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BACKGROUND RRx-001 is an anti-cancer immunotherapeutic that increases the sensitivity of drug resistant tumors via multiple mechanisms which involve binding to hemoglobin and enhancing nitrite reductase activity of deoxyhemoglobin. OBJECTIVE In the present study, the effect of clinically used doses of RRx-001 on erythrocyte deformability was examined. METHODS A dose dependent effect of RRx-001 (1-1000 micro molar) on erythrocyte deformability was measured by ektacytometer under hypoxia (n = 8). Low dose RRx-001 (20 micro molar) in the presence of ODQ (1H-[1,2,4]Oxadiazolo[4,3-a]quinoxalin-1-one), L-NAME (L-NG-Nitroarginine methyl ester) or nitrite were examined both in normoxia and hypoxia. Intracellular nitric oxide (NO) levels were measured fluorometrically with DAF-FM-DA. RESULTS Higher doses of RRx-001 (100, 1000 micro molar) significantly decreased erythrocyte deformability under hypoxia (p

BACKGROUND: Measurement of abnormal Red Blood Cell (RBC) deformability is a main indicator of Sickle Cell Anemia (SCA) and requires standardized quantification methods. Ektacytometry is commonly used to estimate the fraction of Sickled Cells (SCs) by measuring the deformability of RBCs from laser diffraction patterns under varying shear stress. In addition to estimations from model comparisons, use of maximum Elongation Index differences (ΔEImax) at different laser intensity levels was recently proposed for the estimation of SC fractions. OBJECTIVE: Implement a convolutional neural network to accurately estimate rigid-cell fraction and RBC concentration from laser diffraction patterns without using a theoretical model and eliminating the ektacytometer dependency for deformability measurements. METHODS: RBCs were collected from control patients. Rigid-cell fraction experiments were performed using varying concentrations of glutaraldehyde. Serial dilutions were used for varying the concentration of RBC. A convolutional neural network was constructed using Python and TensorFlow. RESULTS and CONCLUSIONS: Measurements and model predictions show that a linear relationship between ΔEImax and rigid-cell fraction exists only for rigid-cell fractions less than 0.2. The proposed neural network architecture can be used successfully for both RBC concentration and rigid-cell fraction estimations without a need for a theoretical model.

Background In the microcirculation, red blood cells (RBCs) were observed to be confined to an axial stream surrounded by a marginal RBC depleted layer. This axial accumulation of RBCs is considered to arise from the RBC deformability. Objective To quantitatively evaluate the effect of RBC deformability on their axial accumulation at a flow condition comparable to that in arterioles by developing a new observation system for accurate measurements of radial RBC positions in the cross section of capillary tubes. Methods The cross-sectional distributions of normal and hardened RBCs as well as softened RBCs suspended in capillary tube flows were measured with high spatial resolution. A new observation system was developed in which enface views of the cross-section of the tube were obtained at small distances upstream of the outlet at various longitudinal positions in the tube. Results The radial positions of individual RBCs were detected within 1 μm accuracy. It was found that normal and softened RBCs rapidly migrated away from the wall towards the tube axis, whereas glutaraldehyde-hardened RBCs were dispersed widely over the tube cross-section, depending on the concentration of glutaraldehyde solution. Conclusions The newly devised observation system revealed quantitatively the essential role of RBC deformability in their axial accumulation.

Background Acute exercise increases red blood cell-nitric oxide synthase (RBC-NOS) activation and RBC deformability but the effect of regular training remains unclear. Objective To detect the chronic effect of enduring moderate and high intensity training on the RBC-NOS/NO pathway and to detect a relation between RBC deformability and endurance capacity. Methods 38 healthy male subjects were randomly assigned to one of three training groups: High Volume Training (HVT; 120-140 beats per minute (bpm)), High Intensity Training (HIT; 160-180 bpm) and Moderate Intensity Training (MIT; 140-160 bpm). Blood parameters, maximum oxygen capacity (VO2 max), RBC deformability, RBC nitrite level and RBC-NOS activation were measured after venous blood sampling at rest pre (T0) and after six weeks of training (T1). Results RBC-NOS activation, RBC nitrite concentration and RBC deformability were significantly increased at T1 in the HIT group. Parameters were unaltered in MIT and HVT. Maximum oxygen uptake was only significantly increased in the HIT group and regression analysis revealed positive regression between VO2 max and RBC deformability. Conclusions High intensity training was the only training programme that sustainably affected RBC-NOS dependent NO production and performance capacity. HIT therefore represents a time efficient training program resulting in improved RBC function potentially improving physical condition.

BACKROUND: Possible toxic effects of hyperoxia have been reported previously. However, the number of studies investigating the influence of hyperoxia on blood cells is limited and there are no data regarding its hemorheological effects. OBJECTIVE: The aim of this study was to investigate the effects of acute hyperoxia, performed in human subjects at normal atmospheric pressure, on the rheological properties of blood. METHOD: The study was conducted with 12 brain death patients mechanically ventilated in the intensive care unit. The patients were ventilated with 21%, 40%, and 100% oxygen before induction of apnea testing performed for diagnosis of brain death. Blood samples were obtained at each oxygen concentration value for all patients. RESULT: The results of the study indicated no significant change of red blood cell aggregation, deformability and plasma or whole blood viscosity associated with acute hyperoxia at normobaric conditions. CONCLUSION: The results of the study suggest that application of normobaric hyperoxia does not have detrimental effects on hemorheological parameters in brain death patients, and that organs considered for donation from such subjects are not adversely affected by abnormalities of blood flow and tissue perfusion.

BACKGROUND: Postmenopausal women often develop hemorheological disorders which may affect the systemic blood circulation and present a cardiovascular risk factor. OBJECTIVE: We evaluated effects of secoisolariciresinol (SECO), a phytoestrogen, on hemorheological parameters and lipid peroxidation in a model of the age-related and/or surgical menopause induced by ovariectomy in rats. METHODS: Arterial blood was sampled from sham-operated female rats, ovariectomized rats (OVX), and OVX treated with SECO (OVXSECO) (20 mg/kg/day intragastrically for two weeks). Plasma estrogen concentration and the following hemorheological parameters were measured: RBC aggregation (half-time of aggregation, T1/2; amplitude of aggregation, AMP; aggregation index, AI), RBC deformability (elongation index, EI), whole blood viscosity at the shear rate of 3–300 s −1 ,p l a s m a viscosity, hematocrit, plasma fibrinogen. Lipid peroxidation was evaluated by measuring conjugated dienes (CD) and thiobarbituric acid reactive substances (TBARS) in plasma. RESULTS: Ovariectomy in rats caused a 60% decrease in plasma estrogen level and triggered the development of macro- and microhemorheological abnormalities. Blood viscosity increased by 12–31%, RBC elongation index reduced by 16–28%, and T1/2 and AI increased by 35% and 29% respectively. The increase in blood viscosity correlated predominantly with reduced RBC deformability. Plasma CD and TBARS were elevated by 47% and 104% respectively. SECO therapy for OVX rats reduced blood viscosity by 9–18% and T1/2 by 32%, and increased EI by 4–17%. SECO therapy disrupted the correlation between blood viscosity and RBC deformability. Lipid peroxidation was significantly inhibited, as shown by the reduction in CD and TBARS plasma concentrations by 89% and 70% respectively. SECO did not affect plasma viscosity, estrogen or fibrinogen levels. CONCLUSIONS: SECO treatment for OVX rats improves blood macro- and microrheological parameters, possibly through antioxidant protection of RBC.

BACKGROUND Reperfusion injury often occurs with therapeutic intervention addressing the arterial occlusions causing acute myocardial infarction and stroke. The no-reflow phenomenon has been ascribed to leukocyte plugging and blood vessel constriction in the microcirculation. OBJECTIVE To assess possible red cell contributions to post-thrombolytic no-reflow phenomenon. METHODS Blood clots were formed by recalcifying 1 ml of citrated fresh human venous blood and then lysed by adding 1,000 units of streptokinase (SK) at several intervals within 1 hour. Red cell deformability was tested by both a microscopic photometric and a filtration technique, viscosity by a cone and plate viscometer, and erythrocyte aggregation by an optical aggregometer. RESULTS Two sampling methods were devised for the microscopic photometric test, both of which indicated increases of erythrocyte stiffness after being lysed from the clot by SK. In accompanying experiments, the viscosity, aggregation and filterability of the post-lytic erythrocytes were assessed. Results indicated increased viscosity in Ringer's, decreased aggregation index and filterability through a 5 μm pore size Nuclepore membrane. CONCLUSION Findings demonstrated that post-lytic changes in red cell deformability do occur which could contribute to the no-reflow phenomenon.

BACKGROUND: Hemorheological responses to swimming exercise have never been investigated in spontaneously hypertensive rats (SHR). OBJECTIVE: We aimed to investigate the effects of moderate intensity swimming exercise followed by detraining on erythrocyte deformability and aggregation in SHR. METHODS: SHR and WKY rats were randomized into sedentary, exercised, detrained (5 weeks) and late detrained (10 weeks) groups. Swimming exercise of 60 min, 5 days/week, 10 weeks was applied. Systolic blood pressure (SBP), heart rate, body weights were measured every 2 weeks. Erythrocyte deformability and aggregation were determined by ektacytometry. RESULTS: Exercise training reduced SBP in both WKY and SHR rats and decreased erythrocyte aggregation in SHR group. SBP lowering effect of exercise was maintained until a detraining period equal to the duration of the exercise protocol, while 5 weeks of detraining reverted the improvements observed in erythrocyte aggregation of hypertensive rats. Although exercise training did not affect erythrocyte deformability, detraining for 10 weeks decreased RBC deformability in normotensive, but not in hypertensive rats. CONCLUSIONS: It can be suggested that, the exercise training applied herein has favorable effects on circulation not only by lowering blood pressure, but also by decreasing erythrocyte aggregation which are reversed after 5 weeks of detraining in SHR. © 2014 - IOS Press and the authors. All rights reserved.

BACKGROUND: Previous studies have demonstrated that red blood cells (RBC) either lyse or at least experience mechanical damage following prolonged exposure to high shear stress (=100 Pa). Conversely, prolonged shear stress exposure within the physiological range (5-20 Pa, 300 s) was recently reported to improve RBC deformability. This study investigated the relationships between shear stress and RBC deformability to determine the breakpoint between beneficial vs. detrimental exposure to shear stress (i.e., "subhemolytic threshold"). A second aim of the study was to determine whether the frequency of intermittent application of shear stress influenced the subhemolytic threshold. METHODS: RBC were exposed to various levels of shear stress (0-100 Pa) in a Couette type shearing system for 300 s. RBC deformability was then immediately measured via ektacytometry. Parallel experiments were conducted at the same shear stresses, except the application time differed while keeping constant the total exposure time: shear stress was applied either for 30 s and repeated 10 times (10׳0 s) or applied for 15 s and repeated 20 times (20ױ5 s). RESULTS: For a range of donors, the subhemolytic threshold with constant shear stress application was between 30-40 Pa. When physiological shear stress was applied in an intermittent manner, more frequent applications tended to improve (i.e., increase) RBC deformability. However, when supra-physiological shear stress was applied, both continuous and intermittent protocols damaged RBC. Changes of RBC mechanical behavior occurred without increases of hemoglobin in the suspending media, thus attesting to the absence of hemolysis. CONCLUSION: Shear stress has a biphasic effect on the mechanical properties of RBC, with the duration and rate of exposure appearing to have minimal impact on the subhemolytic threshold when compared with the magnitude of applied shear stress.

Sickle cell disease (SCD) is characterized by decreased erythrocyte deformability, microvessel occlusion and severe painful infarctions of different organs. Ektacytometry of SCD red blood cells (RBC) is made difficult by the presence of rigid, poorly-deformable irreversibly sickled cells (ISC) that do not align with the fluid shear field and distort the elliptical diffraction pattern seen with normal RBC. In operation, the computer software fits an outline to the diffraction pattern, then reports an elongation index (EI) at each shear stress based on the length and width of the fitted ellipse: EI = (length − width)/(length + width). Using a commercial ektacytometer (LORCA, Mechatronics Instruments, The Netherlands) we have approached the problem of ellipse fitting in two ways: (1) altering the height of the diffraction image on a computer monitor using an aperture within the camera lens; (2) altering the light intensity level (gray level) used by the software to fit the image to an elliptical shape. Neither of these methods affected deformability results (elongation index-shear stress relations) for normal RBC but did markedly affect results for SCD erythrocytes: (1) decreasing image height by 15% and 30% increased EI at moderate to high stresses; (2) progressively increasing the light level increased EI over a wide range of stresses. Fitting data obtained at different image heights using the Lineweaver–Burke routine yielded percentage ISC results in good agreement with microscopic cell counting. We suggest that these two relatively simple approaches allow minimizing artifacts due to the presence of rigid discs or ISC and also suggest the need for additional studies to evaluate the physiological relevance of deformability data obtained via these methods.

INTRODUCTION Despite current generation mechanical assist devices being designed to limit shear stresses and minimise damage to formed elements in blood, severe secondary complications suggestive of impaired rheological functioning are still observed. At present, the precise interactions between the magnitude-duration of shear stress exposure and the deformability of red blood cells (RBC) remain largely undescribed for repeated subhaemolytic shear stress duty-cycles of less than 15 s. Given that the time taken for blood to traverse mechanical devices (e.g., Bio Pump) typically ranges from 1.85-3.08 s, the present study examined the influence of repeated, short duration, supraphysiological shear stress exposure on RBC function. METHODS RBC were exposed to shear stress duty-cycles of 64 Pa × 3 s or 88 Pa × 2 s, for 10 repeated bouts, in an annular Couette shearing system and ektacytometer. Laser diffractometry was used to measure RBC deformability before and after application of each duty-cycle. Free haemoglobin concentration and RBC morphology was also examined following shear exposure to determine cell viability. RESULTS Initial exposure to shear stress duty-cycles decreased RBC deformability and increased RBC sensitivity to mechanical damage. Interestingly, the pattern of change in these variables reversed and returned to baseline values within two successive duty-cycle exposures. Significant improvements in RBC deformability were then observed by the 9th repeated exposure to 64 Pa × 3 s. CONCLUSIONS Repeat applications of short duration supraphysiological, subhaemolytic shear stress induces a biphasic RBC deformability response that appears to progressively improve initially impaired RBC populations.

BACKGROUND Systemic arterial pressure (AP) depends on two physiological variables: cardiac output (CO) and total peripheral resistance (TPR). The latter depends on vascular hindrance and blood viscosity (BV). However, the relative contributions of the vascular and rheological factors to TPR remain unclear. OBJECTIVE The aim of our work was to study the haemodynamic and haemorheologic effects of a treatment course with pentoxifylline (PTX) in SHRs in an effort to assess the impact of the rheological factor on TPR and AP. METHODS The effects of the treatment course with PTX (100 mg/kg/day p.o. for six weeks) on BV, plasma viscosity, haematocrit, erythrocyte aggregation and deformability, mean AP (MAP), stroke volume (SV), CO, and TPR were studied in SHRs and in control Wistar Kyoto (WKY) rats. RESULTS PTX-treated SHRs had a lower BV, lower erythrocyte aggregation, and higher erythrocyte deformability index compared with the controls. The TPR level was higher by 43% compared with that in WKY rats and did not differ from the values obtained from control SHRs. In SHRs, moderate and strong positive correlations were found between BV and MAP and between BV and TPR. PTX-treated SHRs did not have any significant correlations between the above mentioned parameters. CONCLUSIONS Treatment with PTX attenuated whole blood viscosity, but did not affect the AP and hemodynamic parameters in the experimental SHRs compared with the control SHRs. The magnitude of the rheologic effects of PTX was insufficient to cause appreciable decreases in TPR and AP.

Ektacytometry measures the shape of red blood cells under shear stress by analyzing the diffraction pattern of laser light passing through a thin layer of suspended cells. Here we model the diffraction pattern using a combination of Bessel and anomalous scattering functions, and employ a global pattern-fitting technique over nine different shear stresses to determine the separate mechanical properties of normal and non-deformable cells. This technique is capable of yielding the correct elongation index of the normal cells over a range of shear stresses even when they are mixed with as much as 50% non-deformable cells. Additionally, the relative concentrations of normal and non-deformable cells can be determined.

In this study, we simulated multiple red blood cells flowing through straight microvessels with the immersed-boundary lattice-Boltzmann model to examine the shear stress variation on the microvessel surface and its relation to the properties of cell-free layer. Significant variation in shear stress has been observed due to the irregular configuration of blood cells flowing near the microvessel wall. A low shear stress is typically found at locations where there is a cell flowing close to the wall, and a large shear stress at locations with a relatively wide gap between cell and wall. This relationship between the shear stress magnitude and the distance between cell and wall has been attributed to the reverse pressure difference developed between the front and rear sides of a cell flowing near the vessel wall. We further studied the effects of several hemodynamic factors on the variation of shear stress, including the cell deformability, the flow rate, and the aggregation among red blood cells. These simulations show that the shear stress variation is less profound in situations with wider cell-free layers, since the reverse pressure difference around the edge cells is less evident, and the influence of this pressure difference on wall shear stress becomes weaker. This study also demonstrates the complexity of the flow field in the gap between cell and wall. More precise experimental techniques are required accurately measure such shear stress variation in microcirculation.

Piezoresistance describes the change of electrical resistance in a material undergoing deformation. Heterogeneous materials having different resistivities of dispersed and continuous matrix phases, such as blood (comprised of red and white blood cells and platelets suspended in plasma), can exhibit the piezoresistance effect. For an initially isotropic material, two independent intrinsic material coefficients, λ1 and λ2, would uniquely describe the piezoresistance phenomenon. Materials undergoing deformation affect a material's resistivity in two ways: (a) by introducing anisotropy in the material, which is characterized by λ1 and (b) by changing the volume density of the inclusions, which is associated with ( 1 λ1 + λ2). In this paper, the piezoresistance effect in bovine blood samples is studied under oscillatory shear flow with a planar sensor rosette. The first piezoresistance coefficient, λ1, was measured at various frequencies and shear rates in the blood flow and compared with cos δ (equal to G � /G ∗ ,w hereGand G ∗ are the storage and complex moduli, respectively), which reflects the degree of elasticity. The coefficient λ1 was found to have a trend similar to that of cos δ under all conditions tested. Thus λ1 might potentially be used to characterize the viscoelastic properties of blood and the deformability of red blood cells, thus clarifying pathophysiology and facilitating diagnosis.

Alterations of blood rheology related to muscular activity have been extensively studied over the last 20 years. It has been shown that exercise exerts a "triphasic" action on the rheological properties of blood. In the short term, exercise induces a transient hyperviscosity, mostly due to a rise in hematocrit and plasma viscosity, but also to alterations in erythrocyte rheology. Reversal of this hyperviscosity pattern over the following 24 h can be described as an "autohemodilution". Later, training results in several profiles of "hemorheologic fitness" with a low hematocrit reflecting an expansion in plasma volume, and improvements in red cell rheology (increased deformability, decreased aggregation, reduced disaggregation shear rate). Some specific aspects of these long-term adaptations have been described, such as the intriguing occurrence of a paradoxical improvement in RBC deformability during exercise in some athletes, and overtraining, which is associated with higher plasma viscosity. Given the variety of modes of exercise and the wide heterogeneity of their effects on blood rheology in the short and long term, many investigations remain to be performed in this area of clinical hemorheology.

The extract from Panax ginseng has been reported to improve the microcirculation in various organs. However, the mechanisms underlying this phenomenon are still poorly understood. In the present study, using the rheological properties of erythrocytes as an index, we have screened the components of Panax ginseng extract and identified Rg(2) and Rh(1) as the active ingredients. These two ginsenosides prevented the oxidative stress-induced elevation of erythrocyte suspension viscosity and the impairment of erythrocyte elongation in response to shear stress. Rg(2) and Rh(1) ginsenosides did not have antioxidant activity in an aqueous phase and did not inhibit the peroxidation of membrane lipids, either. However, they inhibited the oxidation-induced decrease of SH-groups in band 3 (anion exchanger-1), one of the important structural proteins of the erythrocyte membrane, but not in other structural proteins: bands 1 and 2 (spectrins), band 4.2 or band 5 (actin). These results suggest that ginsenosides Rg(2) and Rh(1) protect the rheological functions of erythrocytes against oxidative stress by preventing the oxidation of SH-groups in band 3 protein.

There is evidence that hyperlipidemia can induce hemorheological and microcirculatory disturbances. Myakuryu, a Chinese traditional medicine is efficacious in promoting lipid metabolism and protecting oxidative stress, but whether this drug can ameliorate rheologic disturbances caused by hyperlipidemia is still unknown. The present study was conducted to investigate the effects of myakuryu on hemorheological and microcirculatory disturbances induced by hyperlipidemia. Wistar rats were divided into a group on control diet (n=8) and a group on high-fat diet (HFD, n=44). Eight weeks later, plasma triglyceride (TG) and total cholesterol (TC) were determined. Sixteen animals with the highest levels of hyperlipidemia from the HFD group were randomly divided into two sub-groups: the untreated hyperlipidemia group (n=8) and the group treated with myakuryu (n=8). At the end of the sixteenth week, rheological and microcirculatory parameters were measured. Chemical analysis showed that myakuryu treatment caused significant reductions of plasma TG and TC levels (P

BACKGROUND: Acute hemorheological responses to different types of aerobic exercises have never been compared in a single study in healthy people., OBJECTIVE: We aimed to compare acute effects of high intensity intermittent exercise (HIIE) and moderate intensity continuous exercise (MICE) on hemorheological parameters, in healthy young subjects., METHODS: A total of 34 sedentary young adults (12 males, 22 females) with a mean age of 20.0±2.1 years were randomly assigned to HIIE, MICE or non-exercise groups. MICE exercised at the power corresponding to 50% of heart rate reserve (HRR) continuously for 25 min. HIIE exercised at the power corresponding to 100% of HRR for 30 s followed by 30 s rest for 25 min. The non-exercise group rested. Blood samples were collected before and after exercise and studied for blood count, whole blood viscosity (WBV), plasma viscosity (PV) and red blood cell (RBC) elongation at nine different shear stresses., RESULTS: WBV, PV, RBC elongation of MICE and HIIE groups were not found to be statistically different from each other or from the non-exercise group. Compared to the non-exercise group, there was a significant increase in white blood cell (WBC) and RBC counts in the MICE group., CONCLUSIONS: Different types of aerobic exercises, namely MICE, HIIE are not different from each other in terms of hemorheological parameters immediately after exercise. © 2014-IOS Press and the authors.

Low-shear viscometry is one of the methods commonly used to estimate the degree of red blood cell (RBC) aggregation in various bloods and RBC suspensions. However, it has been previously shown that alterations in RBC morphology and mechanical behavior can affect the low-shear apparent viscosity of RBC suspensions; RBC aggregation is also sensitive to these cellular factors. This study used heat treatment (48 degrees C, 5 min), glutaraldehyde (0.005-0.02%) and hydrogen peroxide (1 mM) to modify cell geometry and deformability. Red blood cell aggregation was assessed via a Myrenne Aggregometer ("M" and "MI" indexes), RBC suspension viscosity was measured using a Contraves LS-30 viscometer, and RBC shape response to fluid shear stresses (i.e., deformability) was determined by ektacytometry (LORCA system). Our results indicate that low-shear apparent viscosity and related indexes may not always reflect changes of RBC aggregation if cellular properties are altered: for situations where RBC aggregation has been only moderately affected, cellular mechanical factors may be the major determinant of low-shear viscosity. These findings thus imply that in situations which may be associated alterations of RBC geometry and/or deformability, low-shear viscometry should not be the sole measurement technique used to assess RBC aggregation.

Red blood cell (RBC) shape change under shear is generally reversible, with the time course of shape recovery a function of the elastic and viscous properties of the RBC membrane. RBC shape recovery can be investigated, using several different techniques, to provide information about the membrane material properties that are not directly accessible by frequently used methods to assess RBC deformability ( e.g. , micropore filtration). In the present study, RBC shape recovery was studied in a Couette system after abrupt cessation of shear, either by analyzing the time course of laser light reflection or by serial measurements of elongation indexes from laser diffraction patterns. The time course of shape recovery monitored with both techniques can be described with an exponential equation. Calculated time constants for normal human RBC were 119 ± 17 msec and 97 ± 15 msec as measured by light reflection and ektacytometry, respectively. Treatment of RBC with glutaraldehyde resulted in dose-dependent decreases in the shape recovery time constant. Heat treatment (48 ° C, 20 min), which is known to increase mainly the shear elastic modulus of the membrane, decreased the time constant by 65%. In contrast, wheat germ agglutinin treatment increased the shape recovery time constant by 22%, presumably by increasing membrane surface viscosity. Our results indicate that the shape recovery time constant of RBC can be measured easily and accurately by computerized light reflection analysis.

At flow onset the blood filtration rate accelerates to a steady state, this may affect the interpretation of red blood cell (RBC) filterability. We studied the acceleration of flow while the pressure is built up across the filter to analyse effects of various hematocrits and RBC rigidity by glutaraldehyde (GA) hardening. This was analysed by a new filtration system with high time resolution and unlimited filtration volume. The system uses a digital balance that samples the accumulated weight (e.g., filtration rate through 5 microns Nucleopore membranes) with on-line computer communication. The filtration is computer controlled via a pneumatic valve. White blood cells (WBC) were removed prior to filtration by a WBC-eliminating filter to avoid clogging artifacts. When flow is initiated a steady state is reached at 0.3-0.4 s. This timing was also tested and confirmed by a video monitoring technique of filtration flow into a horizontal pipette. The digital balance has a mathematical function to reduce the effects of vibration noise; when this function was activated the apparent acceleration was retarded to 1.2 s. With any of these techniques the steady state timing did not vary with the hematocrit, however, the volume of filtered suspension during acceleration varied with both the hematocrit and the GA hardening (p0.001). Extrapolation to yield the initial filtration rate from the relative flow curve (RBC suspension divided by buffer flow) varied depending on if the acceleration phase was included or not. In the most unfavourable situation, with GA-hardened RBC, this difference was 340% (p0.01). The slope to calculate clogging rate was affected in a similar way. Moreover, with the most GA-hardened RBC a delay in flow onset was observed with this technique. The acceleration phenomenon may cause artifacts in systems employing volume-derived filtration kinetics because of fixed volumes of filtrated medium.

Much attention has been paid to the study of blood flow in long, narrow tubes. While the influence of tube diameter and driving pressure have been examined in detail, the influence of suspending phase viscosity has generally been assumed only to affect the blood viscosity in a linearly proportional manner, hence the practice of normalizing apparent blood viscosity values by the suspending phase viscosity to give a relative viscosity (e.g., Pries et al., 1992). While this assumption is probably valid for long tubes, it apparently does not hold for blood flow in short tubes (and by extension also for flow in short or branching capillary segments in vivo) in which RBC deformation plays a more significant role. In this paper we present a series of experiments using the Cell Transit Analyzer (CTA) in which the influence of driving pressure and suspending phase viscosity on RBC passage through short, narrow tubes has been systematically evaluated. Over the range studied (1 to 10 cm water), the influence of driving pressure was found to be unremarkable, in that RBC velocity scaled directly and linearly with pressure. This finding is consistent with previous studies. However, a distinct intercept was observed in the linear relationship between RBC pore transit time and suspending phase viscosity, which presumably arises as a consequence of RBC deformation either at the pore entrance or within the pore. Two simple mathematical models for the suspending phase-viscosity/transit-time relationship were considered. The results show that making CTA measurements over a range of suspending medium viscosities is a simple and practical way to obtain additional information about RBC mechanical properties.

The Microscopic Photometric Monolayer Technique provides a tool to measure red blood cell (RBC) stiffness (resistance to elongation) and relaxation time. It combines many of the advantages of flow channel studies of point-attached RBCs with the simplicity, sensitivity and accuracy of photometric light transmission measurement. This technique allows the study of the effects of physicochemical factors on the elongation and relaxation time of the same cells within an average of four to five thousand cells adhered as a monolayer to glass. Further, the time course of physicochemical effects on cell membrane and wash-in/wash-out kinetics of interactions can be followed. An automated version of this technique was developed. A dense monolayer of point-attached RBCs was prepared at the bottom of a flow-chamber. A steady-state flow, with stepwise increases of flow rate, induced the RBC elongation. The light transmission perpendicular through the monolayer plane was measured photometrically. Photomicrographs compared with photometric results showed that the flow-induced bending and curvature change of RBC membrane was associated with the increase of light transmission. There was a linear correlation between the photometric index of elongation and the elongation taken from photomicrographs for shear stresses up to 0.75 Pa. A stiffness parameter, S (in Pa), was defined as the ratio of shear stress and elongation at a shear stress of 0.25 Pa. Following a sudden flow stoppage, the RBCs returned to their resting shape and the RBC relaxation time was measured. The stiffness-relaxation time product, V (in mPas), was calculated to provide an estimate of viscosity. Diamide treatment, known to stiffen RBCs, did result in dose-dependent decreases of elongation and relaxation time. With increasing temperature, the relaxation time decreased at a rate of -2.96 ms/K; the stiffness increased significantly at a rate of 0.0038 Pa/K, and the stiffness-relaxation time product decreased with -2.95 mPas/K, reflecting an inverse relationship between RBC viscosity and temperature. Using the automated version of this technique (Elias-c-) to test RBCs of 36 healthy subjects, we found the inter-individual coefficients of variation to be 8.6% for stiffness, 7.9% for relaxation time and 12.4% for stiffness-relaxation time product.

The present study was designed to investigate the oxidant susceptibility of red blood cells (RBC) from four species (echidna, human, koala, Tasmanian devil) based on changes in cellular deformability. These species were specifically chosen based on differences in lifestyle and/or biology associated with varied levels of oxidative stress. The major focus was the influence of superoxide radicals generated within the cell (phenazine methosulfate, PMS, 50 μM) or in the extracellular medium (xanthine oxidase-hypoxanthine, XO-HX, 0.1 U/ml XO) on RBC deformability at various shear stresses (SS). RBC deformability was assessed by laser-diffraction analysis using a "slit-flow ektacytometer". Both superoxide-generating treatments resulted in significant increases of methemoglobin for all species (p < 0.01), with Tasmanian devil RBC demonstrating the most sensitivity to either treatment. PMS caused impaired RBC deformability for all species, but vast interspecies variations were observed: human and koala cells exhibited a similar sigmoid-like response to SS, short-beaked echidna values were markedly lower and only increased slightly with SS, while Tasmanian devil RBC were extremely rigid. The effect of XO-HX on RBC deformability was less when compared with PMS (i.e., smaller increase in rigidity) with the exception of Tasmanian devil RBC which exhibited essentially no deformation even at the highest SS; Tasmanian devil RBC response to XO-HX was thus comparable to that observed with PMS. Our findings indicate that ektacytometry can be used to determine the oxidant susceptibility of RBC from different species which varies significantly among mammals representing diverse lifestyles and evolutionary histories. These differences in susceptibility are consistent with species-specific discrepancies between observed and allometrically-predicted life spans and are compatible with the oxidant theory of aging.

Rheological characteristics of red cells in two patients with refractory anemia (with single chromosomal abnormality of 20q- or 13q-, respectively) were investigated with the hematological and biochemical properties. (1) Whole blood viscosity was remarkably increased, and the red cell deformability was greatly impaired (the impairments were prominent in patient with 20q-). (2) The hematocrit of both patients was about half of the normal value. Remarkable anisocytosis with elliptocytes and poikilocytes was observed in the patient with 20q-, but the anisocytosis was not so prominent in the patient with 13q-. (3) 2,3-diphosphoglycerate content in red cells was markedly increased in both patients, but adenylate content was not. (4) The red cells were slightly resistant to osmotic hemolysis, but they were not heat-labile. (5) Structural abnormality of spectrin was suggested from the impaired dimer-dimer association in red cell membrane and from the different susceptibility of spectrin to tryptic digestion. In conclusion, the rheological impairments and the abnormal shape of red cells in refractory anemia probably originated from the structural abnormality of cytoskeletal proteins in membrane, and the functional and structural abnormality may be different among patients.

Although many RBC rheological properties have been previously described in detail, the biochemical mechanisms leading to premature destruction of red blood cells are less clear. However, several biochemical processes have been suggested as possible mechanisms for membrane structural alterations (e.g., crosslinking of membrane proteins, oxidant damage, binding of cytoplasmic proteins, and altered intracellular ion composition). We have carried out a series of studies aimed at evaluating the effects of calcium-regulated membrane-bound hemoglobin (Hbm) on RBC and derived ghost rheologic behavior. Intracellular calcium was elevated by 10 microM A23187, with cell deformability determined via the Cell Transit Analyzer (CTA). Our results indicate: 1) Linear, positive correlations between Hbm and average RBC rigidity and 2) a marked influence of heterogeneous calcium concentration on both Hbm and rheologic properties for various subpopulation. These findings therefore suggest the importance of hemoglobin-membrane interactions as a determinant of erythrocyte deformability, and may be relevant to RBC aging as well as to diseases such as sickle cell anemia, hereditary spherocytosis and thalassemia.

Exposure of human erythrocytes to subhemolytic shear stress is known to cause lipid loss and ion fluxes across the red cell membrane and to result in decreased filterability of suspensions of these cells. Damage to the lipid bilayer of traumatized erythrocytes has been examined by fluorescence anisotropy using the probe 1,6-diphenylhexatriene. Because literature methods for the introduction of the probe damaged the cells, a gentler method was developed using liposomes. Significant disruption of the lipid bilayer following subhemolytic trauma was detected by a decreased anisotropy of the membrane-bound fluorescent probe after stress.

The deformability of red blood cells is important in the microcirculation where capillary diameters are often smaller than those of the red blood cells. In the present study, ektacytometry was used to examine the effect of hypoxia on the deformability of red blood cells from five mammalian species: Human, cat, rat, rabbit, and dog. Deformability was characterized in both normoxic (PO2 = 129 +/- 6 mm Hg) and hypoxic (PO2 = 47 +/- 6 mm Hg) conditions in two different ways. First, we used the Elongation Index (EI) which quantitates the extent of elongation of red blood cells in response to increasing fluid shear stress; second, we used the Elongation Constant (EC), which quantitates the exponential dependence of the fraction of maximal elongation on the varying shear stress. The EI was measured at high shear stresses (150-250 dyn/cm2), as well as at lower shear stresses (15, 32 and 64 dyn/cm2) that occur in the microcirculation. In response to hypoxia at high shear stresses, the EI of the rat red blood cells decreased by 9.3% (P < 0.05), but was not altered in the other four species studied. Moreover, in all five species, the EC and EI at the lower shear stresses were unaltered in response to hypoxia. These ektacytometry experiments indicate that (1) the elongation constant is a new and useful parameter for characterizing the deformability of red blood cells and (2), the deformability of human, cat, dog, and rabbit red blood cells is unaltered by hypoxia. The results constrain the possible mechanisms that could account for the observation that hypoxia decreases the filterability of certain species of red blood cells, which was reported previously.

This paper reports on a theoretical examination of the hypothesis that red blood cell network characteristics influence the mechanical properties of the fluid. For this purpose a newly developed energy-rate based blood viscosity model, which incorporates network dynamics, was used to predict the transient behaviour of blood viscosity (steady-state results of this model have been reported in Biorheology 46 (2009), 487-508). The main network characteristic examined in the present work was the inter-aggregate branch size and its relationship to the evolving aggregates. Branch size was used to define a network integrity index that accounted for the strength of the developed network. For the development and validation of the model, experiments performed with an optical shearing microscope, with different step-changes in shear rate, were utilised, as well as viscosity measurements under similar flow conditions performed in a double wall Couette instrument. The experimental data were compared with the response of the model, which incorporated the network integrity index. The results suggest that network characteristics may influence the viscosity of blood at low shear rates and exhibit good agreement with experimental observations.

Although the stability and viscoelasticity of the red cell membrane are undoubtedly governed by the membrane's underlying protein skeleton, the mechanism by which this network controls elasticity is uncertain. The structural constraints, that impose end-to-end spacing on the spectrin molecules well below that in free solution, may impart rubbery (entropic) elasticity to the system. However, other enthalpic and entropic contributions due to interactions between spectrin chains or between spectrin and other proteins, the lipid bilayer or the solvent must also prevail. To relate structural features to elasticity, explicit measurements of membrane rigidity are required. The most widely used measurement is that of the membrane shear elastic modulus by micropipette aspiration. Analysis of genetic variants of membrane structure have shown that the density of spectrin is directly correlated with membrane rigidity. Although cross-linking of the skeleton increases rigidity, interruption of the continuity of the network by dissociating spectrin tetramers into dimers does not reduce rigidity as might be expected. On the other hand, external ligands that cause new interactions between integral proteins and the skeletal network do increase rigidity. Moreover, hereditary ovalocytes, which have a deletion of 9 amino acids from band 3 at the first point of entry into the membrane, are extremely rigid. This mutation is associated with decreased translational and rotational mobility of the band 3, and may impair flexural freedom of its cytoplasmic domain. It thus appears that elasticity may be regulated not only by the structure of the spectrin network, but also by its interactions with and freedom of motion relative to the lipid bilayer.

The effect of superoxide anions (O2-) on red blood cells (RBC) deformability and membrane proteins was investigated using hypoxanthine-xanthine oxidase system. Exposure of RBC to O2- caused a marked decrease in RBC deformability with a concomitant increase in cell volume and shape changes. The RBC exposed to O2- also displayed pronounced degradation of membrane proteins such as band 3 protein and spectrin; new bands of low molecular weight products appeared as the original membrane proteins tended to diminish, without the appearance of high molecular weight products. Since the membrane proteins are involved in processes regulating membrane properties such as permeability and viscoelasticity, the decreased deformability induced by O2- may be attributable to changes in membrane proteins. Interestingly, resealed ghosts exposed to O2- did not show any significant change in membrane proteins, which suggests the existence of further generation of O2- and subsequent production of other active oxygen species mediated by O2(-)-initiated autoxidation of hemoglobin in intact RBC. Furthermore, electrophoretic analysis suggested that active oxygens increased the endogenous proteolytic susceptibility of RBC. In conclusion, a close linkage was suggested between RBC deformability and the membrane proteins.

We applied laser diffractometry and a linear image sensor to measurement of erythrocyte deformability to detect the light intensity pattern of the diffraction image. Deformability was evaluated as the deformability index (DI), calculated from the width and length of the diffraction pattern ellipse, estimated by the linear image sensor. With the erythrocytes under various shear stresses, the DI was linearly related to results by the geometric method (r = 0.996, p < 0.01). The coefficient of variance of DI at a shear stress of 236 dynes/cm2 was 0.2% (seven human blood samples), which was satisfactory for practical use. The DI was independent of the erythrocyte concentration in the range of 1.5 x 10(7)-5.0 x 10(7) cells/ml of suspension. Correlation between the DI and the logarithm of shear stress was linear in the range of 5 to 350 dynes/cm2 of shear stress in suspension media of different viscosities. Heat-treatment, which decreased membrane flexibility, caused parallel reduction of the DI plotted against the logarithm of shear stress. The method was sensitive and gave reproducible results. It may be useful for clinical applications.

The Cell Transit Analyser (CTA) provides a means to rapidly measure the deformability of large numbers of individual cells. It combines many of the advantages of micropipette studies with the simplicity and speed of filtrometry methods by measuring the duration of each resistive pulse generated as a cell passes through one of 30 identical micropores in a membrane. However, in our opinion, the potential of the system is limited by the microcomputer and software supplied for data analysis. We have therefore written new software for a more-powerful microcomputer to examine the shape of each resistive pulse rather than just the duration. Seven new parameters are derived, which provide additional information regarding the passage of cells through the pores. In particular, the contribution of the entry and exit phases of the cell transit are evident in the rise time and fall time of the pulses. The software is user-friendly and allows the analysis of each pulse to be reviewed, which aids understanding of the system and helps to avoid errors in interpreting the data.

International audience; Aerobic performance is dependent on both cardio-respiratory and peripheral factors with hemodynamic parameters playing a major role. However, whether blood rheology might affect aerobic performance through an effect on hemodynamic factors is not known. The aim of the present study was to assess the relationships between hemodynamic, hemorheological and metabolic parameters in response to a sub-maximal cycling exercise protocol consisting of three successive levels of nine min duration (50, 100 and 150 W). Ten young sportsmen participated in the present study. Mean arterial pressure (MAP) was measured manually, with thoracic impedance used to monitor cardiac output (Qc): systemic vascular resistance (SVR) was then calculated. Whole blood viscosity (etab) was measured and used to calculate systemic vascular hindrance. Hematocrit (Hct) was determined by micro-centrifugation and red blood cell (RBC) deformability (EI) was determined by ecktacytometry. A breath-by-breath gas analyzer was used to measure oxygen uptake (VO2); the Fick equation was used to calculate arterio-venous oxygen difference [(a-v)O(2)] from VO(2) and Qc. All measurements were performed at rest, during exercise and during recovery. Compared to baseline, Qc, MAP, Hct, EI, VO(2), and (a-v)O(2) increased during exercise. etab increased above baseline only at 150 W and remained elevated during recovery; the increase in etab during the last level of exercise was associated with a decrease of SVR and systemic vascular hindrance. There was a significant negative correlation between EI and SVR (r=-0.35, p

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.

The rheological properties of blood were studied in patients supported by both the Jarvik-7 total artificial heart (TAH) and Novacor left ventricular assist device (LVAD) as a bridge to cardiac transplantation. Both groups of patients had abnormalities in blood rheology which differed according to the type of device implanted as well as on the clinical state of the patient. The rheology of individual patients correlated well with their clinical status and outcome, with incidences of TIA's and/or stroke being accompanied by marked increases in relative blood viscosity, erythrocyte rigidity, fibrinogen concentration and platelet aggregation in varying combination. Observed abnormalities in blood rheology were also crucial to thrombus formation on artificial heart valves as well. Our results show that the therapeutic management of rheological parameters should prove to be a unique and clinically rewarding approach to these patients.