Abnormal blood rheology and chronic low grade inflammation: possible risk factors for accelerated atherosclerosis and coronary artery disease in Lewis negative subjects.

OBJECTIVE: To test the hypothesis that abnormal hemorheology and chronic low-grade inflammation are more prevalent in Lewis negative individuals, possibly contributing to premature atherosclerosis. METHODS AND RESULTS: We enrolled 223 healthy subjects (154 females, mean age: 64yrs). Conventional risk factors, markers of inflammation and hemorheological profiles were measured; Lewis blood group was determined by serology. Conventional risk factors (age, gender, BMI, blood pressure, lipid profile, smoking habit) did not differ among Lewis phenotypes. However, markers of inflammation (WBC, hs-CRP, ESR) were significantly elevated and rheological parameters (RBC aggregation, plasma viscosity) were abnormal in Lewis negative subjects, especially when compared to the Le(a-b+) group. CONCLUSIONS: With a prevalence of 33% in select populations, our data support the hypothesis that Le(a-b-) represents a pro-inflammatory phenotype that may contribute to the elevated cardiovascular risk in this group.

Regulated expansion of human pancreatic beta-cells.

Although pancreatic beta-cell transplantation may serve as a potential cure for diabetes mellitus (DM), limited donor tissue availability poses a major challenge. Thus, there is a great demand to find new sources for pancreatic beta-cells. Here, we present a lentiviral vector-based approach to achieve beta-cell proliferation through the beta-cell-specific activation of the hepatocyte growth factor (HGF)/cmet signaling pathway. The methodology is based on the beta-cell-specific expression of a ligand-inducible, chimeric receptor (F36Vcmet), under transcriptional control of the promoter from the human insulin gene, and its ability to induce HGF/cmet signaling in the presence of a synthetic ligand (AP20187). High transduction efficiency of human pancreatic islets was achieved utilizing this approach with chimeric receptor expression confined to the beta-cell population. In addition, specific proliferation of human pancreatic beta-cells was induced utilizing this approach. Selective, regulated beta-cell expansion may help to provide greater availability of cells for transplantation in patients with DM.

A rapid method to estimate Westergren sedimentation rates.

The erythrocyte sedimentation rate (ESR) is a nonspecific but simple and inexpensive test that was introduced into medical practice in 1897. Although it is commonly utilized in the diagnosis and follow-up of various clinical conditions, ESR has several limitations including the required 60 min settling time for the test. Herein we introduce a novel use for a commercially available computerized tube viscometer that allows the accurate prediction of human Westergren ESR rates in as little as 4 min. Owing to an initial pressure gradient, blood moves between two vertical tubes through a horizontal small-bore tube and the top of the red blood cell (RBC) column in each vertical tube is monitored continuously with an accuracy of 0.083 mm. Using data from the final minute of a blood viscosity measurement, a sedimentation index (SI) was calculated and correlated with results from the conventional Westergren ESR test. To date, samples from 119 human subjects have been studied and our results indicate a strong correlation between SI and ESR values (R(2)=0.92). In addition, we found a close association between SI and RBC aggregation indices as determined by an automated RBC aggregometer (R(2)=0.71). Determining SI on human blood is rapid, requires no special training and has minimal biohazard risk, thus allowing physicians to rapidly screen for individuals with elevated ESR and to monitor therapeutic responses.

A novel high-throughput screening assay for sickle cell disease drug discovery.

Although the pathophysiology and molecular basis of sickle cell disease (SCD) were described more than half a century ago, an effective and safe therapy is not yet available. This may be explained by the lack of a suitable high-throughput technique that allows rapid screening of thousands of compounds for their antisickling effect. The authors have thus developed a novel high-throughput screening (HTS) assay based on detecting the ability of red blood cells (RBC) to traverse a column of tightly packed Sephacryl chromatography beads. When deoxygenated, sickle RBC are rigid and remain on the top of the column. However, when deoxygenated and treated with an effective antisickling agent, erythrocytes move through the Sephacryl media and produce a red dot on the bottom of the assay tubes. This approach has been adapted to wells in a 384-well microplate. Results can be obtained by optical scanning: The size of the red dot is proportional to the antisickling effect of the test molecule. The new assay is simple, inexpensive, reproducible, requires no special reagents, and should be readily adaptable to robotic HTS systems. It has the potential to identify novel drug candidates, allowing the development of new therapeutic options for individuals affected with SCD.

Effects of cyclodextrins on RBC aggregation and blood viscosity.

Cyclic oligomers of glucose, termed cyclodextrins (CDs), can contain 6 (alpha-CD), 7 (beta-CD) or 8 (gamma-CD) glucose units and are able to remove cholesterol from platelet membranes and decrease platelet aggregation. The present study was designed to examine the effects of these CDs on RBC aggregation and blood viscosity. Blood from normal adult volunteers was incubated at 37 degrees C with 3.0 x 10(-4) to 1.5 mM levels of the CDs, then processed to obtain platelet-rich plasma, platelet poor plasma and 40% hematocrit blood; measurements included collagen-induced platelet aggregation, RBC aggregation (Myrenne Aggregometer) and blood viscosity at 1-1000 sec(-1)(Rheolog). Our results indicate the expected dose-dependent inhibition of platelet aggregation by beta-CD, with no significant effects of alpha-CD or gamma-CD. RBC aggregation studies showed no effect of alpha-CD but highly significant (p<0.01) decreases by both beta-CD and gamma-CD; at the concentrations studied (1.5 x 10(-3) to 1.5 mM), beta-CD had somewhat greater effects. Blood viscosity was not affected by alpha-CD, but was significantly decreased in a dose-dependent manner by beta-CD and, at the highest concentration (1.5 mM), by gamma-CD. Interestingly, the effects of beta-CD and gamma-CD were independent of shear, with these effects not explained by the usual mechanisms. These results suggest the potential hemorheological value of CDs, yet also indicate the need for additional studies.

Effects of nattokinase, a pro-fibrinolytic enzyme, on red blood cell aggregation and whole blood viscosity.

The vegetable cheese-like food, natto, is extremely popular in Japan with a history extending back over 1000 years. A fibrinolytic enzyme, termed nattokinase, can be extracted from natto; the enzyme is a subtilisin-like serine protease composed of 275 amino acid residues and has a molecular weight of 27.7 kDa. In vitro and in vivo studies have consistently demonstrated the potent pro-fibrinolytic effect of the enzyme. However, no studies to date have evaluated the effects of nattokinase on various hemorheological parameters and thus we have begun to assess the effects of the enzyme on RBC aggregation and blood viscosity. Blood samples were incubated with nattokinase (final activities of 0, 15.6, 31.3, 62.5 and 125 units/ml) for 30 minutes at 37 degrees C. RBC aggregation was measured using a Myrenne MA-1 aggregometer and blood viscosity assessed over 1-1000 s(-1) with a computer controlled scanning capillary rheometer (Rheolog). Our in vitro results showed a significant, dose-dependent decrease of RBC aggregation and low-shear viscosity, with these beneficial effects evident at concentrations similar to those achieved in previous in vivo animal trials. Our preliminary data thus indicate positive in vitro hemorheological effects of nattokinase, and suggest its potential value as a therapeutic agent and the need for additional studies and clinical trials.

Rheologic behavior of sickle and normal red blood cell mixtures in sickle plasma: implications for transfusion therapy.

BACKGROUND: Guidelines for transfusion in sickle cell disease usually define an upper hematocrit (Hct) limit of 0.30 to 0.35 to avoid blood hyperviscosity. In vitro viscosity studies of normal (AA) and sickle (SS) red blood cell (RBC) mixtures in buffer appear to confirm that this Hct limit is optimal for oxygen delivery to vascular beds as judged by the ratio of Hct to viscosity, with this ratio often termed "oxygen or RBC transport effectiveness." In the absence of plasma, however, effects due to RBC-RBC interactions mediated by plasma proteins cannot be assessed. STUDY DESIGNS AND METHODS: To investigate the optimal Hct-to-viscosity ratio of RBCs in plasma, the rheologic effects of Hct (0.20-0.40), the proportion of SS RBCs (0-100%), and shear rate (1-1000/sec) for mixtures of oxygenated and deoxygenated SS and AA RBCs were evaluated in sickle plasma at 37 degrees C. RESULTS: RBC suspension viscosity was shear-dependent (i.e., viscosity decreased with increasing shear rate) and increased with Hct and proportion of SS RBCs. An "optimal" Hct level (defined as a maximal of the Hct-to-viscosity ratio) was seen only at shear rates above 50/sec. At lower shear rates (e.g., 5/sec), where plasma-mediated RBC-RBC interactions predominate, any increment in Hct was offset by a proportionally greater increase in viscosity, thus leading to a lower Hct-to-viscosity ratio. CONCLUSION: These results indicate the importance of plasma-mediated RBC interactions and suggest that the benefits of transfusion may vary depending on local flow rates (i.e., shear rates) and organ-specific hemodynamics.

Measurement of whole blood viscosity profiles via an automated viscometer: technical details and clinical relevance.

Recent basic science and large-scale clinical studies involving blood rheological factors have led to a similar conclusion: the mechanics of blood flow play an important role in the development and progression of various cardiovascular diseases (e.g., coronary artery disease, stroke). Several viscometer systems to measure whole blood viscosity have been developed, yet blood viscosity measurements are not routinely employed in clinical practice, primarily due to the complexity of currently available methods. Herein we provide a description of a new, computer-controlled capillary viscometer that offers a convenient approach to the measurement of blood viscosity over a wide range of shear rates. The new viscometer uses a disposable test section, requires small volumes of blood, provides viscosity data that compare well with those from other viscometers, and completes all testing and data analysis within five minutes.