Abnormal phospholipid molecular species of erythrocytes in sickle cell anemia

As the lipid composition of cell membranes has significant effects upon cellular function, we hypothesized that the membranes of sickle cells might have a distorted lipid composition. Accordingly, we analyzed the molecular species of the choline and ethanolamine glycerophospholipids, the fatty acid composition of the total phospholipids and of the five major individual phospholipids of erythrocytes from 8 patients with sickle cell anemia and from 14 normal subjects. Of the 31 molecular species identified for each subclass of the glycerophospholipids, 12 were found to be distinctly abnormal. Sickle cells contained more molecular species with saturated and monounsaturated fatty acid at the sn-2 position and fewer molecular species with polyunsaturated fatty acids at the sn-2 position. The values ranged from 20 to 60% above or below normal values. In diacyl choline glycerophospholipids (outer membrane leaflet), sickle erythrocytes contained lower amounts of the 16:0-18:2 species and higher 16:0-18:1 and 16:0-16:0 species. In diacyl ethanolamine glycerophospholipid (inner membrane leaflet), sickle erythrocytes had lower amounts of 18:0-22:6; 16:0-22:4; 18:0-18:2; 18:1-18:2; and 18:1-20:3. In phosphatidylcholine and phosphatidylethanolamine, sickle erythrocytes contained less linoleic acid, less docosahexaenoic acid (30-40%) and more oleic and palmitic acids (20-30%) compared to normal erythrocytes. These same differences were seen also in the total phospholipids. Our data demonstrated distinct abnormalities of the phospholipid molecular species composition in the membrane lipids of sickle erythrocytes. These defects might have a role in one or more known metabolic abnormalities of sickle cell disease including cation imbalance, dehydration, disturbed membrane phospholipid asymmetry, and hypercoagulability. Furthermore, detailed information of the phospholipid molecular species composition of normal erythrocytes was provided.

Clinical one-year outcomes after stenting in acute myocardial infarction

We retrospectively review our results of 96 stent placements in 64 patients identified from our data base who received stents acutely and within 48 hr of acute myocardial infarction. The average age was 60 years; 77% were male. The average length of stay was 6.75 days. Three patients needed coronary artery bypass grafting (CABG) before discharge: 2 for stent occlusion and 1 for papillary muscle rupture. Need for CABG, further percutaneous transluminal coronary angioplasty (PTCA), myocardial infarction, and death defined outcome. Mean patient follow-up was 10.3 (+/-5.3) months. Seventy-two percent of patients were free of outcome events at 1 year, 17% needed CABG, and 11% required further PTCA. There were 2 myocardial infarctions and 1 death. Presence of left bundle branch block on admission electrocardiogram and angina in hospital after stent placement predicted worse outcome (P < 0.01).