree of distortion provides an indicator of the heterogeneity of the erythrocytes in blood. In sickle cell anemia, this is correlated with the percentage of rigid cells, which reflects the hemoglobin concentration and hemoglobin composition of the erythrocytes. In addition to measuring deformability, osmotic gradient ektacytometry provides information about the osmotic fragility and hydration status of erythrocytes. These parameters also reflect the hemoglobin composition of red blood cells from sickle cell patients. Ektacytometry measures deformability in populations of red cells and does not, therefore, provide information on the deformability or mechanical properties of individual erythrocytes. Regardless, the goal of the techniques described herein is to provide a convenient and reliable method for measuring the deformability and cellular heterogeneity of blood. These techniques may be useful for monitoring temporal changes, as well as disease progression and response to therapeutic intervention in several disorders. Sickle cell anemia is one well-characterized example. Other potential disorders where measurements of red cell deformability and/or heterogeneity are of interest include blood storage, diabetes, Plasmodium infection, iron deficiency, and the hemolytic anemias due to membrane defects.
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Affiliation(s)
- Nermi L Parrow
- Department of Pediatrics, Saint Louis University School of Medicine;
| | - Pierre-Christian Violet
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases
| | - Hongbin Tu
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases
| | - James Nichols
- Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases
| | - Corinne A Pittman
- Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health
| | - Courtney Fitzhugh
- Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health
| | - Robert E Fleming
- Department of Pediatrics, Saint Louis University School of Medicine; Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine
| | | | - John F Tisdale
- Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases
| | - Mark Levine
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases
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25
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Simmonds MJ, Meiselman HJ. Prediction of the level and duration of shear stress exposure that induces subhemolytic damage to erythrocytes. Biorheology 2017; 53:237-249. [PMID: 28222499 DOI: 10.3233/bir-16120] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Current generation mechanical circulatory assist devices are designed to minimize high shears to blood for prolonged durations to avoid hemolysis. However, red blood cells (RBC) demonstrate impaired capacity to deform when exposed to shear stress (SS) well below the "hemolytic threshold". OBJECTIVE We endeavored to identify how changes in the magnitude and duration of SS exposure alter RBC deformability and subsequently develop a model to predict erythrocyte subhemolytic damage. METHODS RBC suspensions were exposed to discrete magnitudes of SS (1-64 Pa) for specific durations (1-64 s), immediately prior to RBC deformability being measured. Analyses included exploring the maximal RBC deformation (EImax) and SS required for half EImax (SS1/2). A surface-mesh was interpolated onto the raw data to predict impaired RBC deformability. RESULTS When SS was applied at <16Pa, limited changes were observed. When RBC were exposed to 32 Pa, mild impairments in EImax and SS1/2 occurred, although 64 Pa caused a dramatic impairment of RBC deformability. A clear relation between SS duration and magnitude was determined, which could predict impaired RBC deformability. CONCLUSION The present results provide a model that may be used to predict whether RBC deformability is decreased following exposure to a given level and duration of SS, and may guide design of future generations of mechanical circulatory assist devices.
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Affiliation(s)
- Michael J Simmonds
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - Herbert J Meiselman
- Department of Physiology and Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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26
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Horobin JT, Sabapathy S, Simmonds MJ. Repetitive Supra-Physiological Shear Stress Impairs Red Blood Cell Deformability and Induces Hemolysis. Artif Organs 2017; 41:1017-1025. [PMID: 28543744 DOI: 10.1111/aor.12890] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 12/20/2022]
Abstract
The supra-physiological shear stress that blood is exposed to while traversing mechanical circulatory assist devices affects the physical properties of red blood cells (RBCs), impairs RBC deformability, and may induce hemolysis. Previous studies exploring RBC damage following exposure to supra-physiological shear stress have employed durations exceeding clinical instrumentation, thus we explored changes in RBC deformability following exposure to shear stress below the reported "hemolytic threshold" using shear exposure durations per minute (i.e., duty-cycles) reflective of that employed by circulatory assist devices. Blood collected from 20 male donors, aged 18-38 years, was suspended in a viscous medium and exposed to an intermittent shear stress protocol of 1 s at 100 Pa, every 60 s for 60 duty-cycles. During the remaining 59 s/min, the cells were left at stasis until the subsequent duty-cycle commenced. At discrete time points (15/30/45/60 duty-cycles), an ektacytometer measured RBC deformability immediately after shear exposure at 100 Pa. Plasma-free hemoglobin, a measurement of hemolysis, was quantified via spectrophotometry. Supra-physiological shear stress impaired RBC properties, as indicated by: (1) decreased maximal elongation of RBCs at infinite shear stress following 15 duty-cycles (P <0.05); (2) increased real-time RBC deformability during application of the supra-physiological shear stress protocol (100 Pa) following exposure to 1 duty-cycle (F (1.891, 32.15) = 12.21, P = 0.0001); and (3) increased plasma-free hemoglobin following 60 duty-cycles (P < 0.01). The present study indicates that exposure of RBCs to short-term, repeated supra-physiological shear stress, impairs RBC deformability, with the extent of impairment exacerbated with each duty-cycle, and ultimately precipitates hemolysis.
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Affiliation(s)
- Jarod T Horobin
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Surendran Sabapathy
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Michael J Simmonds
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia
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27
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Parrow NL, Tu H, Nichols J, Violet PC, Pittman CA, Fitzhugh C, Fleming RE, Mohandas N, Tisdale JF, Levine M. Measurements of red cell deformability and hydration reflect HbF and HbA 2 in blood from patients with sickle cell anemia. Blood Cells Mol Dis 2017; 65:41-50. [PMID: 28472705 DOI: 10.1016/j.bcmd.2017.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
Decreased erythrocyte deformability, as measured by ektacytometry, may be associated with disease severity in sickle cell anemia (SCA). Heterogeneous populations of rigid and deformable cells in SCA blood result in distortions of diffraction pattern measurements that correlate with the concentration of hemoglobin S (HbS) and the percentage of irreversibly sickled cells. We hypothesize that red cell heterogeneity, as well as deformability, will also be influenced by the concentration of alternative hemoglobins such as fetal hemoglobin (HbF) and the adult variant, HbA2. To test this hypothesis, we investigate the relationship between diffraction pattern distortion, osmotic gradient ektacytometry parameters, and the hemoglobin composition of SCA blood. We observe a correlation between the extent of diffraction pattern distortions and percentage of HbF and HbA2. Osmotic gradient ektacytometry data indicate that minimum elongation in the hypotonic region is positively correlated with HbF, as is the osmolality at which it occurs. The osmolality at both minimum and maximum elongation is inversely correlated with HbS and HbA2. These data suggest that HbF may effectively improve surface-to-volume ratio and osmotic fragility in SCA erythrocytes. HbA2 may be relatively ineffective in improving these characteristics or cellular hydration at the levels found in this patient cohort.
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Affiliation(s)
- Nermi L Parrow
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Hongbin Tu
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - James Nichols
- Molecular and Clinical Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Pierre-Christian Violet
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Corinne A Pittman
- Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Courtney Fitzhugh
- Sickle Cell Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert E Fleming
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO, USA; Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Narla Mohandas
- Red Cell Physiology Laboratory, New York Blood Center, New York, NY, USA
| | - John F Tisdale
- Molecular and Clinical Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Mark Levine
- Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA.
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28
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Mozar A, Connes P, Collins B, Hardy-Dessources MD, Romana M, Lemonne N, Bloch W, Grau M. Red blood cell nitric oxide synthase modulates red blood cell deformability in sickle cell anemia. Clin Hemorheol Microcirc 2017; 64:47-53. [PMID: 26890236 DOI: 10.3233/ch-162042] [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: 12/11/2022]
Abstract
Sickle cell anemia (SCA) is an inherited red blood cells (RBC) disorder characterized by significantly decreased RBC deformability. The present study aimed to assess whether modulation of RBC Nitric Oxide Synthase (RBC-NOS) activation could affect RBC deformability in SCA.Blood of twenty-five SCA patients was treated for 1 hour at 37°C with Phosphate Buffered Saline (PBS) or PBS containing 1% of Dimethylsulfoxyde as control, L-arginine or N(5)-(1-Iminoethyl)-L-ornithine (L-NIO) to directly stimulate or inhibit RBC-NOS, insulin or wortmannin to indirectly stimulate or inhibit RBC-NOS through their effects on the PI3 Kinase/Akt pathway, and sodium nitroprusside (SNP) and 2-(4-Carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (cPTIO) as NO donor and NO scavenger, respectively. RBC deformability was measured by ektacytometry at 3 Pa.RBC deformability significantly increased after insulin treatment and significantly decreased after L-NIO and wortmannin incubation. The other conditions did not affect deformability. Significantly increased nitrotyrosine levels, a marker of enhanced free radical generation, were detected by immunohistochemistry in SNP and insulin treated samples.These data suggest that RBC deformability of SCA can be modulated by RBC-NOS activity but also that oxidative stress may impair effectiveness of RBC-NOS produced NO.
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Affiliation(s)
- Anaïs Mozar
- UMR Inserm U1134, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe, France.,Laboratoire d'Excellence GR-Ex, PRES Sorbonne, Paris, France
| | - Philippe Connes
- UMR Inserm U1134, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe, France.,Laboratoire d'Excellence GR-Ex, PRES Sorbonne, Paris, France.,Laboratoire CRIS EA647, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, France; Institut Universitaire de France, Paris, France
| | - Bianca Collins
- Institute of Cardiovascular Research and Sports Medicine, Department of Molecular and Cellular Sports Medicine, German Sport University, Cologne, Germany
| | - Marie-Dominique Hardy-Dessources
- UMR Inserm U1134, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe, France.,Laboratoire d'Excellence GR-Ex, PRES Sorbonne, Paris, France
| | - Marc Romana
- UMR Inserm U1134, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe, France.,Laboratoire d'Excellence GR-Ex, PRES Sorbonne, Paris, France
| | - Nathalie Lemonne
- Unité Transversale de la Drépanocytose, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Wilhelm Bloch
- Institute of Cardiovascular Research and Sports Medicine, Department of Molecular and Cellular Sports Medicine, German Sport University, Cologne, Germany
| | - Marijke Grau
- Institute of Cardiovascular Research and Sports Medicine, Department of Molecular and Cellular Sports Medicine, German Sport University, Cologne, Germany
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29
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Mozar A, Charlot K, Sandor B, Rabaï M, Lemonne N, Billaud M, Hardy-Dessources MD, Beltan E, Pandey RC, Connes P, Ballas SK. Pfaffia paniculata extract improves red blood cell deformability in sickle cell patients. Clin Hemorheol Microcirc 2017; 62:327-33. [PMID: 26444603 DOI: 10.3233/ch-151972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of the present study was to test the effects of Pfaffia paniculata (PP) extract on the red blood cell (RBC) rheological properties of patients with sickle cell disease (SCD) and healthy (AA) individuals. Blood from 7 SCD and 4 AA individuals were collected in EDTA tubes. Washed RBCs were incubated with various concentration of PP extract: 0.0, 0.2 or 0.5 mg/ml of PP solution for 5 hrs at 37°C. RBC deformability was measured by ektacytometry at 9 shear stresses ranging from 0.3 to 30 Pa, and RBC aggregation properties were determined by laser-backscattered techniques. Because RBCs from SCD patients are fragile, a stability test was also performed to test for the fragility of RBC exposed to a constant shear stress (70 Pa) for 10 min. While RBC deformability was not improved by the use of PP extract in AA, we noted an improvement of this parameter in patients with SCD between the 0.0 and 0.5 mg/ml conditions. In contrast to AA RBCs, the fragility of SCD RBCs was not affected by PP extract. In conclusion, this study demonstrates the beneficial effects, in-vitro, of PP extract on the RBC deformability of SCD patients, notably at high shear stress (a shear stress condition usually found in capillaries).
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Affiliation(s)
- Anais Mozar
- Inserm U 1134, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe.,Laboratory of Excellence GR-Ex, Paris, France
| | - Keyne Charlot
- Inserm U 1134, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe.,Laboratory of Excellence GR-Ex, Paris, France.,Laboratoire ACTES-EA3596, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
| | - Barbara Sandor
- Department of Medicine, University of Pecs Medical School, Pecs, Hungary
| | - Miklos Rabaï
- Department of Medicine, University of Pecs Medical School, Pecs, Hungary
| | - Nathalie Lemonne
- Unité Transversale de la Drépanocytose, CHU de Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe
| | - Marie Billaud
- Unité Transversale de la Drépanocytose, CHU de Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe
| | - Marie-Dominique Hardy-Dessources
- Inserm U 1134, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe.,Laboratory of Excellence GR-Ex, Paris, France
| | - Eric Beltan
- Service d'Immunologie-Hématologie, CHU de Pointe à Pitre, Pointe-à-Pitre, Guadeloupe
| | - Ramesh C Pandey
- Research Laboratories, GDP Ayurvedic University (GDPAU), New Brunswick, NJ, USA
| | - Philippe Connes
- Inserm U 1134, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe.,Laboratory of Excellence GR-Ex, Paris, France.,Institut Universitaire de France, Paris, France.,Laboratoire CRIS EA647, Equipe "Biologie Vasculaire et Globule Rouge", Université de Lyon (UCBL1), France
| | - Samir K Ballas
- Cardeza Foundation, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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30
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Renoux C, Parrow N, Faes C, Joly P, Hardeman M, Tisdale J, Levine M, Garnier N, Bertrand Y, Kebaili K, Cuzzubbo D, Cannas G, Martin C, Connes P. Importance of methodological standardization for the ektacytometric measures of red blood cell deformability in sickle cell anemia. Clin Hemorheol Microcirc 2016; 62:173-9. [DOI: 10.3233/ch-151979] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Céline Renoux
- Laboratoire CRIS EA647, Team “Vascular Biology and Red Blood Cell”, Université Lyon 1, Université de Lyon, Lyon, France
- Laboratoire de Biochimie et de Biologie Moléculatire, Hôpital Edouard Herriot, Lyon, France
- Laboratoired’Excellence GR-Ex « The red cell: from genesis to death », Paris, France
| | - Nermi Parrow
- National Institutes of Health, Washington, DC, USA
| | - Camille Faes
- Laboratoire CRIS EA647, Team “Vascular Biology and Red Blood Cell”, Université Lyon 1, Université de Lyon, Lyon, France
- Laboratoired’Excellence GR-Ex « The red cell: from genesis to death », Paris, France
| | - Philippe Joly
- Laboratoire CRIS EA647, Team “Vascular Biology and Red Blood Cell”, Université Lyon 1, Université de Lyon, Lyon, France
- Laboratoire de Biochimie et de Biologie Moléculatire, Hôpital Edouard Herriot, Lyon, France
- Laboratoired’Excellence GR-Ex « The red cell: from genesis to death », Paris, France
| | - Max Hardeman
- Academic Medical Center, Amsterdam, The Netherlands
| | - John Tisdale
- National Institutes of Health, Washington, DC, USA
| | - Mark Levine
- National Institutes of Health, Washington, DC, USA
| | | | - Yves Bertrand
- Institut d’Hématologie et d’Oncologie Pédiatrique, Lyon, France
| | - Kamila Kebaili
- Institut d’Hématologie et d’Oncologie Pédiatrique, Lyon, France
| | | | - Giovanna Cannas
- Service de Médecine Interne, Hôpital Edouard Herriot, Lyon, France
| | - Cyril Martin
- Laboratoire CRIS EA647, Team “Vascular Biology and Red Blood Cell”, Université Lyon 1, Université de Lyon, Lyon, France
- Laboratoired’Excellence GR-Ex « The red cell: from genesis to death », Paris, France
| | - Philippe Connes
- Laboratoire CRIS EA647, Team “Vascular Biology and Red Blood Cell”, Université Lyon 1, Université de Lyon, Lyon, France
- Laboratoired’Excellence GR-Ex « The red cell: from genesis to death », Paris, France
- Institut Universitaire de France, Paris, France
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