Geraniol Exerts Cytotoxic Effects in Red Cells Through Ca2+ Elevation and Membrane Hyperpolarization: Attenuating Effects of COX/CK1α/Rac1 GTPase Inhibition

Background: Hemolysis and eryptosis of red blood cells (RBCs) contribute to chemotherapy-induced anemia, a marker of poor prognosis. Geraniol (GER) is an anticancer acyclic monoterpene alcohol found in several plant extracts, but a dearth of evidence exists regarding the potential toxicity of GER in RBCs. Methods: Hemolysis and eryptosis were evaluated using colorimetric and fluorescence-assisted cell-sorting methods, respectively. Phosphatidylserine (PS) exposure, loss of volume, and intracellular Ca2+ were measured by annexin-V-FITC, forward scatter (FSC), and Fluo4/AM staining. Cells were also examined by electron microscopy to identify membrane blebbing and by the Westergren method to assess erythrocyte sedimentation rate (ESR). Results: In a concentration-responsive fashion, GER induced hemolysis and PS exposure in addition to elevated ESR. GER-induced cell death was characterized by reduced FSC, membrane blebs, and increased Fluo4 fluorescence. Ca2+ deprivation prevented eryptosis, whereas concurrent Ca2+ deprivation and membrane depolarization prevented hemolysis, eryptosis, and cell shrinkage. Furthermore, whereas inhibition of cyclooxygenase (COX), casein kinase 1α (CK1α), or Rac1 GTPase ameliorated eryptosis and hemolysis, the latter was only prevented by caspase, nitric oxide synthase, or serine palmitoyltransferase inhibition. Exclusive reversal of eryptosis was rather only achieved in the presence of either caffeine or adenine. Conclusions: GER is a novel stimulator of hemolysis and eryptosis, an activity mediated through membrane hyperpolarization following Ca2+ elevation. In parallel, GER seems to involve the COX/CK1α/Rac1 GTPase axis to trigger its cytotoxic effects. Targeting the identified mechanisms in combination therapy may attenuate the off-target toxicity of GER and enhance its specificity to cancer cells.