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1 Medical Sciences Program, Indiana University, Bloomington, Indiana 47405-7005; and 2 Jacob Blaustein Institute for Desert Research and Department of Life Sciences, Ben-Gurion University of the Negev, Midreshet Ben-Gurion, 84990 Israel
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ABSTRACT |
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The PO2-dependent binding of
chloride to Hb decreases the Cl
concentration of the red
blood cell (RBC) intracellular fluid in venous blood to ~1-3
mmol/l less than that in arterial blood. This change is
physiologically important because 1) Cl
is a
negative heterotropic allosteric effector of Hb that competes for
binding sites with 2,3-bisphosphoglycerate and CO2 and
decreases oxyhemoglobin affinity in several species; 2) it
may help reconcile several longstanding problems with measured values
of the Donnan ratios for Cl
, HCO

blood-gas transport; Donnan ratio; Bohr effect; Haldane effect; strong ion difference; bicarbonate; erythrocyte; chloride shift
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INTRODUCTION |
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DURING GAS EXCHANGE,
CHLORIDE ions move between the plasma and red blood cell
intracellular fluid (RBC-ICF). The discovery of this
phenomenon, known as the chloride shift, is generally attributed to
Hamburger (18). The chloride shift is linked to the
transport of HCO
binding are too small to be of physiological
consequence. The focus of the research presented here has been to
investigate the binding of Cl
to Hb, both qualitatively
and quantitatively, to determine the existence and extent of its
physiological consequences.
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MATERIALS AND METHODS |
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To test the existence and importance of O2-dependent
binding of chloride to Hb under physiologically relevant conditions, we
measured the changes in the ratio of bound to free Cl
with 35Cl-NMR in Hb solutions, in whole blood, and in
isolated plasma equilibrated with either venous or arterial blood
gases. To quantify the changes in bound and free chloride pools, we
used a chloride electrode to measure the changes in free
[Cl
] (where brackets denote concentration) in Hb
solutions under the same conditions.
Whole blood samples were drawn from volunteers who had signed informed
consent documents. Packed cells were obtained from recently expired
units of blood. Gas mixtures used either were mixed with a Wosthoff
gas-mixing pump or were purchased as premixed tanks. The dry
composition of simulated arterial gas was 15.2% O2-5.1%
CO2-balance N2. Simulated venous gas was 3.1%
O2-7.2% CO2-balance N2. Partial
pressures varied slightly but not importantly with changes in
barometric pressure. Samples of whole blood, plasma, or Hb solutions
were equilibrated with humidified gases in a tonometer (IL 237, Instrumentation Laboratories) before a measurement was made. The
PO2, PCO2, pH,
[Cl
], [Na+], [K+], [Hb],
and O2 saturation were measured using a Radiometer ABL-505 blood gas/electrolyte analyzer and a Radiometer OSM 3 hemoximeter.
To prepare the Hb solutions, packed human RBCs were washed at least
twice with a 0.9% NaCl solution. After each wash, the cells were
centrifuged at 10,000 rpm for 20 min, and the supernatant and buffy
coat were removed. A lysing buffer (5 mM
Na2HPO4, pH 8) was added to the washed cells
and stirred for 1 h. The mixture was then centrifuged at 10,000 rpm for 40 min to separate the ghosts from the supernatant. The
supernatant was concentrated until the [Hb] in the solution was 26 g/dl by using a Millipore Minitan ultrafiltration system with a
retentate cutoff of 10 kDa. The Hb solution was then equilibrated in
the tonometer for 1 h at 37°C with either a venous or arterial
gas mixture. The preparation of Hb solutions removed Cl
from the retentate; therefore, it was necessary to restore
Cl
to the preparation before analysis. During
equilibration, a calculated amount of 0.9 mol/l KCl was added to the
solution to bring the [Cl
] to 150 mmol/l. This
concentration was somewhat higher than presumed intracellular levels
but was necessary to ensure a detectable signal for NMR analysis. Hb
solutions were adjusted to a pH of 7.15 using 0.1 mol/l KOH, and
2,3-bisphosphoglycerate (2,3-BPG) was added to achieve a concentration
that was 25% of the measured [Hb] to simulate the environment of the
RBC-ICF (1).
Whole blood samples were taken from human volunteers by venipuncture and were immediately placed on ice to minimize 2,3-BPG degradation. The whole blood samples were subjected to the same treatments and equilibration as the Hb samples except that the whole blood samples did not have 2,3-BPG added. A 10-ml sample of the subject's blood was also centrifuged at 10,000 rpm for 20 min at 4°C to obtain packed RBCs to add to the blood samples after they were diluted with the KCl standard and 2H2O to bring the hematocrit to a value between 0.41 and 0.46.
A small volume of 100% 2H2O was added to each
mixture for increased NMR stability. The PO2,
PCO2, [Hb], and [Cl
] were
measured with the blood-gas analyzer and hemoximeter. Samples were
placed in gastight J. Young NMR tubes that were flushed with either
arterial or venous gas mixtures and sealed. At least four tubes were
analyzed for each gas mixture. 35Cl-NMR spectra were
acquired at 37°C by using a Varian UNITY Inova NMR spectrometer
operating at 9.4 T. One-dimensional spectra were acquired with 512 scans with an interscan delay of 0.5 s to ensure complete
relaxation recovery between scans. Chemical shifts and line widths were
measured from spectra processed with 5 Hz of line-broadening
apodization. Immediately after the NMR experiments, the samples were
reanalyzed to ensure that pH, PO2,
PCO2, and [Hb] had not significantly changed
during the NMR analysis.
To quantify the reversible binding of chloride to Hb, Hb was isolated
and purified as in the NMR studies. As the isolated Hb was being
equilibrated to a venous gas mixture, we added 0.9 M KCl, 0.1 M KOH,
and 2,3-BPG to create a Hb solution in which [Cl
] = 80 mmol/l, pH = 7.15, [Hb] = 24 gm/dl, and [2,3-BPG] = 25% of
the molar [Hb]. These parameters, with the exception of [Hb], which
was low because of dilution, correspond to the internal environment of
a RBC. A given sample was then alternately equilibrated to arterial and
venous gas mixtures to demonstrate the on and off binding of chloride.
Each sample was cycled between arterial and venous gases at least four
times. The [Cl
] of the free pool was measured with the
Cl
electrode of the blood-gas analyzer. The accuracy of
this measurement was constrained by the blood-gas analyzer, which
reports [Cl
] to only the nearest millimoles per liter.
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RESULTS |
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NMR data.
Results of the 35Cl-NMR studies on plasma, Hb solutions,
and whole blood are presented in Tables 1-3, respectively.
Included in Tables 1-3 are the associated blood chemistry values
for the samples. The arteriovenous differences in standard values of
blood chemistry are as expected.
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free in solution has a line width
of ~17 Hz, and chloride bound to Hb has a very broad line width (too
broad to detect) (4, 22). When Cl
is
exchanging rapidly (faster than 1 exchange/ms), the line width is a
time-weighted average of the line width of free and bound chloride. An
increase in line width, therefore, indicates an increase in the amount
of chloride that is bound.
T1 and T2 do not show the same significance as line width because of
the very slow tumbling of RBCs, which enhances the anisotropic portion
of the quadripolar relaxation effect in the line width. For a viscous
sample, where anisotropic effects have to be considered, such as RBC
tumbling in whole blood, a nucleus like 35Cl has a
quadripolar moment in addition to the standard dipole moment. For this
reason, line width is a more sensitive measurement in structurally
complex solutions like whole blood (26).
In plasma, the strong ions were unchanged, whereas those variables
dependent on PCO2 changed appropriately. The
NMR values for isolated plasma (Table 1)
were not statistically significantly different for arterial and venous
samples. This finding indicates that there is no important binding of
chloride in the plasma and no change in plasma [Cl
] due
directly to changes in gas equilibration. Hence, in whole blood
samples, whatever changes are observed in chloride binding must reflect
events that occur in the RBC-ICF.
In venous Hb solutions (Table 2), there
were decreases in [Cl
] and increases in
[HCO
], increases in [HCO
Cl
electrode data.
The concentration of free Cl
in Hb solutions decreased by
a consistent 1-2 mmol/l from arterial to venous blood-gas partial pressures. This change was reversed by subsequent equilibration to
arterial blood gas. The measures of changes in the amount of chloride
bound to Hb that occur between arterial and venous conditions are
appropriate in both their quantity and direction. For a given experiment, which consisted of no fewer than four cycles between gas
mixtures, the change was always identical in direction and magnitude.
In three replications of the experiment, the reported change was
measured invariably as either 1 or 2 mmol/l for a given set. Because
the resulting variance of a given set of data was zero, no statistical
comparison of the data is necessary.
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DISCUSSION |
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The binding of chloride to Hb, as indicated by NMR studies of Hb solutions and whole blood and by tonometry studies of Hb solutions, is greater in venous than in arterial blood. Thus the phenomenon of oxygen-dependent binding of chloride to Hb, previously studied with large changes in PO2, operates in whole blood with physiologically relevant changes in PO2. Furthermore, this reversible binding, which is in the millimolar range, is of sufficient magnitude to be of importance to several phenomena of the RBC. Although further research is necessary to elucidate the degree to which chloride binding to Hb influences each of the following examples, we will briefly discuss four areas wherein understanding may be enhanced by incorporation of the reversible binding of chloride to Hb: Donnan ratios, Haldane effect, allostery, and acid-base balance of the RBC-ICF.
Donnan ratios.
The distribution of ions between the RBC-ICF and plasma takes on the
appearance of a Donnan equilibrium (27). The exact ratios
of intracellular-to-extracellular concentrations of Cl
,
HCO
] by way of a difference
either of the activity coefficient for chloride (15, 19,
40) or of protein binding of chloride (15). We feel
that the findings of our research demonstrate that the fraction of
total chloride that is ionized is, in fact, different between plasma
and RBC-ICF because of Hb binding, which may help to explain the
aforementioned aberrations between calculated and experimental data.
As an example of the effect of binding of chloride, consider that
Funder and Wieth (15) reported an inequality between the Donnan ratios for Cl
and H+
(rCl
= 0.707;
rH+ = 0.676). If, of the 82 mmol/l they
report for intracellular [Cl
], the concentration were
reduced by 3.5 mmol/l as a result of binding to Hb, the concentration
of ionized Cl
would be sufficiently reduced such that
rCl
would equal rH+.
The chloride binding in the preceding example is greater than the
binding found in our study. However, we measured only the change of
oxylabile chloride and not total bound chloride. It is well established
that Hb has both oxylabile and nonoxylabile chloride binding sites
(4, 5); therefore, the quantity bound may be greater than
our measurements indicate. The binding of chloride is, therefore,
an important factor in the reconciliation of the discrepancies in the
Donnan ratios for Cl
, HCO
Haldane effect.
Deoxyhemoglobin is a weaker acid than oxyhemoglobin. This fact was
first demonstrated in 1914 (7) and has become known as the
Haldane effect. The change in the dissociation constant for the
combined nonvolatile weak acids (KA) of Hb
associated with the Haldane effect causes more H+ to bind
to Hb and allows more HCO
in deoxyhemoglobin.
Rather, Cl
is a chaotropic effector of Hb in that it
disrupts the protein molecule in such a way that 1 meq of effector
alters the charge of the protein by more or less than 1 meq
(30). In the case of Cl
and Hb, 1 meq of
bound chloride increases the negativity of Hb by 3-5 meq
(30). How and why this occurs is not completely understood nor is the exact role of the chaotropic effect of chloride binding in
facilitating H+ binding. Unfortunately, the definitive work
that quantified the Haldane coefficient (35) did not
report [Cl
] or changes in [Cl
]
associated with the Haldane effect.
Allostery.
Chloride decreases the O2 affinity of Hb and increases the
alkaline Bohr effect through allosteric interaction (33).
It has been estimated that ~30% of the Bohr effect is eliminated when chloride binding is inhibited (29). Relative to
2,3-BPG, the negative allosteric effect of chloride is of lesser
importance in healthy humans. However, information on the importance of
Cl
binding in human disease is lacking. Inorganic
phosphate, for example, binds to Hb, and, although it occurs to only a
limited extent, knowledge of its mechanism has led to successful
therapeutic treatment of at least one human condition, diabetic
ketoacidosis (8). In bovines, where Cl
is
the major allosteric effector, hyperchloremia has been implicated in
altering the O2 half-saturation pressure of Hb (3,
14, 16, 17). We believe that the chloride binding found
in the present study, as well as the importance of chloride binding for the Bohr effect, suggests that similar clinical benefits may be uncovered through further study of chloride binding in humans.
Acid-base balance of the RBC-ICF.
Analysis and understanding by means of the independent variable
approach, first proposed by Stewart (36, 37), has gained acceptance among physiologists as a useful framework for the study of
acid-base balance in the body (9, 13, 20, 21, 38). It
combines the laws of mass action, conservation of mass, and electroneutrality into a summary equation (Eq. 1) that
describes the electrochemical environment of a solution
|
(1) |
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].
KA and the dissociation constants for
HCO

]), carbonate
([CO
]),
respectively. The magnitudes of the [H+],
[CO
] are vanishingly
small relative to the other terms (9) but are presented
here for mathematical completeness.
When the terms of the equation are converted to a common denominator
for mathematical solution, the individual chemical components lose
their identity, and the equation takes on a quartic form (Eq. 2), which is practically insoluble by hand but can be solved readily on a desktop computer with the appropriate software (we used
MathSoft's MathCad 4.0)
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(2) |
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on CO2
carriage in the plasma and RBC-ICF via their alteration of [SID] can
be understood through manipulations of [SID] and subsequent solutions
of the summary equation. It is conventionally assumed that the
H+ liberated in the synthesis of HCO



|
is bound (Table 4, venousa), the pH
decrease is 0.064, and, more importantly, the
[HCO
is bound
(Table 4, venousb), the pH decrease is reduced by about one-half, and [HCO

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ACKNOWLEDGEMENTS |
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We thank M. Pagel and J. Frey for assistance with the NMR analysis, D. Daleke for assistance with Hb solution preparation, N. Marshall for technical and bibliographic assistance, and S. Rothenberger for units of expired blood.
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FOOTNOTES |
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This work was supported by National Institute of General Medical Sciences Grant GM-057372.
Address for reprint requests and other correspondence: H. D. Prange, Medical Sciences Program, Indiana Univ., Jordan Hall 104, 1001 East 3rd St., Bloomington, IN 47405-7005 (E-mail: prange{at}indiana.edu).
The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Received 30 March 2000; accepted in final form 24 January 2001.
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