Host cell deformability is linked to transmission in the human malaria parasite Plasmodium falciparum

Gametocyte maturation in Plasmodium falciparum is a critical step in the transmission of malaria. While the majority of parasites proliferate asexually in red blood cells, a small fraction of parasites undergo sexual conversion and mature over 2 weeks to become competent for transmission to a mosquito vector. Immature gametocytes sequester in deep tissues while mature stages must be able to circulate, pass the spleen and present themselves to the mosquito vector in order to complete transmission. Sequestration of asexual red blood cell stage parasites has been investigated in great detail. These studies have demonstrated that induction of cytoadherence properties through specific receptor-ligand interactions coincides with a significant increase in host cell stiffness. In contrast, the adherence and biophysical properties of gametocyte-infected red blood cells have not been studied systematically. Utilizing a transgenic line for 3D live imaging, in vitro capillary assays and 3D finite element whole cell modelling, we studied the role of cellular deformability in determining the circulatory characteristics of gametocytes. Our analysis shows that the red blood cell deformability of immature gametocytes displays an overall decrease followed by rapid restoration in mature gametocytes. Intriguingly, simulations suggest that along with deformability variations, the morphological changes of the parasite may play an important role in tissue distribution in vivo. Taken together, we present a model, which suggests that mature but not immature gametocytes circulate in the peripheral blood for uptake in the mosquito blood meal and transmission to another human host thus ensuring long-term survival of the parasite.     

Measurement of the distribution of red blood cell deformability using an automated rheoscope

BACKGROUND: Red blood cells (RBCs) have to deform markedly to pass through the smallest capillaries of the microcirculation. Techniques for measuring RBC deformability often result in an indication of the mean value. A deformability distribution would be more useful for studying diseases that are marked by subpopulations of less deformable cells because even small fractions of rigid cells can cause circulatory problems. METHODS: We present an automated rheoscope that uses advanced image analysis techniques to determine a RBC deformability distribution (RBC-DD) by analyzing a large number of individual cells in shear flow. The sensitivity was measured from density-separated fractions of one blood sample and from cells rendered less deformable by heat treatment. A preliminary experiment included the RBC-DDs of a patient with sickle cell anemia, one on dialysis and being treated with erythropoietin, and one with elliptocytosis. RESULTS: Measurement of the RBC-DD was highly reproducible. The sensitivity test showed markedly different deformability distributions of density-separated cells and yielded distinct RBC-DDs after each additional minute of heat treatment. CONCLUSION: The automated rheoscope enabled the determination of RBC-DDs from which less deformable subpopulations can be established. The shape of an RBC-DD may be valuable in assessing cell fractions with normal and anomalous deformability within pathologic blood samples.     

The effect of copper on erythrocyte deformability. A possible mechanism of hemolysis in acute copper intoxication

Although the development of hemolytic anemia as a complication of acute copper intoxication is well documented, the precise mechanism by which copper produces accelerated erythrocyte destruction is unknown. Normal erythrocyte survival depends in part on the ability of the cell to deform and pass through narrow areas of microcirculation in the liver and especially in the spleen. In the present study, it is demonstrated that toxic concentrations of copper rapidly and markedly reduce erythrocyte deformability. This reduction in cell deformability is associated with a marked increase in membrane permeability and osmotic fragility of copper-treated cells. Further, the decrease in deformability occurs despite normal levels of cell ATP and the apparent absence of oxidative damage to the cell. These observations indicate that copper-mediated changes in the erythrocyte membrane may be responsible for reducing the flexibility of the cell. The loss of deformability could act to reduce erythrocyte survival and thus explain the hemolysis associated with copper intoxication in vivo.     

Cellular and rheological factors contributing to sickle cell microvascular occlusion

Sickle (HbSS) erythrocytes contain subpopulations that are heterogeneous in shape, size, and density and exhibit abnormal microcirculatory behavior. Their phthalate esters density distributions quantitatively distinguish subpopulations of HbSS cells from density profiles of normal (HbAA) erythrocytes. Filtration of HbSS cell suspensions, devoid of leukocytes, through 5-microns Nucleopore filters at constant flow rate (29.5 microliters/s) yields pressure-time curves that demonstrate deformability of the sickle cells to be several-fold less than equivalent suspensions of normal (HbAA) cells. For a cell flux of 6.43 X 10(5) cells/s, the rate of the rise of the pressure (Pi/t) following 1-2 s of the initial pressure reading indicates occlusion of the filter pores by the dense cell fraction. Rats exchange-transfused with human sickle (HbSS), normal (HbAA), or autologous rat erythrocytes were used to investigate the flow dynamics of these cells in the mesenteric microcirculation by intravital videomicroscopy. Time-averaged velocities of the autologous rat red cells in 16-30 microns (i.d.) arterioles ranged from 1.10 to 1.25 mm/s with varying flux and wall shear rates. Time-averaged velocities of the HbAA cells in single 15-35-microns arterioles ranged from 1.16 to 1.24 mm/s with wall shear rates similar to the estimates for the autologous cells. In contrast, sickle cells exhibited time-averaged velocities of 0.38-0.45 mm/s with lower wall shear rates in 10-35 microns single unbranched arterioles with three times less volumetric flux. In some arterioles, sickle RBCs with a high axial ratio of 3-4 and low deformability showed apparent adhesion to endothelial surfaces and occluded precapillary junctions or entry points for several seconds until dislodged by the higher flow velocity. Within single unbranched vessels or at microvascular bifurcations, sickle elliptocytes and sickle echinocytes with low deformability and axial ratios of 3-4 obstructed flow and exhibited residence times of 6-75 s at the sites of occlusion, thereby causing stasis and increasing the local apparent viscosity. Thus, both the in vitro and in vivo data demonstrate the rheological disequilibrium state induced by HbSS cells as they traverse artificial micropores or course through successive segments of the microcirculation. The specific tendency of dense cells with high axial ratio (ISCs) to manifest precapillary junctional blockade and prolonged residence times implicates this cell fraction in the initiation of microvascular occlusion.     

The flow of sickle blood in glass capillaries: Fundamentals and potential applications

We have characterized the imbibed horizontal flow of sickle blood into 100-μm-diameter glass capillaries. We find that blood containing sickled cells typically traverses the capillaries between three and four times as slowly as oxygenated cells from the same patient for all genotypes tested, including SS, AS, SC and Sβ⁺ thalassemia blood. Blood from SS patients treated with hydroxyurea has a viscosity intermediate between the SS and AA values. Blood containing cells that are not rigidified, such as normal red cells or oxygenated sickle cells, follows a simple Lucas-Washburn flow throughout the length of the 3-cm capillary. By fitting the flexible-cell data to the Lucas-Washburn model, a viscosity can be derived that is in good agreement with previous measurements over a range of volume fractions and is obtained using an apparatus that is far more complex. Deoxygenation sickles and thus rigidifies the cells, and their flow begins as Lucas-Washburn, albeit with higher viscosity than flexible cells. However, the flow further slows as a dense mass of cells forms behind the meniscus and increases in length as flow progresses. By assuming that the dense mass of cells exerts a frictional force proportional to its length, we derive an equation that is formally equivalent to vertical imbibition, even though the flow is horizontal, and this equation reproduces the observed behavior well. We present a simple theory using activity coefficients that accounts for this viscosity and its variation without adjustable parameters. In the course of control experiments, we have found that deoxygenation increases the flexibility of normal human red cells, an observation only recently published for mouse cells and previously unreported for human erythrocytes. Together, these studies form the foundation for an inexpensive and rapid point-of-care device to diagnose sickle cell disease or to determine blood viscosity in resource-challenged settings.     

Alteration in protein kinase C activity and subcellular distribution in sickle erythrocytes

In agreement with previous data, membrane protein phosphorylation was found to be altered in intact sickle cells (SS) relative to intact normal erythrocytes (AA). Similar changes were observed in their isolated membranes. The involvement of protein kinase C (PKC) in this process was investigated. The membrane PKC content in SS cells, measured by [3H]phorbol ester binding, was about 6-times higher than in AA cells. In addition, the activity of the enzyme, measured by histone phosphorylation was also found to be increased in SS cell membranes but decreased in their cytosol compared to the activity in AA cell membranes and cytosol. The increase in membrane PKC activity was observed mostly in the light fraction of SS cells, fractionated by density gradient, whereas the decrease in cytosolic activity was only observed in the dense fraction. PKC activity, measured in cells from the blood of reticulocyte-rich patients, exhibited an increase in both membranes and cytosol, thus explaining some of the effects observed in the SS cell light fraction, which is enriched in reticulocytes. The increase in PKC activity in the membranes of SS cells is partly explained by their young age but the loss of PKC activity in their cytosol, particularly in that of the dense fraction, seems to be specific to SS erythrocytes. The relative decrease in membrane PKC activity between the dense and the light fractions of SS cells might be related to oxidative inactivation of the enzyme.     

The study on the mechanism of G intolerance of rabbits after simulated weightlessness

The direct consequence of cardiovascular adaptation to weightlessness (WL) is the decrease of G tolerance. In studying the mechanism of G intolerance after WL, respiration, heart rate, electrocardiogram, temporal arterial flow, loss of vision were usually used as the indices for evaluation of G tolerance. However the changes of microcirculation and blood rheological indices were seldom observed. Considering that the changes of status of blood circulation after WL may be one of the important factors causing decrease of G tolerance, the purpose of this paper is to observe the changes of microcirculation, blood rheological and the structure and circulatory status of four organs in rabbits during -4Gx after exposure to simulated weightlessness (SWL), in order to understand the cause of G intolerance after WL.     

Electron microscopy of gas space (aerenchyma) formation in adventitious roots of Zea mays L. subjected to oxygen shortage

This paper examines the ultrastructure of cortical cells in maize root tips during the early stages in lysigenous aerenchyma formation, promoted by oxygen-deficient nutrient solution. The aim was to determine whether changes in fine structure were compatible with oxygen starvation as the primary cause of cell degeneration and death. There was an initial collapse of some cortical cells, indicating loss of turgor, and the cytoplasm became more electron dense. Mitochondria and endoplasmic reticulum appeared normal at this early stage though the tonoplast lost its integrity. Subsequently the cytoplasm became less electron dense than surrounding healthy cells, and underwent further degeneration while the plasmalemma retracted from the cell wall. Cell walls remained unaltered until this stage, but some then became thin and electron transparent. No cells of the stele were found to degenerate. These observations, which do not readily accord with the hypothesis that oxygen starvation was the cause of cell death, are compared with detailed studies of cell degeration in other cell types. An alternative mechanism for the stimulation of cortical cell lysis in poorly oxygenated roots involving the hormone ethylene, is discussed.     

Acute and transient effects of stress on immunoreactive somatostatin cell bodies and fibers in the preoptic-anterior hypothalamus and median eminence of female rats

Stress in rats causes acute release of hypothalamic somatostatin (SS) in median eminence (ME) that induces a marked and prolonged suppression of growth hormone (GH) secretion. This was evidenced by immunocytochemistry (ICC) and radioimmunoassay (RIA) in the present study. Adult female rats were decapitated under nonstress or for 30, 60, 120 and 180 min after 15 min leg restraint stress. The rabbit anti-SS was used to detect SS-14 and SS-28 containing cell bodies with ICC in preoptic-anterior hypothalamus (PO-AH). At 30, 60, 120 min after stress, there was marked decrease in the number and size of subsets of SS cell bodies. RIA demonstrated striking increase in SS in ME and significant decrease in GH of the portal blood. The most reproducible changes in cell bodies involved subsets of PeV neurons. Interestingly, these changes were largely reversed by 180 min. The results of the study demonstrate that stress cause acute changes in PO-AH, SS system and it appears that stress affects both SS synthesis and the secretion.     

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.     

Influence of sickle hemoglobin polymerization and membrane properties on deformability of sickle erythrocytes in the microcirculation.

The rheological properties of normal erythrocytes appear to be largely determined by those of the red cell membrane. In sickle cell disease, the intracellular polymerization of sickle hemoglobin upon deoxygenation leads to a marked increase in intracellular viscosity and elastic stiffness as well as having indirect effects on the cell membrane. To estimate the components of abnormal cell rheology due to the polymerization process and that due to the membrane abnormalities, we have developed a simple mathematical model of whole cell deformability in narrow vessels. This model uses hydrodynamic lubrication theory to describe the pulsatile flow in the gap between a cell and the vessel wall. The interior of the cell is modeled as a Voigt viscoelastic solid with parameters for the viscous and elastic moduli, while the membrane is assigned an elastic shear modulus. In response to an oscillatory fluid shear stress, the cell--modeled as a cylinder of constant volume and surface area--undergoes a conical deformation which may be calculated. We use published values of normal and sickle cell membrane elastic modulus and of sickle hemoglobin viscous and elastic moduli as a function of oxygen saturation, to estimate normalized tip displacement, d/ho, and relative hydrodynamic resistance, Rr, as a function of polymer fraction of hemoglobin for sickle erythrocytes. These results show the transition from membrane to internal polymer dominance of deformability as oxygen saturation is lowered. More detailed experimental data, including those at other oscillatory frequencies and for cells with higher concentrations of hemoglobin S, are needed to apply fully this approach to understanding the deformability of sickle erythrocytes in the microcirculation. The model should be useful for reconciling the vast and disparate sets of data available on the abnormal properties of sickle cell hemoglobin and sickle erythrocyte membranes, the two main factors that lead to pathology in patients with this 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.     

Blood Thixotropy in Patients with Sickle Cell Anaemia: Role of Haematocrit and Red Blood Cell Rheological Properties

We compared the blood thixotropic/shear-thinning properties and the red blood cells’ (RBC) rheological properties between a group of patients with sickle cell anaemia (SS) and healthy individuals (AA). Blood thixotropy was determined by measuring blood viscosity with a capillary viscometer using a “loop” protocol: the shear rate started at 1 s⁻¹ and increased progressively to 922 s⁻¹ and then re-decreased to the initial shear rate. Measurements were performed at native haematocrit for the two groups and at 25% and 40% haematocrit for the AA and SS individuals, respectively. RBC deformability was determined by ektacytometry and RBC aggregation properties by laser backscatter versus time. AA at native haematocrit had higher blood thixotropic index than SS at native haematocrit and AA at 25% haematocrit. At 40% haematocrit, SS had higher blood thixotropic index than AA. While RBC deformability and aggregation were lower in SS than in AA, the strength of RBC aggregates was higher in the former population. Our results showed that 1) anaemia is the main modulator of blood thixtropy and 2) the low RBC deformability and high RBC aggregates strength cause higher blood thixotropy in SS patients than in AA individuals at 40% haematocrit, which could impact blood flow in certain vascular compartments.     

Intraerythrocytic parasites and red cell deformability: Plasmodium berghei and Babesia microti

In the studies reported here, we examined the effects of two intraerythrocytic parasites (Plasmodium berghei and Babesia microti) on the deformability of their host red cells. Red cell deformability was assessed by three criteria: 1) the prevalence of tank-treading (the tank-tread-like movement of the red cell membrane around its cytoplasmic contents), 2) elongation under fluid shear stress (the steady-state length: width ratio), and 3) the time required for the red cell to reduce its steady-state elongation by 63.2% after the abrupt release of the shear stress (the characteristic shape-recovery time). Trophozoite-stage parasites of both species reduced the prevalence of tank-treading. Ring- and trophozoite-stage parasites of both species reduced steady-state elongation, and ring-stage P. berghei prolonged the shape-recovery time. These results suggest that altered red cell deformability is a common feature of infection with intraerythrocytic parasites.     

Reduction of the surface-volume ratio: a physical mechanism contributing to the loss of red cell deformability in malaria

Plasmodia and other intraerythrocytic parasites reduce the deformability of the red cells they infect. One mechanism potentially responsible for this reduction in deformability is the decrease in the surface:volume (S/V) ratio of the red cell which occurs with parasite growth. To examine this hypothesis, normal red cells were allowed to phagocytize polylysine-coated latex spheres 1.0 to 2.9 microns in diameter. Deformability decreased progressively with spheres of increasing size, consistent with the decreasing S/V ratios of those cells (from an initial length:width [L/W] ratio of 2.398 +/- 0.549 for normal red cells to 1.559 +/- 0.249 for red cells containing 2.92 microns latex spheres at 40 dynes per cm2, p less than 0.001). Nevertheless, red cells containing latex spheres 2.0-2.9 microns in diameter remained deformable and continued to tank tread, in contrast to red cells containing Plasmodium falciparum parasites of that size, which are not deformable and do not tank tread. The progressive decrease in S/V produced by the latex spheres is consistent with their effect on the L/W ratio. However, the total loss of deformability observed with red cells containing parasites of similar or smaller size cannot be explained on these grounds alone. It suggests an additional mechanism, such as calcium-induced crosslinking of the red cell cytoskeleton.     

Deformability of stored erythrocytes as a criteria for their in vivo survival rate

The loss of deformability observed in erythrocytes stored as whole blood for 36 days (ACD-AG) or as buffy-coat free erythrocyte concentrate (EK) was characterized by measuring their filterability. During the first 3 weeks the index of filterability for ACD-AG erythrocytes increased only slightly and rose to about 140% of its initial value on the 36th day. In contrast, a heavy loss of deformability (increase of the filterability index to more than 600%) was detected for erythrocytes from EK, which, from a rheological point of view, is apt to raise doubts of using this stored blood. An incubation of 1 hour at 37 degrees C in fresh plasma did not result in improving the deformability. A cell volume loss of more than 20% connected with an increase of the inner viscosity to more than 400% was found to be the cause of this decrease of deformability. These rheological differences are also reflected in the 24 hours in vivo survival rate (SR), if the "early loss" of damaged erythrocytes immediately after transfusion is taken into account. Whereas the SR values of 80% for whole blood erythrocytes do not change significantly, the SR values for EK values can be found to reach 54% approximately.     

Osmotic effects of protein polymerization: Analysis of volume changes in sickle cell anemia red cells following deoxy-hemoglobin S polymerization

Summary Polymerization-depolymerization of proteins within cells and subcellular organelles may have powerful osmotic effects. As a model to study these we analyzed the predicted volume changes following hemoglobin (Hb) S polymerization in sickle cell anemia (SS) red cells with different initial volumes. The theoretical analysis predicted that dehydrated SS red cells may sustain large polymerization-induced volume shifts whose direction would depend on whether or not small solutes were excluded from polymer-associated water. Experiments with SS cells from promptly fractionated venous blood showed oxygenation-induced swelling, maximal in the densest cells, in support of nonexclusion models. The predicted extent of cell dehydration on polymerization was strongly influenced by factors such as the dilution of residual soluble Hb and the increased osmotic contribution of Hb in cells dehydrated by salt loss, largely overlooked in the past. The osmotic effects of polymer formation may thus play an important part in microcirculatory infarction by dense SS cells, as they become even denser and stiffer during deoxygenation in the capillaries.     

Na+/H+ exchange is increased in sickle cell anemia and young normal red cells

Summary Red cell volume regulation is important in sickle cell anemia because the rate and extent of HbS polymerization are strongly dependent on initial hemoglobin concentration. We have demonstrated that volume-sensitive K:Cl cotransport is highly active in SS whole blood and is capable of increasing MCHC. We now report that Na⁺/H⁺ exchange (Na/H EXC), which is capable of decreasing the MCHC of erythrocytes with pH_i<7.2, is also very active in the blood of patients homozygous for HbS. The activity of Na/H EXC (maximum rate) was determined by measuring net Na⁺ influx (mmol/liter cell·hr=FU) driven by an outward H⁺ gradient in oxygenated, acidloaded (pH_i 6.0), DIDS-treated SS cells. The Na/H EXC activity was 33±3 FU (mean±se) (n=19) in AA whites, 37±8 FU (n=8) in AA blacks, and 85±15 FU (n=14) in SS patients (P<0.005). Separation of SS cells into four density-defined fractions by density gradient revealed mean values of Na/H EXC four to five times higher in reticulocytes (SS1), discocytes (SS2) and dense discocytes (SS3), than in the fraction containing irreversibly sickled cells and dense discocytes (SS4). In contrast to K:Cl cotransport, which dramatically decreases after reticulocyte maturation, Na/H EXC persists well after reticulocyte maturation. In density-defined, normal AA red cells, Na/H EXC decreased monotonically as cell density increased. In SS and AA red cells, the magnitude of stimulation of Na/H EXC by cell shrinkage varied from individual to individual. We conclude that Na/H EXC is highly expressed in SS and AA young red cells and decays slowly after reticulocyte maturation.     

Effect of lanthanides on red blood cell deformability and response to mechanical stress: role of lanthanide ionic radius

Prior studies exploring the effects of lanthanides (Ln) on red blood cells (RBC) have primarily focused on ion transport, cell fusion, and membrane protein structure. Our previous report [Biorheology 44 (2007), 361-373] dealt only with lanthanum (La) and cell rigidity; the present study extends these observations to other lanthanides (Nd, Sm, Eu, Dy, Er) and to RBC response to mechanical shear. Deformation-shear stress behavior of normal human RBC was measured at Ln concentrations up to 200 μM. In another series of experiments, RBC were exposed to mechanical stress (190 Pa, 300 s) at 50 μM Ln and deformation-stress data obtained prior to and after this stress. Data were fitted to a Lineweaver-Burke model to obtain the shear stress at one-half maximum deformation (SS1/2). Our results include: (1) lanthanides cause decreased cell deformability with the magnitude of the decrease dependent on concentration and shear stress; (2) this decrease of deformability is affected by Ln ionic radius such that La>Nd>Sm>Eu>Dy>Er and is reversible for cells in Ln-free media; (3) mechanical stress decreases deformability (i.e., increases SS1/2) such that compared to control, La and Sm reduce and Dy and Er enhance the mechanical stress effect; (4) the decrease of deformability consequent to mechanical stress scales inversely with Ln ionic radius. These results indicate a reciprocal relation between cell rigidity and sensitivity to mechanical stress that is mediated by Ln ionic radius. Additional studies are clearly warranted, particularly those that explore membrane-glycocalyx and intracellular mechanisms.     

Inhibition of sickle red cell adhesion and vasoocclusion in the microcirculation by antioxidants

In sickle cell anemia (SCA), inflammatory (i.e., intravascular sickling and transient vasoocclusive) events result in chronic endothelial activation. In addition to sickling behavior, sickle (SS) red blood cells exhibit abnormal interaction with the vascular endothelium, which is considered to have an important role in initiation of vasoocclusion. Upregulation of endothelial adhesion molecules caused by oxidants (and cytokines) may lead to increased SS red cell adhesion. We hypothesize that endothelial activation is indispensable in SS red cell adhesion to the endothelium and that antioxidants will have an inhibitory effect on this interaction. We examined the effect of selected antioxidants in ex vivo mesocecum vasculature, a well-established model that allows measurement of hemodynamic parameters and, by intravital microscopy, can allow quantification of adhesion. We tested antioxidant enzymes (SOD and catalase) and an intravascular SOD mimetic, polynitroxyl albumin (PNA), in the presence of platelet-activating factor (PAF); the latter causes endothelial oxidant generation and endothelial activation, which characterize SCA. In ex vivo preparations, PAF not only induced marked endothelial oxidant generation, it also enhanced SS red cell adhesion, resulting in frequent blockage of small-diameter venules. The adhesion, inversely related to venular diameter, and vasoocclusion were markedly inhibited by antioxidants, resulting in improved hemodynamics. PNA, the most effective antioxidant, also abolished SS red cell adhesion in non-PAF-activated preparations. Thus SS red cell adhesion and related vasoocclusion may be ameliorated by antioxidant therapy with a stable and long-acting molecule (e.g., PNA).