“…However, the passive mechanical properties of the RBC membrane themselves depend strongly on ATP, as illustrated by the stiffening of the RBC membrane on starvation [17][18][19]6,15 , that correlates with a sudden transition from discocyte to spiculated echinocyte shapes 20,21 . Therefore a direct and compelling explanation for the decrease of fluctuations observed in ATP-depleted cells is the stiffening of the membrane 22,23 rather than the loss of putative active (that is, non-equilibrium) fluctuations. To make a different assessment of the involvement of metabolic activity in flickering, an attractive approach was used by Tuvia et al 14 : at equilibrium, the mean-square fluctuations amplitude is a thermodynamic variable, which, by definition, cannot depend on the dynamics, and in particular on medium viscosity.…”