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Hemolysis dictates monocyte differentiation via two distinct pathways in sickle cell disease vaso-occlusion
Yunfeng Liu, … , Hui Zhong, Karina Yazdanbakhsh
Yunfeng Liu, … , Hui Zhong, Karina Yazdanbakhsh
Published July 25, 2023
Citation Information: J Clin Invest. 2023;133(18):e172087. https://doi.org/10.1172/JCI172087.
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Research Article Hematology Article has an altmetric score of 1

Hemolysis dictates monocyte differentiation via two distinct pathways in sickle cell disease vaso-occlusion

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Abstract

Sickle cell disease (SCD) is a hereditary hemoglobinopathy characterized by painful vaso-occlusive crises (VOC) and chronic hemolysis. The mononuclear phagocyte system is pivotal to SCD pathophysiology, but the mechanisms governing monocyte/macrophage differentiation remain unknown. This study examined the influence of hemolysis on circulating monocyte trajectories in SCD. We discovered that hemolysis stimulated CSF-1 production, partly by endothelial cells via Nrf2, promoting classical monocyte (CMo) differentiation into blood patrolling monocytes (PMo) in SCD mice. However, hemolysis also upregulated CCL-2 through IFN-I, inducing CMo transmigration and differentiation into tissue monocyte–derived macrophages. Blocking CMo transmigration by anti–P selectin antibody in SCD mice increased circulating PMo, corroborating that CMo-to–tissue macrophage differentiation occurs at the expense of CMo-to–blood PMo differentiation. We observed a positive correlation between plasma CSF-1/CCL-2 ratios and blood PMo levels in patients with SCD, underscoring the clinical significance of these two opposing factors in monocyte differentiation. Combined treatment with CSF-1 and anti–P selectin antibody more effectively increased PMo numbers and reduced stasis compared with single-agent therapies in SCD mice. Altogether, these data indicate that monocyte fates are regulated by the balance between two heme pathways, Nrf2/CSF-1 and IFN-I/CCL-2, and suggest that the CSF-1/CCL-2 ratio may present a diagnostic and therapeutic target in SCD.

Authors

Yunfeng Liu, Shan Su, Sarah Shayo, Weili Bao, Mouli Pal, Kai Dou, Patricia A. Shi, Banu Aygun, Sally Campbell-Lee, Cheryl A. Lobo, Avital Mendelson, Xiuli An, Deepa Manwani, Hui Zhong, Karina Yazdanbakhsh

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Figure 4

CMo migration blockade promotes differentiation into PMo in vitro and in vivo.

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CMo migration blockade promotes differentiation into PMo in vitro and in...
(A) Schematic representation of experimental design. Transwell culture of purified BM Ly-6ChiMHC-II– CMo placed above mouse endothelial cells (ECs) seeded in the upper compartment for 2 days. Monocytes in the bottom compartment are considered as having transmigrated through the ECs, while the ones remaining in the top well are considered the nonmigrated subpopulation. (B) Representative histograms showing the gating strategy for Ly-6ChiMHC-II– CMo, Ly-6Clo/–MHC-II– PMo, and Ly-6C+MHC-II+ transient macrophages in the Transwell culture, as shown in A. Numbers represent the frequency of Ly-6ChiMHC-II– CMo (98.8, 46.1, and 9.17 before culture, nonmigrated cells, and migrated cells, respectively), Ly-6Clo/–MHC-II– PMo (0.68, 47.5, and 1.15 before culture, nonmigrated cells, and migrated cells, respectively), and Ly-6C+MHC-II+ transient macrophages (0.12, 2.67, and 89.2 before culture, nonmigrated cells, and migrated cells, respectively). (C) Bar graph showing expression of surface markers on cultured monocytes, as shown in A (n = 6). (D) Bar graph showing the monocyte numbers in cocultures of purified BM Ly-6ChiMHC-II– CMo layered above mouse ECs, which had been pretreated with blocking antibody against P selectin, VCAM-1, ICAM-1, E selectin, CD11b, or isotype control (10 ng/mL, n = 6). (E) Bar graph showing absolute number of circulating Ly-6Chi CMo and Ly-6Clo/– PMo at 20 hours in hemin-injected (35 μmol/kg body weight) WT mice pretreated for 30 minutes with anti–P selectin blocking antibody (5 mg/kg body weight, i.v.), anti–VCAM-1 blocking antibody (5 mg/kg body weight, i.v), or isotype control antibody (5 mg/kg body weight, i.v) (n = 6). (F) Bar graph showing absolute numbers of liver Ly-6ChiMHC-II– CMo and Ly-6C+MHC-II+ transient macrophages (tMΦ) in mice, injected as in D (n = 6). Each symbol represents data from an individual mouse. Data are shown as the mean ± SEM and were compared using 2-way ANOVA with Bonferroni’s multiple comparisons. *P < 0.05.

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