Autophagic vesicles on mature human reticulocytes explain phosphatidylserine-positive red cells in sickle cell disease.
During maturation to an erythrocyte, a reticulocyte must eliminate any residual organelles and reduce its surface area and volume. Here we show this involves a novel process whereby large, intact, inside-out phosphatidylserine (PS)-exposed autophagic vesicles are extruded. Cell surface PS is a well-characterized apoptotic signal initiating phagocytosis. In peripheral blood from patients after splenectomy or in patients with sickle cell disease (SCD), the number of circulating red cells exposing PS on their surface is elevated. We show that in these patients PS is present on the cell surface of red cells in large (∼1.4 µm) discrete areas corresponding to autophagic vesicles. The autophagic vesicles found on reticulocytes are identical to those observed on red cells from splenectomized individuals and patients with SCD. Our data suggest the increased thrombotic risk associated with splenectomy, and patients with hemoglobinopathies is a possible consequence of increased levels of circulating mature reticulocytes expressing inside-out PS-exposed autophagic vesicles because of asplenia.
Bristol Institute for Transfusion Sciences, National Health Service Blood and Transplant, Filton, Bristol, United Kingdom, and.
Tosti J
TJ
Mankelow
Bristol Institute for Transfusion Sciences, National Health Service Blood and Transplant, Filton, Bristol, United Kingdom, and.
Rebecca E
http://orcid.org/0000-0001-7461-0635
RE
Griffiths
Joint Red Cell Unit, University College London National Health Service Foundation Trust, Haematology Department, London, United Kingdom.
Sara
http://orcid.org/0000-0002-7099-8449
S
Trompeter
Bristol Institute for Transfusion Sciences, National Health Service Blood and Transplant, Filton, Bristol, United Kingdom, and.
Joanna F
http://orcid.org/0000-0002-8645-6476
JF
Flatt
Bristol Institute for Transfusion Sciences, National Health Service Blood and Transplant, Filton, Bristol, United Kingdom, and.
Nicola M
NM
Cogan
Bristol Institute for Transfusion Sciences, National Health Service Blood and Transplant, Filton, Bristol, United Kingdom, and.
Edwin J
EJ
Massey
Bristol Institute for Transfusion Sciences, National Health Service Blood and Transplant, Filton, Bristol, United Kingdom, and.
David J
DJ
Anstee
D000755:Anemia, Sickle Cell / Q000097:blood* / Q000473:pathology*; D001343:Autophagy; D015153:Blotting, Western; D016022:Case-Control Studies; D049109:Cell Proliferation; D002478:Cells, Cultured; D004912:Erythrocytes / Q000378:metabolism / Q000473:pathology*; D005434:Flow Cytometry; D006021:Glycophorins / Q000378:metabolism; D006801:Humans; D007091:Image Processing, Computer-Assisted; D010587:Phagocytosis; D010718:Phosphatidylserines / Q000737:chemistry / Q000378:metabolism*; D012156:Reticulocytes / Q000378:metabolism / Q000473:pathology*; D013156:Splenectomy
D006021:Glycophorins; D010718:Phosphatidylserines