Lipid peroxidation injury to red blood cells during extracorporeal circulation: mechanism and protection

Twelve dogs were subjected to cardiopulmonary bypass with membrane oxygenator for 120 minutes. The effect of lipid peroxide injury on red blood cells was studied by measurement of plasma and erythrocyte membrane lipid peroxide, deformabioity of erythrocyte, plasma free hemoglobin, superoxide dismutase, Na(+)-K(+)-ATPase and Ca(2+)-Mg(2+)-ATPase of erythrocytes. The effect of vitamin E on red blood cells was also investigated. The findings indicated that vitamin E might protect red blood cells from lipid peroxide injury during extracorporeal circulation. The mechanism of damage effect of lipid peroxide and the protective effect of vitamin E on red blood cells were briefly discussed.     

Diabetic retinopathy: a review

In the United States, diabetic retinopathy is the leading cause of new blindness in those of occupational age. We present an overview of risk factors, including renal disease, uncontrolled blood pressure, pregnancy, poor glucose control, elevated glycosylated hemoglobin, duration of disease, and age at time of diagnosis; pathogenesis, addressing the involvement of aldose reductase, nonenzymatic glycosylation of proteins, vasoproliferative factors, ischemia and vasodilation, systemic growth factors, and platelets and blood viscosity; pathology, including nonproliferative, preproliferative, and proliferative retinopathy; and the management of this condition.     

Changes in absorbance at 413 nm in plasma from three rodent species exposed to phosgene

Mice, rats and guinea pigs were exposed to phosgene (COCl2), a highly irritating and oxidizing gas. Animals were exposed to 87 mg/m3 phosgene for 20 min in a whole-body exposure chamber. Within 55-65 minutes after the start of exposure, plasma was scanned spectrophotometrically from 200-600 nm. A distinct and significant increase in area under the curve in the Soret band region at 413 nm was observed in plasma from phosgene-exposed animals when compared with air-exposed controls in all three species. These peaks were consistent with hemoglobin, an indication that the integrity of the erythrocyte membrane had been compromised by exposure. An erythrocyte osmotic fragility assay on blood from mice exposed to phosgene indicated that 30% less NaCl was needed to cause 50% hemolysis compared to air-exposed mice. These results suggest a new mechanism of phosgene-induced acute lung injury that may be linked, in part, to a direct attack on the erythrocyte membrane.     

Quinone-dependent tertiary amine N-oxide reduction in rat blood

Rat blood exhibited a significant quinone-dependent N-oxide reductase activity towards imipramine N-oxide. The reduction mediated by the blood proceeded in the presence of both NAD(P)H and menadione under anaerobic conditions. When menadione was replaced with 1,4-naphthoquinone or 9,10-phenanthrenequinone, similar results were obtained. The reduction was also mediated by the combination of rat erythrocytes and plasma. The reducing activity was inhibited by dicumarol and carbon monoxide. When boiled plasma was combined with untreated erythrocytes, the N-oxide reducing activity was abolished. In contrast, when boiled erythrocytes were combined with untreated plasma, the activity was unchanged. These results suggest that the activity is caused by the heme of hemoglobin in erythrocytes and quinone reductase in plasma. In fact, erythrocytes and hemoglobin have the ability to reduce the N-oxide when supplemented with DT-diaphorase purified from rat liver in the presence of both NAD(P)H and menadione. Hemoglobin also exhibits N-oxide reductase activity with reduced menadione (menadiol). Furthermore, hematin exhibits a significant reducing activity in the presence of menadiol. The reduction appears to proceed in two steps. The first step is enzymatic reduction of quinones to dihydroquinones by quinone reductase(s) with NADPH or NADH in plasma. The second step is nonenzymatic reduction of imipramine N-oxide to imipramine by the dihydroquinones, catalyzed by the heme group of hemoglobin in erythrocytes. Cyclobenzaprine N-oxide and brucine N-oxide are similarly transformed to the corresponding amines by the above reducing system in blood. These results suggest that blood plays an important role in the reduction of tertiary amine N-oxides to tertiary amines.     

Macromolecular interactions of [14C-ring]melphalan in blood

The pharmacokinetics and macromolecular interactions of [14C-ring]melphalan (L-PAM) in blood were studied in rats following a single oral dose (20 mg/kg, 0.1 mCi/kg). Radioactivity levels were monitored in blood over a period of 72 hr. The highest levels of radioactivity were observed at 2 hr. The decline of radioactivity from the blood was biphasic with T1/2 alpha = 7 hr and T1/2 beta = 75 hr. The radioactive species in plasma corresponded to unchanged L-PAM and its two known hydrolytic products 4,2-hydroxyethyl 2-chloroethylamino-L-phenylalanine (L-MOH) and 4-[bis(2-hydroxyethyl)amino]-L-phenylalanine (L-DOH). In addition, four other major, previously unknown, metabolites of L-PAM were detected in plasma. At 72 hr, most of the radioactivity was bound to macromolecular components, 26% to plasma macromolecules and 62% in red blood cells. Covalent binding to blood cells was mainly to membrane proteins. Binding to hemoglobin and other soluble components of the red cells was also observed, with a 5000-fold greater affinity for membranes. These studies suggest extensive interaction of melphalan, or its metabolites, with membrane and soluble proteins of red blood cells.     

Lens glutathione, lens protein glycation and electrophoretic patterns of lens proteins in STZ induced diabetic rats

As diabetes is a very complex disease, with the pathological symptoms varying with age, diabetic type and means of control, it still warrants many in vivo and in vitro studies. During hyperglycaemia, increases in the sorbitol pathway, nonenzymatic glycosylation of lens proteins and damage to antioxidant systems have been reported to cause opacification of the lens leading to cataract formation. In this study, intracapsular extracts of lenses from STZ induced diabetic female rats were examined. Total protein, glutathione and nonenzymatic glycosylation were determined by the Lowry, Ellman reagent and thiobarbituric acid methods respectively. Laemmli protein electrophoresis was also carried out on the lens homogenates. After a period of as short as 5 weeks, a decrease in lens glutathione, and an increase in nonenzymatic glycosylation of lens proteins were found. The electrophoresis showed an increase in proteins of high molecular weight.     

Analysis and biochemistry of blood folate

Although the analysis of low plasma concentrations of 5-methyltetrahydrofolate by several specific HPLC methods has been reported, considerably fewer routine chromatographic techniques exist for the analysis of specific folate coenzymes in the erythrocyte where a nonspecific bioassay indicates that the vitamin achieves a level 10 times higher than that in plasma. By using three separate folypolyglutamate deconjugation procedures and combining an extraction technique which adequately preserves all native folate coenzymes with an HPLC technique utilizing fluorescence, diode array, and off-line radioassay detection capable of resolving all crucial native folates in their monoglutamyl forms, we were unable to demonstrate levels of 5-methyltetrahydrofolate in whole blood hemolysate beyond what might be expected from the plasma component. While the exact nature of erythrocyte folate could not be ascertained, we provide evidence that a proportion of it may exist at the formyl level of oxidation. The complex pH and enzymatic interrelationship between folate coenzymes at the formyl oxidation level is discussed in terms of our extraction technique and findings, as well as in a broader biological context. This paper also describes a simple acid precipitation technique for measuring plasma 5-methyltetrahydrofolate, as well as providing comprehensive data on the chromatographic behavior of all the folylmonoglutamates in reversed-phase and weak anion-exchange modes, including useful spectral data for optimizing detection parameters and identifying individual coenzymes. 10-Formyltetrahydrofolate and 5-methyltetrahydrofolate are the two most important one-carbon-substituted folate coenzymes. 10-Formyltetrahydrofolate is unavailable commercially, probably due to its instability. We chart the chemical synthesis of this important coenzyme and show that it and what is thought to be 5,10-hydroxymethylenetetrahydrofolate are actually minor products compared to the parent 5,10-methenyltetrahydrofolate and the ultimate reaction product, 5-formyltetrahydrofolate. Since intraerythrocyte folate binds to a specific hemoglobin site, we ascertained the total number of binding sites on hemoglobin (Bmax) and the equilibrium dissociation constant (Kd) for 5-methyltetrahydrofolate, 5-formyltetrahydrofolate, and the antimetabolite methotrexate. Binding affinities were consistent with a low-affinity, low-capacity interaction for all three. It was demonstrated that hemoglobin has a greater affinity for 5-methyltetrahydrofolate than for the other folate derivatives (Kd = 1.2 x 10(-3) M), while rather surprisingly, methotrexate had a higher affinity for hemoglobin than did 5-formyltetrahydrofolate (Kd = 2.5 x 10(-3) and 3.7 x 10(-2) M, respectively.     

Erythrocytes participate significantly in blood transport of amino acids during the post absorptive state in normal humans

To investigate the participation of erythrocytes in the blood transport of amino acids during the course of intestinal absorption in humans, erythrocyte and plasma amino-acid concentrations were determined following ingestion of an oral load of amino acids. In addition to baseline plasma and erythrocyte amino acid concentrations in 18 subjects, plasma and erythrocyte amino acids kinetics during the 125 min following an oral amino acid load were further determined in 9 of the 18 subjects. The results showed that human erythrocytes contained most amino acids at similar or higher concentrations than plasma. Furthermore, the correlations observed between plasma and erythrocyte contents clearly indicated that erythrocytes were involved in the transport of amino acids by the blood. For some amino acids erythrocyte transport sometimes exceeded that of plasma. Significant correlation coefficients showed that strong plasma-erythrocyte relationships existed for alanine, valine, methionine, isoleucine, leucine, phenylalanine, and ornithine. In conclusion, our data supported the hypothesis that both blood compartments, plasma and erythrocytes, are involved significantly in the blood transport of amino acids in humans during the postabsorptive state.     

Distribution of bacterial endotoxin in human and rabbit blood and effects of stroma-free hemoglobin

Bacterial endotoxin (lipopolysaccharide [LPS]) is known to interact with numerous components of blood, including erythrocytes, mononuclear cells, platelets, neutrophils, lipoproteins, and plasma proteins. The relative affinities of LPS for these elements, and the distribution of LPS between them, are unknown. Cross-linked stroma-free hemoglobin (SFH), a potential substitute for erythrocyte transfusion, produces in vivo toxicity in animals consistent with significant LPS contamination. Therefore, we studied the distribution of LPS in human and rabbit blood and examined whether the presence of SFH altered LPS distribution. In either the presence or absence of SFH, LPS was associated predominantly with high-density lipoproteins and apoproteins. There was lesser binding to low- and very-low-density lipoproteins. Examination of the apoprotein pool by column chromatography and density centrifugation demonstrated that LPS in this fraction was predominantly protein bound. Binding of LPS to SFH resulted in dissociation of a portion of the LPS into low-molecular-weight complexes. Cell-bound LPS was only 2 to 16% of the total and was unaffected by SFH. The distribution among blood cells demonstrated predominant binding to platelets in human blood but predominant binding to erythrocytes in rabbit blood. Cellular distribution was not significantly altered by SFH.     

In vitro blood compatibility of surface-modified polyurethanes

Polyurethanes have proven durable materials for the manufacture of flexible trileaflet heart valves, during in vitro tests. The response of two polyurethanes of differing primary structure to parameters of blood compatibility has now been investigated, using an in vitro test cell. Platelet (beta-thromboglobulin) release, complement (C3a) activation, the activation of free plasma and surface-bound factor XII were studied using fresh, human blood (no anticoagulant) or citrated plasma in control and surface-modified polyurethane. Surface modifications were designed to affect material thrombogenicity and included covalent attachment of heparin, taurine, a platelet membrane glycoprotein fragment, polyethylene oxide (PEO), 3-aminopropyltriethoxysilane, and glucose or glucosamine. Unmodified control polyurethanes caused platelet release and complement activation. High molecular weight (2000 D) polyethylene oxide reduced platelet release slightly but only glucose attachment to the surface produced a significant reduction in platelet activation. All modifications reduced C3 activation compared with controls, but the greatest reduction was achieved with polyethylene oxide attachment or glycosylation. Most surface modifications were more activating of factor XII, both in plasma and on the material surfaces, than the control polyurethanes. Heparin and high molecular weight PEO produced the greatest activation of factor XII in the free plasma form, but low molecular weight PEO and glucosamine produced the greatest activation of surface-bound factor XIIa. The least activating surfaces, affecting both free plasma and surface-bound factor XIIa, were those treated with platelet membrane glycoprotein fragment and glucose. PEO surfaces performed relatively well, compared with controls and most surface modifications. The best overall surface, however, was the glucose-modified surface which was least activating considering all parameters of blood compatibility.     

Impaired left ventricular relaxation and hyperinsulinemia in patients with primary hypercholesterolemia

Fifteen non-obese patients with familial hypercholesterolemia and fifteen normocholesterolemic subjects matched for age, body mass index, waist/hip ratio, arterial blood pressure and sedentary life style underwent blood sampling for determination of fasting plasma glucose, insulin, total-, LDL-, HDL-cholesterol, triglycerides, free fatty acids, apolipoprotein A1 and B. In both groups of subjects we determined erythrocyte membrane microviscosity and performed an echocardiographic study. We demonstrated that hypercholesterolemic patients had a significant increase in fasting plasma total cholesterol (8.9 +/- 0.5 vs. 5.5 +/- 0.3 mmol/l, P less than 0.001), insulin (79 +/- 4 vs. 58 +/- 4 pmol/l, P less than 0.05) and apolipoprotein B (2.2 +/- 0.5 vs. 1.3 +/- 0.5 g/l P less than 0.01). In the echocardiographic study we found a significant impairment in left ventricular relaxation (isovolumic relaxation time (IRT) 106 +/- 6 vs. 73 +/- 7 ms, P less than 0.01). Erythrocyte membrane microviscosity (0.253 +/- 0.004 vs. 0.225 +/- 0.003, P less than 0.05) was also increased in hypercholesterolemic patients. Finally we found that erythrocyte membrane microviscosity correlated with fasting plasma insulin levels (r = -0.46, P less than 0.03) and IRT (r = -0.52, P less than 0.01).     

Effects of taxol and taxol/hyperthermia treatments on the functional polarization of cytotoxic T lymphocytes

We have assessed gravimetric methods for determination of intravascular water, established whole blood-, plasma- and erythrocyte water reference values in a healthy volunteer group (n = 97, 48 females) and correlated these variables with 30 simultaneous hematological, clinicochemical and body parameters. The water standard was 55.56 mol/kg = 100 mass %. For erythrocyte water determination three methods were evaluated: 2 indirect methods were easy to perform, the third, using a hematocrit centrifuge, was the most reliable. Imprecision (within-batch coefficient of variation (CV), %) was excellent: whole blood 0.2, plasma 0.1, erythrocytes 0.7-2.2 and recoveries (means, %) 99.7-100.1. Serum water was found to be slightly higher than plasma water. Volunteer group, mean reference values, mass %: whole blood water 79.7, plasma water 91.2, erythrocyte water, three methods 66.2, 64.6 and 64.2, respectively. Females had mean 1.6 mass % higher whole blood water and 0.9-1.0 mass % higher erythrocyte water than males with no difference in plasma water. In the volunteer group whole blood water correlated strongly with hematocrit (r = -0.96), hemoglobin (r = -0.94) and erythrocytes (r = -0.85) and centrifuge hematocrit (r = -0.91). Plasma water correlated strongly with plasma total protein (r = -0.74, all correlations P < 0.001). Hemoglobin and hematocrit can serve as surrogate parameters for whole blood water when water determination is not available; total protein reflects plasma water.     

Proximal locking screw repositioning in reconstruction femoral nails

Chard (Beta vulgaris L. var. cicla) is one of the plants used as hypoglycaemic agent by diabetics in Turkey and it has been reported to reduce blood glucose. The purpose of this study was to investigate the effect of feeding chard on diabetes induced impairments in rat skins. Uncontrolled induced diabetes caused significant increases in nonenzymatic glycosylation of skin proteins, lipid peroxidation and blood glucose. Administration of chard extract inhibited these effects except the increase in lipid peroxidation. SDS-polyacrylamide gel electrophoresis revealed no significant differences in any protein bands between any of the groups. The data indicate that the use of chard may be effective in preventing or at least retarding the development of some diabetic complications.     

Plasma hemoglobin measurement techniques for the in vitro evaluation of blood damage caused by medical devices

A sensitive measure of the in vitro blood damage potential of a medical device is the rate at which hemoglobin is released into the plasma from red blood cells flowing through the device. Presently there is no one widely accepted method for measuring the plasma hemoglobin concentration. Nine currently used assays, classified as either direct optical or added chemical techniques, were evaluated for accuracy, reproducibility, sensitivity, interference effects, and ease of use by adding hemoglobin (1-200 mg/dl) to saline, lipid, and bilirubin solutions and to normal cow plasma. Most of the assays displayed good linearity, accuracy, and reproducibility down to 1 mg/dl when interferents were absent. However, representative of the effects caused by interferents, the endogenous hemoglobin concentration of a typical cow plasma sample measured by the 9 techniques ranged from -2 to 39 mg/dl. Although used by fewer organizations, some of the direct optical spectrophotometric methods (e.g., the Cripps and Harboe baseline correction methods) are safer, easier, and more precise and accurate than the chemical addition methods used to measure plasma hemoglobin concentration from in vitro blood damage testing of medical devices.     

Influence of pentobarbital sodium anesthesia on hematologic values in the dog

The effects of intravenously administered commercial pentobarbital sodium, pentobarbital sodium in saline solution, 40% propylene glycol in saline solution, 10% ethanol in saline solution, and saline solution on erythrocyte fragility and blood coagulation variables were studied in the dog. The pentobarbital solution and the 40% propylene glycol caused erythrocyte lysis and obvious hemoglobin release into the plasma. They also caused a shortening of the whole blood clotting time and partial thromboplastin time tests, evidence of increased procoagulant activity involving the intrinsic coagulation system. Alterations in these variables were not noticed after pentobarbital sodium in saline solution, 10% ethanol in saline solution, and saline solution injections. Changes were not noticed in the extrinsic coagulation system or in platelet function.     

Characterization of hemoglobin variants by MALDI-TOF MS using a polyurethane membrane as the sample support

A new method for the sampling and off-site analysis of hemoglobin variants by mass spectrometry is reported. This technique uses a nonporous polyurethane membrane as the collection device and transportation medium of a blood sample for analysis. The same membrane is then used as the MALDI-TOF MS sample support for mass spectrometric analysis. Minimal invasive sample collection is afforded by collecting less than 1 microL of blood using a common lancet device. MALDI-TOF MS is performed directly on the membrane, after washing off the interfering plasma components, followed by the addition of matrix. This reduces the time of analysis and prevents sample loss. Enzymatic digestion can be performed directly on the membrane, using in this case trypsin, allowing for further characterization of the sample. The method is much less invasive compared to drawing blood with a syringe. The sample may be transported to the laboratory by regular mail, and thus the method can serve remote locations. We demonstrate the procedure by characterizing the Hb Shepherds Bush hemoglobin variant, b74-(E18)Gly-->Asp.     

Irreversible deformation of the spectrin-actin lattice in irreversibly sickled cells

Irreversibly sickled cells (ISC's) are circulating erythrocytes in patients with sickle cell disease that retain a sickled shape even when oxygenated. Evidence points to a membrane defect that prevents the return of these cells to the normal biconcave shape. The erythrocyte membrane protein spectrin is believed to help control erythrocyte shape and deformability. Recent studies suggest that normally spectrin and an erythrocyte actin form a self-supporting, fibrillar, lattice-like network on the cytoplasmic membrane surface. When normal erythrocyte ghosts are extracted with Triton X-100 all the integral membrane proteins and most of the membrane lipids are removed, leaving a ghost-shaped residue composed principally of spectrin and actin. We concentrated ISC's from patients with sickle cell anemia and compared the morphology and protein composition of ghosts and Triton-extracted ghost residues prepared from these ISC's with similar preparations of reversibly sickable cells and normal cells. (a) Many ISC's formed ISC-shaped ghosts. (b) All ISC-shaped ghosts formed ISC-shaped Triton residues. (c) Spectrin, erythrocyte actin (Band 5), an unidentified Band 3 component, and Band 4.1 were the major protein components of the Triton residues. All membrane-associated sickle hemoglobin was removed by the Triton treatment. (d) No ISC-shaped ghosts or ISC-shaped Triton residues were formed when deoxygenated, sickled RSC's were lysed or Triton-extracted. ISC-shaped ghosts and Triton residues were never formed from normal cells. These observations suggest that a defect of the "spectrin-actin lattice" may be the primary abnormality of the ISC membrane. Since ISC's are rigid cells, the data support the postulate that spectrin is a major determinant of membrane deformability. Finally, they provide direct evidence that spectrin is important in determining erythrocyte shape.     

Chemical characterization and distribution of ABO blood group active glycoprotein in human erythrocyte membrane

Occurrence and distribution of glycoprotein H substances in blood type O human erythrocyte membrance were studied using an alpha N-acetylgalactosaminyltransferase (A-enzyme) purified from milk of blood type A women. Erythrocytes of blood group O, nonsecretors and secretors alike, contain H substances that serve as a substrate for this transferase, and the H determinants seem to occur in all three erythrocyte membrane glycoproteins (periodic acid-Schiff (PAS)-1, PAS-2, and PAS-3). Structural studies of the A glycoproteins obtained by the transferase action, suggested that all erythrocyte H glycoproteins contain only type 2 antigenic determinant.     

Separation and detection of the alpha- and beta-chains of hemoglobin of a single intact red blood cells using capillary electrophoresis/electrospray ionization time-of-flight mass spectrometry

A single intact red blood cell (erythrocyte) was injected into a capillary electrophoresis column, and following in-capillary lysing the alpha- and beta-chains of the hemoglobin (approximately 450 amol) were separated and detected using capillary electrophoresis/electrospray ionization time-of-flight mass spectrometry. The mass specta of the electropherogram peaks of the alpha and beta chains showed identifiable peaks corresponding to multiply protonated and sodiated alpha- and beta-chains of hemoglobin.