The research in this dissertation aims to optimise blood donation processes in the framework of the Dutch national blood bank Sanquin. The primary health risk for blood donors is iron deficiency,... Show moreThe research in this dissertation aims to optimise blood donation processes in the framework of the Dutch national blood bank Sanquin. The primary health risk for blood donors is iron deficiency, which is evaluated based on donors' hemoglobin and ferritin levels. If either of these levels are inadequate, donors are deferred from donation. Deferral due to low hemoglobin levels occurs on-site, meaning that donors have already traveled to the blood bank and then have to return home without donating, which is demotivating for the donor and inefficient for the blood bank. A large part of this dissertation therefore has the objective to develop a prediction model for donors' hemoglobin levels, based on historical measurements and donor characteristics.The prediction model that was developed reduces the deferral rate by approximately 60\% (from 3\% to 1\% for women, and from 1\% to 0.4\% for men), showing the potential of using data to enhance blood bank policy efficiency. Additionally, the model predictions were made explainable, providing the blood bank with insights into why specific predictions are made. These insights increase our understanding of the relationships between donor characteristics and hemoglobin levels. If this prediction model would be implemented in practice, the explanations could also be shared with the donor to help them understand why they are (not) invited to donate, which could also contribute to donor satisfaction and retention.In a collaborative effort with blood banks in Australia, Belgium, Finland and South Africa, the same prediction model was applied on data from each blood bank. Despite differences in blood bank policies and donor demographics, the models found similar associations with the predictor variables in all countries. Differences in performance could mostly be attributed to differences in deferral rates, with blood banks with higher deferral rates obtaining higher model accuracy.Beyond hemoglobin prediction models, additional research questions are explored. One study aims to identify determinants of ferritin levels in donors through repeated measurements, and linking these to environmental variables. Another study involves modeling the pharmacokinetics of antibodies in COVID-19 recovered donors, and finding relationships between patient characteristics, symptoms, and antibody levels over time.In summary, the research in this dissertation shows the potential within the wealth of data collected by blood banks. The proposed data-driven donation strategies not only decrease deferral rates but also increase donor retention and understanding. This comprehensive approach allows Sanquin to provide more personalised feedback to donors regarding their iron status, ultimately optimising the blood donation process and contributing to the overall efficacy of blood banking systems. Show less
Ferritin is a spherical metalloprotein, capable of storing and releasing iron in a controllable way. It is composed of a protein shell of about 12 nm and within its cavity, iron is stored in a... Show moreFerritin is a spherical metalloprotein, capable of storing and releasing iron in a controllable way. It is composed of a protein shell of about 12 nm and within its cavity, iron is stored in a mineral form. The ferritin core resembles an iron-based nanoparticle that is isolated from the environment by the ferritin shell, which makes ferritin an attractive element to be used in the fabrication of bioelectronic devices. Another intriguing aspect of ferritin is its potential relation to neurodegenerative diseases, such as Alzheimer’s and Parkinson’s. The relation is not yet well understood, but the studies indicate that dysfunctional ferritin appears to play an important role. This dissertation aims to characterize ferritin electrically and magnetically. First, the electrical properties of single ferritin are explored to understand the charge transport through ferritin, and additionally, the first ferritin single-electron transistor is obtained. Second, the magnetic properties of multiple ferritin particles are studied by electron paramagnetic resonance, which supplies information about the ferritin core. A model of the electron-spin structure of the ferritin core is proposed and extended to the ferritin signal from post-mortem brain tissues. Show less
Aims: Non-invasive measures of brain iron content would be of great benefit in neurodegeneration with brain iron accumulation (NBIA) to serve as a biomarker for disease progression and evaluation... Show moreAims: Non-invasive measures of brain iron content would be of great benefit in neurodegeneration with brain iron accumulation (NBIA) to serve as a biomarker for disease progression and evaluation of iron chelation therapy. Although magnetic resonance imaging (MRI) provides several quantitative measures of brain iron content, none of these have been validated for patients with a severely increased cerebral iron burden. We aimed to validate R 2 * as a quantitative measure of brain iron content in aceruloplasminemia, the most severely iron-loaded NBIA phenotype. Methods: Tissue samples from 50 gray-and white matter regions of a postmortem aceruloplasminemia brain and control subject were scanned at 1.5 T to obtain R 2 * , and biochemically analyzed with inductively coupled plasma mass spectrometry. For gray matter samples of the aceruloplasminemia brain, sample R 2 * values were compared with postmortem in situ MRI data that had been obtained from the same subject at 3 T - in situ R 2 * . Relationships between R 2 * and tissue iron concentration were determined by linear regression analyses. Results: Median iron concentrations throughout the whole aceruloplasminemia brain were 10 to 15 times higher than in the control subject, and R 2 * was linearly associated with iron concentration. For gray matter samples of the aceruloplasminemia subject with an iron concentration up to 1000 mg/kg, 91% of variation in R 2 * could be explained by iron, and in situ R 2 * at 3 T and sample R 2 * at 1.5 T were highly correlated. For white matter regions of the aceruloplasminemia brain, 85% of variation in R 2 * could be explained by iron. Conclusions: R 2 * is highly sensitive to variations in iron concentration in the severely iron-loaded brain, and might be used as a non-invasive measure of brain iron content in aceruloplasminemia and potentially other NBIA disorders. Show less
Kenkhuis, B.; Somarakis, A.; Haan, L. de; Dzyubachyk, O.; IJsselsteijn, M.E.; Miranda, N.F.C.C. de; ... ; Weerd, L. van der 2021
Brain iron accumulation has been found to accelerate disease progression in amyloid-beta(A beta) positive Alzheimer patients, though the mechanism is still unknown. Microglia have been identified... Show moreBrain iron accumulation has been found to accelerate disease progression in amyloid-beta(A beta) positive Alzheimer patients, though the mechanism is still unknown. Microglia have been identified as key players in the disease pathogenesis, and are highly reactive cells responding to aberrations such as increased iron levels. Therefore, using histological methods, multispectral immunofluorescence and an automated in-house developed microglia segmentation and analysis pipeline, we studied the occurrence of iron-accumulating microglia and the effect on its activation state in human Alzheimer brains. We identified a subset of microglia with increased expression of the iron storage protein ferritin light chain (FTL), together with increased Iba1 expression, decreased TMEM119 and P2RY12 expression. This activated microglia subset represented iron-accumulating microglia and appeared morphologically dystrophic. Multispectral immunofluorescence allowed for spatial analysis of FTL(+)Iba1(+)-microglia, which were found to be the predominant A beta-plaque infiltrating microglia. Finally, an increase of FTL(+)Iba1(+)-microglia was seen in patients with high A beta load and Tau load. These findings suggest iron to be taken up by microglia and to influence the functional phenotype of these cells, especially in conjunction with A beta. Show less
Aims: Aceruloplasminemia is an ultra-rare neurodegenerative disorder associated with massive brain iron deposits, of which the molecular composition is unknown. We aimed to quantitatively determine... Show moreAims: Aceruloplasminemia is an ultra-rare neurodegenerative disorder associated with massive brain iron deposits, of which the molecular composition is unknown. We aimed to quantitatively determine the molecular iron forms in the aceruloplasminemia brain, and to illustrate their influence on iron-sensitive MRI metrics.Methods: The inhomogeneous transverse relaxation rate (R2*) and magnetic susceptibility obtained from 7 T MRI were combined with Electron Paramagnetic Resonance (EPR) and Superconducting Quantum Interference Device (SQUID) magnetometry. The basal ganglia, thalamus, red nucleus, dentate nucleus, superior- and middle temporal gyrus and white matter of a post-mortem aceruloplasminemia brain were studied. MRI, EPR and SQUID results that had been previously obtained from the temporal cortex of healthy controls were included for comparison.Results: The brain iron pool in aceruloplasminemia detected in this study consisted of EPR-detectable Fe3+ ions, magnetic Fe3+ embedded in the core of ferritin and hemosiderin (ferrihydrite-iron), and magnetic Fe3+ embedded in oxidized magnetite/maghemite minerals (maghemite-iron). Ferrihydrite-iron represented above 90% of all iron and was the main driver of iron-sensitive MRI contrast. Although deep gray matter structures were three times richer in ferrihydrite-iron than the temporal cortex, ferrihydrite-iron was already six times more abundant in the temporal cortex of the patient with aceruloplasminemia compared to the healthy situation (162 & micro;g/g vs. 27 & micro;g/g), on average. The concentrations of Fe3+ ions and maghemite-iron in the temporal cortex in aceruloplasminemia were within the range of those in the control subjects.Conclusions: Iron-related neurodegeneration in aceruloplasminemia is primarily associated with an increase in ferrihydrite-iron, with ferrihydrite-iron being the major determinant of iron-sensitive MRI contrast. Show less
The aim of this thesis was to study the impact and etiology of anemia in the oldest old in the general population, in order to support the development of evidence-based diagnostic and treatment... Show moreThe aim of this thesis was to study the impact and etiology of anemia in the oldest old in the general population, in order to support the development of evidence-based diagnostic and treatment recommendations for anemia in the oldest old. All studies presented in this thesis were embedded in the Leiden 85-plus Study and the Newcastle 85-plus Study. First, the impact of anemia was investigated. Anemia in old age appeared to be associated with an increased risk of death, independent of comorbidity, but the associated functional decline appeared to be attributed mainly to comorbidity. In various chapters, the etiology of anemia in old age was studied. An important finding was that, while folate deficiency at age 85 years was associated with the development of anemia during follow-up, vitamin B12 deficiency was not. In addition, low ferritin was associated with lower hemoglobin levels, but this association was more pronounced in participants with inflammation than in participants without inflammation. In the general discussion, a description of the possible clinical implications of this thesis and recommendations for further studies are provided. Show less
