Types and sources of fuels for platelets in a medium containing minimal added fuels and a low carryover plasma.

The storage of platelets in synthetic media can result in plasma savings and reduced transfusion reactions. Accordingly, a wide range of storage formulations have been developed with the aim of replacing at least a proportion of the plasma in the storage medium. However, the concentrations and types of fuels in the carryover plasma, and the utilization of these fuels by platelets in storage, has not been investigated. We have developed a system which can measure total ATP turnover, and the contribution to total ATP turnover by the oxidation of various fuels and by lactate production, in a bag of partially purified platelets in a buffered saline with minimal carryover citrate phosphate double dextrose (CP2D) plasma. Carryover plasma was about 1% and the final platelet suspension contained, on average, 0.62 mM glucose, 9.6 mg/l free fatty acids, 32 mg/l triglycerides and 0.23 mM total amino acids. The oxidation of carbohydrate (glucose, glycogen and lactate) accounted for 60% of total ATP turnover. The platelets also produced lactate (<6% of total ATP turnover) and consumed free fatty acids and amino acids/proteins (15.2% of total ATP turnover). Therefore we have identified the fuels that account for about 80% of oxygen consumption and ATP turnover by platelets in a medium with low carryover plasma. The implications of these data for storage strategies are discussed.

Fuel choices by human platelets in human plasma.

Despite the fact that homogeneous preparations of isolated cells are now being used very effectively to study a range of important biochemical questions, it is still not known what combination of fuels and energy-producing pathways is used by cells when offered the complex mixture characteristic of plasma or extracellular fluid. We have developed an in vitro system whereby highly purified and functional human platelets are incubated in human plasma that has been minimally modified from its native state. The concentration of platelets and fuels, and the complexity of fuels in the incubation are similar to those in vivo. The preparation thus represents a reasonable approximation of the physiological condition, considering the complex nature of the system being studied. Measurements carried out simultaneously during the incubation are rates of oxygen consumption, lactate production and fuel oxidation. The data allow the calculation of total ATP turnover, and contributions to this turnover by lactate production and the oxidation of individual fuels. Lactate production accounts for 24% of the ATP turnover. The oxidation of glucose and 3-hydroxybutyrate each account for under 5%, palmitate for 21%, oleate for 7% and acetate for 9%, leaving 32% of the ATP turnover as yet unaccounted for. The results confirm some previous measurements in the literature, but show that data collected under non-physiological experimental conditions can be misleading.

The Pasteur effect in human platelets: implications for storage and metabolic control.

The Pasteur effect and the associated acidosis have long been considered a major cause of platelet death during storage. We have investigated this phenomenon using a defined platelet preparation and a system whereby the oxidative and glycolytic contributions to total ATP production can be measured over a range of oxygen concentrations from saturating (pO2 = 158 mmHg) to anoxic (pO2 = 0 mmHg). Platelets do not show a Pasteur effect until the pO2 decreases to < 2.0 mmHg, whereupon lactate production increases 1.5-fold. The Pasteur effect is therefore not a likely cause of platelet death during storage where pO2 in a storage bag typically drops to no less than 50 mmHg. The data also have implications for the role of oxygen diffusion in oxidative metabolism, and for the compensatory nature of the Pasteur effect. As platelets are relatively small cells, and the onset of the Pasteur effect occurs at a relatively low oxygen concentration, diffusion may limit the rate of oxygen consumption in most other (larger) cells. The Pasteur effect is only fully compensative if the P/O2 ratio used for the calculations is lower than the conventional one. Since recent research strongly suggests that the conventional P/O2 ratio is too high, examples of fully compensative Pasteur effects may be more common than the literature suggests.

A complete platelet system for metabolic studies: pure, defined, and viable over 8 hours.

We have been using a human platelet preparation to investigate various aspects of cellular metabolism. These experiments require a pure, quantitated platelet preparation that is viable for up to 8 h. The purity of the preparation has previously been characterized and we have now assessed its viability over 8 h and developed a simple spectrophotometric counting method. This method of counting results in estimations that are within 6% of those from an electronic cell counter (Coulter). Pure platelets stored in a Hepes physiological saline were resuspended periodically in autologous plasma to assess function over 24 h. The platelets consumed oxygen, changed shape, aggregated, and released dense granule ATP at all times. There was a slow and linear decrease in the various processes with time, ranging from 1.7% per hour for oxygen consumption to 3.8% per hour for percentage aggregation. The preparation is therefore not stable, but the changes with time are small and defined and it represents a useful system for the study of platelet and cell biology.

Quantitative study of starving platelets in a minimal medium: maintenance by acetate or plasma but not by glucose.

The requirement of donor platelets for fuels, plasma and calcium were studied using platelets washed, filtered to remove leucocytes and resuspended in a new glucose-free minimal platelet storage medium with low citrate (3 mmol/l), low buffer capacity and no calcium. This is the first study of platelets stored without plasma, glucose or calcium and it was shown that platelets continued to aggregate with collagen plus adrenaline for 48 h and showed only a 50% fall in 'swirl index', an objective morphology score, after 3 days, showing that by these criteria human platelets do not require glucose. Sodium acetate extended the storage time by between 2 and 4 days, depending on the index parameter. This is the first evidence showing that failure of platelets in these conditions is at least partly due to exhaustion of fuel, and the first evidence that acetate prolongs in vitro survival. As little as 10% low-glucose plasma extended the storage time, but it was no better than acetate. New observations using this system included a very rapid fall in pH during resuspension of the washed platelet pellet, a rising pH in the absence of added fuel and an increased pH with added acetate.

pH, temperature and lactate production in human red blood cells: implications for blood storage and glycolytic control.

The interaction of temperature and pH in biological systems comprises two components. Temperature change may perturb the pH of solutions, and it may change the pKa of some ionizable groups that are involved in enzyme catalysis. The pH optima of single reactions and whole pathways are therefore temperature sensitive. The pH optimum of glycolysis in human red cells has been investigated only at 37 degrees C. We have measured the effect of temperature on the pH of stored blood suspensions and on the pH optimum of glycolysis in the human red cell. The pH of the cell suspensions in a traditional storage medium was 7.25 +/- 0.2 at 4 degrees C. The pH optimum of glycolysis was high (7.8-8.5) between 15 and 35 degrees C. It can be inferred from our data that human red cells are currently stored at least 0.5 pH units below the pH optimum of glycolysis at 4 degrees C. This suggestion is supported by storage experiments which showed that glycolysis at 4 degrees C was at least 1.5-fold more active at an initial pH of 7.67 versus 7.36. Equations which describe the variation in reaction velocity with pH were fitted to the pH curves for glycolysis in order to identify the ionizable groups that contribute to the effect of pH on glycolysis. It is generally accepted that hexokinase catalyses the rate-limiting step in glycolysis in the human red cell, but none of the ionizable groups implicated correspond to that involved in the hexokinase reaction.

Alternative fuels for platelet storage: a metabolic study.

We have studied the metabolism of platelets in vitro using washed platelets. Oxygen uptake and fuel utilization were measured. It was found that glucose is never oxidized to any significant extent and is always converted to lactate, regardless of oxygen availability. Oxidative metabolism fuels 70-100% of the ATP turnover, and oxygen uptake is the same whether the platelet is consuming glucose, acetate or only an unidentified endogenous fuel. When acetate is the added fuel, no endogenous fuel is oxidized, whereas the addition of glucose results in sparing of only 8% of endogenous fuel. Preliminary storage experiments using plasma-free media show that an acetate-containing buffered salt solution provided excellent storage conditions and that a medium without any exogenous fuel is better than one containing glucose. Thus we conclude that a successful storage medium should contain minimal amounts of glucose, and an oxidizable fuel such as acetate, in order to supplement the endogenous one.

Fructose formation in stored blood.

At the high glucose concentrations used in the collection and storage of donor blood the activity of the fructose-forming polyol pathway (Reaction I and II) could act to deplete NADPH and thus GSH, thereby exposing the cells to oxidative stress. Fructose levels were found to be high in red cells and the supernatant plasma of blood collected into CP2D, which contains 258 mM glucose. Elevated fructose was not produced by the polyol pathway, but was formed by the autoclaving process. A high fructose concentration sufficient to account for the fructose in donor red cells was also found in the CP2D anticoagulant and in samples of autoclaved glucose.

Polycythaemia associated with a new haemoglobin variant: haemoglobin Palmerston North beta 23 (B5) val----phe.

A new haemoglobin variant, with increased oxygen affinity, has been identified in a patient with a long history of polycythaemia. This new haemoglobin, Hb Palmerston North, has an amino acid substitution of valine to phenylalanine at position beta 23 (B5). The increased oxygen affinity is accompanied by a decrease in globin stability which was responsible for the laboratory detection of the haemoglobinopathy.