Caprari Patrizia, Profumo Elisabetta, Massimi Sara, Buttari Brigitta, Riganò Rachele, Regine Vincenza, Gabbianelli Marco, Rossi Stefania, Risoluti Roberta, Materazzi Stefano, Gullifa Giuseppina, Maffei Laura, Sorrentino Francesco
National Centre for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy.
Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.
Front Mol Biosci. 2023 Jan 9;9:1108896. doi: 10.3389/fmolb.2022.1108896. eCollection 2022.
The rheological properties of blood play an important role in regulating blood flow in micro and macro circulation. In thalassemia syndromes red blood cells exhibit altered hemodynamic properties that facilitate microcirculatory diseases: increased aggregation and reduced deformability, as well as a marked increase in adherence to the vascular endothelial cells. A personalized approach to treating thalassemia patients (transfusions, iron chelation, and splenectomy), has increased patients' life expectancy, however they generally present many complications and several studies have demonstrated the presence of high incidence of thromboembolic events. In this study the hemorheological profiles of thalassemia patients have been characterized to point out new indices of vascular impairment in thalassemia. Plasma viscosity, blood viscosities at low and high shear rates (η1 and η200, respectively), erythrocyte aggregation index (η1/η200), and the erythrocyte viscoelastic profile (elastic modulus G', and viscous modulus G") have been studied in transfusion-dependent and non-transfusion-dependent thalassemia patients. Moreover, the levels of inflammation biomarkers in thalassemia have been evaluated to investigate a relationship between the biomarkers, the disease severity and the rheological parameters. The biomarkers studied are the main components of the immune and endothelial systems or are related to vascular inflammation: cytokines (IL-2, IL-6, IL-10, IL-17A, TNF-alpha), chemokines (IL-8, MIP-1alpha), adipocytokines (leptin and adiponectin), growth factors (VEGF, angiopoietin-1), adhesion molecules (ICAM-1, VCAM-1, E-selectin, L-selectin), and a monocyte/macrophage activation marker (CD163). This study shows that transfusion-dependent thalassemia patients, both major and intermedia, have blood viscosities comparable to those of healthy subjects. Non-transfusion-dependent thalassemia intermedia patients show high blood viscosities at low shear rates (η1), corresponding to the flow conditions of the microcirculation, an increase in erythrocyte aggregation, and high values of the elastic G' and viscous G" modules that reflect a reduced erythrocyte deformability and an increase in blood viscosity. Levels of cytokines, chemokines and adhesion molecules are different in transfusion- and non-transfusion dependent patients and positive correlations between η1 or η1/η200 and the cytokines IL-6 and IL-10 have been observed. The evaluation of the hemorheological profiles in thalassemia can provide new indicators of vascular impairment and disease severity in thalassemia in order to prevent the onset of thromboembolic events.
血液的流变学特性在调节微循环和大循环中的血流方面起着重要作用。在地中海贫血综合征中,红细胞表现出血流动力学特性改变,这易引发微循环疾病:聚集性增加、可变形性降低,以及与血管内皮细胞的黏附显著增加。针对地中海贫血患者的个性化治疗方法(输血、铁螯合和脾切除术)提高了患者的预期寿命,然而他们通常会出现许多并发症,并且多项研究已证明血栓栓塞事件的发生率很高。在本研究中,对地中海贫血患者的血液流变学特征进行了表征,以指出地中海贫血中血管损伤的新指标。研究了依赖输血和非依赖输血的地中海贫血患者的血浆黏度、低剪切率和高剪切率下的血液黏度(分别为η1和η200)、红细胞聚集指数(η1/η200)以及红细胞黏弹性特征(弹性模量G'和黏性模量G")。此外,还评估了地中海贫血中炎症生物标志物的水平,以研究生物标志物、疾病严重程度和流变学参数之间的关系。所研究的生物标志物是免疫和内皮系统的主要成分或与血管炎症相关:细胞因子(IL-2、IL-6、IL-10、IL-17A、TNF-α)、趋化因子(IL-8、MIP-1α)、脂肪细胞因子(瘦素和脂联素)、生长因子(VEGF、血管生成素-1)、黏附分子(ICAM-1、VCAM-1、E-选择素、L-选择素)以及单核细胞/巨噬细胞活化标志物(CD163)。本研究表明,依赖输血的重型和中间型地中海贫血患者的血液黏度与健康受试者相当。非依赖输血的中间型地中海贫血患者在低剪切率(η1)下表现出高血液黏度,这与微循环的血流条件相对应,红细胞聚集增加,弹性G'和黏性G"模块值较高,这反映了红细胞可变形性降低和血液黏度增加。输血依赖和非输血依赖患者的细胞因子、趋化因子和黏附分子水平不同,并且观察到η1或η1/η200与细胞因子IL-6和IL-10之间存在正相关。评估地中海贫血患者的血液流变学特征可为地中海贫血中的血管损伤和疾病严重程度提供新指标,以预防血栓栓塞事件的发生。
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