The effects of sickling on ion transport. II. The effect of sickling on sodium and cesium transport

When the red cells from patients with sickle cell anemia (S-S) were kept in the disk shape by incubation in O₂, they maintained cell sodium in the steady state for at least 10 hours. The sodium flux in such cells at 37°C. was 6.0 ± 1.5 m.eq./ (liters RBC) x (hours). When S-S cells were sickled by incubation in N₂, sodium outflux increased two- to threefold, while influx increased four- to fivefold and the cells gained net sodium. A small but undetermined fraction of the sodium in disk and sickle shaped S-S cells exchanges at one or more rates which are substantially slower than those calculated here from the initial rate of transfer of tracer from cells to the medium. The penetration of tracer Cs into normal and both disk and sickled S-S cells was markedly inhibited by increasing the K concentration in the medium, indicating that Cs and K compete for an entrance pathway in all three cell types. The ratio of the inward rate constant for tracer Cs to that for K⁴² in normal and disk-shaped S-S cells increased only slightly when the K concentration in the medium was increased, indicating that almost all the Cs entered such cells in competition with K. Sickling accelerated the entrance of tracer cesium into S-S cells. Furthermore, the rate constant ratio increased with increasing external K concentration in sickled cells, suggesting the simultaneous presence of a non-competitive route for cesium influx in this cell type. The results are interpreted to support the view that sickling (a) accelerates inward transport of K and Cs and outward transport of Na by a non-diffusion, assumed carrier, process and (b) opens pathways for the diffusion of all three ions.     

Augmentation of sickling process due to turbulent blood flow.

The purpose of this study was to determine if the fluid mechanical stresses associated with turbulent blood flow can contribute to the sickling process. Blood from seven patients with sickle cell disease was subjected to intermediate and high levels of turbulent flow in vitro. Turbulence was quantitated by hot film anemometry. Control samples showed 20 +/- 3% sickled cells. Cells subjected to intermediate levels of turbulent flow showed 26 +/- 4% sickling (P less than 0.01); and blood subjected to high intensities of turbulence showed 31 +/- 4% sickling (P less than 0.01). A quantitative count by electronmicroscopy, performed in one patient, showed polymerization of the hemoglobin indicative of sickling in more cells subjected to turbulence than in the control sample. A turbulence-reducing agent, polyethylene oxide, diminished the augmentation of the sickling process as it reduced turbulence at comparable Reynolds numbers. These results support the hypothesis that a deleterious effect upon hemoglobin SS erythrocytes may occur due to the mechanical stresses of turbulent flow. The agitation associated with turbulent flow presumably modifies the stabilizing factors of the intracellular colloidal solution of hemoglobin, thereby contributing to sol-gel transformation. Such hydrodynamic stresses may supplement the previously described factors which contribute to sickle cell crises.     

β-Globin Sleeping Beauty Transposon Reduces Red Blood Cell Sickling in a Patient-Derived CD34+-Based In Vitro Model

The ultimate goal of gene therapy for sickle cell anemia (SCA) is an improved phenotype for the patient. In this study, we utilized bone marrow from a sickle cell patient as a model of disease in an in vitro setting for the hyperactive Sleeping Beauty transposon gene therapy system. We demonstrated that mature sickle red blood cells containing hemoglobin-S and sickling in response to metabisulfite can be generated in vitro from SCA bone marrow. These cells showed the characteristic morphology and kinetics of hemoglobin-S polymerization, which we quantified using video microscopy and imaging cytometry. Using video assessment, we showed that delivery of an IHK-β^T87Q antisickling globin gene by Sleeping Beauty via nucleofection improves metrics of sickling, decreasing percent sickled from 53.2 ± 2.2% to 43.9 ± 2.0%, increasing the median time to sickling from 8.5 to 9.6 min and decreasing the maximum rate of sickling from 2.3 x 10^-3 sickling cells/total cells/sec in controls to 1.26 x 10^-3 sickling cells/total cells/sec in the IHK-β^T87Q-globin group (p < 0.001). Using imaging cytometry, the percentage of elongated sickled cells decreased from 34.8 ± 4.5% to 29.5 ± 3.0% in control versus treated (p < 0.05). These results support the potential use of Sleeping Beauty as a clinical gene therapy vector and provide a useful tool for studying sickle red blood cells in vitro.     

Effect of beta-adrenergic blockers on the sickling phenomenon

Dichloroisoproterenol (DCI) and propranolol were found to inhibit sickling in vivo when they were added to red-cell suspensions prior to deoxygenation. The effectiveness was maximal between PO2's of 30 and 40 mmHg (1 mmHg = 133.322 Pa). When cells were sickled at a low oxygen tension (PO2 = 32 mmHg), and then DCI was added later, the drug decreased the degree of sickling while the suspension was maintained at the same oxygen tension. The antisickling effect of these drugs was not antagonized by isoproterenol, a beta-adrenergic stimulator, by the addition of cAMP or increase of the intracellular calcium concentration. Other beta-blockers, such as MJ1999 (sotalol) and timolol, did not show antisickling activity. It was also found that DCI, propranolol, and timolol had some effect on the delay time of gelation of sickle-cell hemoglobin (Hb S), as well as on the oxygen affinity of sickle cells.     

Prostaglandin E2 effects on cation flux in sickle erythrocyte ghosts

Prostaglandin E₂ has previously been shown to enhance the shape transformation of sickle prone erythrocytes (8) and to reduce the oxygen resaturation of Hemoglobin SS within intact sickle cell erythrocytes after deoxygenation (15). In view of the recent importance attributed to calcium transport in maintaining erythrocyte shape and viability (10) and the suggestion that prostaglandins may act via a calcium ionophore mechanism (9) on cell membranes, erythrocyte ghosts were prepared following the method of Lepke and Passow (12) from normal and sickle cell anemia erythrocytes. These two classes of ghosts are shown to display differing patterns of sodium and calcium transport, with calcium influx being preferentially stimulated by prostaglandin E₂ in sickle cell ghosts. It is suggested that in hypoxic, stasis conditions , prostaglandins may play a role in accelerating sickling of sickle prone erythrocytes via stimulation of calcium influx.     

Effect of dichloromethane on sickle cells. An in vitro water proton magnetic resonance relaxation study

To examine the manner in which dichloromethane inhibits sickling, sickle blood was subjected to both prevention and reversal schemes over a range of CH₂Cl₂ vapor pressures. Following CH₂Cl₂-treatment, the rotating frame spin lattice relaxation time (T_1?) of water protons in deoxygenated packed sickle cells was measured, cell types in a deoxygenated fixed sample were counted, and the extent of hemolysis determined. At CH₂Cl₂ vapor pressures above 200 mm, the NMR relaxation rate decreased sharply, the extent of hemolysis increased, the fraction of sickled cells and other abnormal erythrocytes decreased, and the fraction of biconcave discs increased. Apparently CH₂Cl₂ is absorbed by the cell membrane and preferentially lyses sickled cells and other abnormal cells. Part of the decrease in NMR relaxation rate with increased CH₂Cl₂ pressure is due to a larger fraction of discs, but an additional factor probably arises from CH₂Cl₂ inhibition of hemoglobin S gelation.     

Inhibition of invitro sickling by liposome-mediated transport of amino acids into intact human red blood cells

To investigate the role of phenylalanine and tryptophane as potential antisickling agents in intact human SS-red blood cells a liposomal transport system was employed to transfer phenyl-alanine or tryptophane into intact SS-red blood cells. Aromatic amino acids and short peptides containing phenylalanine have been demonstrated to increase the minimum gelling concentration and solubility of deoxy-hemoglobin S in aqueous solution. However, these compounds do not cross the red blood cell membrane under usual incubation conditions. Incorporation of phenylalanine or tryptophane into intact SS-red blood cells $\text{via}$ liposomal transport system markedly inhibited the $\text{in}\text{vitro}$ sickling of deoxy-hemoglobin S. These findings raise the possibility that a nontoxic liposomal transport system which facilitates incorporation of antisickling agents into intact SS-RBC may have significant therapeutic implications in the treatment of sickle cell disease.     

The effect of prostaglandin E2-induced echinocytic transformation on the optassium loss,viscosity and osmotic fragility of normal and sickle cell erythrocytes

Prostaglandin E₂ (PGE₂)-induced discocyte → echinocytic transformation has no effect om the viscosity or osmotic fragility of normal or stickle cell erythrocytes. Membrane permeability, reflected, reflected as potassium efflux, is significantly affected in normal erythrocytes when >90% of the cells are morphologically transformed to the enchinocytic III stage (PGE₂ concentration of 1–2×10⁶ ng/ml blood). This potassium loos is significant in sickle erythrocytes when 50–70% of the cell population has been transformed (PGE₂ concentration, 5×10⁵ ng/ml blood). This change in membrane permeability reprensents one-half to one-third the flux that occurs with sickling (i.e., >80% of the erythrocytes sickled).     

The effect of ACTH and adrenal steroids on K transport in human erythrocytes

The effect of ACTH and adrenal steroids on K transport in human erythrocytes has been studied. A new method of calculation has revealed that in normal human erythrocytes the K transport is not independent of external K concentration as had previously been thought. The equation describing the relationship is, K influx (m.eq./liter cells hour) = [K]_pi/(0.697 + 0.329 [K]_pi) in which [K]_pi refers to the plasma K concentration at the beginning of the experiment. At the physiological plasma K concentration of 4.65 m.eq./liter, K influx is 2.09 m.eq./liter cells hour; K efflux is 1.95 m.eq./liter cells hour and is independent of plasma K concentration. The effect of the infusion of ACTH and adrenal steroids on the K content of the erythrocytes was also studied. Infusions of ACTH or cortisone do not cause the expected loss in erythrocyte K content and may well cause a gain. Infusions of ACTH and cortisone decrease the rate of K influx and efflux slightly at all stages of the infusion, as measured in vitro in blood samples drawn at various times during and following the infusion. However, the erythrocytes incubated in vitro do not exhibit the same changes in K content as are found in vivo. Hydrocortisone added to normal cells in vitro also decreases both influx and efflux of K, without affecting the K content of the cells.     

Cat Heart Muscle In Vitro : IV. Inhibition of transport in quiescent muscles

Cellular concentrations, [K]_i, [Na]_i, and [Cl]_i, and cell water contents were measured in vitro at 27°C in cat papillary muscles. Measurements were made with and without ouabain at varying concentrations of K and ouabain, at pH 5.2 and 9.0, in absence of O₂, and in NaCl-free solution. Large losses of cell K and increases of cell Na occurred in presence of ouabain, at 2–3°C, and in K-free medium. The dependence of inhibition of cation transport by ouabain on external K concentration, studied at constant initial [K]_i, was consistent with a competition between K and ouabain localized to the external face of the membrane. In NaCl-free sucrose solution [K]_i remained at its physiological value and was not affected by exposure to ouabain or low temperature, except when Ca was also omitted. Ouabain inhibition persisted at pH 9.0 and in Ca-poor media. Cells swelled and lost K at pH 5.2, and residual ouabain effect was small. At pH 9.0, or in absence of O₂, or in Ca-poor solutions cells became permeable to mannitol. The ion movements observed after inhibition of active transport are compatible either with a passive K distribution and a primary inhibition of Na extrusion or with inhibition of a coupled active transport of both K and Na.     

Prostaglandin E2 effects on cation flux in sickle erythrocyte ghosts.

Prostaglandin E2 has previously been shown to enhance the shape transformation of sickle prone erythrocytes (8) and to reduce the oxygen resaturation of Hemoglobin SS within intact sickle cell erythrocytes after deoxygenation (15). In view of the recent importance attributed to calcium transport in maintaining erythrocyte shape and viability (10) and the suggestion that prostaglandins may act via a calcium ionophore mechanism (9) on cell membranes, erythrocyte ghosts were prepared following the method of Lepke and Passow (12) from normal and sickle cell anemia erythrocytes. These two classes of ghosts are shown to display differing patterns of sodium and calcium transport, whith calcium influx being preferentially stimulated by prostaglandin E2 in sickle cell ghosts. It is suggested that in hypoxic, stasis conditions in vivo, prostaglandins may play a role in accelerating sickling of sickle prone erythrocytes via stimulation of calcium influx.     

The specific heat and the heat of compression of human red cells,sickled red cells,and paracrystalline rat red cells

The investigation of two thermal properties of red cells throws some light on whether sickling is a process involving the crystallization of a relatively insoluble hemoglobin. These properties are the specific heat and the heat of compression, both of which would be expected to become numerically less if the hemoglobin of the red cell were to crystallize. In the case of paracrystalline rat red cells, which give spacings at 45 A and 58 A by x-ray diffraction, the specific heat is reduced to 85 per cent of that of the normal red cells, and the heat of compression is only about 75 per cent of that found for the normal red cell. In the case of the red cell sickled by a reduction of the O₂ tension, the specific heat and the heat of compression are substantially the same as found for the normal red cell. This is an argument against sickling being the result of a crystallization process, and supports the observation that sickled cells do not give x-ray spacings. The result is compatible, on the other hand, with sickling being the result of the formation of an oriented and birefringent gel.     

Water proton magnetic resonance studies of normal and sickle erythrocytes Temperature and volume dependence

The temperature and cell volume dependence of the NMR water proton linewidth, spin-lattice, and spin-spin relaxation times have been studied for normal and sickle erythrocytes as well as hemoglobin A and hemoglobin S solutions. Upon deoxygenation, the spin-spin relaxation time (T₂) decreases by a factor of 2 for sickle cells and hemoglobin S solutions but remains relatively constant for normal cells and hemoglobin A solutions. The spin-lattice relaxation time (T₁) shows no significant change upon dexygenation for normal or sickle packed red cells. Studies of the change in the NMR linewidth, T₁ and T₂ as the cell hydration is changed indicate that these parameters only slightly by a 10–20% cell dehydration. This result suggests that the reported 10% cell dehydration observed with sickling is not important in the altered NMR properties. Low temperature studies of the linewidth and T₁ for oxy and deoxy hemoglobin A and hemoglobin S solutions suggest that the “bound” water possesses similar properties for all four species. The low temperature linewidth ranges from about 250 Hz at ?15°C to 500 Hz at ?36°C and analysis of the NMR curves yield hydration values near 0.4 g water/g hemoglobin for all four species. The low temperature T₁ data go through a minimum at ?35°C for measurements at 44.4 MHz and ?50°C for measurements at 17.1 MHz and are similar for oxy and deoxy hemoglobin A and hemoglobin S. These similarities in the low temperature NMR data for oxy and deoxy hemoglobin A and hemoglobin S suggest a hydrophobically driven sickling mechanism. The room temperature and low temperature relaxation time data for normal and sickle cells are interpreted in terms of a three-state model for intracellular water. In the context of this model the relaxation time data imply that type III, or irratationally bound water, is altered during the sickling process.     

Membrane components in the red cells of patients with sickle cell anemia. Relationship to cell aging and to irreversibility of sickling

Cholesterol, phospholipid and sialic acid were measured in red cells from patients with sickle cell anemia to determine whether the cells had abnormal concentrations of these components and whether the amounts of these compounds differed in irreversibly sickled cells as compared to non-irreversibly sickled cells. Sickle cells had significantly higher levels of both lipids than similar populations of normal cells, however, comparisons to populations of young control cells showed that the differences were generally not significant. Sialic acid levels in sickle cells were not significantly different from normal cells. Irreversibly sickled cells had lower lipid and sialic acid concentrations than those not irreversibly sickled, but the differences were either not significant or did not occur when compared to young control cells. The studies show that the increased lipid concentrations in the membrane of sickle cells are not abnormal but are related to cell age and that the decrease in membrane components in irreversibly sickled cells is no greater than would be predicted for similarly aged populations of cells.     

O2 dependence of K+ transport in sickle cells: the effect of different cell populations and the substituted benzaldehyde 12C79.

The molecular basis of sickle cell disease (SCD) is well known but the pathophysiology is poorly understood. It remains intractable to therapy. Hyperactivity of several membrane transport systems, including the K+-Cl- cotransporter (termed KCC), cause HbS-containing red cells (termed HbS cells) to dehydrate and sickle, leading to the development of sickle cell crises (SCCs). Contrary to normal red cells (HbA cells), KCC in HbS cells is active at low O2 tensions (PO2s), remaining responsive to low pH or urea. Since these stimuli are usually encountered in hypoxic regions, the abnormal O2 dependence increases the contribution of KCC to dehydration, and hence development of SCCs. These differences with HbA cells may be due to the younger population of cells or to polymerization of HbS. We used 86Rb+ as a K+ congener to investigate the activity of KCC at different PO2s, and density gradient separation to investigate different red cell fractions. We found no correlation of O2 dependence with cell fractions. We also used the substituted benzaldehyde 12C79 to increase the O2 affinity of HbS and found that its effect on HbS O2 saturation and cell sickling correlated with that on both Cl--independent and Cl--dependent K+ transport, implying that, at low PO2s, KCC activity correlated with HbS polymerization. The importance of these results to understanding the pathophysiology of SCD, and for the design of chemotherapeutic agents to ameliorate or prevent SCC, is discussed.     

Mathematical model of red cell sickling

A mathematical model of red cell sickling without crisis was established in vitro as a function of the parameters on which it depends: the oxygen partial pressure, the abnormal hemoglobin S concentration, the temperature and the pH. This model was verified both for the homozygotic sickling SS and heterozygotic sickling SC. Such a model allows systematic investigation of patients. Moreover, it opens up the way for rational comparison in the testing of drugs which are effective in the treatment of red cell sickling.     

Inhibition of the in vitro formation of dense cells and of irreversibly sickled cells by charybdotoxin, a specific inhibitor of calcium-activated potassium efflux

Charybdotoxin, a specific inhibitor of the calcium-activated potassium channel, was found to inhibit the in vitro formation of irreversibly dehydrated cells and of irreversibly sickled cells, which occur as a result of repeated cycles of sickling and unsickling of sickle red blood cells. The degree of formation of dense cells was measured by Percoll-renografin density gradient centrifugation. 50% inhibition of the formation was achieved at a concentration of 30 nM of charybdotoxin. The approximate half-life of this compound in the circulation of the guinea pig was determined to be 4 h. Charybdotoxin did not inhibit the sickling of sickle cells under deoxygenation. The effects of charybdotoxin in preventing the irreversible changes of sickle cell membranes may be related to the inhibition of calcium-activated potassium efflux in sickle red blood cells.     

Membrane components in the red cells of patients with sickle cell anemia Relationship to cell aging and to irreversibility of sickling

Cholesterol, phospholipid and sialic acid were measured in red cells from patients with sickle cell anemia to determine whether the cells had abnormal concentrations of these components and whether the amounts of these compounds differed in irreversibly sickled cells as compared to non-irreversibly sickled cells. Sickle cells had significantly higher levels of both lipids than similar populations of normal cells, however, comparisons to populations of young control cells showed that the differences were generally not significant. Sialic acid levels in sickle cells were not significantly different from normal cells. Irreversibly sickled cells had lower lipid and sialic acid concentrations than those not irreversibly sickled, but the differences were either not significant or did not occur when compared to young control cells. The studies show that the increased lipid concentrations in the membrane of sickle cells are not abnormal but are related to cell age and that the decrease in membrane components in irreversibly sickled cells is no greater than would be predicted for similarly aged populations of cells.     

Pulsed nuclear magnetic resonance studies in sickled erythrocytes

Pulsed proton magnetic resonance studies were made to determine T₁ (spin-lattice) and T₂ (spin-spin) relaxation times for normal and sickled blood cells in the oxygenated and deoxygenated states as a function of temperature between 0°C and 37°C. It was found that the sickling phenomenon affects T₂ values but not T₁ values in these cells. These results are ascribed to a proton-exchange mechanism. The functional relationship found between T₂ and temperature in the sickled cells is similar to that between the formation of hydrophobic bonds and temperature proposed by Nalbandian and Scheraga.