Although changes in the mechanical properties of infected red cells may contribute to the pathophysiology of malaria, such changes have not previously been described in detail. In this study, the physical properties of individual cells from both clinical and cultured samples infected with Plasmodium falciparum were tested using micropipette aspiration techniques. Cells containing ring forms took about 50% longer to enter 3 microns pipettes compared with nonparasitised cells, and there was a similar increase in the critical pressure required to induce cell entry. These abnormalities were similar in clinical and cultured samples. More mature cultured parasites (ie, trophozoites and schizonts containing pigment) caused much greater loss of deformability, with entry time and pressure increased four to sixfold. The decrease in deformability of the ring forms was attributable to a deficit in cell surface area/volume ratio (based on micropipette measurement of the surface area and volume of individual cells) and slight stiffening of the cell membrane (shear elastic modulus increased 13%, as measured by pipette aspiration of small membrane tongues). Measurement of the rate of cell shape recovery indicated that the membrane of parasitised cells was not more viscous. The main factor in the drastic loss of deformability of the trophozoites and schizonts was the presence of the large very resistant parasite itself. Otherwise, the cell surface area/volume deficit was slightly less and membrane rigidification slightly greater compared with ring forms. The above abnormalities should cause the trophozoites and schizonts to have great difficulty in traversing splenic or marrow sinuses and could contribute to microvascular occlusion and sequestration. On the other hand, the ring forms may be expected to circulate relatively unhindered.

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Interaction between neutrophils and platelets at the site of vascular damage or in ischaemic tissue may promote thrombosis and/or vascular occlusion. To study this interaction, we have developed a novel technique that allows visualization of adhesion of flowing neutrophils to immobilized, activated platelets. The total number of adherent neutrophils decreased with increasing wall shear stress in the range 0.05 to 0.4 Pa. Although a proportion of the adherent neutrophils were stationary, most were rolling with a velocity greater than 0.4 micron/s. The percentage of rolling cells increased with increasing wall shear stress, but the mean rolling cell velocity was nearly independent of shear stress. Adhesion of neutrophils was nearly abolished by treatment of the platelets with antibody to P-selectin, or by treatment of neutrophils with either neuraminidase, dextran sulfate, or EDTA. Studies with a series of antibodies to L-selectin (TQ-1, Dreg- 56, LAM1–3, and LAM1–10) suggested that this molecule was one neutrophil ligand for rolling adhesion. Thus, sialylated carbohydrate on neutrophils appears essential for P-selectin-mediated adhesion, and a proportion of this ligand may be presented by L-selectin. Treatment of the neutrophils with N-formyl-methionyl-leucyl-phenylalanine decreased the number of rolling cells, and increased the rolling velocity, possibly due to shedding of neutrophil ligand(s) and/or cell shape change. In vivo, immobilized platelets could play an important role in promoting attachment of neutrophils to vessel walls, eg, by slowing neutrophils so that integrin-mediated immobilization could occur.

To assess the influence of intracellular hemoglobin concentration on red cell viscoelasticity and to better understand changes related to in vivo aging, membrane shear elastic moduli (mu) and time constants for cell shape recovery (tc) were measured for age-fractionated human erythrocytes and derived ghosts. Time constants were also measured for osmotically shrunk cell fractions. Young and old cells had equal mu, but tc was longer for older cells. When young cells were shrunk to equal the volume (and hence hemoglobin concentration and internal viscosity) of old cells, tc increased only slightly. Thus membrane viscosity (eta = mu . tc) increases during aging, regardless of increased internal viscosity. However, further shrinkage of young cells, or slight shrinkage of old cells, caused a sharp increase in tc. Because this increased tc is not explainable by elevated internal viscosity, eta increased, possibly due to a concentration-dependent hemoglobin-membrane interaction. Ghosts had a greater mu than intact cells, with proportionally faster tc; their membrane viscosity was therefore similar to intact cells. However, the ratio of old/young membrane viscosity was less for ghosts than for intact cells, indicating that differences between young and old cell eta may be partly explained by altered hemoglobin-membrane interaction during aging. It is postulated that these changes in viscoelastic behavior influence in vivo survival of senescent cells.

Aims: To determine the clinical, haematological, biochemical and rheological changes that occur in the asymptomatic steady state of sickle cell anaemia. Methods: Patient self-assessment visual analogue scores (for wellbeing and tiredness), the blood concentration of acute phase proteins (C-reactive protein, orosomucoid, and fibrinogen), and blood rheology (percentage of dense cells and the number of sickled cells that occluded pores 5 ,m in diameter) were studied longitudinally on 10 occasions in each of 20 outpatients with sickle cell anaemia.

Although changes in the mechanical properties of infected red cells may contribute to the pathophysiology of malaria, such changes have not previously been described in detail. In this study, the physical properties of individual cells from both clinical and cultured samples infected with Plasmodium falciparum were tested using micropipette aspiration techniques. Cells containing ring forms took about 50% longer to enter 3 microns pipettes compared with nonparasitised cells, and there was a similar increase in the critical pressure required to induce cell entry. These abnormalities were similar in clinical and cultured samples. More mature cultured parasites (ie, trophozoites and schizonts containing pigment) caused much greater loss of deformability, with entry time and pressure increased four to sixfold. The decrease in deformability of the ring forms was attributable to a deficit in cell surface area/volume ratio (based on micropipette measurement of the surface area and volume of individual cells) and slight stiffening of the cell membrane (shear elastic modulus increased 13%, as measured by pipette aspiration of small membrane tongues). Measurement of the rate of cell shape recovery indicated that the membrane of parasitised cells was not more viscous. The main factor in the drastic loss of deformability of the trophozoites and schizonts was the presence of the large very resistant parasite itself. Otherwise, the cell surface area/volume deficit was slightly less and membrane rigidification slightly greater compared with ring forms. The above abnormalities should cause the trophozoites and schizonts to have great difficulty in traversing splenic or marrow sinuses and could contribute to microvascular occlusion and sequestration. On the other hand, the ring forms may be expected to circulate relatively unhindered.

Little data exist for the mechanical properties of individual irreversible or reversible sickle cells (ISC and RSC, respectively), nor is the process of ISC formation well understood. For oxygenated ISC and density-fractionated RSC, we have used micropipette techniques to measure cell surface area (SA) and volume (V), membrane shear elastic modulus (mu), time constant for viscoelastic shape recovery (tc), and hence to calculate membrane surface viscosity (eta = mu X tc). Volume loss associated with increasing cell density was accompanied by a proportionately smaller surface area decrease; SA/V ratio thus increased for denser cells, with ISC having the highest values. Membrane area loss by fragmentation must thus be accompanied by an accelerated decrease in cell volume. ISC had relatively rigid membranes (mu 130% above normal controls) and tc close to normal values, so that their effective membrane viscosity was more than double control. RSC had viscoelastic properties close to control, but showed wider variation between sickle cell donors and within samples. Measurements on density-separated RSC showed that, on average, mu was nearly constant, but that tc was longer for the densest cells, with their eta approaching ISC levels. A small subpopulation of RSC were found that had mu close to ISC values. Hypotonically swollen ISC (with internal hemoglobin concentration decreased to normal levels) retained their increased membrane stiffness but had markedly decreased tc, so that their eta approached normal values. The results show that elevated hemoglobin concentration influences the viscoelastic behavior of ISC and RSC, but that an irreversible change in membrane elasticity also occurs for ISC. These data suggest that ISC formation occurs via a two- stage process: (1) accelerated volume loss leading to increased cytoplasmic and effective membrane viscosity; (2) a sharp rise in membrane rigidity, presumably linked to membrane structural alteration.

Shear deformation of young and old human red blood cells was examined over a range of shear stresses and suspending phase viscosities (eta o) using a cone-plate Rheoscope. The internal viscosities (eta i) of these cell types differ, and further changes in internal viscosity were induced by alteration of suspension osmolality and hence cell volume. For low suspending viscosities (0.0555 or 0.111 P) old cells tended to tumble in shear flow, whereas young cells achieved stable orientation and deformed. Changes in osmolality, at these external viscosities, altered the percentage of cells deforming, and for each cell type threshold osmolalities (Osm-50) were determined where 50% of cells deformed. The threshold osmolalities were higher for younger cells than for older cells, but the internal viscosities of the two cell types were similar at their respective Osm-50. Threshold osmolalities were also higher for the higher external viscosity, but the ratio of internal to external viscosities (i.e., eta i/eta o) was nearly constant for both external viscosities. Deformation of stably oriented cells increased with increasing shear stress and approached a value limited by cell surface area and volume. For isotonic media, over a wide range of external viscosities and shear stresses, deformation was greater for younger cells than for older cells. However, deformation vs. shear stress data for the two cell types became nearly coincident if young cells were osmotically shrunk to have their internal viscosity close to that for old cells. Increases in external viscosity, at constant shear stress, caused greater deformation for all cells. This effect of external viscosity was not equal for young and old cells; the ratio of old/young cell deformation increased with increasing eta o. However, if deformation was plotted as a function of the ratio lambda = eta i/eta o, at constant shear stress, young and old cell data followed similar paths. Thus the ratio lambda is a major determinant of cell deformation as well as a critical factor affecting stable orientation in shear flow.