Behavior of model particles and blood cells at spherical obstructions in tube flow

Blood cell interactions and segregation in flow

For more than a century, pioneering researchers have been using novel experimental and computational approaches to probe the mysteries of blood flow. Thanks to their efforts, we know that blood cells generally prefer to migrate to the axis of flow, that red and white cells segregate in flow, and that cell deformability and their tendency to reversibly aggregate contribute to the non-Newtonian nature of this unique fluid. All of these properties have beneficial physiological consequences, allowing blood to perform a variety of critical functions. Our current understanding of these unusual flow properties of blood have been made possible by the ingenuity and diligence of a number of researchers, including Harry Goldsmith, who developed novel technologies to visualize and quantify the flow of blood at the level of individual cells. Here we summarize efforts in our lab to continue this tradition and to further our understanding of how blood cells interact with each other and with the blood vessel wall.

A perfusion chamber developed to investigate thrombus formation and shear profiles in flowing native human blood at the apex of well-defined stenoses

The precipitating event leading to stroke, myocardial infarction, and/or sudden death may be related to the formation of mural thrombus at the site of a ruptured or superficially damaged stenotic plaque. The fluid dynamic properties at atherosclerotic plaques that may be implicated in this thrombus formation have been described in a wide variety of model systems in both the process of plaque rupture and the growth of platelet thrombi. In general, the local fluid dynamic conditions are complex and show major variations from flow in well-defined laminar flow systems. However, no studies have attempted to quantify the effect of stenosis-related disturbances on thrombus formation in native human blood and to compare them with the local fluid dynamics. We developed a parallel-plate perfusion chamber device in which thrombus formation is measured at the "apex" of eccentric stenoses and have correlated such measurements with values of the local fluid dynamics obtained by computer simulation. The extent of stenoses (reduction in the cross-sectional area of the blood flow channel) was 60%, 80%, and 89%, corresponding to "apex" wall shear rates of 2600, 10,500, and 32,000 sec-1, respectively. The wall shear rate in the laminar flow region proximal and distal to the stenoses was 420 sec-1. The surface of the stenosis was purified collagen type III fibrils that were exposed to flowing nonanticoagulated human blood drawn directly from an antecubital vein by a pump placed distally to the perfusion chamber. The resulting blood-collagen interactions were quantified by light microscopy by using a morphometric image analysis technique. Under all conditions studied, platelet thrombus formation at the "apex" was extensive.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of aspirin and epinephrine on experimentally induced thrombogenesis in dogs. A parallelism between in vivo and ex vivo thrombosis models

Thrombosis on the damaged or ruptured vascular wall in a stenotic coronary artery is believed to be the precipitating factor leading to unstable angina. Little is known about the nature of the interactions among platelets, fluid dynamic factors, and vessel wall properties under such conditions. In the present investigation we have compared two experimental models of thrombosis simultaneously in anesthetized dogs. The first was an in vivo model of unstable angina, in which a fixed circumflex coronary artery stenosis was produced and the resultant cyclic blood flow reductions (CFRs) through the vessel were investigated after infusion of aspirin and a combination of aspirin and epinephrine. As previously reported, aspirin inhibited the CFRs, but the continuous infusion of epinephrine reestablished the appearance of CFRs. The second was an ex vivo model, in which thrombus formation on a type III collagen surface was investigated in a parallel-plate perfusion system under controlled conditions of exposure time and flow; morphological evaluation of thrombus volume, platelet adhesion, and fibrin deposition was performed. The chamber was positioned in an extracorporeal shunt between the carotid artery and the jugular vein of anesthetized dogs and exposed to nonanticoagulated blood at a shear rate of 1,600 sec-1. Thirty minutes after establishment of the CFRs, a blood sample for platelet aggregation was collected and a bleeding time and a first ex vivo perfusion were performed. At the end of this perfusion, animals were subjected either to no treatment (n = 10) or to an intravenous bolus of 10 mg/kg aspirin (n = 7), and a second perfusion was conducted 30 minutes later. Additional untreated animals (n = 6) were given aspirin followed by a continuous intravenous infusion of 10 micrograms/ml epinephrine, and a third perfusion was conducted. Results with respect to platelet adhesion, thrombus volume, and fibrin deposition were similar in the two perfusions in untreated animals. Treatment with aspirin abolished the CFRs in all dogs and concomitantly reduced the ex vivo thrombus volume by 84% (p less than 0.01) without affecting platelet adhesion and fibrin deposition. Bleeding time increased by 40% (p less than 0.05), and collagen-induced platelet aggregation was virtually abolished (p less than 0.01). However, infusion of epinephrine in dogs after aspirin treatment restored the CFRs, and the ex vivo thrombus volumes were not statistically different from predrug values. Thus, the ex vivo model satisfactorily reflects the more complicated in vivo model events with respect to intracoronary thrombosis and substantiates the view that aspirin interrupts coronary thrombogenesis in the dog by interfering with platelet cohesion.

Long-term behavior of bovine collagen membrane used as vascular substitute. Experimental study in rats

The aim of the present study was to evaluate the sequence of the immediate and the mid/long-term organization of the blood interface of a collagenous membrane used as vascular substitute in rats. The implants were prepared from calf skin type I insoluble collagen, obtained after acidic dispersion, in absence of chemical or tanning treatment. They were used to patch an aortic defect by means of microsurgical techniques. The animals were sequentially sacrificed for immediate hemocompatibility studies at 10 s, 30 s, 10 min, 3 h, and 6 h, for long-term analyses of the organization of the blood material interface at the 7th, 15th, 45th, 60th, 90th day following the surgery and each month until 14 months after aortic replacement. The superficial immediate events at the blood patch interface demonstrated erythrocytes heavily engulfed in a thin but dense fibrin mesh both at the patch and at the adjacent aortic wall surfaces. Neither adherent platelet nor platelet aggregate were detectable on the collagen patch surface. This fibrinoerythrocytic membrane covered the patch completely at 60 s and at 3 h the deposit was limited to 5-6 erythrocyte layers as confirmed by histology. It did not further develop on the 7th day. At the blood-collagen interface there progressively developed a tissue composed of active myofibroblasts, collagen bundles, and elastic fibers. After 4 months, nests of fibroendothelial cells were present, and between 6 and 14 months surface cell differentiation, although complete on the adjacent aorta was still incomplete on the bovine collagen patch, amorphous fibers, and fibroendothelial cells coexisting. Heterologous patch debris were still present 14 months after implantation and were associated with macroscopic and ultrastructural calcification, which need further investigations concerning the exact nature and mechanism of mineralization of vascular substitutes of biological nature.

Platelets and extracorporeal circulation

Extensive contact between blood and the synthetic surfaces of an extra-corporeal circuit causes thrombocytopenia, release of platelet granular contents, initiation of thromboxane synthesis, disruption of subcellular architecture and loss of platelet sensitivity to standard platelet agonists. All too frequently, these adverse platelet alterations are reflected in a prolongation of the post-operative bleeding time and excessive blood loss which precludes implementation of long-term circulatory assist devices. Unfortunately, a truly biocompatible material does not exist and efficiency of gas transport demands haemodynamic designs which actually promote platelet injury. Although manipulation of surface properties and mechanical improvements in circuitry have managed to reduce platelet-surface interactions, the ultimate potential of these manoeuvres may be limited. Synthetic surfaces and soluble agonists, however, appear to modulate similar pathways suggesting that temporary platelet inhibition might provide significant protection by preserving the morphological and functional integrity of circulating platelets during contact with extracorporeal circuits.

Flow disturbances at the apex and lateral angles of a variety of bifurcation models and their role in development and manifestations of arterial disease

Dye flow patterns were studied in 12 glass model bifurcations with angles of 45, 90, 135, and 180 degrees, and area ratios of 0.78, 1.03 and 1.27. At the apex, the dye formed a saddle zone, and streamlines from the core which entered this region were swept over the upper and lower surfaces to enter the lateral angles. Qualitatively, the shape and size of the apex played a key role in this effect. Boundary layer separation occurred in the lateral angles, and increased as flow into the branch was reduced. If the branch was occluded, a complex vortex developed in the first few diameters of the branch, and no flow occurred beyond this, even though the occlusion was about 20 diameters downstream. The results were comparable with steady and pulsatile flow. The implications of these results for the localization of atherosclerosis are discussed.

Experimental evaluation of streamline patterns and separated flows in a series of branching vessels with implications for atherosclerosis and thrombosis

Flow conditions in four models representing the aortic bifurcation, iliac bifuraction, and a renal artery branch were investigated at volumetric flow rates corresponding to Reynolds numbers from 1000 to 4000 over the complete range of flow division between daughter vessels. Qualitative flow streamline patterns and quantitative definition of those flow conditions leading to disturbed flow (flow separation ) were determined primarily at steady flow with a limited set of pulsatie experiments. Under conditions of no flow separation, common characteristic streamline patterns not parallel to the center lines of parent or daughter tubes were found for all models. These effects were accentuated with increasing Reynolds number. Flow separation was inducible through alteration of flow division between daughter vessels or by an increase in flow rate. Each of the four models had distinct combinations of flow division ratio and flow rate which gave: (1) no flow separation, (2) flow separation at the outside of the right daughter tube, and (3) flow separation at the outside of the left daughter tube. Models representing the renal artery also had regions of simultaneous left- and righthand separation on the outside of their daughter tubes. The separated flows observed here displayed streamlines forming an open vortex with flows entering and leaving. These regions, which occur only at distinct combinations of flow rate and flow division, may be key centers where platelet aggregates may form, release constituents, and cause vessel injury.

Flow behaviour of blood cells and rigid spheres in an annular vortex

Results have been presented on the size and shape of an annular vortex seen in the common median plane of a sudden concentric expansion when suspensions of red cells, platelets and rigid spheres are subjected to steady and pulsatile flow. In steady flow, the location of the vortex centre, the reattachment point and the velocity distributions were in good agreement with theory. In pulsatile flow, the vortex appeared to oscillate in phase with the upstream fluid velocity U (r, t ), symmetrically about a location corresponding to its position in the absence of the oscillatory flow component. The most interesting and novel observations, however, and those which prompted this investigation, were concerned with the migration of red cells, platelets and rigid spheres across the fluid streamlines of the annular vortex. Such radial migration, dependent in magnitude and direction on Reynolds number and particle size, may have interesting implications for the dynamics of blood flow in arteries. Before dealing with this question and the possible mechanism underlying particle migration, the observations on cell orientations in the vortex are first discussed.

Significance of macrorheology and microrheology in atherogenesis

Atheromatous lesions represent a disturbance of homeostasis in the arterial wall, where the rates of uptake and production of atherogenic materials exceed the rates of egress and metabolic removal. The pressure and flow in the arterial system generate circumferential stress in the wall and shear stress on the wall. The magnitude and distribution of these stresses are affected by local vascular geometry and microrheologic behavior of blood. Circumferential stress is borne primarily by the media and adventitia, and shear stress has a greater influence on the endothelial cells, which form the principal barrier to transport of macromolecules into the arterial wall. Shear stress, turbulence, and longitudinal stretch cause an increase of macromolecular uptake by arterial wall, especially when the mechanical disturbances are periodic. These effects may be explained by an enhanced diffusion of plasmalemmal vesicles in the endothelial cells. Such short-term effects of rheologic factors should be considered together with their long-term influences on the structure and function of the arterial wall in order to elucidate the role of rheology in atherogenesis.