The limitations of the efficiency of ammonium-neutralizing erythrocyte-bioreactors based on glutamate dehydrogenase and alanine aminotransferase reactions were analyzed using a mathematical model. At low pyruvate concentrations in the external medium (below about 0.3 mM), the main limiting factor is the rate of pyruvate influx into the erythrocyte from the outside, and at higher concentrations, it is the disappearance of a steady state in glycolysis if the rate of ammonium processing is higher than the critical value (about 12 mM/h). This rate corresponds to different values of glutamate dehydrogenase activity at different concentrations of pyruvate in plasma. Oxidation of reduced nicotinamide adenine dinucleotide phosphate (NADPH) by glutamate dehydrogenase decreases the fraction of NADPH in the constant pool of nicotinamide adenine dinucleotide phosphates (NADP + NADPH). This, in turn, activates the pentose phosphate pathway, where NADP reduces to NADPH. Due to the increase in flux through the pentose phosphate pathway, stabilization of the ATP concentration becomes impossible; its value increases until almost the entire pool of adenylates transforms into the ATP form. As the pool of adenylates is constant, the ADP concentration decreases dramatically. This slows the pyruvate kinase reaction, leading to the disappearance of the steady state in glycolysis.

A mathematical model of energy metabolism in erythrocyte-bioreactors loaded with alcohol dehydrogenase and acetaldehyde dehydrogenase was constructed and analyzed. Such erythrocytes can convert ethanol to acetate using intracellular NAD and can therefore be used to treat alcohol intoxication. Analysis of the model revealed that the rate of ethanol consumption by the erythrocyte-bioreactors increases proportionally to the activity of incorporated ethanol-consuming enzymes until their activity reaches a specific threshold level. When the ethanol-consuming enzyme activity exceeds this threshold, the steady state in the model becomes unstable and the model switches to an oscillation mode caused by the competition between glyceraldehyde phosphate dehydrogenase and ethanol-consuming enzymes for NAD. The amplitude and period of metabolite oscillations first increase with the increase in the activity of the encapsulated enzymes. A further increase in these activities leads to a loss of the glycolysis steady state, and a permanent accumulation of glycolytic intermediates. The oscillation mode and the loss of the steady state can lead to the osmotic destruction of erythrocyte-bioreactors due to an accumulation of intracellular metabolites. Our results demonstrate that the interaction of enzymes encapsulated in erythrocyte-bioreactors with erythrocyte metabolism should be taken into account in order to achieve the optimal efficacy of these bioreactors.

The metabolic control analysis (MCA) was applied to several subsystems selected from the model of human erythrocyte energy metabolism. These subsystems represent varying degrees of simplification of energy metabolism, from the simplest subsystem of the first three glycolytic reactions that determine the steady-state rate of glycolysis, to an expanded subsystem that includes all glycolytic reactions plus passive and active ion transport across the cell membrane. The control coefficients of enzyme activities for the rate of glycolysis are found to be very different in different subsystems. However, no specific trend is observed in changes in control coefficients as the subsystem becomes more complex. Thus, in subsystems containing only glycolysis, the control coefficients of hexokinase (HK) and phosphofructokinase (PFK) together amount to 0.99. When ATPases are added, this value decreases to 0.18 and below, and the maximum control coefficient goes to ATPase (0.82–1.00). It would seem that there is a natural decrease in the contribution of HK and PFK to the regulation of the rate of glycolysis as the dimension of the system increases. However, disabling the allosteric regulation of PFK by AMP completely changes the picture. In a subsystem containing only glycolysis, disabling this regulation does not affect the control coefficients. After adding ATPase to such a subsystem, the HK and PFK control coefficients increase, and the control coefficient of ATPase takes on a negative value. Thus, we found that in extended subsystems involving glycolysis and ATPase or transmembrane ion transport, information on the initial regulation of glycolysis may not be revealed in the MCA results. It appears that the MCA alone cannot reveal regulatory mechanisms of metabolic systems in the presence of strong allosteric and feedback regulation.

Hereditary hemolytic anemias (HHAs) have very similar clinical manifestations, complicating differential diagnosis and determining treatment strategies, such as splenectomy. To differentiate between hereditary spherocytosis (HS), pyruvate kinase deficiency (PKD), and hereditary stomatocytosis (HSt), we proposed measuring erythrocyte filterability using membrane filters with a pore diameter of 3 or 3.5 μm. Our modified method provides improved reproducibility, reducing the scattering in results caused by differences in the filters used. Erythrocytes’ filterability differs significantly between patients with HS, HSt, and PKD (medians and 95% confidence intervals were 0.025 [0.004; 0.100] (n = 86); 0.645 [0.520; 0.730] (n = 10), and 0.760 [0.700; 0.782] (n = 26), respectively). The specificity of the filterability test for the HS diagnosis was 99.1%, comparable with the best available tests, while its sensitivity (85.4%) was slightly lower than that of some alternative methods. Only the filterability test was able to identify a second subgroup of HS patients (14.0%) with higher filterability (close to normal), but the diagnosis of HS in these patients could be confirmed by reduced filterability on a 3-μm filter. This subgroup requires further detailed study. The proposed method for measuring filterability is promising for diagnosing HS. It has high sensitivity and specificity and can be performed quickly without expensive equipment.