Introduction The ocular surface provides a unique opportunity to study hemodynamics since the vessels can be visualized directly, without treatment and non-invasively. The availability of instruments to measure various hemodynamic parameters on the ocular surface in an objective manner are lacking. The quantification of red blood cell velocity, blood oxygen saturation and conjunctival redness on the ocular surface using novel, validated techniques has the potential of providing useful information about vascular physiology. The specific aims of each chapter are as follows: Chapter 3: The objective was to design, develop and validate a system that would non-invasively quantify the red blood cell velocity in the conjunctival vessels. A tool was developed to automatically analyze video sequences of conjunctival vessels, digitally imaged with high enough magnification to resolve movement of the blood within the vessel. Chapter 4: The objective was to: a) design and develop a method in order to non-invasively quantify the changes in blood oxygen saturation (SO2) in the conjunctival vessels and demonstrate reliability of the measures and, b) demonstrate the application of the method by showing a response to an isocapnic hyperoxic provocation and compare those values to the results from a valid instrument. Chapter 5: The aim of this experiment was to examine variations in ocular redness levels, red blood cell velocities and oxygen saturation levels over time in clinically healthy participants and also to compare differences between two age groups. Chapter 6: The aim of this experiment was to examine the ocular redness levels, red blood cell velocities and oxygen saturation levels in clinically healthy participants when a topical ophthalmic decongestant was instilled onto the eye and to demonstrate the validity of the use of two novel techniques. Chapter 7: The aim of this experiment was to examine ocular redness, red blood cell velocity and oxygen saturation in participants who were habitual soft contact lens wearers (study) compared to those that did not (control) and also to compare differences in silicone (SH) and non-silicone hydrogel wearers. Methods Chapter 3: Simulations representing moving RBCs within a vessel and the random variation of each cell in terms of speed, shape and intensity were created in order to evaluate the performance of the algorithm. For each vessel, a signal that correlated to blood cell position was extracted from each frame, and the inter-frame displacement was estimated through a modified dynamic time warping (DTW) algorithm. This provided the red blood cell velocity over time in each point of the vessels. Thus, from these estimates, the mean red blood cell velocity for each vessel was easily evaluated. The true mean velocity from the simulation with the one estimated by the algorithm was compared and the system accuracy was determined. Chapter 4: a) Conjunctival vessels were imaged with two narrow-band interference filters with O2-sensitive and O2-insensitive peak transmissions using a Zeiss slit lamp at 32x magnification. Optical densities were calculated from vascular segments using the average reflected intensities inside and outside the vessels. Optical density ratios were used to calculate relative oxygen saturation values. Video images of the bulbar conjunctiva were recorded at three times of the day. Measurement repeatability was assessed over location at each time and across consecutive frames. b) Subjects initially breathed air for 10 minutes followed by pure oxygen (O2) for 20 minutes, and then air for a final 10 minute period using a sequential re-breathing circuit. Simultaneously, SO2 values measured with a pulse oximeter ear clip and finger clip were recorded. The validity of the dual wavelength method was demonstrated by comparing the values to those from the ear clip pulse oximeter. Chapter 5: Participants attended eight separate visits over the course of a day. Levels of bulbar conjunctival redness, red blood cell velocity and blood oxygen saturation were measured on a vessel of interest. Chapter 6: Participants attended three separate visits during an allotted 60 minute session. Bulbar conjunctival redness, red blood cell velocity and blood oxygen saturation were measured on a vessel of interest, pre-insertion, just after insertion and, 10 minutes after insertion of a topical ocular decongestant. Significant differences between the three measures were assessed and correlations between the three parameters were reported. Chapter 7: Participants were measured 8 times over the course of a day with their contact lenses in place. Bulbar conjunctival redness, red blood cell velocity and blood oxygen saturation were measured. Results Chapter 3: Results for the simulated videos demonstrated a very good concordance between the estimated and actual velocities supporting its validity. The mean relative error for the modified Dynamic Time Warping (DTW) method is 6%. Chapter 4: The intraclass correlations (ICCs) between the three locations at each time point were 0.93, 0.56 and 0.86 respectively. Measurements across 5 consecutive frames showed no significant difference for all subjects (ICC = 0.96). The ICCs between the two methods at each time point were 0.45, 0.10 and 0.11 respectively. a) There was no significant difference in SO2 between the three locations measured using the dual wavelength method for all subjects. There was also no significant difference between the three locations at any of the time points for the dual wavelength method. b) In response to isocapnic hyperoxic provocation using the dual wavelength method, blood oxygen saturation was increased from control values and subsequently recovered after withdrawal of hyperoxia. Blood oxygen saturation values recorded from the ear clip and finger clip of the pulse oximeter also showed an increase from control values and subsequently recovered after withdrawal of hyperoxia. SO2 comparison between the dual wavelength method and the ear-clip pulse oximeter method did not show a significant difference. The interaction between the two methods and time on SO2 was not significant. Chapter 5: From baseline, the group mean redness and oxygen saturation did not change significantly over time. There was a significant difference in the group mean red blood cell velocity values over time. There was no significant difference between age strata for all three measures. Chapter 6: After drop instillation redness values decreased significantly. There was no change in red blood cell velocity and oxygen saturation over time. There was a moderate significant correlation between SO2 and red blood cell velocity just after drop insertion. Chapter 7: When comparing the study and control groups, no significant difference in redness or SO2 over time was found. RBC velocity over time was found to be significantly different between groups. When comparing the two study groups (SH vs. hydrogel) no significant difference across either measure over time was found. Conclusions Chapter 3: Signal displacement estimation through the DTW algorithm can be used to estimate mean red blood cell velocity. Successful application of the algorithm in the estimation of RBC velocity in conjunctival vessels was demonstrated. Chapter 4: The application of the dual wavelength method was demonstrated and optical density ratios can be used in a reliable manner for relative oxygen saturation measurements. This valid method promises to enable the study of conjunctival O2 saturation under various experimental and physiological conditions. Chapter 5: The results of this study support the theory of metabolic regulation. The lack of any significant change across time for redness and oxygen saturation along with significant changes in red blood cell velocity substantiates this notion. Chapter 6: This study supports the literature regarding metabolic regulation of the microvasculature during the use of various stimuli. The results demonstrated that oxygen saturation levels remain stable even when a significant decrease in ocular redness is measured. The novel techniques used in this experiment demonstrated the expected action of the decongestant further contributing to their application and validity. Chapter 7: In summary, the participants in the study group were habitual contact lens wearers that had lower RBC velocities when compared to the control group supporting the notion that contact lenses initiate a hypoxic response. The lack of change in SO2 in either group supports the theory of metabolic regulation.

Flavonoids are of great interest for their antioxidant and health-promoting activities. Ascorbate (vitamin C) has antioxidant activities but also sometimes displays pro-oxidant activities <i>in vitro</i> and reportedly <i>in vivo</i>. This research investigated to what extent flavonoids moderate oxidative stress from vitamin C <i>in vivo</i>.<p>Dietary experiments were conducted in two phases using adult male Wistar rats. First, all animals were maintained for two weeks on a control flavonoid-free diet with the dietary requirement (27 IU) of vitamin E/kg diet. In the subsequent four weeks, the animals were treated in four groups (8 rats/group), being fed the following diets: flavonoid-free control (C), ascorbate-supplemented (7.55 mmol/kg diet) (A), flavonoid-supplemented (2.67 mmol/kg diet) (F) and flavonoids (2.67 mmol/kg diet) plus ascorbate (7.55 mmol/kg diet)-supplemented (T). Measurements were done on in vivo biomarkers of oxidative stress, tissue antioxidants and on tissue in vitro susceptibility to oxidative stress.<p>In the combined feeding of ascorbate plus flavonoids, endogenous thiobarbituric acid reactive substances (TBARS) increased in liver by 114%. No effects of dietary ascorbate or flavonoids were seen on endogenous TBARS in brain or heart, or on plasma thiols or erythrocyte fragility.<p><i>In vitro</i>, the susceptibility to TBARS formation of liver homogenate (incubated for 60 min at 37ºC in air) showed a significant 60% increase in ascorbate-fed animals compared to control, but no increase in animals fed ascorbate plus flavonoids, suggesting that the additional feeding of flavonoids helped to prevent the increase produced by ascorbate-feeding. Incubation of liver mitochondria with 300 µM ascorbate in vitro produced a large (2-7 fold) increase in TBARS, but there was no difference among mitochondria from the different feeding groups.<p>The ability of flavonoid-feeding in protecting against oxidative stress from ascorbate in vivo could not be demonstrated in this study, even showing pro-oxidant effects of flavonoids in combination with ascorbate in liver. However, in vitro tests in liver suggest a protective effect of flavonoid-feeding against susceptibility to oxidative stress from ascorbate. Further investigations are needed in order to resolve the differences observed in vitro and in vivo and to determine the endogenous effects of specific flavonoids under ascorbate-induced oxidative stress.

This study explored the effects of dietary unsaturated fatty acids on feline lipid metabolism. It was hypothesized that high dietary linoleic acid (18:2n-6, LA) would enhance conversion to arachidonic acid (20:4n-6), enrichment of dietary long chain n-3 FA (LCn-3FA) would affect lipid parameters, and n-3 FAs incorporation may blunt n-6 FA incorporation. Twenty-nine cats were randomized into groups (n = 9, 10, 10), and fed for 28 days with blood collections on days 0, 14, and 28. Experimental diets consisted of a commercial diet, supplemented with 8g oil/100g kibble. Oil supplements and subsequent diets were: high-oleic sunflower (H diet) with 82% oleic acid (18:1n-9), Menhaden fish (M diet) with LCn-3FA, and safflower (S diet) with 75% 18:2n-6. Dietary 20:4n-6 content was: 0.03 for H and S, and 0.09 for M (g FA/kg diet). Nonesterified fatty acid (NEFA), triacylglycerol (TG), total cholesterol (TC), lipoproteincholesterol (LP-C), plasma phospholipid (PL) FAs, red blood cell membrane (RBC) FAs, and ∆5 and ∆6 desaturase indices were measured. Statistical analyses were performed with SAS PROC MIXED with p < 0.05 determining significance. Neither TC nor NEFA showed significant effects. Diet M resulted in significant TG lowering, despite typically low feline TGs. Similarly, pre-β LP-C (i.e. TG-rich VLDL) was decreased in diet M. Plasma PL FAs revealed significant accumulations of the following: 18:1n-9 in diet H, 18:2n-6 in diet S, and LCn-3FA in diet M. Despite high dietary 18:2n-6, plasma PL 20:4n-6 was not increased in diet S over diets H or M. Increased docosadienoic acid (20:2n-6) in diet S demonstrated that 18:2n-6 chain elongation occurred in deference to its ∆6 desaturation further substantiating low feline ∆6 desaturase activity. Interestingly, no diet M blunting of 20:4n-6 incorporation occurred because fish oil supplementation provided additional 20:4n-6. Tissue 20:4n-6 content appears to be diet-dependent. Accumulation of eicosapentaenoic acid (20:5n-3), but low affinity for docosahexaenoic acid (22:6n-3) occurred in diet M RBC membranes. After 28 days, plasma PLs reflect dietary intake more readily than RBC membranes. Fish oil supplementation resulted in plasma PL LCn-3FA enrichment and lowered plasma TG concentrations, both of which may have physiological significance in cats.

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The purpose of this thesis is to design a physical microchannel model for micro-Couette blood flow that provides constant and controlled conditions to study and analyze Red Blood Cell (RBC) aggregation. The innovation of this work is that the Couette blood flow is created by the motion of a second fluid with different properties, thereby entraining the blood. The experimental work is coupled with three-dimensional numerical simulations performed using a research Computational Fluid Dynamic (CFD) Solver, Nek5000, based on the spectral element method, while the experiments are conducted using a micro Particle Image Velocimetry (μPIV) system with a double frame CCD camera and an inverted laser imaging microscope. The design of the channel (150 × 33 μm and 170 × 64 μm microchannels) is based on several parameters determined numerically, such as the velocity and viscosity ratios and the degree of miscibility between the fluids, and the resulting configurations are fabricated in the laboratory using standard photolithography methods. The microchannel designed numerically is then tested experimentally, first, with a Newtonian fluid (glycerol), then with RBC suspensions to be compared to the simulations results. It was found that, numerically, using a velocity ratio of 4 between the two fluids, a third of the channel thickness corresponds to the blood layer. Within that range, it can be concluded, that the velocity profile of the blood layer is approximately linear as confirmed by experimental tests, resulting in the desired profile to study RBC aggregation in controlled conditions. The effect of several parameters, such as the hematocrit and the shear rate, on the RBC aggregates and the velocity profile is investigated, through experiments on the RBC suspensions. The final goal of this research is to ensure the compatibility of the results between the experiments and the Newtonian numerical model for several ranges of shear rate with the future intention of finding an accurate method to be able to quantitatively analyze aggregates and determine the number of RBC in each aggregate depending on the flow conditions (the shear rate).

京都大学 / 0048 / 新制・課程博士 / 博士(生命科学) / 甲第18626号 / 生博第317号 / 新制||生||42(附属図書館) / 31526 / 京都大学大学院生命科学研究科統合生命科学専攻 / (主査)教授 上村 匡, 教授 西田 栄介, 教授 James Hejna / 学位規則第4条第1項該当 / Doctor of Philosophy in Life Sciences / Kyoto University / DGAM

Close to one million red blood cell (RBC) units are transfused annually in Canadian hospitals, with surgical inpatients accounting for up to 44% of transfusions. There is evidence of significant variation in transfusion practice in the operating room (i.e., intraoperative). Although variation is expected based on disease severity and patient preference, inappropriate clinical care due to either under- or over-transfusion likely also contributes to significant variation. Indeed, estimates of unwarranted intraoperative RBC transfusions in the literature range from 19% to 49%, owing partly to a lack of evidence-based consensus on RBC transfusion practice in the OR. Our two systematic reviews have highlighted this gap, demonstrating a lack of evidence from trials or actionable clinical practice guidelines to inform decisions in the OR. Perhaps more importantly, avoidance of blood product exposure is an important patient-prioritized outcome that has yet to be studied empirically in the OR. As such, the observed variation in transfusion practice suggests that transfusion decision-making during surgery represents a clear and important knowledge and evidence gap. Transfusion decision-making in the OR is a complex and dynamic process that we cannot begin to improve without first understanding it. It is influenced by 1) physiologic parameters such as acute blood loss, the effects of general anesthesia, and surgical manipulation. Decision-making is also likely heavily influenced by 2) behavioural factors in the OR (heuristics, team dynamics, institutional culture), for which very little empirical work has been conducted. Finally, the importance of 3) patient input in influencing transfusion decisions is inadequately studied, given the documented disconnect between patient priorities and outcomes used in the medical literature and by clinicians. In this context, the aim of my thesis was to develop an empirical understanding of transfusion decision-making in the OR based on stakeholder perceptions and priorities, informed by an integrated patient engagement process. With this work, I address an important knowledge gap in intraoperative blood transfusion, thereby contributing to efforts to reduce variation in blood transfusion practice in surgery. It is my hope that this work will be influential in informing actionable perioperative tools to optimize blood management including providing both evidence and knowledge gaps for future research.

Nous avons étudié les marqueurs hémorhéologiques, hématologiques et biochimiques chez des sujets drépanocytaires homozygotes SS (HbS/HbS) et hétérozygotes composites SC (HbS/HbC) dans deux cohortes, pédiatriques et adultes, de patients drépanocytaires, et ce, à travers 7 complications récurrentes de la drépanocytose : 2 appartenant au profil hémolytique (l’ulcère de jambes et la glomérulopathie) et 5 appartenant au phénotype visqueux/vaso-occlusif (l’hypertension artérielle, le syndrome thoracique aigu (STA), la crise vaso-occlusive (CVO), la rétinopathie et l’ostéonécrose). Nous avons montré que : 1) une viscosité sanguine et une déformabilité érythrocytaire élevées sont des facteurs de risques de CVO chez les enfants homozygotes ; 2) Une viscosité sanguine élevée est associée à une hypertension artérielle systémique relative chez des adultes SS ; 3) les enfants SC présente une fonction vasculaire mieux préservée que les enfants SS pour faire face à une augmentation de la viscosité sanguine ; 4) les patients adultes SS avec une ostéonécrose présentent une déformabilité érythrocytaire plus élevée que les patients sans ostéonécrose ; 5) une viscosité sanguine élevée est associée à la présence d’une rétinopathie chez les adultes SC mais pas chez les SS ; 6) les patients adultes SS présentant une glomérulopathie ont un taux d’hémolyse élevé, une déformabilité érythrocytaire réduite et des agrégats érythrocytaires très robustes ; 7) les patients adultes SS avec des ulcères de jambes récurrents ont un taux d’hémolyse accru et une déformabilité érythrocytaire réduite. De plus, nos travaux confirment que l’-thalassémie module les propriétés de déformabilité érythrocytaire, mais montrent pour la première fois qu’elle module aussi les propriétés d’agrégation érythrocytaire, et notamment la force des agrégats érythrocytaires. En conclusion, ces travaux permettent de préciser le rôle de la rhéologie sanguine dans un certain nombre de complications de la drépanocytose et d’enrichir le modèle préexistant divisant les complications de la drépanocytose selon 2 phénotypes : hémolytique versus visqueux/vaso-occlusif. Nous montrons pour la première fois que le phénotype hémolytique est caractérisé aussi par des anomalies de la rhéologie du globule rouge : rigidité accrue et agrégats érythrocytaire robustes. / Hemorheological, hemathological, and biochemical marquers of patients with sickle cell anemia (SS) and patients with sickle cell SC disease (SC) were studied in 2 cohorts: children and adults. We focused on 7 recurrent complications: 5 belonging to the viscosity/vaso-occlusion phenotype (systemic hypertension, acute chest syndrome (ACS), vaso-occlusive crisis (VOC), retinopathy and osteonecrosis) and 2 belonging to the hemolytic phenotype (leg ulcer and glomerulopathy). Our results show that 1) high viscosity is associated with increased risk for VOC in SS children; 2) blood viscosity is increased in SS adults with systemic relative hypertension; 3) SC children have preserved vascular function compared to SS children; 4) SS adults with osteonecrosis are characterized by higher red blood cell (RBC) deformability than SS adults without osteonecrosis; 5) high blood viscosity is associated with retinopathy in SC adults but not in SS adults; 6) SS adults affected by glomerulopathy have high hemolytic rate, low RBC deformability and increased RBC aggregates strenght; 7) SS adults with recurrent leg ulcers have high hemolytic rate and reduced RBC deformability. Moreover, our studies shows that alpha-thalassemia modulate RBC deformability and RBC aggregation properties. In conclusion, this work shows for the first time that the hemolytic phenotype is characterized by an abnormal RBC rheology which may play a role in several sickle cell complications.

Red blood cells (RBCs) are vital for oxygen delivery to tissues and constitute the vast majority of all cells in blood. After leaving the red bone marrow as mature cells, RBCs have a lifespan of approximately 120 days before they are removed from the circulation by macrophages, mainly in the spleen and liver. RBC transfusion is a common therapy in modern healthcare. Major surgery, numerous cancer treatments and other, often lifesaving, interventions would be unthinkable without available blood supply. For this reason, hospitals store donated RBCs in blood banks. The metabolic and structural changes that occur during prolonged storage of RBCs (the storage lesion) have been studied in detail in vitro and include oxidative stress, a reduction in glycolysis, increased membrane rigidity and shedding of microparticles from the RBC membrane. Stored RBCs share several features of senescent RBCs, but also with RBCs undergoing an apoptotic-like process called eryptosis. A consequence of the storage lesion is the fact that as much as 25% of stored RBCs could be rapidly removed from the circulation within 24 hours after transfusion. The mechanisms behind this rapid macrophage-mediated recognition and removal of stored RBCs, and its immunological consequences, remain largely unknown. Therefore, the aims of this thesis were to investigate if cryopreserved human RBCs induced an inflammatory response following autologous transfusion into healthy volunteers, and to further understand the mechanisms behind macrophage recognition of stored RBCs in vitro and in vivo. Autologous transfusion of two units of cryopreserved RBCs into healthy human recipients was found to be associated with an increased extravascular RBC elimination already at 2 hours after transfusion. However, there were no signs of an increased production of any of the investigated pro-inflammatory cytokines, indicating that an increase in the destruction of RBCs per se did not induce an inflammatory response. Eryptosis is a form of induced RBC death associated with an increased cytoplasmic Ca2+ uptake. We found that a subset of human RBCs increased their Ca2+ permeability during prolonged storage at +4°C. Using a murine model, to further understand how RBCs with an increased Ca2+ permeability were eliminated by phagocytic cells in the spleen, it was found that such RBCs were taken up by marginal zone macrophages and dendritic cells (DCs) in a manner distinct from that of naturally senescent RBCs. The DC population particularly efficient in this process expressed CD207 and are known for their ability to promote immunological tolerance. Eryptotic cell uptake was not regulated by the phagocytosis-inhibitory protein CD47 on the RBCs. To investigate how RBCs damaged during liquid storage are recognized and taken up by macrophages, a model to store and transfuse murine RBCs was developed. This storage model generated murine RBCs with several characteristics similar to that of stored human RBCs (i.e. loss of ATP, formation of RBC microparticles and rapid clearance of up to 35% of the RBCs during the first 24 h after transfusion). In vitro phagocytosis of human as well as murine stored RBCs was serum dependent and could be inhibited by blocking class A scavenger receptors using fucoidan or dextran sulphate. In conclusion, the findings of this thesis contribute to further understanding how changes inflicted to RBCs during storage direct the fate of these cells in their interaction with cells of the immune system after transfusion. The observation of an increased Ca2+ permeability of stored RBCs, and the possible recognition of such cells by tolerance-promoting DCs, in combination with the findings that class A scavenger receptors and serum factors may mediate recognition of stored RBCs, may result in novel new directions of research within the field of transfusion medicine.