Sorbinil partially prevents decreased erythrocyte deformability in experimental diabetes mellitus

The ability of red blood cells (RBCs) to undergo an adaptation in shape that permits passage through the smallest vessels is reportedly impaired in diabetes. Several hypotheses have been proposed to explain decreased erythrocyte deformability, which has been implicated in the pathogenesis of microvascular complications, but the mechanisms responsible for this change have not been clearly delineated. In view of the fact that sorbitol accumulates in RBCs in diabetes and the postulate that increased sorbitol could alter deformability properties, we examined the influence of the aldose reductase inhibitor sorbinil on erythrocyte deformability. Erythrocyte deformability, determined as the volume of RBCs (VRBC) filtered per minute through 4.7-micron pore size filters, was significantly reduced in samples from diabetic rats compared with samples from controls (0.76 +/- 0.03 vs. 0.97 +/- .02 ml RBC/min; P less than .001). In contrast, deformability of RBCs from diabetic animals treated with sorbinil was significantly greater than in untreated diabetes, although not completely normalized (0.88 +/- 0.02; P less than .01 vs. diabetic, and P less than .02 vs. control). The reduced deformability characterizing cells from diabetic rats and its partial prevention by sorbinil persisted even when RBCs were washed to eliminate hyperglycemia and hyperviscous plasma. Thus, hyperviscosity per se is not responsible for the decreased deformability, and sorbinil can partially prevent this change despite persistent hyperglycemia. This effect may derive from sorbinil's action as an aldose reductase inhibitor and/or its ability to influence physicochemical properties of the erythrocyte membrane.