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A new study found that diabetes alters rheologic properties due to red blood cell deformity and increased adhesion, which increases cardiovascular risk in the condition.

Diabetes is one of the most significant health disorders globally, and there has been a fourfold increase in the number of individuals affected by the condition since 1980. Among the various complications associated with diabetes, cardiovascular diseases (CVDs) remain the predominant cause of morbidity and mortality, specifically coronary and artery diseases. Understanding how diabetes affects red blood cells (RBCs) may help lower CVD risk in diabetes patients. In the proceedings of the 65th ASH Annual Meeting & Exposition, researchers shared findings of their in-vitro study investigating the impact of diabetes on RBCs.

Deformed Red Blood Cells in Diabetes Show Higher Occlusion and Adhesion

To comprehensively understand the impact of diabetes on RBC deformability and adhesiveness, two critical factors in assessing disease status and CVD risk, researchers conducted a study employing two proprietary microfluidic assays: the OcclusionChip and Adhesion Biochip. 

The OcclusionChip assay, developed previously, utilizes micropillar arrays with varying spacing, creating a gradient of microcapillaries. These arrays, fabricated through soft lithography, are perfused with isolated RBCs at a constant inlet pressure. Venous samples from diabetic and non-diabetic individuals were collected and tested within 48 hours. Isolated RBCs, resuspended in phosphate-buffered saline, were flown through the chip, and subsequent imaging allowed manual counting of cells trapped within the micropillar arrays, providing the occlusion index as a biomarker for RBC deformability. 

To assess RBC adhesion to endothelial cells, the Adhesion Biochip employed human umbilical vein endothelial cells (HUVECs) cultured within a microfluidic channel under flow conditions. Activated by heme, HUVECs were exposed to isolated RBCs, and adherent erythrocytes were quantified through manual imaging.

Results indicated that RBCs from individuals with diabetes (A1c > 6.5%) exhibited a higher occurrence of occlusion events compared to those from healthy individuals (A1c < 5.7%), signifying a loss of deformability. In contrast, the elongation index, assessed through ektacytometry, showed no statistically significant difference. Moreover, RBCs from diabetic individuals displayed increased adhesion to the endothelium, as evident from the count of adherent RBCs.

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The Bottom Line

In summary, the microfluidic assays revealed a substantial adverse impact of diabetes on RBC deformability and adhesiveness. The findings of the study may help create tools that help predict CVD risk in diabetes patients. Hence, there is a need for more extensive studies in the future. It is vital to conduct multi-center studies to confirm and build on these findings. There is a need for studies with larger sample sizes, including healthy individuals, those with pre-diabetes, and those living with various types of diabetes.


Fraiwan, A. (2023, December 9). Novel RBC adhesion and Deformability assays reveal deleterious effect of diabetes on RBC health. https://ash.confex.com/ash/2023/webprogram/Paper182036.html