The binding of hemoglobin to membranes of normal and sickle erythrocytes.

The binding of hemoglobins A, S, and A2 to red cell membranes prepared by hypotonic lysis from normal blood and blood from persons with sickle cell anemia was quantified under a variety of conditions using hemoglobin labelled by alkylation with 14C-labelled Nitrogen Mustard. Membrane morphology was examined by electron microscopy. Normal membranes were found capable of binding native hemoglobin A and hemoglobin S in similar amounts when incubated at low hemoglobin: membrane ratios, but at high ratios hemoglobin saturation levels of the membranes increased progressively for hemoglobin A, hemoglobin S and hemoglobin A2, respectively, in order of increasing electropositivity. Binding was unaffected by variations in temperature (4-22 degrees C) and altered little by the presence of sulfhydryl reagents, but was inhibited at pH levels above 7.35; disrupted at high ionic strength; and dependent on the ionic composition of the media. These findings suggest that electrostatic, but not hydrophobic or sulfhydryl bonds are important in membrane binding of the hemoglobin under the conditions studied. An increased retention of hemoglobin in preparations of membranes from red cells of patients with sickle cell anemia (homozygote S) was attributable to the dense fraction of homozygote S red cells rich in irreversibly sickled cells, and the latter membranes had a smaller residual binding capacity for new hemoglobin. This suggests that in homozygote S cells which have become irreversibly sickled cells in vivo, there are membrane changes which involve alteration and/or blockade of hemoglobin binding sites. These findings support the notion that hemoglobin participates in the dynamic structure of the red cell membrane in a manner which differs in normal and pathological states.     

Differences in erythrocyte membrane proteins and glycoproteins in sickle cell disease

Erythrocyte membrane proteins obtained from individuals with sickle cell anemia show an SDS polyacrylamide gel pattern that differs in five regions from the normal pattern. These membranes when compared with membranes from normal individuals also show a marked decrease in sialic acid content which correlates with a marked reduction of the periodic acid-Schiff staining of the three major glycoprotein components. The observed membrane protein and glycoprotein changes are a characteristic of all the red cells in sickle cell anemia and do not correlate with the proportion of irreversibly sickled 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.     

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.     

The anti-sickling drug lawsone (2-OH-1,4-naphthoquinone) protects sickled cells against membrane damage

The ability of an anti-sickling drug lawsone, 2-OH-1,4-naphthoquinone, and two related compounds to inhibit the haematoporphyrin-sensitised photohaemolysis of normal and sickle cell erythrocytes has been investigated. The compounds appear to protect the erythrocyte membranes by reaction with transient oxidative species. Differential effects between normal and sickle cells are shown and these are attributed to the different membrane composition of irreversibly sickled erythrocytes. This report describes a possible basis for the decreased formation of irreversibly sickled cells in the presence of lawsone.     

Viscoelastic properties of the oxygenated sickle erythrocyte membrane

Although most apparent in permanently misshapen irreversibly sickled erythrocytes (ISC), biochemical and structural alterations are present in the majority of sickle cell membranes. The relationship of membrane rigidity to cell shape and its dependence upon the internal hemoglobin cytosol are not clarified. We therefore examined the frequency dependent viscoelasticity of oxygenated, packed sickle red cell and ghost suspensions and hemoglobin solutions prepared from density gradient separated ISC and reversibly sickled cell (RSC) fractions. Low amplitude, oscillatory shear was applied in a Weissenberg cone and plate viscometer and the resultant viscoelastic signals provided a dynamic viscosity (eta') and elastic storage modulus (G') which varied with frequency of deformation. The viscoelastic response of the cell and ghost suspensions reflected the material properties of the membrane over most of the frequency range tested. Sickle erythrocyte, red ghost, and white ghost suspensions demonstrated greater viscocoelasticity than comparable normal suspensions. The viscoelastic magnitude of ISC was several-fold greater than normal, with little variation of viscoelasticity with frequency. RSC samples which were characterized by normal shape, size, and internal hemoglobin concentration were also significantly harder than normal, although similar in frequency dependence. Red ghosts prepared from ISC manifested 80% of the viscoelasticity of intact ISC despite diminution of the internal hemoglobin concentration by 90%. Under conditions of low amplitude shear, the behavior of the RSC membrane is compatible with a cytoskeleton possessing an increased number of molecular associations. The mechanical stability of the ISC membrane is related to a substantial, intrinsic reorganization of the cytoskeleton.     

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.     

Preparation of irreversibly sickled cell beta-actin from normal red blood cell beta-actin.

We have previously demonstrated that an oxidative change, the formation of a disulfide bridge between two cysteine residues, in the membrane protein beta-actin is primarily responsible for locking the irreversibly sickled red blood cells (ISCs) of sickle cell anemic patients into the sickle shape. To support studies on biological and chemical characterization of the oxidized beta-actin and pharmacological research toward the reversal of the oxidation, we attempted to prepare oxidized beta-actin from normal red blood cell (RBC) beta-actin by a chemical reaction, expecting a product equivalent to that found in ISCs. 5,5'-Dithiobis(2-nitrobenzoic acid) (DTNB, or Ellman's reagent) was used for the oxidation. We proved the absence of accessible sulfhydryl groups in the oxidized product using liquid chromatography (LC) with both UV and fluorescence detection. Polymerization assays indicated that the chemically produced ISC actin demonstrated the same kinetics as ISC actin obtained from patients with sickle cell disease. The effect of the oxidation could be reversed by the use of the reducing agent tris(carboxyethyl)phosphine (TCEP).     

The effects of sickling on ion transport. I. Effect of sickling on potassium transport

The conversion of red cells of patients with sickle cell anemia (S-S) from biconcave disk to sickle shape by removal of oxygen was found to increase the fraction of medium trapped in cells packed by centrifugation from 0.036 (S.E. 0.003) to 0.106 (S.E. 0.004). The fraction of water in the cells (corrected for trapped medium) was not affected by this shape transformation. Cation transport, however, was changed profoundly. S-S cells incubated in N₂ rather than O₂ showed net K loss with acceleration of both influx and outflux. That this change in K transport was due to the process of sickling was indicated by (1) the persistence of the effect in the absence of plasma, (2) the absence of the effect in hypoxic S-S cells in which sickling was inhibited by alkali or carbon monoxide, (3) the reversal of the effect when sickling was reversed by exposure to O₂, and (4) the independence of the effect from such potentially important factors as age of the cell population. The acceleration of K transport by sickling is probably mediated by modification of the cell surface rather than the cell interior since concentrated sickle hemoglobin solutions in O₂ or N₂ did not show selective affinity for K. In molecular terms, the effect of sickling on K transport can be explained by presuming that the shape change (1) opens pathways for the free diffusion of K, and (2) accelerates K transport by a non-diffusion carrier process. The evidence for the former mechanism included (a) dependence of K influx into sickled cells on the concentration of K in the medium, and (b) increase in the total cation content of sickled cells with increasing pH. Observations suggestive of a carrier process included (a) the failure of sickled cell K concentration to become equal to external K concentration even after 48 hours, (b) the deviation of the flux ratio from that characteristic of diffusion, and (c) the dependence of K influx on glycolysis.     

Photoaffinity labeling of procaine-binding sites in normal and sickle cell membranes

A photoaffinity probe, procaine azide, was employed to determine the sites of interaction of procaine in normal and sickle cell erythrocytes. Studies show that the number of binding sites and affinity of procaine to membranes derived from normal and sickled cell erythrocytes were similar, although procaine retards the in vitro formation of irreversibly sickled cells from cells. The results show that procaine azide, a photoaffinity analogue of procaine, is covalently incorporated into both protein (60–70%) and lipid (40–30%) components of the membrane. Sodium dodecyl sulfate-gel electrophoresis of the labeled ghosts show that procaine binds specifically to band 3 and periodic acid-Schiff staining bands in membranes derived from labeled erythrocytes. Binding of procaine or covalent incorporation of procaine azide into membrane proteins does not affect the phosphate transport. Moreover, pre-treatment of intact erythrocytes with 4,4′-diisothiocyano-2,2′-stilbene disulfonate, an anion transport inhibitor, did not affect either the binding or covalent incorporation of procaine azide into erythrocytes. These results indicate that the binding of procaine azide to Band 3 protein occurs at a locus different than that involved in anion translocation process.     

Ubiquitination of spectrin regulates the erythrocyte spectrin-protein-4.1-actin ternary complex dissociation: implications for the sickle cell membrane skeleton.

It has been demonstrated by our laboratory that the irreversibly sickled cell (ISC) spectrin-4.1-actin complex dissociates slowly as compared to ternary complexes formed out of control (AA) and reversibly sickle cell (RSCs) core skeletons. These studies indicated that the molecular basis for the inability of irreversibly sickled cells (ISCs) to change shape is a skeleton that disassembles, and therefore reassembles, very slowly. The present study is based on the following observations: a) alpha-spectrin repeats 20 and 21 contain ubiquitination sites, and b) The spectrin repeats beta-1 and beta-2 are in direct contact with spectrin repeats alpha-20 and alpha-21 during spectrin heterodimer formation, and contain the protein 4.1 binding domain. We demonstrate here that alpha-spectrin ubiquitination at repeats 20 and 21 increases the dissociation of the spectrin-protein-4.1-actin ternary complex thereby regulating protein 4.1's ability to stimulate the spectrin-actin interaction. Performing in vitro ternary complex dissociation assays with AA control and sickle cell SS spectrin (isolated from high-density sickle cells), we further demonstrate that reduced ubiquitination of alpha-spectrin is, in part, responsible for the locked membrane skeleton in sickle cell disease.     

The effect of thyroid hormones on the membrane adenylate cyclase activity in sickle red blood cells in vitro

A comparative study of thyroid hormone responsive membrane adenylate cyclase activity has been carried out on normal (Hb-AA) and sickle cell (Hb-SS) subjects. Thyroid hormones (T3 and T4) and selected analogues (TRIAC and DLT) enhanced adenylate cyclase activity in Hb-AA membranes. The interaction of Hb-SS membranes with the hormones and analogues was not significant except for T3 which moderately stimulated Hb-SS membrane adenylate cyclase. We suggest that circulating irreversibly sickled cells, in view of their membrane phospholipid defect, probably contribute to the low response of membrane adenylate cyclase to effector stimulation.     

Understanding the shape of sickled red cells

To understand the physical basis of the wide variety of shapes of deoxygenated red cells from patients with sickle cell anemia, we have measured the formation rate and volume distribution of the birefringent domains of hemoglobin S fibers. We find that the domain formation rate depends on the approximately 80th power of the protein concentration, compared to approximately 40th power for the concentration dependence of the reciprocal of the delay time that precedes fiber formation. These remarkably high concentration dependences, as well as the exponential distribution of domain volumes, can be explained by the previously proposed double nucleation model in which homogeneous nucleation of a single fiber triggers the formation of an entire domain via heterogeneous nucleation and growth. The enormous sensitivity of the domain formation rate to intracellular hemoglobin S concentration explains the variable cell morphology and why rapid polymerization results in cells that do not appear sickled at all.     

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.     

Inhibitory effect of deoxyhemoglobin A2 on the rate of deoxyhemoglobin S polymerization.

From a consideration of the primary sequence of hemoglobin A₂ and the reported 5 å molecular contacts between deoxyhemoglobin S molecules in a crystal, it is predicted that hemoglobin A₂ might act as an inhibitor of the polymerization of deoxyhemoglobin S in a manner similar to hemoglobin. F. This has been tested experimentally by measuring the rate of change of the transverse water proton relaxation times (T₂) in equimolar mixtures of hemoglobin S and one of the non-gelling hemoglobins A, F or A₂. Hemoglobins A₂ and F have far more pronounced inhibitory effects on the rate of polymerization than does hemoglobin A. These molecules contain several amino acid differences from hemoglobin A beta chains which are located in the 5 Å molecular crystal contacts and these altered crystal contacts result in a much stronger inhibition of the rate of polymerization. Since hemoglobin A₂ is a normal hemoglobin found in small amounts in all adult red cells, increased delta chain synthesis may have potential importance in therapy for sickle cell disease.     

Ultrastructural Damage to the Malaria Parasite in the Sickled Cell

The process by which malaria parasites are killed in sickled erythrocytes was studied by electron microscopy. In vitro cultures of Plasmodium falciparum in sickle cell hemoglobin (HbS) homozygous (SS) and heterozygous (SA) red cells were deoxygenated for up to 6 h and fixed under anaerobic conditions. Parasites in SS cells appeared to be disrupted by intrusions of needle-like deoxyHbS aggregates; disintegration of cytoplasm and membranes followed. In SA red cells, the parasites were generally not disrupted. Instead, extensive vacuolization occurred, a sign of metabolic inhibition. The resistance of HbS gene carriers to malaria results partly from these causes of intracellular parasite death.     

The effects of erythrocyte membranes on the nucleation of sickle hemoglobin

Pathology in sickle cell disease begins with nucleation-dependent polymerization of deoxyhemoglobin S into stiff, rodlike fibers that deform and rigidify red cells. We have measured the effect of erythrocyte membranes on the rate of homogeneous nucleation in sickle hemoglobin, using preparations of open ghosts (OGs) with intact cytoskeletons from sickle (SS) and normal adult (AA) red cells. Nucleation rates were measured by inducing polymerization by laser photolysis of carboxy sickle hemoglobin and observing stochastic variation of replicate experiments of the time for the scattering signals to reach 10% of their respective maxima. By optical imaging of membrane fragments added to a hemoglobin solution we contrast the rate of nucleation immediately adjacent to membrane fragments with nucleation in a region of the same solution but devoid of membranes. From analysis of 29,272 kinetic curves obtained, we conclude that the effect of AA OGs is negligible (10% enhancement of nucleation rates +/-20%), whereas SS OGs caused 80% enhancement (+/-20%). In red cells, where more membrane surface is available to Hb, this implies enhancement of nucleation by a factor of 6. These experiments represent a 10-fold improvement in precision over previous approaches and are the first direct, quantitative measure of the impact of erythrocyte membranes on the homogeneous nucleation process that is responsible for polymer initiation in sickle cell disease.     

The role of the superoxide anion as a toxic species in the erythrocyte.

The toxic action of the superoxide anion (O₂^?) toward the erythrocyte was investigated with O₂^? generated through the autooxidation of dihydroxyfumaric acid (DHF). A suspension of human red cells exposed to DHF undergoes a rapid breakdown of the cellular hemoglobin to methemoglobin and other green pigments. This hemoglobin breakdown is inhibited by superoxide dismutase (SOD) or catalase (CAT) and is accelerated by lactoperoxidase (LP) added externally to the red cell medium. Associated with the hemoglobin breakdown is a hypotonic hemolysis also inhibited by SOD or CAT and initially accelerated but later inhibited by LP. Conversion of the red cell hemoglobin to carbonmonoxyhemoglobin in an aerated medium results in no hemoglobin breakdown or hypotonic lysis in the presence of DHF, even though O₂^? can be demonstrated in the medium. Although no evidence for membrane sulfhydryl oxidation or lipid peroxidation can be demonstrated in red cells exposed to DHF, the membranes of these cells were found to retain a green pigment. The presence of this green pigment in red cell membranes was inhibited by SOD, CAT, or conversion of the cellular hemoglobin to carbonmonoxyhemoglobin, but was not inhibited by LP. These results have been interpreted as a peroxide-dependent formation of O₂^? by DHF, followed by attack of O₂^? on hemoglobin. The reaction of O₂^? with hemoglobin leads to the formation of a hemoglobin-breakdown product that binds to the red cell membrane, resulting in an increased osmotic fragility of the cell.     

Electron microscopic studies of the intracellular polymerization of sickle hemoglobin

Transmission electron microscopy has been used to study intracellular sickle hemoglobin polymer in unfractionated cells from the arterial and venous blood of patients and after external deoxygenation. We detect polymerized hemoglobin in up to 10% of the cells in the venous circulation, especially in cells that are "cigar-shaped" and appear to be irreversibly sickled. We could not see well-defined polymer in mixed arterial samples; nevertheless, we found electron opaque spots, which could be ferritin granules, hemosiderin, or small aggregates of hemoglobin S. However, upon sequential chemical deoxygenation using 1.0% sodium metabisulphite, polymer formation was seen at oxygen saturation values of 75%-85%. Cells that were physically deoxygenated using gas mixtures containing nitrogen-carbon dioxide-oxygen mixtures were found to contain distinct polymers of deoxyhemoglobin S at oxyhemoglobin saturation values of 50%-75%. As deoxygenation increases, we detect short, randomly arranged polymer in a loose network, with occasional long polymers. Upon further deoxygenation, the length and number of polymer forms increased. Between 0% and 50% saturation, most erythrocytes were full of long, parallel, closely packed polymers that tend to align and run parallel to the cell membrane. In both chemical and physically deoxygenated blood samples, cells were seen at 50%-75% oxyhemoglobin saturation that retained their normal biconcave disc shape, although they contained significant amounts of polymer. The structural changes in sickle erythrocytes seen in vitro due to physical or chemical deoxygenation of cells, may reflect in vivo intracellular changes in the sickle cell patient.     

Ultrastructural damage to the malaria parasite in the sickled cell.

The process by which malaria parasites are killed in sickled erythrocytes was studied by electron microscopy. In vitro cultures of Plasmodium falciparum in sickle cell hemoglobin (HbS) homozygous (SS) and heterozygous (SA) red cells were deoxygenated for up to 6 h and fixed under anaerobic conditions. Parasites in SS cells appeared to be disrupted by intrusions of needle-like deoxyHbS aggregates; disintegration of cytoplasm and membranes followed. In SA red cells, the parasites were generally not disrupted. Instead, extensive vacuolization occurred, a sign of metabolic inhibition. The resistance of HbS gene carriers to malaria results partly from these causes of intracellular parasite death.