Energy balance in red cell interactions.

Introduction: Red blood cell(RBC), which passes through capillaries and exchanges O2 and CO2 with surrounding tissues, plays a very important in the blood circulation in the human body. Imbalance in blood circulation could lead to various cardiovascular related diseases such as high blood pressure, arteriosclerosis, diabetes, and stroke.[1] This is closely related to RBC aggregation. Negatively charged RBC membrane arranges a compact layer of positive ions around the membrane by electrical attraction with cations in plasma.The rearranged ions layer in plasma forms zeta potential with compact layer. When the electrostatic interaction between RBCs, i.e., zeta potential increases, RBC aggregation is improved. It is known that zeta potential depends on electronegativity of the RBC membrane, the dielectric constant of the medium and ionic strength [2]. Since pulsed magnetic field (PMF) influences human physiology, many clinical studies demonstrated the effect of PMF for wound healing, reducing pain, increasing angiogenesis, as well as improving blood circulation.[3-5] In this study, we have tried to elucidate the effect of PMF on RBC aggregation by indirectly observing zeta potential using negatively-charged magnetic beads(MB). Our hypothesis is that the increase of negative charges on RBC membrane results in the increase of cations in the compact layer, thus the increase of the zeta potential. As a result, the number of MB attached to the RBC increases, as the binding force between MB and compact layer increases.Experimental Method: Blood needed for experiment was obtained from Korean Red Cross after reviewing IRB exemption in Sangji University Bioethics Committee. Whole blood of 6 ml was centrifuged at 3000 rpm for 5 min in 4 oC for separating RBCs and plasma. MB used this experiment has diameter 1 μm with OH- groups (SiMAG-Silanol, Chemicell). To clearly see the MB attached to RBCs and, in addition, to avoid blood clots caused by proteins in plasma, RBC suspension of hematocrit (Ht) of 10% was prepared using PBS(phosphate buffer saline). The amount of MB added to RBC suspension was 0.5 mg. RBCs were also oxidative stressed with tBHP(Tert-Butyl hydroperoxide) in 0.4 mM at 37 oCincubator for 30 min, in order to confirm the change of RBCs membrane charge due to oxidative stress under PMF stimulus. In oxidative stressed RBCs, hemoglobin(Fe2+) is altered to methemoglobin(Fe3+) because of loss an electron, thereby, electronegativity of RBC membrane will be changed.[6] Each sample was exposed to PMF for 3 min. Our PMF stimulator system consisted of single layered coil of 10 turns with an elliptical shape of 12.0 x 4.5 cm. The maximum intensity is 0.27 T at a transition time of 0.102 ms, with pulse intervals of 1 Hz. The numbers of RBC attached MB were compared with control group and PMF treatment group. Only RBCs with a distance of about 1 μm between the MB and the surface of RBC were counted using hemocytometer.Results and Discussion: Fig.1. shows the numbers of RBCs according to the number of attached MB in the control and PMF treatment group. The numbers of RBCs attached MB increased after PMF treatment. The more the number of MBs attached to RBCs, the thicker the compact layer surrounding RBC membranes. This phenomenon might be inferred due to an increase of zeta potential, thereby, increase of negative charges on the RBC membrane. Thus, it can be interpreted that MB having hydroxide OH- group are more attached to RBCs via binding force between MB and compact layer. Also the numbers of MB in the group treated tBHP and the group exposed to PMF after tBHP treatment (tBHP+PMF) were compared in Fig.2. Although the number of MB attached to RBCs was 1~2 in tBHP group, after PMF stimulus, i.e. in tBHP+PMF group it appears the number of MB attached to RBCs increased up to 3~4. This might be explained that PMF affects the increase of RBC membrane charge on not only normal RBCs but also oxidative stressed RBCs. Therefore, it can be deduced that high instantaneous flux change of PMF improves the aggregation of RBCs by increasing the zeta potential, due to the increase of the membrane charge. **

The electrophoretic mobility of native and glutaraldehyde‐fixed bovine, human, and horse red blood cells (RBC) was investigated as a function of ionic strength (5–150 mM) and concentration of 464 kDa dextran (2 and 3 g/dl); RBC aggregation in autologous plasma and in dextran solutions was also measured. In agreement with previous observations, human and horse RBC form stable rouleaux whereas bovine RBC do not aggregate in either plasma or in dextran 464 kDa solutions. Electrophoretic measurements showed a species‐dependent adsorption and depletion of dextran that can be theoretically evaluated. Adsorption of polymer is not a prerequisite for RBC aggregation (bovine RBC show the highest amount of adsorbed dextran yet do not aggregate). Aggregate formation thus occurs as long as the Gibbs free energy difference, given by the osmotic pressure difference between the bulk phase and the polymer‐depleted region between two RBC, is larger than the steric and electrostatic repulsive energy contributed by the macromolecules present on the RBC surface. With increasing bulk‐phase polymer concentration the depletion layer thickness decreases and the amount of adsorbed macromolecules increases, thereby resulting in an increase of the repulsive component of the interaction energy and decreased aggregation. We thus view electrophoretic measurements of RBC in various media as an important tool for understanding polymer behavior near the red cell surface and hence the mechanisms involved in RBC aggregation.

Novel single-cell functional analysis of red blood cells using laser tweezers Raman spectroscopy: Application for sickle cell disease

Red blood cell (RBC) aggregation, a determinant of blood viscosity, plays an important role in blood flow rheology. RBC aggregation is induced by the adhesion of RBCs when the electrostatic repulsion between RBCs weakens owing to increases in protein and saturated fatty acid levels in blood, and excessive RBC aggregation may lead to various circulatory diseases. This study was conducted to establish a noninvasive quantitative method for the assessment of RBC aggregation. The spectrum of nonaggregating RBCs presents Rayleigh behavior, indicating that the power of a scattered wave is proportional to the fourth power of frequency. By dividing the measured power spectrum of echoes from scatterers by that from a silicone plate reflector, the frequency responses of transmitting and receiving transducers are removed from the former spectrum. This normalized power spectrum changes linearly with respect to logarithmic frequency. In non-Rayleigh scattering, on the other hand, the spectral slope decreases because a larger scatterer behaves as a reflector and echoes from a reflector do not show frequency dependence. Therefore, it is possible to assess RBC aggregation using the spectral slope value. In this study, spherical scatterers with diameters of 5, 11, 15, and 30 µm were measured in basic experiments. The spectral slope of the normalized power spectrum of echoes from the lumen of the vein in the dorsum manus of a 24-year-old healthy male was close to that from microspheres with a diameter of 15 µm, and the typical RBC diameter was smaller than this value. The frequency-dependent attenuation of ultrasound during propagation in a biomedical tissue was considered to be one reason for this. Furthermore, during avascularization, the slope gradually decreased owing to the aggregation of RBCs. These results show the possibility of using the proposed method for the noninvasive assessment of RBC aggregation.

Red blood cell aggregation in experimental sepsis

Prior literature has implicated red blood cells (RBCs) in the initiation of thrombosis and suggests that posttransfusion hypercoagulability may occur secondary to the effects of RBCs. Elevated serum tissue factor is a known sequelae of acute trauma. Phosphatidylserine (PS) is a prothrombotic phospholipid present within the RBC cell membrane. We hypothesized that RBC aggregation is dependent on the interaction between RBC membrane bound (exposed) PS, extracellular calcium, and tissue factor. Human whole blood (WB) was separated into components, including RBCs and platelet-rich plasma (PRP). Whole blood, PRP, and RBCs underwent impedance aggregometry utilizing arachidonic acid (AA), ADP, collagen, calcium, and tissue factor (TF)-based agonists. Red blood cells then underwent impedance aggregometry utilizing combined calcium and TF agonists. Red blood cells were pretreated with Annexin V, a known PS blocking agent, and underwent impedance aggregometry with combined calcium and TF agonists to determine if the mechanism of calcium/TF-induced RBC aggregability is dependent on PS. Red blood cells treated with calcium, TF, calcium+TF, and pre-treated with Annexin V followed by calcium+TF were perfused through an in vitro model of pulmonary microcirculatory flow. Red blood cell aggregation was significantly higher than that of WB and PRP when utilizing a TF agonist, an effect unique to TF. The combination of calcium and TF demonstrated significantly higher RBC aggregation than either agonist alone. Pretreatment with Annexin V resulted in a significantly reduced aggregability of RBC following treatment with TF + calcium. Red blood cells aged to 42 days did not exhibit significant change in aggregation. Exposure to calcium and TF significantly reduced time to thrombosis of RBCs perfused through a pulmonary microcirculatory model. Treatment with both TF and calcium synergistically induces RBC aggregation. Phosphatidylserine appears to play an integral role in the TF/calcium-based, age-independent RBC aggregation response. Red blood cells treated with TF + calcium exhibit more rapid thrombus formation in an in vitro model of pulmonary microcirculatory perfusion.

Cerebral arterial occlusion and the resultant hemodynamic changes in the microvasculature of the local cerebral tissue supplied by the artery are important issues that are not only of scientific interest but also of clinical significance. Clarification of the pathophysiology seems relevant to a better understanding of transient ischemic attack (TIA) and reversible ischemic neurological deficit (RIND). Recently, we found by our photoelectric method [5] that a rapid but transitory decrease in optical density of the cerebrocortical tissue of the suprasylvian gyrus in cats occurred unfailingly following middle cerebral artery (MCA) occlusion [4]. The decrease in tissue optical density was interpreted by us as a decrease in cerebral blood volume (CBV) [=diminution of cerebrovascular volume (CVV)] brought about by an abrupt fall in the intramicrovascular pressure. However, against this interpretation, it might be argued that CVV could not shrink since it was effectively protected by the autoregulatory mechanism, and that the decrease in tissue optical density could be attributed to intravascular aggregate formation of red blood cells (RBCs) since RBC aggregation also causes a decrease in optical density of the blood [3, 6]. The importance of RBC aggregation in the development of the “no-flow” phenomenon in the ischemic microvasculature was emphasized by Fischer [1]. He considered that one hemorheological consequence of RBC aggregation was an increase in viscous resistance to flow leading to further circulatory impairment. So far no correlative observations on such vascular and hemorheological factors have been carried out because of the lack of appropriate methods for following rapidly changing RBC aggregation and hemodynamic impairment.

Oral Administration of FT-4202, an Allosteric Activator of Pyruvate Kinase-R, Has Potent Anti-Sickling Effects in a Sickle Cell Anemia (SCA) Mouse Model, Resulting in Improved RBC Survival and Hemoglobin Levels

An elevated concentration of fibrinogen in blood is a significant risk factor during many pathological diseases, as it leads to an increase in red blood cells (RBC) aggregation, resulting in hemorheological disorders. Despite the biomedical importance, the mechanisms of fibrinogen-induced RBC aggregation are still debatable. One of the discussed models is the non-specific adsorption of fibrinogen macromolecules onto the RBC membrane, leading to the cells bridging in aggregates. However, recent works point to the specific character of the interaction between fibrinogen and the RBC membrane. Fibrinogen is the major physiological ligand of glycoproteins receptors IIbIIIa (GPIIbIIIa or αIIββ3 or CD41/CD61). Inhibitors of GPIIbIIIa are widely used in clinics for the treatment of various cardiovascular diseases as antiplatelets agents preventing the platelets’ aggregation. However, the effects of GPIIbIIIa inhibition on RBC aggregation are not sufficiently well studied. The objective of the present work was the complex multimodal in vitro study of the interaction between fibrinogen and the RBC membrane, revealing the role of GPIIbIIIa in the specificity of binding of fibrinogen by the RBC membrane and its involvement in the cells’ aggregation process. We demonstrate that GPIIbIIIa inhibition leads to a significant decrease in the adsorption of fibrinogen macromolecules onto the membrane, resulting in the reduction of RBC aggregation. We show that the mechanisms underlying these effects are governed by a decrease in the bridging components of RBC aggregation forces.

beta-Thalassemia major (TM), a congenital hemoglobinopathy, is associated with hemodynamic disorders and with structural red blood cell (RBC) anomalies that may indicate impairment of RBC rheological properties. To gain insight into the possible contribution of RBC to the hemodynamic disorders, we studied RBC aggregability, which plays a central role in blood flow, particularly in the microcirculation. RBC aggregate size distribution and morphology of TM RBC were determined using a novel system for image analysis of blood cells in a flow chamber. It was found that the aggregability of RBC of TM patients is markedly enhanced. These cells form large clusters, as opposed to normal rouleaux, and higher shear stress is required to disperse them. The aggregate size of TM RBC is reduced to the normal range after the patients have received a blood transfusion. This study suggests that the hemodynamic disorders observed in TM may be linked to the enhanced RBC aggregability and that improvement of RBC rheological properties may be considered in the treatment of thalassemia.

Impaired heart rate variability (HRV)and haemorheology are independently associated with cardiovascular disease and diabetic complications. The aim of the present study was to investigate the relationships between parameters of HRV,and red blood cell (RBC) aggregation and deformability, in older women with type 2 diabetes. Twenty women (age 69 ± 2 yr) with uncomplicated type 2 diabetes and twenty controls (age 69 ± 3 yr) participated in the study. Beat-to-beat cardiac (RR) intervals over 5 min were analysed for HRV parameters in the time and frequency domains. Blood was sampled for RBC deformability, as well as RBC aggregation in two suspending mediums: haematocrit adjusted plasma and 3% dextran 70. RBC aggregation was increased and HRV was impaired for those with type 2 diabetes when compared with control. RBC aggregation was negatively related to low frequency power of HRV, and was positively related to high frequency power of HRV, for subjects with type 2 diabetes. RBC deformability was positively related to HRV only for those with type 2 diabetes. Impaired haemorheology is associated with reduced HRV in older women with type 2 diabetes, suggesting changes in the microcirculation may result in impaired modulation of cardiac cycles.

Studies on the haemodynamics of human circulation are clinically and scientifically important. In order to investigate the effect of deformation and aggregation of red blood cells (RBCs) in blood flow, a computational technique has been developed by coupling the interaction between the fluid and the deformable RBCs. Parallelization was carried out for the coupled code and a high speedup was achieved based on a spatial decomposition. In order to verify the code's capability of simulating RBC deformation and transport, simulations were carried out for a spherical capsule in a microchannel and multiple RBC transport in a Poiseuille flow. RBC transport in a confined tube was also carried out to simulate the peristaltic effects of microvessels. Relatively large-scale simulations were carried out of the motion of 49,512 RBCs in shear flows, which yielded a hematocrit of 45%. The large-scale feature of the simulation has enabled a macroscale verification and investigation of the overall characteristics of RBC aggregations to be carried out. The results are in excellent agreement with experimental studies and, more specifically, both the experimental and simulation results show uniform RBC distributions under high shear rates (60–100/s) whereas large aggregations were observed under a lower shear rate of 10/s.

Impaired Erythrocyte Methemoglobin Reduction in Sickle Cell Disease: Dependence of Methemoglobin Reduction on Reduced Nicotinamide Adenine Dinucleotide Content

Counting morphologically normal cells in human red blood cells (RBCs) is extremely beneficial in the health care field. We propose a three-dimensional (3-D) classification method of automatically determining the morphologically normal RBCs in the phase image of multiple human RBCs that are obtained by off-axis digital holographic microscopy (DHM). The RBC holograms are first recorded by DHM, and then the phase images of multiple RBCs are reconstructed by a computational numerical algorithm. To design the classifier, the three typical RBC shapes, which are stomatocyte, discocyte, and echinocyte, are used for training and testing. Nonmain or abnormal RBC shapes different from the three normal shapes are defined as the fourth category. Ten features, including projected surface area, average phase value, mean corpuscular hemoglobin, perimeter, mean corpuscular hemoglobin surface density, circularity, mean phase of center part, sphericity coefficient, elongation, and pallor, are extracted from each RBC after segmenting the reconstructed phase images by using a watershed transform algorithm. Moreover, four additional properties, such as projected surface area, perimeter, average phase value, and elongation, are measured from the inner part of each cell, which can give significant information beyond the previous 10 features for the separation of the RBC groups; these are verified in the experiment by the statistical method of Hotelling's T-quare test. We also apply the principal component analysis algorithm to reduce the dimension number of variables and establish the Gaussian mixture densities using the projected data with the first eight principal components. Consequently, the Gaussian mixtures are used to design the discriminant functions based on Bayesian decision theory. To improve the performance of the Bayes classifier and the accuracy of estimation of its error rate, the leaving-one-out technique is applied. Experimental results show that the proposed method can yield good results for calculating the percentage of each typical normal RBC shape in a reconstructed phase image of multiple RBCs that will be favorable to the analysis of RBC-related diseases. In addition, we show that the discrimination performance for the counting of normal shapes of RBCs can be improved by using 3-D features of an RBC.

The hemolytic action of sodium alginate solution on human red blood cells (RBC), and the aggregations of human and rat RBC in the presence of sodium alginate were studied. The human RBC in sodium alginate solution did not indicate any morphological change of RBC. The hemoglobin was not detected in the supernatant of incubation medium. These results show that sodium alginate has no hemolytic action on human RBC. Human and rat RBC showed a marked aggregation by sodium alginate in the neutral medium. The rouleaux formations of RBC in various concentrations of sodium alginate having different molecular weights were examined. In addition, the concentration of sodium alginate required to induce a discernible aggregation of RBC was determined. Sodium alginates having larger molecular weights showed more pronounced activities for aggregation of RBC as compared with those having smaller molecular weights, and the aggregation of RBC increased with an increase in the concentration of sodium alginate. The aggregation of RBC in sodium alginate solution was inhibited by urea, suggesting that the aggregation of RBC is mainly caused by hydrogen bonding. The rouleaux of RBC covered with fibrin net was observed in the coagulation cruor by means of scanning electron microscopy, when sodium alginate was added to human or rat blood.