1
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Gurkan UA, Wood DK, Carranza D, Herbertson LH, Diamond SL, Du E, Guha S, Di Paola J, Hines PC, Papautsky I, Shevkoplyas SS, Sniadecki NJ, Pamula VK, Sundd P, Rizwan A, Qasba P, Lam WA. Next generation microfluidics: fulfilling the promise of lab-on-a-chip technologies. Lab Chip 2024; 24:1867-1874. [PMID: 38487919 DOI: 10.1039/d3lc00796k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Microfluidic lab-on-a-chip technologies enable the analysis and manipulation of small fluid volumes and particles at small scales and the control of fluid flow and transport processes at the microscale, leading to the development of new methods to address a broad range of scientific and medical challenges. Microfluidic and lab-on-a-chip technologies have made a noteworthy impact in basic, preclinical, and clinical research, especially in hematology and vascular biology due to the inherent ability of microfluidics to mimic physiologic flow conditions in blood vessels and capillaries. With the potential to significantly impact translational research and clinical diagnostics, technical issues and incentive mismatches have stymied microfluidics from fulfilling this promise. We describe how accessibility, usability, and manufacturability of microfluidic technologies should be improved and how a shift in mindset and incentives within the field is also needed to address these issues. In this report, we discuss the state of the microfluidic field regarding current limitations and propose future directions and new approaches for the field to advance microfluidic technologies closer to translation and clinical use. While our report focuses on using blood as the prototypical biofluid sample, the proposed ideas and research directions can be extrapolated to other areas of hematology, oncology, biology, and medicine.
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Affiliation(s)
| | | | | | | | | | - E Du
- Florida Atlantic University, USA
| | | | | | - Patrick C Hines
- Wayne State University School of Medicine, USA
- Functional Fluidics, Inc., USA
| | | | | | | | | | - Prithu Sundd
- VERSITI Blood Research Institute and Medical College of Wisconsin, USA
| | - Asif Rizwan
- National Heart, Lung, and Blood Institute, USA
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2
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Ghosh SK, Man Y, Fraiwan A, Waters C, McKenzie C, Lu C, Pfau D, Kawsar H, Bhaskaran N, Pandiyan P, Jin G, Briggs F, Zender CC, Rezaee R, Panagakos F, Thuener JE, Wasman J, Tang A, Qari H, Wise-Draper T, McCormick TS, Madabhushi A, Gurkan UA, Weinberg A. Beta-defensin index: A functional biomarker for oral cancer detection. Cell Rep Med 2024; 5:101447. [PMID: 38442713 PMCID: PMC10983043 DOI: 10.1016/j.xcrm.2024.101447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/14/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024]
Abstract
There is an unmet clinical need for a non-invasive and cost-effective test for oral squamous cell carcinoma (OSCC) that informs clinicians when a biopsy is warranted. Human beta-defensin 3 (hBD-3), an epithelial cell-derived anti-microbial peptide, is pro-tumorigenic and overexpressed in early-stage OSCC compared to hBD-2. We validate this expression dichotomy in carcinoma in situ and OSCC lesions using immunofluorescence microscopy and flow cytometry. The proportion of hBD-3/hBD-2 levels in non-invasively collected lesional cells compared to contralateral normal cells, obtained by ELISA, generates the beta-defensin index (BDI). Proof-of-principle and blinded discovery studies demonstrate that BDI discriminates OSCC from benign lesions. A multi-center validation study shows sensitivity and specificity values of 98.2% (95% confidence interval [CI] 90.3-99.9) and 82.6% (95% CI 68.6-92.2), respectively. A proof-of-principle study shows that BDI is adaptable to a point-of-care assay using microfluidics. We propose that BDI may fulfill a major unmet need in low-socioeconomic countries where pathology services are lacking.
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Affiliation(s)
- Santosh K Ghosh
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA.
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, CWRU, Cleveland, OH, USA
| | - Arwa Fraiwan
- Department of Mechanical and Aerospace Engineering, CWRU, Cleveland, OH, USA
| | | | - Crist McKenzie
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | - Cheng Lu
- Center for Computational Imaging & Personalized Diagnostics, CWRU, Cleveland, OH, USA
| | - David Pfau
- School of Medicine, CWRU, Cleveland, OH, USA
| | - Hameem Kawsar
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA
| | - Natarajan Bhaskaran
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA
| | - Pushpa Pandiyan
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA
| | - Ge Jin
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA
| | - Farren Briggs
- Department of Population and Quantitative Health Sciences, CWRU, Cleveland, OH, USA
| | - Chad C Zender
- Department of Otolaryngology, University Hospital of Cleveland, Cleveland, OH, USA
| | - Rod Rezaee
- Department of Otolaryngology, University Hospital of Cleveland, Cleveland, OH, USA
| | - Fotinos Panagakos
- West Virginia University (WVU) School of Dentistry, Morgantown, WV, USA
| | - Jason E Thuener
- Department of Otolaryngology, University Hospital of Cleveland, Cleveland, OH, USA
| | - Jay Wasman
- Department of Pathology, University Hospital of Cleveland, Cleveland, OH, USA
| | - Alice Tang
- Otolaryngology, Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hiba Qari
- Department of Diagnostic Sciences, WVU School of Dentistry, Morgantown, WV, USA
| | - Trisha Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | | | - Anant Madabhushi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, CWRU, Cleveland, OH, USA
| | - Aaron Weinberg
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA.
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Sekyonda Z, An R, Goreke U, Man Y, Monchamp K, Bode A, Zhang Q, El-Gammal Y, Kityo C, Kalfa TA, Akkus O, Gurkan UA. Rapid measurement of hemoglobin-oxygen dissociation by leveraging Bohr effect and Soret band bathochromic shift. Analyst 2024. [PMID: 38501195 DOI: 10.1039/d3an02071a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Oxygen (O2) binds to hemoglobin (Hb) in the lungs and is then released (dissociated) in the tissues. The Bohr effect is a physiological mechanism that governs the affinity of Hb for O2 based on pH, where a lower pH results in a lower Hb-O2 affinity and higher Hb-O2 dissociation. Hb-O2 affinity and dissociation are crucial for maintaining aerobic metabolism in cells and tissues. Despite its vital role in human physiology, Hb-O2 dissociation measurement is underutilized in basic research and in clinical laboratories, primarily due to the technical complexity and limited throughput of existing methods. We present a rapid Hb-O2 dissociation measurement approach by leveraging the Bohr effect and detecting the optical shift in the Soret band that corresponds to the light absorption by the heme group in Hb. This new method reduces Hb-O2 dissociation measurement time from hours to minutes. We show that Hb deoxygenation can be accelerated chemically at the optimal pH of 6.9. We show that time and pH-controlled deoxygenation of Hb results in rapid and distinct conformational changes in its tertiary structure. These molecular conformational changes are manifested as significant, detectable shifts in Hb's optical absorption spectrum, particularly in the characteristic Soret band (414 nm). We extensively validated the method by testing human blood samples containing normal Hb and Hb variants. We show that rapid Hb-O2 dissociation can be used to screen for and detect Hb-O2 affinity disorders and to evaluate the function and efficacy of Hb-modifying therapies. The ubiquity of optical absorption spectrophotometers positions this approach as an accessible, rapid, and accurate Hb-O2 dissociation measurement method for basic research and clinical use. We anticipate this method's broad adoption will democratize the diagnosis and prognosis of Hb disorders, such as sickle cell disease. Further, this method has the potential to transform the research and development of new targeted and genome-editing-based therapies that aim to modify or improve Hb-O2 affinity.
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Affiliation(s)
- Zoe Sekyonda
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Glennan Building 616B, Cleveland, OH, 44106, USA.
| | - Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Glennan Building 616B, Cleveland, OH, 44106, USA.
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Glennan Building 616B, Cleveland, OH, 44106, USA.
| | - Karamoja Monchamp
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Glennan Building 616B, Cleveland, OH, 44106, USA.
- Division of Hematology and Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Glennan Building 616B, Cleveland, OH, 44106, USA.
- Division of Hematology and Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Qiaochu Zhang
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Glennan Building 616B, Cleveland, OH, 44106, USA.
| | - Yasmin El-Gammal
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cissy Kityo
- The Joint Clinical Research Center, Kampala, Uganda
| | - Theodosia A Kalfa
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ozan Akkus
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Glennan Building 616B, Cleveland, OH, 44106, USA.
- Department of Orthopedics, Case Western Reserve University, Cleveland, OH, USA
| | - Umut A Gurkan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Glennan Building 616B, Cleveland, OH, 44106, USA.
- Department of Orthopedics, Case Western Reserve University, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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Isiksacan Z, D’Alessandro A, McKenna DH, Tessier SN, Kucukal E, Gokaltun AA, William N, Sandlin RD, Bischof J, Mohandas N, Busch MP, Elbuken C, Gurkan UA, Toner M, Acker JP, Yarmush ML, Usta OB. Reply to Kaestner et al.: Pioneering quantitative platforms for stored red blood cell assessment open the door for precision transfusion medicine. Proc Natl Acad Sci U S A 2024; 121:e2320521121. [PMID: 38437566 PMCID: PMC10945785 DOI: 10.1073/pnas.2320521121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Affiliation(s)
- Ziya Isiksacan
- Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, CO80045
| | - David H. McKenna
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN55455
| | - Shannon N. Tessier
- Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
| | | | - A. Aslihan Gokaltun
- Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
- Department of Chemical Engineering, Hacettepe University, Ankara06532, Turkey
| | - Nishaka William
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, ABT6G 2R8, Canada
| | - Rebecca D. Sandlin
- Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
| | - John Bischof
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN55455
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN55455
| | | | - Michael P. Busch
- Vitalant Research Institute, San Francisco, CA94105
- Department of Laboratory Medicine, University of California, San Francisco, CA94105
| | - Caglar Elbuken
- Institute of Materials Science and Nanotechnology, National Nanotechnology Research Center, Bilkent University, Ankara06800, Turkey
- Faculty of Biochemistry and Molecular Medicine, Faculty of Medicine, University of Oulu, Oulu90014, Finland
- Valtion Teknillinen Tutkimuskeskus Technical Research Centre of Finland Ltd., Oulu90570, Finland
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH44106
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH44106
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH44106
| | - Mehmet Toner
- Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
| | - Jason P. Acker
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, ABT6G 2R8, Canada
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, ABT6G 2R8, Canada
| | - Martin L. Yarmush
- Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ08854
| | - O. Berk Usta
- Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
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Wegierak D, Cooley MB, Perera R, Wulftange WJ, Gurkan UA, Kolios MC, Exner AA. Decorrelation Time Mapping as an Analysis Tool for Nanobubble-Based Contrast Enhanced Ultrasound Imaging. IEEE Trans Med Imaging 2024; PP:1-1. [PMID: 38329864 DOI: 10.1109/tmi.2024.3364076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Nanobubbles (NBs; ~100-500 nm diameter) are preclinical ultrasound (US) contrast agents that expand applications of contrast enhanced US (CEUS). Due to their sub-micron size, high particle density, and deformable shell, NBs in pathological states of heightened vascular permeability (e.g. in tumors) extravasate, enabling applications not possible with microbubbles (~1000-10,000 nm diameter). A method that can separate intravascular versus extravascular NB signal is needed as an imaging biomarker for improved tumor detection. We present a demonstration of decorrelation time (DT) mapping for enhanced tumor NB-CEUS imaging. In vitro models validated the sensitivity of DT to agent motion. Prostate cancer mouse models validated in vivo imaging potential and sensitivity to cancerous tissue. Our findings show that DT is inversely related to NB motion, offering enhanced detail of NB dynamics in tumors, and highlighting the heterogeneity of the tumor environment. Average DT was high in tumor regions (~9 s) compared to surrounding normal tissue (~1 s) with higher sensitivity to tumor tissue compared to other mapping techniques. Molecular NB targeting to tumors further extended DT (11 s) over non-targeted NBs (6 s), demonstrating sensitivity to NB adherence. From DT mapping of in vivo NB dynamics we demonstrate the heterogeneity of tumor tissue while quantifying extravascular NB kinetics and delineating intra-tumoral vasculature. This new NB-CEUS-based biomarker can be powerful in molecular US imaging, with improved sensitivity and specificity to diseased tissue and potential for use as an estimator of vascular permeability and the enhanced permeability and retention (EPR) effect in tumors.
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An R, Avanaki A, Thota P, Nemade S, Mehta A, Gurkan UA. Point-of-Care Diagnostic Test for Beta-Thalassemia. Biosensors (Basel) 2024; 14:83. [PMID: 38392002 PMCID: PMC10886532 DOI: 10.3390/bios14020083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
Hemoglobin (Hb) disorders are among the most common monogenic diseases affecting nearly 7% of the world population. Among various Hb disorders, approximately 1.5% of the world population carries β-thalassemia (β-Thal), affecting 40,000 newborns every year. Early screening and a timely diagnosis are essential for β-thalassemia patients for the prevention and management of later clinical complications. However, in Africa, Southern Europe, the Middle East, and Southeast Asia, where β-thalassemia is most prevalent, the diagnosis and screening for β-thalassemia are still challenging due to the cost and logistical burden of laboratory diagnostic tests. Here, we present Gazelle, which is a paper-based microchip electrophoresis platform that enables the first point-of-care diagnostic test for β-thalassemia. We evaluated the accuracy of Gazelle for the β-Thal screening across 372 subjects in the age range of 4-63 years at Apple Diagnostics lab in Mumbai, India. Additionally, 30 blood samples were prepared to mimic β-Thal intermediate and β-Thal major samples. Gazelle-detected levels of Hb A, Hb F, and Hb A2 demonstrated high levels of correlation with the results reported through laboratory gold standard high-performance liquid chromatography (HPLC), yielding a Pearson correlation coefficient = 0.99. This ability to obtain rapid and accurate results suggests that Gazelle may be suitable for the large-scale screening and diagnosis of β-Thal.
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Affiliation(s)
- Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Biomedical Engineering, University of Houston, Houston, TX 77004, USA
- Department of Biomedical Sciences, University of Houston, Houston, TX 77004, USA
| | | | | | - Sai Nemade
- Plasma Lab, Jalgaon 425001, India (A.M.)
- Apple Diagnostics Lab, Ghatkopar, Mumbai 400077, India
| | - Amrish Mehta
- Plasma Lab, Jalgaon 425001, India (A.M.)
- Apple Diagnostics Lab, Ghatkopar, Mumbai 400077, India
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
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7
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Goreke U, Gonzales A, Shipley B, Man Y, Wulftange W, An R, Hinczewski M, Gurkan UA. Motion Blur Microscopy. bioRxiv 2023:2023.10.08.561435. [PMID: 37873474 PMCID: PMC10592665 DOI: 10.1101/2023.10.08.561435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Imaging and characterizing the dynamics of cellular adhesion in blood samples is of fundamental importance in understanding biological function. In vitro microscopy methods are widely used for this task, but typically require diluting the blood with a buffer to allow for transmission of light. However whole blood provides crucial mechanical and chemical signaling cues that influence adhesion dynamics, which means that conventional approaches lack the full physiological complexity of living microvasculature. We propose to overcome this challenge by a new in vitro imaging method which we call motion blur microscopy (MBM). By decreasing the source light intensity and increasing the integration time during imaging, flowing cells are blurred, allowing us to identify adhered cells. Combined with an automated analysis using machine learning, we can for the first time reliably image cell interactions in microfluidic channels during whole blood flow. MBM provides a low cost, easy to implement alternative to intravital microscopy, the in vivo approach for studying how the whole blood environment shapes adhesion dynamics. We demonstrate the method's reproducibility and accuracy in two example systems where understanding cell interactions, adhesion, and motility is crucial-sickle red blood cells adhering to laminin, and CAR-T cells adhering to E-selectin. We illustrate the wide range of data types that can be extracted from this approach, including distributions of cell size and eccentricity, adhesion times, trajectories and velocities of adhered cells moving on a functionalized surface, as well as correlations among these different features at the single cell level. In all cases MBM allows for rapid collection and processing of large data sets, ranging from thousands to hundreds of thousands of individual adhesion events. The method is generalizable to study adhesion mechanisms in a variety of diseases, including cancer, blood disorders, thrombosis, inflammatory and autoimmune diseases, as well as providing rich datasets for theoretical modeling of adhesion dynamics.
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Affiliation(s)
- Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | - Ayesha Gonzales
- Department of Physics, Case Western Reserve University, Cleveland, OH
| | - Brandon Shipley
- Department of Physics, Case Western Reserve University, Cleveland, OH
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | - William Wulftange
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | | | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
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8
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Dhillon NS, Jeon N, Gurkan UA, Gupta AS, Bonomo RA, Drummy LF, Zhang M, Chance MR. Military Medicine and Medical Research as a Source of Inspiration and Innovation to Solve National Security and Health Challenges in the 21st Century. Pathog Immun 2023; 8:51-63. [PMID: 37799210 PMCID: PMC10550252 DOI: 10.20411/pai.v8i1.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 10/07/2023] Open
Abstract
The history of military medicine and research is rife with examples of novel treatments and new approaches to heal and cure soldiers and others impacted by war's devastation. In the 21st century, new threats, like climate change, are combined with traditional threats, like geopolitical conflict, to create novel challenges for our strategic interests. Extreme and inaccessible environments provide heightened risks for warfighter exposure to dangerous bacteria, viruses, and fungi, as well as exposure to toxic substances and extremes of temperature, pressure, or both providing threats to performance and eroding resilience. Back home, caring for our veterans is also a health-care priority, and the diseases of veterans increasingly overlap with the health needs of an aging society. These trends of climate change, politics, and demographics suggest performance evaluation and resilience planning and response are critical to assuring both warfighter performance and societal health. The Cleveland ecosystem, comprising several hospitals, a leading University, and one of the nation's larger Veteran's Health Administration systems, is ideal for incubating and understanding the response to these challenges. In this review, we explore the interconnections of collaborations between Defense agencies, particularly Air Force and Army and academic medical center-based investigators to drive responses to the national health security challenges facing the United States and the world.
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Affiliation(s)
- Nanak S. Dhillon
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, OH
- Center for Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Nayeon Jeon
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, OH
- Center for Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Anirban Sen Gupta
- Department of Biomedical Engineering, School of Medicine, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Robert A. Bonomo
- Center for Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Case Western Reserve University, Cleveland, OH; VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES); Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, and Biochemistry, Case Western Reserve University, Cleveland, Ohio
| | - Lawrence F. Drummy
- Materials and Manufacturing Directorate, Air Force Research Laboratory, Dayton, Ohio
| | - Mei Zhang
- Department of Biomedical Engineering, School of Medicine, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Mark R. Chance
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, OH
- Center for Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Biomedical Engineering, School of Medicine, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
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9
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Isiksacan Z, D’Alessandro A, Wolf SM, McKenna DH, Tessier SN, Kucukal E, Gokaltun AA, William N, Sandlin RD, Bischof J, Mohandas N, Busch MP, Elbuken C, Gurkan UA, Toner M, Acker JP, Yarmush ML, Usta OB. Assessment of stored red blood cells through lab-on-a-chip technologies for precision transfusion medicine. Proc Natl Acad Sci U S A 2023; 120:e2115616120. [PMID: 37494421 PMCID: PMC10410732 DOI: 10.1073/pnas.2115616120] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Transfusion of red blood cells (RBCs) is one of the most valuable and widespread treatments in modern medicine. Lifesaving RBC transfusions are facilitated by the cold storage of RBC units in blood banks worldwide. Currently, RBC storage and subsequent transfusion practices are performed using simplistic workflows. More specifically, most blood banks follow the "first-in-first-out" principle to avoid wastage, whereas most healthcare providers prefer the "last-in-first-out" approach simply favoring chronologically younger RBCs. Neither approach addresses recent advances through -omics showing that stored RBC quality is highly variable depending on donor-, time-, and processing-specific factors. Thus, it is time to rethink our workflows in transfusion medicine taking advantage of novel technologies to perform RBC quality assessment. We imagine a future where lab-on-a-chip technologies utilize novel predictive markers of RBC quality identified by -omics and machine learning to usher in a new era of safer and precise transfusion medicine.
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Affiliation(s)
- Ziya Isiksacan
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO80045
| | - Susan M. Wolf
- Law School, Medical School, Consortium on Law and Values in Health, Environment & the Life Sciences, University of Minnesota, Minneapolis, MN55455
| | - David H. McKenna
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN55455
| | - Shannon N. Tessier
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
| | | | - A. Aslihan Gokaltun
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
- Department of Chemical Engineering, Hacettepe University, Ankara06532, Turkey
| | - Nishaka William
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, ABT6G 2R8, Canada
| | - Rebecca D. Sandlin
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
| | - John Bischof
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN55455
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN55455
| | | | - Michael P. Busch
- Vitalant Research Institute, San Francisco, CA94105
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA94105
| | - Caglar Elbuken
- Institute of Materials Science and Nanotechnology, National Nanotechnology Research Center, Bilkent University, Ankara06800, Turkey
- Faculty of Biochemistry and Molecular Medicine, Faculty of Medicine, University of Oulu, 90014Oulu, Finland
- Valtion Teknillinen Tutkimuskeskus Technical Research Centre of Finland Ltd., 90570Oulu, Finland
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH44106
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH44106
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH44106
| | - Mehmet Toner
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
| | - Jason P. Acker
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, ABT6G 2R8, Canada
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, ABT6G 2R8, Canada
| | - Martin L. Yarmush
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ08854
| | - O. Berk Usta
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
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10
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Battalapalli D, Chakraborty P, Jain D, Obaro SK, Gurkan UA, Bonomo RA, Draz MS. Polyethylene Glycol-Mediated Directional Conjugation of Biological Molecules for Enhanced Immunoassays at the Point-of-Care. Polymers (Basel) 2023; 15:3316. [PMID: 37571209 PMCID: PMC10422345 DOI: 10.3390/polym15153316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Rapid and reliable point-of-care (POC) diagnostic tests can have a significant impact on global health. One of the most common approaches for developing POC systems is the use of target-specific biomolecules. However, the conjugation of biomolecules can result in decreased activity, which may compromise the analytical performance and accuracy of the developed systems. To overcome this challenge, we present a polymer-based cross-linking protocol for controlled and directed conjugation of biological molecules. Our protocol utilizes a bifunctional thiol-polyethylene glycol (PEG)-hydrazide polymer to enable site-directed conjugation of IgG antibodies to the surface of screen-printed metal electrodes. The metal surface of the electrodes is first modified with thiolated PEG molecules, leaving the hydrazide groups available to react with the aldehyde group in the Fc fragments of the oxidized IgG antibodies. Using anti-Klebsiella pneumoniae carbapenemase-2 (KPC-2) antibody as a model antibody used for antimicrobial resistance (AMR) testing, our results demonstrate a ~10-fold increase in antibody coupling compared with the standard N-hydroxysuccinimide (NHS)-based conjugation chemistry and effective capture (>94%) of the target KPC-2 enzyme antigen on the surface of modified electrodes. This straightforward and easy-to-perform strategy of site-directed antibody conjugation can be engineered for coupling other protein- and non-protein-based biological molecules commonly used in POC testing and development, thus enhancing the potential for improved diagnostic accuracy and performance.
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Affiliation(s)
| | - Purbali Chakraborty
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Disha Jain
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Stephen K. Obaro
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Umut A. Gurkan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Robert A. Bonomo
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106, USA
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology, Cleveland, OH 44106, USA
| | - Mohamed S. Draz
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44106, USA
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11
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Cooley MB, Wulftange WJ, Wegierak D, Goreke U, Abenojar EC, Gurkan UA, Exner AA. Real-time imaging of nanobubble ultrasound contrast agent flow, extravasation, and diffusion through an extracellular matrix using a microfluidic model. Lab Chip 2023; 23:3453-3466. [PMID: 37424286 DOI: 10.1039/d3lc00514c] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Lipid shell-stabilized nanoparticles with a perfluorocarbon gas-core, or nanobubbles, have recently attracted attention as a new contrast agent for molecular ultrasound imaging and image-guided therapy. Due to their small size (∼275 nm diameter) and flexible shell, nanobubbles have been shown to extravasate through hyperpermeable vasculature (e.g., in tumors). However, little is known about the dynamics and depth of extravasation of intact, acoustically active nanobubbles. Accordingly, in this work, we developed a microfluidic chip with a lumen and extracellular matrix (ECM) and imaging method that allows real-time imaging and characterization of the extravasation process with high-frequency ultrasound. The microfluidic device has a lumen and is surrounded by an extracellular matrix with tunable porosity. The combination of ultrasound imaging and the microfluidic chip advantageously produces real-time images of the entire length and depth of the matrix. This captures the matrix heterogeneity, offering advantages over other imaging techniques with smaller fields of view. Results from this study show that nanobubbles diffuse through a 1.3 μm pore size (2 mg mL-1) collagen I matrix 25× faster with a penetration depth that was 0.19 mm deeper than a 3.7 μm (4 mg mL-1) matrix. In the 3.7 μm pore size matrix, nanobubbles diffused 92× faster than large nanobubbles (∼875 nm diameter). Decorrelation time analysis was successfully used to differentiate flowing and extra-luminally diffusing nanobubbles. In this work, we show for the first time that combination of an ultrasound-capable microfluidic chip and real-time imaging provided valuable insight into spatiotemporal nanoparticle movement through a heterogeneous extracellular matrix. This work could help accurately predict parameters (e.g., injection dosage) that improve translation of nanoparticles from in vitro to in vivo environments.
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Affiliation(s)
- Michaela B Cooley
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - William J Wulftange
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - Dana Wegierak
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA.
| | - Eric C Abenojar
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio 44106, USA.
| | - Umut A Gurkan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA.
| | - Agata A Exner
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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12
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Goreke U, Iram S, Singh G, Domínguez-Medina S, Man Y, Bode A, An R, Little JA, Wirth CL, Hinczewski M, Gurkan UA. Catch bonds in sickle cell disease: Shear-enhanced adhesion of red blood cells to laminin. Biophys J 2023; 122:2564-2576. [PMID: 37177783 PMCID: PMC10323024 DOI: 10.1016/j.bpj.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/14/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023] Open
Abstract
Could the phenomenon of catch bonding-force-strengthened cellular adhesion-play a role in sickle cell disease, where abnormal red blood cell (RBC) adhesion obstructs blood flow? Here, we investigate the dynamics of sickle RBCs adhering to a surface functionalized with the protein laminin (a component of the extracellular matrix around blood vessels) under physiologically relevant microscale flow. First, using total internal reflectance microscopy we characterize the spatial fluctuations of the RBC membrane above the laminin surface before detachment. The complex dynamics we observe suggest the possibility of catch bonding, where the mean detachment time of the cell from the surface initially increases to a maximum and then decreases as a function of shear force. We next conduct a series of shear-induced detachment experiments on blood samples from 25 sickle cell disease patients, quantifying the number and duration of adhered cells under both sudden force jumps and linear force ramps. The experiments reveal that a subset of patients does indeed exhibit catch bonding. By fitting the data to a theoretical model of the bond dynamics, we can extract the mean bond lifetime versus force for each patient. The results show a striking heterogeneity among patients, both in terms of the qualitative behavior (whether or not there is catch bonding) and in the magnitudes of the lifetimes. Patients with large bond lifetimes at physiological forces are more likely to have certain adverse clinical features, like a diagnosis of pulmonary arterial hypertension and intracardiac shunts. By introducing an in vitro platform for fully characterizing RBC-laminin adhesion dynamics, our approach could contribute to the development of patient-specific antiadhesive therapies for sickle cell disease. The experimental setup is also easily generalizable to studying adhesion dynamics in other cell types, for example, leukocytes or cancer cells, and can incorporate disease-relevant environmental conditions like oxygen deprivation.
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Affiliation(s)
- Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Shamreen Iram
- Department of Physics, Case Western Reserve University, Cleveland, Ohio
| | - Gundeep Singh
- Department of Physics, Case Western Reserve University, Cleveland, Ohio
| | - Sergio Domínguez-Medina
- Department of Chemical and Biomolecular Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Jane A Little
- Division of Hematology and Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Christopher L Wirth
- Department of Chemical and Biomolecular Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Michael Hinczewski
- Department of Physics, Case Western Reserve University, Cleveland, Ohio.
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.
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13
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Ke R, Kucukal E, Gurkan UA, Li B. Characterization of fibronectin properties by integrated micro-fluidic experiments and fluid-structure interaction simulations. J Biomech 2023; 150:111505. [PMID: 36867952 DOI: 10.1016/j.jbiomech.2023.111505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/17/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
Fibronectin (Fn) has been observed to assemble in the extracellular matrix (ECM) of cell culture and stretch in response to the external force. The alteration of molecule domain functions generally follows the extension of Fn. Several researchers have investigated fibronectin extensively in molecular architecture and conformation structure. However, the bulk material behavior of the Fn in the ECM has not been fully depicted at the cell scale, and many studies have ignored physiological conditions. Conversely, microfluidic techniques that explore cellular properties based on cell deformation and adhesion have emerged as a powerful and effective platform to study cell rheological transformation in a physiological environment. However, directly quantifying properties from microfluidic measurements remains a challenge. Therefore, it is an efficient way to combine experimental measurements with a robust and reliable numerical framework to calibrate the mechanical stress distribution in the test sample. In this paper, we present a monolithic Lagrangian fluid-structure interaction (FSI) approach within the Optimal Transportation Meshfree (OTM) framework that enables the investigation of the adherent Red Blood Cell (RBC) interacting with fluid and overcomes the drawbacks of the traditional computational tools such as the mesh entanglement and interface tracking, etc. This study aims to assess the material properties of the RBC and Fn fiber by calibrating the numerical predictions to experimental measurements. Moreover, a physical-based constitutive model will be proposed to describe the bulk behavior of the Fn fiber inflow, and the rate-dependent deformation and separation of the Fn fiber will be discussed.
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Affiliation(s)
- Renjie Ke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve, University, Cleveland, 44106 OH, USA
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve, University, Cleveland, 44106 OH, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve, University, Cleveland, 44106 OH, USA
| | - Bo Li
- College of Engineering, Peking University, Beijing 100871, China.
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14
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Man Y, Kucukal E, Liu S, An R, Goreke U, Wulftange WJ, Sekyonda Z, Bode A, Little JA, Manwani D, Stavrou EX, Gurkan UA. A microfluidic device for assessment of E-selectin-mediated neutrophil recruitment to inflamed endothelium and prediction of therapeutic response in sickle cell disease. Biosens Bioelectron 2023; 222:114921. [PMID: 36521205 PMCID: PMC9850363 DOI: 10.1016/j.bios.2022.114921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
Neutrophil recruitment to the inflamed endothelium is a multistep process and is of utmost importance in the development of the hallmark vaso-occlusive crisis in sickle cell disease (SCD). However, there lacks a standardized, clinically feasible approach for assessing neutrophil recruitment to the inflamed endothelium for individualized risk stratification and therapeutic response prediction in SCD. Here, we describe a microfluidic device functionalized with E-selectin, a critical endothelial receptor for the neutrophil recruitment process, as a strategy to assess neutrophil binding under physiologic flow in normoxia and clinically relevant hypoxia in SCD. We show that hypoxia significantly enhances neutrophil binding to E-selectin and promotes the formation of neutrophil-platelet aggregates. Moreover, we identified two distinct patient populations: a more severe clinical phenotype with elevated lactate dehydrogenase levels and absolute reticulocyte counts but lowered fetal hemoglobin levels associated with constitutively less neutrophil binding to E-selectin. Mechanistically, we demonstrate that the extent of neutrophil activation correlates with membrane L-selectin shedding, resulting in the loss of ligand interaction sites with E-selectin. We also show that inhibition of E-selectin significantly reduces leukocyte recruitment to activated endothelial cells. Our findings add mechanistic insight into neutrophil-endothelial interactions under hypoxia and provide a clinically feasible means for assessing neutrophil binding to E-selectin using clinical whole blood samples, which can help guide therapeutic decisions for SCD patients.
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Affiliation(s)
- Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Shichen Liu
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - William J Wulftange
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Zoe Sekyonda
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Medicine, Hematology and Oncology Division, CWRU School of Medicine, Cleveland, OH, USA
| | - Jane A Little
- Department of Hematology, UNC Blood Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY, USA
| | - Evi X Stavrou
- Department of Medicine, Hematology and Oncology Division, CWRU School of Medicine, Cleveland, OH, USA; Medicine Service, Section of Hematology-Oncology, Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
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15
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An R, Man Y, Cheng K, Zhang T, Chen C, Wang F, Abdulla F, Kucukal E, Wulftange WJ, Goreke U, Bode A, Nayak LV, Vercellotti GM, Belcher JD, Little JA, Gurkan UA. Sickle red blood cell-derived extracellular vesicles activate endothelial cells and enhance sickle red cell adhesion mediated by von Willebrand factor. Br J Haematol 2023; 201:552-563. [PMID: 36604837 PMCID: PMC10121869 DOI: 10.1111/bjh.18616] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/14/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023]
Abstract
Endothelial activation and sickle red blood cell (RBC) adhesion are central to the pathogenesis of sickle cell disease (SCD). Quantitatively, RBC-derived extracellular vesicles (REVs) are more abundant from SS RBCs compared with healthy RBCs (AA RBCs). Sickle RBC-derived REVs (SS REVs) are known to promote endothelial cell (EC) activation through cell signalling and transcriptional regulation at longer terms. However, the SS REV-mediated short-term non-transcriptional response of EC is unclear. Here, we examined the impact of SS REVs on acute microvascular EC activation and RBC adhesion at 2 h. Compared with AA REVs, SS REVs promoted human pulmonary microvascular ECs (HPMEC) activation indicated by increased von Willebrand factor (VWF) expression. Under microfluidic conditions, we found abnormal SS RBC adhesion to HPMECs exposed to SS REVs. This enhanced SS RBC adhesion was reduced by haeme binding protein haemopexin or VWF cleaving protease ADAMTS13 to a level similar to HPMECs treated with AA REVs. Consistent with these observations, haemin- or SS REV-induced microvascular stasis in SS mice with implanted dorsal skin-fold chambers that was inhibited by ADAMTS13. The adhesion induced by SS REVs was variable and was higher with SS RBCs from patients with increased markers of haemolysis (lactate dehydrogenase and reticulocyte count) or a concomitant clinical diagnosis of deep vein thrombosis. Our results emphasise the critical contribution made by REVs to the pathophysiology of SCD by triggering acute microvascular EC activation and abnormal RBC adhesion. These findings may help to better understand acute pathophysiological mechanism of SCD and thereby the development of new treatment strategies using VWF as a potential target.
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Affiliation(s)
- Ran An
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Biomedical Engineering, University of Houston, Houston, Texas, USA.,Department of Biomedical Sciences, University of Houston, Houston, Texas, USA
| | - Yuncheng Man
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kevin Cheng
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Tianyi Zhang
- Physiology and Biophysics Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chunsheng Chen
- Division of Hematology, Oncology and Transplantation, Vascular Biology Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Fang Wang
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fuad Abdulla
- Division of Hematology, Oncology and Transplantation, Vascular Biology Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Erdem Kucukal
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - William J Wulftange
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Utku Goreke
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Allison Bode
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lalitha V Nayak
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gregory M Vercellotti
- Division of Hematology, Oncology and Transplantation, Vascular Biology Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - John D Belcher
- Division of Hematology, Oncology and Transplantation, Vascular Biology Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jane A Little
- Divison of Hematology & UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Umut A Gurkan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, Ohio, USA.,Biomedical Engineering Department, Case Western Reserve University, Cleveland, Ohio, USA.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
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16
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Elagooz R, Dhara AR, Gott RM, Adams SE, White RA, Ghosh A, Ganguly S, Man Y, Owusu-Ansah A, Mian OY, Gurkan UA, Komar AA, Ramamoorthy M, Gnanapragasam MN. PUM1 mediates the posttranscriptional regulation of human fetal hemoglobin. Blood Adv 2022; 6:6016-6022. [PMID: 35667093 PMCID: PMC9699939 DOI: 10.1182/bloodadvances.2021006730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/30/2022] [Indexed: 12/14/2022] Open
Abstract
The fetal-to-adult hemoglobin switching at about the time of birth involves a shift in expression from γ-globin to β-globin in erythroid cells. Effective re-expression of fetal γ-globin can ameliorate sickle cell anemia and β-thalassemia. Despite the physiological and clinical relevance of this switch, its posttranscriptional regulation is poorly understood. Here, we identify Pumilo 1 (PUM1), an RNA-binding protein with no previously reported functions in erythropoiesis, as a direct posttranscriptional regulator of β-globin switching. PUM1, whose expression is regulated by the erythroid master transcription factor erythroid Krüppel-like factor (EKLF/KLF1), peaks during erythroid differentiation, binds γ-globin messenger RNA (mRNA), and reduces γ-globin (HBG1) mRNA stability and translational efficiency, which culminates in reduced γ-globin protein levels. Knockdown of PUM1 leads to a robust increase in fetal hemoglobin (∼22% HbF) without affecting β-globin levels in human erythroid cells. Importantly, targeting PUM1 does not limit the progression of erythropoiesis, which provides a potentially safe and effective treatment strategy for sickle cell anemia and β-thalassemia. In support of this idea, we report elevated levels of HbF in the absence of anemia in an individual with a novel heterozygous PUM1 mutation in the RNA-binding domain (p.(His1090Profs∗16); c.3267_3270delTCAC), which suggests that PUM1-mediated posttranscriptional regulation is a critical player during human hemoglobin switching.
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Affiliation(s)
- Reem Elagooz
- Department of Biological, Geological and Environmental Sciences, Cleveland State University, Cleveland, OH
| | - Anita R. Dhara
- Department of Biological, Geological and Environmental Sciences, Cleveland State University, Cleveland, OH
| | - Rose M. Gott
- Department of Biological, Geological and Environmental Sciences, Cleveland State University, Cleveland, OH
| | - Sarah E. Adams
- Department of Biological, Geological and Environmental Sciences, Cleveland State University, Cleveland, OH
| | - Rachael A. White
- Department of Biological, Geological and Environmental Sciences, Cleveland State University, Cleveland, OH
| | - Arnab Ghosh
- Center for Gene Regulation in Health and Disease, Cleveland State University, Cleveland, OH
| | - Shinjini Ganguly
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Amma Owusu-Ansah
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Omar Y. Mian
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Anton A. Komar
- Department of Biological, Geological and Environmental Sciences, Cleveland State University, Cleveland, OH
- Center for Gene Regulation in Health and Disease, Cleveland State University, Cleveland, OH
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH
- Center for RNA Science and Therapeutics, Case Western Reserve University, Cleveland, OH
| | - Mahesh Ramamoorthy
- Center for Gene Regulation in Health and Disease, Cleveland State University, Cleveland, OH
| | - Merlin Nithya Gnanapragasam
- Department of Biological, Geological and Environmental Sciences, Cleveland State University, Cleveland, OH
- Center for Gene Regulation in Health and Disease, Cleveland State University, Cleveland, OH
- Center for RNA Science and Therapeutics, Case Western Reserve University, Cleveland, OH
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17
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An R, Gurkan UA. Emerging functional microfluidic assays for the study of thromboinflammation in sickle cell disease. Curr Opin Hematol 2022; 29:327-334. [PMID: 35916533 PMCID: PMC10440906 DOI: 10.1097/moh.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review briefly summarizes the significant impact of thromboinflammation in sickle cell disease in relation to recent advances in biomarkers that are used in functional microfluidic assays. RECENT FINDINGS Sickle cell disease (SCD) is an inherited hemoglobinopathy that affects 100 000 Americans and millions worldwide. Patients with SCD exhibit chronic haemolysis, chronic inflammation and thrombosis, and vaso-occlusion, triggering various clinical complications, including organ damage and increased mortality and morbidity. Recent advances in functional microfluidic assays provide direct biomarkers of disease, including abnormal white blood cell and red blood cell adhesion, cell aggregation, endothelial degradation and contraction, and thrombus formation. SUMMARY Novel and emerging functional microfluidic assays are a promising and feasible strategy to comprehensively characterize thromboinflammatory reactions in SCD, which can be used for personalized risk assessment and tailored therapeutic decisions.
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Affiliation(s)
- Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
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18
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Girish A, Jolly K, Alsaadi N, de la Fuente M, Recchione A, An R, Disharoon D, Secunda Z, Raghunathan S, Luc NF, Desai C, Knauss E, Han X, Hu K, Wang H, Sekhon UDS, Rohner N, Gurkan UA, Nieman M, Neal MD, Sen Gupta A. Platelet-Inspired Intravenous Nanomedicine for Injury-Targeted Direct Delivery of Thrombin to Augment Hemostasis in Coagulopathies. ACS Nano 2022; 16:16292-16313. [PMID: 35916497 PMCID: PMC10195184 DOI: 10.1021/acsnano.2c05306] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Severe hemorrhage associated with trauma, surgery, and congenital or drug-induced coagulopathies can be life-threatening and requires rapid hemostatic management via topical, intracavitary, or intravenous routes. For injuries that are not easily accessible externally, intravenous hemostatic approaches are needed. The clinical gold standard for this is transfusion of blood products, but due to donor dependence, specialized storage requirements, high risk of contamination, and short shelf life, blood product use faces significant challenges. Consequently, recent research efforts are being focused on designing biosynthetic intravenous hemostats, using intravenous nanoparticles and polymer systems. Here we report on the design and evaluation of thrombin-loaded injury-site-targeted lipid nanoparticles (t-TLNPs) that can specifically localize at an injury site via platelet-mimetic anchorage to the von Willebrand factor (vWF) and collagen and directly release thrombin via diffusion and phospholipase-triggered particle destabilization, which can locally augment fibrin generation from fibrinogen for hemostatic action. We evaluated t-TLNPs in vitro in human blood and plasma, where hemostatic defects were created by platelet depletion and anticoagulation. Spectrophotometric studies of fibrin generation, rotational thromboelastometry (ROTEM)-based studies of clot viscoelasticity, and BioFlux-based real-time imaging of fibrin generation under simulated vascular flow conditions confirmed that t-TLNPs can restore fibrin in hemostatic dysfunction settings. Finally, the in vivo feasibility of t-TLNPs was tested by prophylactic administration in a tail-clip model and emergency administration in a liver-laceration model in mice with induced hemostatic defects. Treatment with t-TLNPs was able to significantly reduce bleeding in both models. Our studies demonstrate an intravenous nanomedicine approach for injury-site-targeted direct delivery of thrombin to augment hemostasis.
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Affiliation(s)
- Aditya Girish
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Ketan Jolly
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Nijmeh Alsaadi
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15123, United States
| | - Maria de la Fuente
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Arielle Recchione
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Dante Disharoon
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Zachary Secunda
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15123, United States
| | - Shruti Raghunathan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Norman F Luc
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Cian Desai
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Elizabeth Knauss
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Xu Han
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Keren Hu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Hanyang Wang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Ujjal Didar Singh Sekhon
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Nathan Rohner
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Marvin Nieman
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Matthew D Neal
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15123, United States
| | - Anirban Sen Gupta
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 44106, United States
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19
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Man Y, An R, Monchamp K, Sekyonda Z, Kucukal E, Federici C, Wulftange WJ, Goreke U, Bode A, Sheehan VA, Gurkan UA. OcclusionChip: A functional microcapillary occlusion assay complementary to ektacytometry for detection of small-fraction red blood cells with abnormal deformability. Front Physiol 2022; 13:954106. [PMID: 36091387 PMCID: PMC9452903 DOI: 10.3389/fphys.2022.954106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
Red blood cell (RBC) deformability is a valuable hemorheological biomarker that can be used to assess the clinical status and response to therapy of individuals with sickle cell disease (SCD). RBC deformability has been measured by ektacytometry for decades, which uses shear or osmolar stress. However, ektacytometry is a population based measurement that does not detect small-fractions of abnormal RBCs. A single cell-based, functional RBC deformability assay would complement ektacytometry and provide additional information. Here, we tested the relative merits of the OcclusionChip, which measures RBC deformability by microcapillary occlusion, and ektacytometry. We tested samples containing glutaraldehyde-stiffened RBCs for up to 1% volume fraction; ektacytometry detected no significant change in Elongation Index (EI), while the OcclusionChip showed significant differences in Occlusion Index (OI). OcclusionChip detected a significant increase in OI in RBCs from an individual with sickle cell trait (SCT) and from a subject with SCD who received allogeneic hematopoietic stem cell transplant (HSCT), as the sample was taken from normoxic (pO2:159 mmHg) to physiologic hypoxic (pO2:45 mmHg) conditions. Oxygen gradient ektacytometry detected no difference in EI for SCT or HSCT. These results suggest that the single cell-based OcclusionChip enables detection of sickle hemoglobin (HbS)-related RBC abnormalities in SCT and SCD, particularly when the HbS level is low. We conclude that the OcclusionChip is complementary to the population based ektacytometry assays, and providing additional sensitivity and capacity to detect modest abnormalities in red cell function or small populations of abnormal red cells.
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Affiliation(s)
- Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Karamoja Monchamp
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
- Division of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Zoe Sekyonda
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Chiara Federici
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
- Division of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - William J. Wulftange
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
- Division of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Vivien A. Sheehan
- Aflac Cancer & Blood Disorders Center Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States
- *Correspondence: Umut A. Gurkan,
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20
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Wulftange WJ, Kucukal E, Man Y, An R, Monchamp K, Sevrain CD, Dashora HR, Owusu-Ansah AT, Bode A, Ilich A, Little JA, Key NS, Gurkan UA. Antithrombin-III mitigates thrombin-mediated endothelial cell contraction and sickle red blood cell adhesion in microscale flow. Br J Haematol 2022; 198:893-902. [PMID: 35822297 PMCID: PMC9542057 DOI: 10.1111/bjh.18328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/27/2022]
Abstract
Individuals with sickle cell disease (SCD) have persistently elevated thrombin generation that results in a state of systemic hypercoagulability. Antithrombin‐III (ATIII), an endogenous serine protease inhibitor, inhibits several enzymes in the coagulation cascade, including thrombin. Here, we utilize a biomimetic microfluidic device to model the morphology and adhesive properties of endothelial cells (ECs) activated by thrombin and examine the efficacy of ATIII in mitigating the adhesion of SCD patient‐derived red blood cells (RBCs) and EC retraction. Microfluidic devices were fabricated, seeded with ECs, and incubated under physiological shear stress. Cells were then activated with thrombin with or without an ATIII pretreatment. Blood samples from subjects with normal haemoglobin (HbAA) and subjects with homozygous SCD (HbSS) were used to examine RBC adhesion to ECs. Endothelial cell surface adhesion molecule expression and confluency in response to thrombin and ATIII treatments were also evaluated. We found that ATIII pretreatment of ECs reduced HbSS RBC adhesion to thrombin‐activated endothelium. Furthermore, ATIII mitigated cellular contraction and reduced surface expression of von Willebrand factor and vascular cell adhesion molecule‐1 (VCAM‐1) mediated by thrombin. Our findings suggest that, by attenuating thrombin‐mediated EC damage and RBC adhesion to endothelium, ATIII may alleviate the thromboinflammatory manifestations of SCD.
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Affiliation(s)
- William J Wulftange
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Karamoja Monchamp
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Charlotte D Sevrain
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Himanshu R Dashora
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Amma T Owusu-Ansah
- Department of Pediatrics, Division of Hematology Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anton Ilich
- Division of Hematology and UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jane A Little
- Division of Hematology and UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nigel S Key
- Division of Hematology and UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
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21
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Goreke U, Bode A, Yaman S, Gurkan UA, Durmus NG. Size and density measurements of single sickle red blood cells using microfluidic magnetic levitation. Lab Chip 2022; 22:683-696. [PMID: 35094036 PMCID: PMC9053311 DOI: 10.1039/d1lc00686j] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Single cells have unique biophysical signatures that can rapidly change during various disease states. For instance, cellular density is an inherent property differing between cell types. Characterizing changes in fundamental density properties down to the single-cell level can reveal sub-populations in pathological states. Here, we have developed a microfluidic, magnetic levitation-based assay (MagDense) that detects minute density differences of individual red blood cells (RBCs) down to 0.0001 g mL-1 resolution. This assay fractionates RBCs based on their density profiles in a non-ionic paramagnetic medium flowing in a capillary microchannel placed between magnets with same poles facing each other. Based on precisely measured levitation height and density of individual RBCs at their specific equilibrium state, we demonstrated that MagDense can accurately analyze the density of sickle hemoglobin (HbS)-containing RBCs and normal hemoglobin (HbA)-containing RBCs. In addition, the precise density and cell size measurements at the single cell level showed three different sub-populations of RBCs in blood samples from individuals with homozygous sickle cell disease receiving blood transfusions; where less dense, HbA-containing RBCs levitated higher, while the denser, HbS-containing RBCs levitated lower. We compared the mean RBC densities of sickle cell disease subjects with healthy controls and found distinctly separated bands of RBC density for each group denoting the likely range of cell densities seen in the blood samples. The high resolution of our method enabled measurement of deviation from the mean RBC density. Moreover, we introduced a new term as a measure of density dispersion, "RBC levitational density width, RLDW". Mean RBC density in sickle cell disease associated with hemoglobin from complete blood count (p = 0.032, linear regression) and RLDW associated with absolute reticulocyte count (ARC) and RBC distribution width (RDW) from complete blood count (p = 0.002 for ARC and p = 003 for RDW, linear regression). Our magnetic levitation-based assay enables rapid, accurate, density-based imaging, profiling and label-free monitoring of single RBCs. Our approach can be broadly applicable to investigate blood cell disorders and the effects of emerging pharmacological and curative therapies in patient outcomes.
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Affiliation(s)
- Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Sena Yaman
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA 94304, USA.
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
| | - Naside Gozde Durmus
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, Stanford, CA 94304, USA.
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22
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Sekyonda Z, An R, Avanaki A, Fraiwan A, Gurkan UA. A Novel Approach for Glycosylated Hemoglobin Testing Using Microchip Affinity Electrophoresis. IEEE Trans Biomed Eng 2022; 70:1473-1480. [PMID: 36315541 PMCID: PMC10185434 DOI: 10.1109/tbme.2022.3218501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Effective management of diabetes largely benefits from early diagnosis followed by intensive long-term regulation of blood glucose. The levels of glycohemoglobin (HbA1 and HbA1c) have been used as standard biomarkers to assess long-term blood glucose concentrations for diabetes diagnosis and management. Gold standard laboratory methods for HbA1 and HbA1c testing are often costly and not widely available. Moreover, currently available point-of-care (POC) immunoassay-based glycohemoglobin tests may produce inaccurate test results for patients with co-existing diseases such as hemoglobin disorders and anemia. Here, we report a POC platform, HemeChip-GHb, for quantitative HbA1 detection leveraging paper-based affinity electrophoresis. METHODS We describe the design and development of the HemeChip-GHb test. Feasibility and accuracy of the HemeChip-GHb system were demonstrated by testing blood samples collected from healthy donors, patients with prediabetes, and patients with diabetes. RESULTS HbA1 levels measured with HemeChip-GHb show 0.96 correlation to the levels reported from the clinical standard HPLC tests, and with a bias of -0.72% based on Bland-Altman analysis. 99.6% of the HbA1 levels for paired HemeChip-GHb and HPLC fell within A and B zones of no difference in clinical outcome based on error grid analysis. CONCLUSION Using HemeChip-GHb we achieved accurate diabetes status detection with sensitivity and specificity of 100%. SIGNIFICANCE We presented a novel POC paper-based affinity electrophoresis platform that has the potential for accurately diagnosing diabetes, and addressing an unmet need for accurate and affordable diagnostics in resource-challenged environments.
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Affiliation(s)
- Zoe Sekyonda
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Ran An
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | | | - Arwa Fraiwan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Umut A. Gurkan
- Mechanical and Aerospace Engineering Department & Biomedical Engineering Department, Case Western Reserve University, Cleveland, USA
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23
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Praljak N, Iram S, Goreke U, Singh G, Hill A, Gurkan UA, Hinczewski M. Integrating deep learning with microfluidics for biophysical classification of sickle red blood cells adhered to laminin. PLoS Comput Biol 2021; 17:e1008946. [PMID: 34843453 PMCID: PMC8659663 DOI: 10.1371/journal.pcbi.1008946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/09/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022] Open
Abstract
Sickle cell disease, a genetic disorder affecting a sizeable global demographic, manifests in sickle red blood cells (sRBCs) with altered shape and biomechanics. sRBCs show heightened adhesive interactions with inflamed endothelium, triggering painful vascular occlusion events. Numerous studies employ microfluidic-assay-based monitoring tools to quantify characteristics of adhered sRBCs from high resolution channel images. The current image analysis workflow relies on detailed morphological characterization and cell counting by a specially trained worker. This is time and labor intensive, and prone to user bias artifacts. Here we establish a morphology based classification scheme to identify two naturally arising sRBC subpopulations-deformable and non-deformable sRBCs-utilizing novel visual markers that link to underlying cell biomechanical properties and hold promise for clinically relevant insights. We then set up a standardized, reproducible, and fully automated image analysis workflow designed to carry out this classification. This relies on a two part deep neural network architecture that works in tandem for segmentation of channel images and classification of adhered cells into subtypes. Network training utilized an extensive data set of images generated by the SCD BioChip, a microfluidic assay which injects clinical whole blood samples into protein-functionalized microchannels, mimicking physiological conditions in the microvasculature. Here we carried out the assay with the sub-endothelial protein laminin. The machine learning approach segmented the resulting channel images with 99.1±0.3% mean IoU on the validation set across 5 k-folds, classified detected sRBCs with 96.0±0.3% mean accuracy on the validation set across 5 k-folds, and matched trained personnel in overall characterization of whole channel images with R2 = 0.992, 0.987 and 0.834 for total, deformable and non-deformable sRBC counts respectively. Average analysis time per channel image was also improved by two orders of magnitude (∼ 2 minutes vs ∼ 2-3 hours) over manual characterization. Finally, the network results show an order of magnitude less variance in counts on repeat trials than humans. This kind of standardization is a prerequisite for the viability of any diagnostic technology, making our system suitable for affordable and high throughput disease monitoring.
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MESH Headings
- Anemia, Sickle Cell/blood
- Anemia, Sickle Cell/diagnostic imaging
- Biophysical Phenomena
- Computational Biology
- Deep Learning
- Diagnosis, Computer-Assisted/statistics & numerical data
- Erythrocyte Deformability/physiology
- Erythrocytes, Abnormal/classification
- Erythrocytes, Abnormal/pathology
- Erythrocytes, Abnormal/physiology
- Hemoglobin, Sickle/chemistry
- Hemoglobin, Sickle/metabolism
- High-Throughput Screening Assays/statistics & numerical data
- Humans
- Image Interpretation, Computer-Assisted/statistics & numerical data
- In Vitro Techniques
- Lab-On-A-Chip Devices/statistics & numerical data
- Laminin/metabolism
- Microfluidics/statistics & numerical data
- Neural Networks, Computer
- Protein Multimerization
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Affiliation(s)
- Niksa Praljak
- Department of Physics, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Physics, Cleveland State University, Cleveland, Ohio, United States of America
| | - Shamreen Iram
- Department of Physics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Gundeep Singh
- Department of Physics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Ailis Hill
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Michael Hinczewski
- Department of Physics, Case Western Reserve University, Cleveland, Ohio, United States of America
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24
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Qua K, Swiatkowski SM, Gurkan UA, Pelfrey CM. A retrospective case study of successful translational research: Gazelle Hb variant point-of-care diagnostic device for sickle cell disease. J Clin Transl Sci 2021; 5:e207. [PMID: 35047218 PMCID: PMC8727719 DOI: 10.1017/cts.2021.871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022] Open
Abstract
Evaluation researchers at Clinical and Translational Science Award (CTSA) hubs are conducting retrospective case studies to evaluate the translational research process. The objective of this study was to deepen knowledge of the translational process and identify contributors to successful translation. We investigated the successful translation of the HemeChip, a low-cost point-of-care diagnostic device for sickle cell disease, using a protocol for retrospective translational science case studies of health interventions developed by evaluators at the National Health Institutes (NIH) and CTSA hubs. Development of the HemeChip began in 2013 and evidence of device use and impact on public health is growing. Data collection methods included five interviews and a review of press, publications, patents, and grants. Barriers to translation included proving novelty, manufacturing costs, fundraising, and academic-industry relations. Facilitators to translation were CTSA pilot program funding, university resources, entrepreneurship training, due diligence, and collaborations. The barriers to translation, how they were overcome, and the key facilitators identified in this case study pinpoint areas for consideration in future funding mechanisms and the infrastructure required to enable successful translation.
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Affiliation(s)
- Kelli Qua
- Clinical and Translational Science Collaborative, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Shannon M. Swiatkowski
- Clinical and Translational Science Collaborative, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, School of Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Engineering, Case School of Engineering, Case Wetern Reserve University, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Clara M. Pelfrey
- Clinical and Translational Science Collaborative, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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25
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An R, Man Y, Iram S, Kucukal E, Hasan MN, Huang Y, Goreke U, Bode A, Hill A, Cheng K, Sekyonda Z, Ahuja SP, Little JA, Hinczewski M, Gurkan UA. Point-of-care microchip electrophoresis for integrated anemia and hemoglobin variant testing. Lab Chip 2021; 21:3863-3875. [PMID: 34585199 PMCID: PMC9714341 DOI: 10.1039/d1lc00371b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Anemia affects over 25% of the world's population with the heaviest burden borne by women and children. Genetic hemoglobin (Hb) variants, such as sickle cell disease, are among the major causes of anemia. Anemia and Hb variant are pathologically interrelated and have an overlapping geographical distribution. We present the first point-of-care (POC) platform to perform both anemia detection and Hb variant identification, using a single paper-based electrophoresis test. Feasibility of this new integrated diagnostic approach is demonstrated via testing individuals with anemia and/or sickle cell disease. Hemoglobin level determination is performed by an artificial neural network (ANN) based machine learning algorithm, which achieves a mean absolute error of 0.55 g dL-1 and a bias of -0.10 g dL-1 against the gold standard (95% limits of agreement: 1.5 g dL-1) from Bland-Altman analysis on the test set. Resultant anemia detection is achieved with 100% sensitivity and 92.3% specificity. With the same tests, subjects with sickle cell disease were identified with 100% sensitivity and specificity. Overall, the presented platform enabled, for the first time, integrated anemia detection and hemoglobin variant identification using a single point-of-care test.
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Affiliation(s)
- Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Shamreen Iram
- Department of Physics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Muhammad Noman Hasan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Yuning Huang
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Ailis Hill
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Kevin Cheng
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Zoe Sekyonda
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Sanjay P Ahuja
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Jane A Little
- Division of Hematology & UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Hinczewski
- Department of Physics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
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Gurkan UA. Poloxamer 188 vs Placebo for Painful Vaso-occlusive Episodes in Children and Adults With Sickle Cell Disease. JAMA 2021; 326:975. [PMID: 34519808 DOI: 10.1001/jama.2021.11100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Umut A Gurkan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, Ohio
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An R, Huang Y, Man Y, Valentine RW, Kucukal E, Goreke U, Sekyonda Z, Piccone C, Owusu-Ansah A, Ahuja S, Little JA, Gurkan UA. Emerging point-of-care technologies for anemia detection. Lab Chip 2021; 21:1843-1865. [PMID: 33881041 PMCID: PMC8875318 DOI: 10.1039/d0lc01235a] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Anemia, characterized by low blood hemoglobin level, affects about 25% of the world's population with the heaviest burden borne by women and children. Anemia leads to impaired cognitive development in children, as well as high morbidity and early mortality among sufferers. Anemia can be caused by nutritional deficiencies, oncologic treatments and diseases, and infections such as malaria, as well as inherited hemoglobin or red cell disorders. Effective treatments are available for anemia upon early detection and the treatment method is highly dependent on the cause of anemia. There is a need for point-of-care (POC) screening, early diagnosis, and monitoring of anemia, which is currently not widely accessible due to technical challenges and cost, especially in low- and middle-income countries where anemia is most prevalent. This review first introduces the evolution of anemia detection methods followed by their implementation in current commercially available POC anemia diagnostic devices. Then, emerging POC anemia detection technologies leveraging new methods are reviewed. Finally, we highlight the future trends of integrating anemia detection with the diagnosis of relevant underlying disorders to accurately identify specific root causes and to facilitate personalized treatment and care.
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Affiliation(s)
- Ran An
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Yuning Huang
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Yuncheng Man
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Russell W Valentine
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Erdem Kucukal
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Utku Goreke
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Zoe Sekyonda
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Connie Piccone
- Department of Pediatric Hematology, Carle Foundation Hospital, Urbana, IL, USA
| | - Amma Owusu-Ansah
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Sanjay Ahuja
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Jane A Little
- Division of Hematology & UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Umut A Gurkan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA. and Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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Kucukal E, Man Y, Gurkan UA, Schmidt BE. Blood Flow Velocimetry in a Microchannel During Coagulation Using Particle Image Velocimetry and Wavelet-Based Optical Flow Velocimetry. J Biomech Eng 2021; 143:1105252. [PMID: 33764427 DOI: 10.1115/1.4050647] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Indexed: 01/05/2023]
Abstract
This article describes novel measurements of the velocity of whole blood flow in a microchannel during coagulation. The blood is imaged volumetrically using a simple optical setup involving a white light source and a microscope camera. The images are processed using particle image velocimetry (PIV) and wavelet-based optical flow velocimetry (wOFV), both of which use images of individual blood cells as flow tracers. Measurements of several clinically relevant parameters such as the clotting time, decay rate, and blockage ratio are computed. The high-resolution wOFV results yield highly detailed information regarding thrombus formation and corresponding flow evolution that is the first of its kind.
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Affiliation(s)
- E Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106
| | - Y Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106
| | - Umut A Gurkan
- Warren E. Rupp Associate Professor Department of Mechanical and Aerospace Engineering, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106; Department of Biomedical Engineering, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106
| | - B E Schmidt
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106
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Abstract
PURPOSE OF REVIEW This review summarizes the significant biophysical and rheological aspects of red blood cell physiology and pathophysiology in relation to recent advances in microfluidic biomarker assays and emerging targeted or curative intent therapies. RECENT FINDINGS Alterations in red cell biophysical properties and blood rheology have been associated with numerous hematologic and circulatory disorders. Recent advances in biomarker assays enable effective assessment of these biophysical and rheological properties in normoxia or physiological hypoxia in a clinically meaningful way. There are emerging targeted or curative therapies that aim to improve red cell pathophysiology, especially in the context of inherited hemoglobin disorders, such as sickle cell disease. SUMMARY Red cell pathophysiology can be therapeutically targeted and the improvements in membrane and cellular biophysics and blood rheology can now be feasibly assessed via new microfluidic biomarker assays. Recent advances provide a new hope and novel treatment options for major red cell ailments, including inherited hemoglobin disorders, membrane disorders, and other pathologies of the red cell, such as malaria.
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Affiliation(s)
- Umut A. Gurkan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH 44106, USA
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH 44106, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
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30
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Man Y, Maji D, An R, Ahuja SP, Little JA, Suster MA, Mohseni P, Gurkan UA. Microfluidic electrical impedance assessment of red blood cell-mediated microvascular occlusion. Lab Chip 2021; 21:1036-1048. [PMID: 33666615 PMCID: PMC8170703 DOI: 10.1039/d0lc01133a] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Alterations in the deformability of red blood cells (RBCs), occurring in hemolytic blood disorders such as sickle cell disease (SCD), contribute to vaso-occlusion and disease pathophysiology. There are few functional in vitro assays for standardized assessment of RBC-mediated microvascular occlusion. Here, we present the design, fabrication, and clinical testing of the Microfluidic Impedance Red Cell Assay (MIRCA) with embedded capillary network-based micropillar arrays and integrated electrical impedance measurement electrodes to address this need. The micropillar arrays consist of microcapillaries ranging from 12 μm to 3 μm, with each array paired with two sputtered gold electrodes to measure the impedance change of the array before and after sample perfusion through the microfluidic device. We define RBC occlusion index (ROI) and RBC electrical impedance index (REI), which represent the cumulative percentage occlusion and cumulative percentage impedance change, respectively. We demonstrate the promise of MIRCA in two common red cell disorders, SCD and hereditary spherocytosis. We show that the electrical impedance measurement reflects the microvascular occlusion, where REI significantly correlates with ROI that is obtained via high-resolution microscopy imaging of the microcapillary arrays. Further, we show that RBC-mediated microvascular occlusion, represented by ROI and REI, associates with clinical treatment outcomes and correlates with in vivo hemolytic biomarkers, lactate dehydrogenase (LDH) level and absolute reticulocyte count (ARC) in SCD. Impedance measurement obviates the need for high-resolution imaging, enabling future translation of this technology for widespread access, portable and point-of-care use. Our findings suggest that the presented microfluidic design and the integrated electrical impedance measurement provide a reproducible functional test for standardized assessment of RBC-mediated microvascular occlusion. MIRCA and the newly defined REI may serve as an in vitro therapeutic efficacy benchmark for assessing the clinical outcome of emerging RBC-modifying targeted and curative therapies.
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Affiliation(s)
- Yuncheng Man
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
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31
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Man Y, Kucukal E, An R, Bode A, Little JA, Gurkan UA. Cover Image. Microcirculation 2021. [DOI: 10.1111/micc.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Can we create robots with the behavioral flexibility and robustness of animals? Engineers often use bio-inspiration to mimic animals. Recent advances in tissue engineering now allow the use of components from animals. By integrating organic and synthetic components, researchers are moving towards the development of engineered organisms whose structural framework, actuation, sensing, and control are partially or completely organic. This review discusses recent exciting work demonstrating how organic components can be used for all facets of robot development. Based on this analysis, we propose a Robotic Taxonomic Key to guide the field towards a unified lexicon for device description.
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Affiliation(s)
| | - Ozan Akkus
- Dept. of Mech. and Aero. Engineering, Case Western Reserve University, Cleveland, OH, USA.,Dept. of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Dept. of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA
| | - Umut A Gurkan
- Dept. of Mech. and Aero. Engineering, Case Western Reserve University, Cleveland, OH, USA.,Dept. of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Dept. of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA
| | - Hillel J Chiel
- Dept. of Biology, Case Western Reserve University, Cleveland, OH, USA.,Dept. of Neurosciences, Case Western Reserve University, Cleveland, OH, USA.,Dept. of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Roger D Quinn
- Dept. of Mech. and Aero. Engineering, Case Western Reserve University, Cleveland, OH, USA
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33
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Man Y, Kucukal E, An R, Bode A, Little JA, Gurkan UA. Standardized microfluidic assessment of red blood cell-mediated microcapillary occlusion: Association with clinical phenotype and hydroxyurea responsiveness in sickle cell disease. Microcirculation 2021; 28:e12662. [PMID: 33025653 DOI: 10.1111/micc.12662] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/14/2020] [Accepted: 09/29/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We present a standardized in vitro microfluidic assay and Occlusion Index (OI) for the assessment of red blood cell (RBC)-mediated microcapillary occlusion and its clinical associations in sickle cell disease (SCD). METHODS Red blood cell mediated microcapillary occlusion represented by OI and its clinical associations were assessed for seven subjects with hemoglobin-SC disease (HbSC), 18 subjects with homozygous SCD (HbSS), and five control individuals (HbAA). RESULTS We identified two sub-populations with HbSS based on the OI distribution. HbSS subjects with relatively higher OIs had significantly lower hemoglobin levels, lower fetal hemoglobin (HbF) levels, and lower mean corpuscular volume (MCV), but significantly higher serum lactate dehydrogenase levels and absolute reticulocyte counts, compared to subjects with HbSS and lower OIs. HbSS subjects who had relatively higher OIs were more likely to have had a concomitant diagnosis of intrapulmonary shunting (IPS). Further, lower OI associated with hydroxyurea (HU) responsiveness in subjects with HbSS, as evidenced by significantly elevated HbF levels and MCV. CONCLUSIONS We demonstrated that RBC-mediated microcapillary occlusion and OI associated with subject clinical phenotype and HU responsiveness in SCD. The presented standardized microfluidic assay may be useful for evaluating clinical phenotype and assessing therapeutic outcomes in SCD, including emerging targeted and curative treatments that aim to improve RBC deformability and microcirculatory health.
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Affiliation(s)
- Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA.,Division of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jane A Little
- Division of Hematology and Oncology, Department of Medicine, UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
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Inanc MT, Demirkan I, Ceylan C, Ozkan A, Gundogdu O, Goreke U, Gurkan UA, Unlu MB. Quantifying the influences of radiation therapy on deformability of human red blood cells by dual-beam optical tweezers. RSC Adv 2021; 11:15519-15527. [PMID: 35481205 PMCID: PMC9029388 DOI: 10.1039/d1ra01948a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 12/21/2022] Open
Abstract
Radiation therapy is widely used as a treatment tool for malignancies. However, radiation-related complications are still unavoidable risks for off-target cells. Little is known about radiation therapy's possible effects on mechanical features of the off-target cells such as human red blood cells (RBCs). RBCs are nucleus-free circulating cells that can deform without losing functionality in healthy conditions. Thus, to evaluate in vitro effects of radiation therapy on the healthy plasma membrane of cells, RBCs were selected as a primary test model. RBCs were exposed to clinically prescribed radiotherapy doses of 2 Gy, 12 Gy and, 25 Gy, and each radiotherapy dose group was compared to a non-irradiated group. Cells were characterized by stretching using dual-beam optical tweezers and compared using the resulting deformability index. The group receiving the highest radiation dose was found statistically distinguishable from the control group (DI0Gy = 0.33 ± 0.08), and revealed the highest deformability index (DI25Gy = 0.38 ± 0.11, p = 0.0068), while no significant differences were found for 2 Gy (DI2Gy = 0.33 ± 0.08, p = 0.9) and 12 Gy (DI12Gy = 0.31 ± 0.09, p = 0.2) dose groups. Based on these findings, we conclude that radiotherapy exposure may alter the deformability of red blood cells depending on the dose amount, and measurement of deformability index by dual-beam optical tweezers can serve as a sensitive biomarker to probe responses of cells to the radiotherapy. Little is known about radiation therapy's possible effects on mechanical features of off-target cells such as human red blood cells. Here, irradiated human red blood cells were stretched using dual-beam optical tweezers and compared using the resulting deformability index.![]()
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Affiliation(s)
| | - Irem Demirkan
- Department of Physics
- Bogazici University
- Istanbul
- Turkey
| | - Cemile Ceylan
- Istanbul Oncology Hospital
- Istanbul
- Turkey
- Health Sciences Institute
- Yeditepe University
| | | | | | - Utku Goreke
- Department of Mechanical and Aerospace Engineering
- Case Western Reserve University
- Cleveland
- USA
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering
- Case Western Reserve University
- Cleveland
- USA
- Department of Biomedical Engineering
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35
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Kucukal E, Man Y, Hill A, Liu S, Bode A, An R, Kadambi J, Little JA, Gurkan UA. Whole blood viscosity and red blood cell adhesion: Potential biomarkers for targeted and curative therapies in sickle cell disease. Am J Hematol 2020; 95:1246-1256. [PMID: 32656816 PMCID: PMC7689825 DOI: 10.1002/ajh.25933] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022]
Abstract
Sickle cell disease (SCD) is a recessive genetic blood disorder exhibiting abnormal blood rheology. Polymerization of sickle hemoglobin, due to a point mutation in the β‐globin gene of hemoglobin, results in aberrantly adhesive and stiff red blood cells (RBCs). Hemolysis, abnormal RBC adhesion, and abnormal blood rheology together impair endothelial health in people with SCD, which leads to cumulative systemic complications. Here, we describe a microfluidic assay combined with a micro particle image velocimetry technique for the integrated in vitro assessment of whole blood viscosity (WBV) and RBC adhesion. We examined WBV and RBC adhesion to laminin (LN) in microscale flow in whole blood samples from 53 individuals with no hemoglobinopathies (HbAA, N = 10), hemoglobin SC disease (HbSC, N = 14), or homozygous SCD (HbSS, N = 29) with mean WBV of 4.50 cP, 4.08 cP, and 3.73 cP, respectively. We found that WBV correlated with RBC count and hematocrit in subjects with HbSC or HbSS. There was a significant inverse association between WBV and RBC adhesion under both normoxic and physiologically hypoxic (SpO2 of 83%) tests, in which lower WBV associated with higher RBC adhesion to LN in subjects with HbSS. Low WBV has been found by others to associate with endothelial activation. Altered WBV and abnormal RBC adhesion may synergistically contribute to the endothelial damage and cumulative pathophysiology of SCD. These findings suggest that WBV and RBC adhesion may serve as clinically relevant biomarkers and endpoints in assessing emerging targeted and curative therapies in SCD.
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Affiliation(s)
- Erdem Kucukal
- Department of Mechanical and Aerospace Engineering Case Western Reserve University Cleveland Ohio
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering Case Western Reserve University Cleveland Ohio
| | - Ailis Hill
- Division of Hematology and Oncology, School of Medicine Case Western Reserve University Cleveland Ohio
| | - Shichen Liu
- Department of Mechanical and Aerospace Engineering Case Western Reserve University Cleveland Ohio
| | - Allison Bode
- Division of Hematology and Oncology, School of Medicine Case Western Reserve University Cleveland Ohio
| | - Ran An
- Department of Mechanical and Aerospace Engineering Case Western Reserve University Cleveland Ohio
| | - Jaikrishnan Kadambi
- Department of Mechanical and Aerospace Engineering Case Western Reserve University Cleveland Ohio
| | - Jane A. Little
- Division of Hematology and Blood Research Center, Department of Medicine University of North Carolina Chapel Hill North Carolina
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering Case Western Reserve University Cleveland Ohio
- Department of Biomedical Engineering Case Western Reserve University Cleveland Ohio
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36
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Chatterjee S, Shkondin E, Takayama O, Fisher A, Fraiwan A, Gurkan UA, Lavrinenko AV, Strangi G. Hydrogen gas sensing using aluminum doped ZnO metasurfaces. Nanoscale Adv 2020; 2:3452-3459. [PMID: 36134290 PMCID: PMC9417916 DOI: 10.1039/d0na00289e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/17/2020] [Indexed: 05/25/2023]
Abstract
Hydrogen (H2) sensing is crucial in a wide variety of areas, such as industrial, environmental, energy and biomedical applications. However, engineering a practical, reliable, fast, sensitive and cost-effective hydrogen sensor is a persistent challenge. Here we demonstrate hydrogen sensing using aluminum-doped zinc oxide (AZO) metasurfaces based on optical read-out. The proposed sensing system consists of highly ordered AZO nanotubes (hollow pillars) standing on a SiO2 layer deposited on a Si wafer. Upon exposure to hydrogen gas, the AZO nanotube system shows a wavelength shift in the minimum reflectance by ∼13 nm within 10 minutes for a hydrogen concentration of 4%. These AZO nanotubes can also sense the presence of a low concentration (0.7%) of hydrogen gas within 10 minutes. Their rapid response time even for a low concentration, the possibility of large sensing area fabrication with good precision, and high sensitivity at room temperature make these highly ordered nanotube structures a promising miniaturized H2 gas sensor.
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Affiliation(s)
- Sharmistha Chatterjee
- CNR-NANOTEC Istituto di Nanotecnologia, Department of Physics, University of Calabria 87036 Rende Italy
- Department of Physics, Case Western Reserve University 10600 Euclid Avenue Cleveland OH 44106 USA +1 216 368 6918
| | - Evgeniy Shkondin
- DTU Nanolab - National Center for Micro- and Nanofabrication, Technical University of Denmark Ørsteds Plads 347, DK-2800 Kgs Lyngby Denmark
| | - Osamu Takayama
- DTU Fotonik - Department of Photonics Engineering, Technical University of Denmark Ørsteds Plads 343, DK-2800 Kgs Lyngby Denmark
| | - Adam Fisher
- Department of Physics, Case Western Reserve University 10600 Euclid Avenue Cleveland OH 44106 USA +1 216 368 6918
| | - Arwa Fraiwan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University Cleveland Ohio 44106 USA
| | - Umut A Gurkan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University Cleveland Ohio 44106 USA
- Biomedical Engineering Department, Case Western Reserve University Cleveland Ohio 44106 USA
- Department of Orthopedics, Case Western Reserve University Cleveland Ohio 44106 USA
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center Cleveland Ohio 44106 USA
| | - Andrei V Lavrinenko
- DTU Fotonik - Department of Photonics Engineering, Technical University of Denmark Ørsteds Plads 343, DK-2800 Kgs Lyngby Denmark
| | - Giuseppe Strangi
- CNR-NANOTEC Istituto di Nanotecnologia, Department of Physics, University of Calabria 87036 Rende Italy
- Department of Physics, Case Western Reserve University 10600 Euclid Avenue Cleveland OH 44106 USA +1 216 368 6918
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Noomuna P, Risinger M, Zhou S, Seu K, Man Y, An R, Sheik DA, Wan J, Little JA, Gurkan UA, Turrini FM, Kalfa T, Low PS. Inhibition of Band 3 tyrosine phosphorylation: a new mechanism for treatment of sickle cell disease. Br J Haematol 2020; 190:599-609. [PMID: 32346864 PMCID: PMC7606656 DOI: 10.1111/bjh.16671] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022]
Abstract
Many hypotheses have been proposed to explain how a glutamate to valine substitution in sickle haemoglobin (HbS) can cause sickle cell disease (SCD). We propose and document a new mechanism in which elevated tyrosine phosphorylation of Band 3 initiates sequelae that cause vaso-occlusion and the symptoms of SCD. In this mechanism, denaturation of HbS and release of heme generate intracellular oxidants which cause inhibition of erythrocyte tyrosine phosphatases, thus permitting constitutive tyrosine phosphorylation of Band 3. This phosphorylation in turn induces dissociation of the spectrin-actin cytoskeleton from the membrane, leading to membrane weakening, discharge of membrane-derived microparticles (which initiate the coagulation cascade) and release of cell-free HbS (which consumes nitric oxide) and activates the endothelium to express adhesion receptors). These processes promote vaso-occlusive events which cause SCD. We further show that inhibitors of Syk tyrosine kinase block Band 3 tyrosine phosphorylation, prevent release of cell-free Hb, inhibit discharge of membrane-derived microparticles, increase sickle cell deformability, reduce sickle cell adhesion to human endothelial cells, and enhance sickle cell flow through microcapillaries. In view of reports that imatinib (a Syk inhibitor) successfully treats symptoms of sickle cell disease, we suggest that Syk tyrosine kinase inhibitors warrant repurposing as potential treatments for SCD.
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Affiliation(s)
- Panae Noomuna
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
- Institute for Drug Discovery, Purdue University, West Lafayette, IN, USA
| | - Mary Risinger
- College of Nursing, University of Cincinnati, Cincinnati, OH
| | - Sitong Zhou
- Department of Chemical Engineering, University of California, Davis, CA
| | - Katie Seu
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | - Daniel A. Sheik
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
- Institute for Drug Discovery, Purdue University, West Lafayette, IN, USA
| | - Jiandi Wan
- Department of Chemical Engineering, University of California, Davis, CA
| | - Jane A. Little
- Department of Medicine, Division of Hematology/Oncology and UNC Blood Research Center, University of North Carolina, Chapel Hill, NC
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland
- Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA
| | | | - Theodosia Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Philip S. Low
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
- Institute for Drug Discovery, Purdue University, West Lafayette, IN, USA
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38
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Man Y, Kucukal E, An R, Watson QD, Bosch J, Zimmerman PA, Little JA, Gurkan UA. Microfluidic assessment of red blood cell mediated microvascular occlusion. Lab Chip 2020; 20:2086-2099. [PMID: 32427268 PMCID: PMC7473457 DOI: 10.1039/d0lc00112k] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Abnormal red blood cell (RBC) deformability contributes to hemolysis, thrombophilia, inflammation, and microvascular occlusion in various circulatory diseases. A quantitative and objective assessment of microvascular occlusion mediated by RBCs with abnormal deformability would provide valuable insights into disease pathogenesis and therapeutic strategies. To that end, we present a new functional microfluidic assay, OcclusionChip, which mimics two key architectural features of the capillary bed in the circulatory system. First, the embedded micropillar arrays within the microchannel form gradient microcapillaries, from 20 μm down to 4 μm, which mimic microcapillary networks. These precisely engineered microcapillaries retain RBCs with impaired deformability, such that stiffer RBCs occlude the wider upstream microcapillaries, while less stiff RBCs occlude the finer downstream microcapillaries. Second, the micropillar arrays are coupled with two side passageways, which mimic the arteriovenous anastomoses that act as shunts in the capillary bed. These side microfluidic anastomoses prevent microchannel blockage, and enable versatility and testing of clinical blood samples at near-physiologic hematocrit levels. Further, we define a new generalizable parameter, Occlusion Index (OI), which is an indicative index of RBC deformability and the associated microcapillary occlusion. We demonstrate the promise of OcclusionChip in diverse pathophysiological scenarios that result in impaired RBC deformability, including mercury toxin, storage lesion, end-stage renal disease, malaria, and sickle cell disease (SCD). Hydroxyurea therapy improves RBC deformability and increases fetal hemoglobin (HbF%) in some, but not all, treated patients with SCD. HbF% greater than 8.6% has been shown to improve clinical outcomes in SCD. We show that OI associates with HbF% in 16 subjects with SCD. Subjects with higher HbF levels (HbF > 8.6%) displayed significantly lower OI (0.88% ± 0.10%, N = 6) compared with those with lower HbF levels (HbF ≤ 8.6%) who displayed greater OI (3.18% ± 0.34%, N = 10, p < 0.001). Moreover, hypoxic OcclusionChip assay revealed a significant correlation between hypoxic OI and subject-specific sickle hemoglobin (HbS) level in SCD. OcclusionChip enables versatile in vitro assessment of microvascular occlusion mediated by RBCs in a wide range of clinical conditions. OI may serve as a new parameter to evaluate the efficacy of treatments improving RBC deformability, including hemoglobin modifying drugs, anti-sickling agents, and genetic therapies.
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Affiliation(s)
- Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
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Man Y, Goreke U, Kucukal E, Hill A, An R, Liu S, Bode A, Solis-Fuentes A, Nayak LV, Little JA, Gurkan UA. Leukocyte adhesion to P-selectin and the inhibitory role of Crizanlizumab in sickle cell disease: A standardized microfluidic assessment. Blood Cells Mol Dis 2020; 83:102424. [PMID: 32208292 DOI: 10.1016/j.bcmd.2020.102424] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/08/2020] [Indexed: 01/21/2023]
Abstract
Upregulated expression of P-selectin on activated endothelium and platelets significantly contributes to the initiation and progression of vaso-occlusive crises (VOC), a major cause of morbidity in sickle cell disease (SCD). Crizanlizumab (ADAKVEO®), a humanized monoclonal antibody against P-selectin, primarily inhibits the interaction between leukocytes and P-selectin, and has been shown to decrease the frequency of VOCs in clinical trials. However, the lack of reliable in vitro assays that objectively measure leukocyte adhesion to P-selectin remains a critical barrier to evaluating and improving the therapeutic treatment in SCD. Here, we present a standardized microfluidic BioChip whole blood adhesion assay to assess leukocyte adhesion to P-selectin under physiologic flow conditions. Our results demonstrated heterogeneous adhesion by leukocytes to immobilized P-selectin, and dose-dependent inhibition of this adhesion following pre-exposure to Crizanlizumab. Importantly, treatment with Crizanlizumab following adhesion to P-selectin promoted detachment of rolling, but not of firmly adherent leukocytes. Taken together, our results suggest that the microfluidic BioChip system is a promising in vitro assay with which to screen patients, monitor treatment response, and guide current and emerging anti-adhesive therapies in SCD.
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Affiliation(s)
- Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Ailis Hill
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Shichen Liu
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Allison Bode
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Ambar Solis-Fuentes
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Lalitha V Nayak
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Jane A Little
- Department of Hematology and Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA.
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Hasan MN, Fraiwan A, An R, Alapan Y, Ung R, Akkus A, Xu JZ, Rezac AJ, Kocmich NJ, Creary MS, Oginni T, Olanipekun GM, Hassan-Hanga F, Jibir BW, Gambo S, Verma AK, Bharti PK, Riolueang S, Ngimhung T, Suksangpleng T, Thota P, Werner G, Shanmugam R, Das A, Viprakasit V, Piccone CM, Little JA, Obaro SK, Gurkan UA. Paper-based microchip electrophoresis for point-of-care hemoglobin testing. Analyst 2020; 145:2525-2542. [PMID: 32123889 DOI: 10.1039/c9an02250c] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nearly 7% of the world's population live with a hemoglobin variant. Hemoglobins S, C, and E are the most common and significant hemoglobin variants worldwide. Sickle cell disease, caused by hemoglobin S, is highly prevalent in sub-Saharan Africa and in tribal populations of Central India. Hemoglobin C is common in West Africa, and hemoglobin E is common in Southeast Asia. Screening for significant hemoglobin disorders is not currently feasible in many low-income countries with the high disease burden. Lack of early diagnosis leads to preventable high morbidity and mortality in children born with hemoglobin variants in low-resource settings. Here, we describe HemeChip, the first miniaturized, paper-based, microchip electrophoresis platform for identifying the most common hemoglobin variants easily and affordably at the point-of-care in low-resource settings. HemeChip test works with a drop of blood. HemeChip system guides the user step-by-step through the test procedure with animated on-screen instructions. Hemoglobin identification and quantification is automatically performed, and hemoglobin types and percentages are displayed in an easily understandable, objective way. We show the feasibility and high accuracy of HemeChip via testing 768 subjects by clinical sites in the United States, Central India, sub-Saharan Africa, and Southeast Asia. Validation studies include hemoglobin E testing in Bangkok, Thailand, and hemoglobin S testing in Chhattisgarh, India, and in Kano, Nigeria, where the sickle cell disease burden is the highest in the world. Tests were performed by local users, including healthcare workers and clinical laboratory personnel. Study design, methods, and results are presented according to the Standards for Reporting Diagnostic Accuracy (STARD). HemeChip correctly identified all subjects with hemoglobin S, C, and E variants with 100% sensitivity, and displayed an overall diagnostic accuracy of 98.4% in comparison to reference standard methods. HemeChip is a versatile, mass-producible microchip electrophoresis platform that addresses a major unmet need of decentralized hemoglobin analysis in resource-limited settings.
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Affiliation(s)
- Muhammad Noman Hasan
- Case Biomanufacturing and Microfabrication Laboratory, Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Yuan C, Quinn E, Kucukal E, Kapoor S, Gurkan UA, Little JA. Priapism, hemoglobin desaturation, and red blood cell adhesion in men with sickle cell anemia. Blood Cells Mol Dis 2019; 79:102350. [PMID: 31404907 DOI: 10.1016/j.bcmd.2019.102350] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/31/2019] [Indexed: 01/22/2023]
Abstract
Priapism is a serious, but episodic, complication of sickle cell disease (SCD). We had previously reported that subjects with SCD had variable red blood cell (RBC) adhesion to the immobilized sub-endothelial protein laminin (LN). We examined adhesion to LN in a microfluidic device, of RBCs from men with homozygous sickle cell anemia. Adhesion under hypoxic, but not ambient, conditions was greater in men with a history of priapism, with median adhesion of 529 RBCs per 32 mm2/unit area (range 5-5248) rising to 3268 RBCs per 32 mm2/unit area (range 49-18,368, P = 0.004), under ambient and hypoxic conditions, respectively (n = 14). This was not seen in RBCs from men without a history of priapism (median 402 (range 14-785) and 122 (range 31-4112) RBCs per 32 mm2/unit area, ambient and hypoxic conditions, respectively (P = N.S., N = 12)). We also observed an association between hypoxia-enhanced RBC adhesion in vitro and a history of hemoglobin desaturation in vivo independent of priapism. Prolonged Hb desaturation may increase sickle polymer formation and RBC damage, resulting in enhanced RBC adhesion, hemolysis, and endothelial dysfunction. The identification of distinct RBC phenotypes could prompt clinical evaluation for suitability for novel or under-used therapies, like oxygen.
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Affiliation(s)
- Charlotte Yuan
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Erina Quinn
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Sargam Kapoor
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA; Seidman Cancer Center at University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Orthopaedics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Jane A Little
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA; Seidman Cancer Center at University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA.
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Abstract
Non-adherence and deformability are the key intrinsic biomechanical features of the red blood cell (RBC), which allow it to tightly squeeze and pass through even the narrowest of microcirculatory networks. Blockage of microcirculatory flow, also known as vaso-occlusion, is a consequence of abnormal cellular adhesion to the vascular endothelium. In sickle cell disease (SCD), an inherited anaemia, even though RBCs have been shown to be heterogeneous in adhesiveness and deformability, this has not been studied in the context of physiologically relevant dynamic shear gradients at the microscale. We developed a microfluidic system that simulates physiologically relevant shear gradients of microcirculatory blood flow at a constant single volumetric flow rate. Using this system, shear dependent adhesion of RBCs from 28 subjects with SCD and from 11 healthy subjects was investigated using vascular endothelial protein functionalized microchannels. We defined a new term, RBC Shear Gradient Microfluidic Adhesion (SiGMA) index to assess shear dependent RBC adhesion in a subject-specific manner. We have shown for the first time that shear dependent adhesion of RBCs is heterogeneous in a microfluidic flow model, which correlates clinically with inflammatory markers and iron overload in subjects with SCD. This study reveals the complex dynamic interactions between RBC-mediated microcirculatory occlusion and clinical outcomes in SCD. These interactions may also be relevant to other microcirculatory disorders and microvascular diseases.
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Affiliation(s)
- Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Biomanufacturing and Microfabrication Laboratory, Case Western Reserve University, Glennan 616B, 10900 Euclid Ave., Cleveland, OH, USA.
| | - Jane A Little
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA and Seidman Cancer Center at University Hospitals, Case Medical Center, Cleveland, OH, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Biomanufacturing and Microfabrication Laboratory, Case Western Reserve University, Glennan 616B, 10900 Euclid Ave., Cleveland, OH, USA. and Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA and Department of Orthopaedics, Case Western Reserve University, Cleveland, OH 44106, USA
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Akkaya B, Kucukal E, Little JA, Gurkan UA. Mercury leads to abnormal red blood cell adhesion to laminin mediated by membrane sulfatides. Biochim Biophys Acta Biomembr 2019; 1861:1162-1171. [PMID: 30890469 DOI: 10.1016/j.bbamem.2019.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/27/2022]
Abstract
Exposure to mercury is associated with numerous health problems, affecting different parts of the human body, including the nervous and cardiovascular systems in adults and children; however, the underlying mechanisms are yet to be fully elucidated. We investigated the role of membrane sulfatide on mercuric ion (Hg2+) mediated red blood cell (RBC) adhesion to a sub-endothelial matrix protein, laminin, using a microfluidic system that mimics microphysiological flow conditions. We exposed whole blood to mercury (HgCl2), at a range of concentrations to mimic acute (high dose) and chronic (low dose) exposure, and examined RBC adhesion to immobilized laminin in microchannels at physiological flow conditions. Exposure of RBCs to both acute and chronic levels of Hg2+ resulted in elevated adhesive interactions between RBCs and laminin depending on the concentration of HgCl2 and exposure duration. BCAM-Lu chimer significantly inhibited the adhesion of RBCs that had been treated with 50 μM of HgCl2 solution for 1 h at 37 °C, while it did not prevent the adhesion of 3 h and 24 h Hg2+-treated RBCs. Sulfatide significantly inhibited the adhesion of RBC that had been treated with 50 μM of HgCl2 solution for 1 h at 37 °C and 0.5 μM of HgCl2 solution for 24 h at room temperature (RT). We demonstrated that RBC BCAM-Lu and RBC sulfatides bind to immobilized laminin, following exposure of RBCs to mercuric ions. The results of this study are significant considering the potential associations between sulfatides, red blood cells, mercury exposure, and cardiovascular diseases.
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Affiliation(s)
- Birnur Akkaya
- Science Faculty, Department of Molecular Biology and Genetics Department, Cumhuriyet University, Sivas, Turkey; Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Erdem Kucukal
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Jane A Little
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Umut A Gurkan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA; Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA; Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA.
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Huang AY, Benson BL, Correa L, Li L, Myers JT, Gurkan UA, Ransohoff R. Abstract A195: Mechanosensory mechanisms and in vivo tissue topology contribute to rheology of circulating leukocytes resulting in efficient post-capillary vessel wall adhesion and recruitment. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-a195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Efficient recruitment of circulating immune cells to various tissues plays a critical role in homeostasis and immune surveillance, a process that serves as the basis of any successful cell-based immunotherapeutic strategies in cancer, particularly for solid tumors and cancers residing in body sites outside of blood vessels and sinusoid network. Clinical and experimental observations suggest that in vivo leukocyte adhesion and extravasation are maximal near the transition from capillary to post-capillary venule, through a multistep process that includes the intravascular capture, rolling, arrest, crawling of cells through interactions of adhesion molecules (selectins, integrins, chemokines/receptors, for example), eventually leading to transcellular or paracellular transmigration through intact endothelium. These cellular and molecular processes are strongly influenced by a confluence of scale-dependent physical effects. Mimicking the scale of physiologic vessels using in vitro microfluidic systems allows the capture and investigation of these effects on leukocyte adhesion assays, but imposes practical limits on reproducibility and reliable quantification. We have developed a microfluidic platform that provides multiple (54-512) technical replicates within a 15-minute sample collection time, coupled with an automated computer vision analysis pipeline that captures leukocyte adhesion probabilities as a function of not only shear stress imposed on leukocytes within the vessels as conventional wisdom dictates, but also of the extensional stresses imposed by the topology of post-capillary venules and the rheology of circulating leukocytes in these vessels. We identified that in post-capillary channels of physiologic scale, efficient leukocyte adhesion requires erythrocytes forcing leukocytes against the wall, a phenomenon that is promoted by the transitional flow in post-capillary venule expansions and highly dependent on the adhesion molecule ICAM-1. These studies help identified a mechanosensory mechanism that determines the increased likelihood of leukocyte adhesion in post-capillary venules, and further suggests a significant role of mechanosensory channel(s) in influencing leukocyte integrin affinity for cellular capture to the vessel wall. Through a series of truncation mutants, we have narrowed down a small region of putative interacting domain between integrin and a candidate mechanosensory channel—PIEZO1—on leukocytes. These ongoing investigations offer new insights into immune cellular recruitment and new molecular targets to enhance leukocyte recruitment to peripheral tumor sites.
Citation Format: Alex Y. Huang, Bryan L. Benson, Luis Correa, Lucy Li, Jay T. Myers, Umut A. Gurkan, Richard Ransohoff. Mechanosensory mechanisms and in vivo tissue topology contribute to rheology of circulating leukocytes resulting in efficient post-capillary vessel wall adhesion and recruitment [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr A195.
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Affiliation(s)
- Alex Y. Huang
- Case Western Reserve University School of Medicine, Cleveland, OH; Biogen, Boston, MA
| | - Bryan L. Benson
- Case Western Reserve University School of Medicine, Cleveland, OH; Biogen, Boston, MA
| | - Luis Correa
- Case Western Reserve University School of Medicine, Cleveland, OH; Biogen, Boston, MA
| | - Lucy Li
- Case Western Reserve University School of Medicine, Cleveland, OH; Biogen, Boston, MA
| | - Jay T. Myers
- Case Western Reserve University School of Medicine, Cleveland, OH; Biogen, Boston, MA
| | - Umut A. Gurkan
- Case Western Reserve University School of Medicine, Cleveland, OH; Biogen, Boston, MA
| | - Richard Ransohoff
- Case Western Reserve University School of Medicine, Cleveland, OH; Biogen, Boston, MA
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Maji D, De La Fuente M, Kucukal E, Sekhon UDS, Schmaier AH, Sen Gupta A, Gurkan UA, Nieman MT, Stavrou EX, Mohseni P, Suster MA. Assessment of whole blood coagulation with a microfluidic dielectric sensor. J Thromb Haemost 2018; 16:2050-2056. [PMID: 30007048 PMCID: PMC6173630 DOI: 10.1111/jth.14244] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Indexed: 12/12/2022]
Abstract
Essentials ClotChip is a novel microsensor for comprehensive assessment of ex vivo hemostasis. Clinical samples show high sensitivity to detecting the entire hemostatic process. ClotChip readout exhibits distinct information on coagulation factor and platelet abnormalities. ClotChip has potential as a point-of-care platform for comprehensive hemostatic analysis. SUMMARY Background Rapid point-of-care (POC) assessment of hemostasis is clinically important in patients with a variety of coagulation factor and platelet defects who have bleeding disorders. Objective To evaluate a novel dielectric microsensor, termed ClotChip, which is based on the electrical technique of dielectric spectroscopy for rapid, comprehensive assessment of whole blood coagulation. Methods The ClotChip is a three-dimensional, parallel-plate, capacitive sensor integrated into a single-use microfluidic channel with miniscule sample volume (< 10 μL). The ClotChip readout is defined as the temporal variation in the real part of dielectric permittivity of whole blood at 1 MHz. Results The ClotChip readout exhibits two distinct parameters, namely, the time to reach a permittivity peak (Tpeak ) and the maximum change in permittivity after the peak (Δεr,max ), which are, respectively, sensitive towards detecting non-cellular (i.e. coagulation factor) and cellular (i.e. platelet) abnormalities in the hemostatic process. We evaluated the performance of ClotChip using clinical blood samples from 15 healthy volunteers and 12 patients suffering from coagulation defects. The ClotChip Tpeak parameter exhibited superior sensitivity at distinguishing coagulation disorders as compared with conventional screening coagulation tests. Moreover, the ClotChip Δεr,max parameter detected platelet function inhibition induced by aspirin and exhibited strong positive correlation with light transmission aggregometry. Conclusions This study demonstrates that ClotChip assesses multiple aspects of the hemostatic process in whole blood on a single disposable cartridge, highlighting its potential as a POC platform for rapid, comprehensive hemostatic analysis.
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Affiliation(s)
- D Maji
- Electrical Engineering and Computer Science Department, Case Western Reserve University, Cleveland, OH, USA
| | - M De La Fuente
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, USA
| | - E Kucukal
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - U D S Sekhon
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - A H Schmaier
- Department of Medicine, Hematology and Oncology Division, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - A Sen Gupta
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - U A Gurkan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - M T Nieman
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, USA
| | - E X Stavrou
- Department of Medicine, Louis Stokes Veterans Administration Medical Center, Cleveland, OH, USA
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - P Mohseni
- Electrical Engineering and Computer Science Department, Case Western Reserve University, Cleveland, OH, USA
| | - M A Suster
- Electrical Engineering and Computer Science Department, Case Western Reserve University, Cleveland, OH, USA
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Kucukal E, Ilich A, Key NS, Little JA, Gurkan UA. Red Blood Cell Adhesion to Heme-Activated Endothelial Cells Reflects Clinical Phenotype in Sickle Cell Disease. Am J Hematol 2018; 93:10.1002/ajh.25159. [PMID: 29905377 PMCID: PMC6295270 DOI: 10.1002/ajh.25159] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/19/2022]
Abstract
In sickle cell disease (SCD), 'disease severity' associates with increased RBC adhesion to quiescent endothelium, but the impact on activated endothelium is not known. Increased concentrations of free heme result from intravascular hemolysis in SCD. Heme is essential for aerobic metabolism, and plays an important role in numerous biological processes. Excess free heme induces reactive oxygen species generation and endothelial activation, which are associated with cardiovascular disorders including atherosclerosis, hypertension, and thrombosis. Here, we utilized an endothelialized microfluidic platform (Endothelium-on-a-chip) to assess adhesion of sickle hemoglobin-containing red blood cells (HbS RBCs), from adults with homozygous SCD, to heme-activated human endothelial cells (EC) in vitro. Confluent EC monolayers in microchannels were treated with pathophysiologically relevant levels of heme in order to simulate the highly hemolytic intravascular milieu seen in SCD. RBC adhesion to heme-activated ECs varied from subject to subject, and was associated with plasma markers of hemolysis (LDH) and reticulocytosis, thereby linking those RBCs that are most likely to adhere with those that are most likely to hemolyze. These results re-emphasize the critical contribution made by heterogeneous adhesive HbS RBCs to the pathophysiology of SCD. We found that adhesion of HbS RBCs to heme-activated ECs varied amongst individuals in the study population, and associated with biomarkers of hemolysis and inflammation, age, and a recent history of transfusion. Importantly, the microfluidic approach described herein holds promise as a clinically feasible Endothelium-on-a-chip platform with which to study complex heterocellular adhesive interactions in SCD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Anton Ilich
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Nigel S. Key
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jane A. Little
- Division of Hematology/Oncology, Case Western Reserve University, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
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Stavrou EX, Fang C, Bane KL, Long AT, Naudin C, Kucukal E, Gandhi A, Brett-Morris A, Mumaw MM, Izadmehr S, Merkulova A, Reynolds CC, Alhalabi O, Nayak L, Yu WM, Qu CK, Meyerson HJ, Dubyak GR, Gurkan UA, Nieman MT, Sen Gupta A, Renné T, Schmaier AH. Factor XII and uPAR upregulate neutrophil functions to influence wound healing. J Clin Invest 2018; 128:944-959. [PMID: 29376892 PMCID: PMC5824869 DOI: 10.1172/jci92880] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 12/14/2017] [Indexed: 01/13/2023] Open
Abstract
Coagulation factor XII (FXII) deficiency is associated with decreased neutrophil migration, but the mechanisms remain uncharacterized. Here, we examine how FXII contributes to the inflammatory response. In 2 models of sterile inflammation, FXII-deficient mice (F12-/-) had fewer neutrophils recruited than WT mice. We discovered that neutrophils produced a pool of FXII that is functionally distinct from hepatic-derived FXII and contributes to neutrophil trafficking at sites of inflammation. FXII signals in neutrophils through urokinase plasminogen activator receptor-mediated (uPAR-mediated) Akt2 phosphorylation at S474 (pAktS474). Downstream of pAkt2S474, FXII stimulation of neutrophils upregulated surface expression of αMβ2 integrin, increased intracellular calcium, and promoted extracellular DNA release. The sum of these activities contributed to neutrophil cell adhesion, migration, and release of neutrophil extracellular traps in a process called NETosis. Decreased neutrophil signaling in F12-/- mice resulted in less inflammation and faster wound healing. Targeting hepatic F12 with siRNA did not affect neutrophil migration, whereas WT BM transplanted into F12-/- hosts was sufficient to correct the neutrophil migration defect in F12-/- mice and restore wound inflammation. Importantly, these activities were a zymogen FXII function and independent of FXIIa and contact activation, highlighting that FXII has a sophisticated role in vivo that has not been previously appreciated.
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Affiliation(s)
- Evi X. Stavrou
- Department of Medicine, Louis Stokes Veterans Administration Medical Center, Cleveland, Ohio, USA
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | - Chao Fang
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | - Kara L. Bane
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | - Andy T. Long
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Clément Naudin
- Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, CWRU, Cleveland, Ohio, USA
| | - Agharnan Gandhi
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | - Adina Brett-Morris
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | - Michele M. Mumaw
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | - Sudeh Izadmehr
- Department of Genetics and Genomics Sciences, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alona Merkulova
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | - Cindy C. Reynolds
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | - Omar Alhalabi
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | - Lalitha Nayak
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
- Department of Medicine, Hematology and Oncology Division, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Wen-Mei Yu
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | - Cheng-Kui Qu
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
| | | | | | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, CWRU, Cleveland, Ohio, USA
| | | | | | - Thomas Renné
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Alvin H. Schmaier
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio, USA
- Department of Medicine, Hematology and Oncology Division, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Maji D, Suster MA, Kucukal E, Sekhon UDS, Gupta AS, Gurkan UA, Stavrou EX, Mohseni P. ClotChip: A Microfluidic Dielectric Sensor for Point-of-Care Assessment of Hemostasis. IEEE Trans Biomed Circuits Syst 2017; 11:1459-1469. [PMID: 28920906 PMCID: PMC6091230 DOI: 10.1109/tbcas.2017.2739724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This paper describes the design, fabrication, and testing of a microfluidic sensor for dielectric spectroscopy of human whole blood during coagulation. The sensor, termed ClotChip, employs a three-dimensional, parallel-plate, capacitive sensing structure with a floating electrode integrated into a microfluidic channel. Interfaced with an impedance analyzer, the ClotChip measures the complex relative dielectric permittivity, ϵr , of human whole blood in the frequency range of 40 Hz to 100 MHz. The temporal variation in the real part of the blood dielectric permittivity at 1 MHz features a time to reach a permittivity peak, , as well as a maximum change in permittivity after the peak, , as two distinct parameters of ClotChip readout. The ClotChip performance was benchmarked against rotational thromboelastometry (ROTEM) to evaluate the clinical utility of its readout parameters in capturing the clotting dynamics arising from coagulation factors and platelet activity. exhibited a very strong positive correlation ( r = 0.99, p < 0.0001) with the ROTEM clotting time parameter, whereas exhibited a strong positive correlation (r = 0.85, p < 0.001) with the ROTEM maximum clot firmness parameter. This paper demonstrates the ClotChip potential as a point-of-care platform to assess the complete hemostatic process using <10 μL of human whole blood.
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Maji D, Suster MA, Kucukal E, Gurkan UA, Stavrou EX, Mohseni P. A PMMA microfluidic dielectric sensor for blood coagulation monitoring at the point-of-care. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:291-294. [PMID: 28268334 DOI: 10.1109/embc.2016.7590697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper describes the design and construct of a fully biocompatible, microfluidic, dielectric sensor targeted at monitoring human whole blood coagulation at the point-of-care (POC). The sensor assembly procedure involves using sputtered electrodes in a microfluidic channel with a physiologically relevant height of 50μm to create a three-dimensional (3D), parallel-plate, capacitive sensing area. The sensor is constructed with biocompatible materials of polymethyl methacrylate (PMMA) for the substrate and titanium nitride (TiN) for the sensing and floating electrodes. The real part of the complex relative dielectric permittivity of human whole blood is measured from 10kHz to 100MHz using an impedance analyzer and under static conditions. The temporal variation in dielectric permittivity at 1MHz for human whole blood undergoing coagulation shows a peak in permittivity at 5 minutes, which closely matches our previously established results. This sensor can pave the way for monitoring blood coagulation under physiologically relevant shear flow rates in the future.
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50
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Kim M, Alapan Y, Adhikari A, Little JA, Gurkan UA. Hypoxia-enhanced adhesion of red blood cells in microscale flow. Microcirculation 2017; 24:10.1111/micc.12374. [PMID: 28387057 PMCID: PMC5679205 DOI: 10.1111/micc.12374] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/03/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The advancement of microfluidic technology has facilitated the simulation of physiological conditions of the microcirculation, such as oxygen tension, fluid flow, and shear stress in these devices. Here, we present a micro-gas exchanger integrated with microfluidics to study RBC adhesion under hypoxic flow conditions mimicking postcapillary venules. METHODS We simulated a range of physiological conditions and explored RBC adhesion to endothelial or subendothelial components (FN or LN). Blood samples were injected into microchannels at normoxic or hypoxic physiological flow conditions. Quantitative evaluation of RBC adhesion was performed on 35 subjects with homozygous SCD. RESULTS Significant heterogeneity in RBC adherence response to hypoxia was seen among SCD patients. RBCs from a HEA population showed a significantly greater increase in adhesion compared to RBCs from a HNA population, for both FN and LN. CONCLUSIONS The approach presented here enabled the control of oxygen tension in blood during microscale flow and the quantification of RBC adhesion in a cost-efficient and patient-specific manner. We identified a unique patient population in which RBCs showed enhanced adhesion in hypoxia in vitro. Clinical correlates suggest a more severe clinical phenotype in this subgroup.
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Affiliation(s)
- Myeongseop Kim
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Yunus Alapan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, Germany
| | - Anima Adhikari
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Jane A. Little
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Seidman Cancer Center at University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Umut A. Gurkan
- Case Biomanufacturing and Microfabrication Laboratory, Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
- Department of Hematology and Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
- Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA
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