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Goh T, Gao L, Singh J, Totaro R, Carey R, Yang K, Cartwright B, Dennis M, Ju LA, Waterhouse A. Platelet Adhesion and Activation in an ECMO Thrombosis-on-a-Chip Model. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2401524. [PMID: 38757670 PMCID: PMC11321669 DOI: 10.1002/advs.202401524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/03/2024] [Indexed: 05/18/2024]
Abstract
Use of extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure remains complicated by blood clot formation (thrombosis), triggered by biomaterial surfaces and flow conditions. Thrombosis may result in ECMO circuit changes, cause red blood cell hemolysis, and thromboembolic events. Medical device thrombosis is potentiated by the interplay between biomaterial properties, hemodynamic flow conditions and patient pathology, however, the contribution and importance of these factors are poorly understood because many in vitro models lack the capability to customize material and flow conditions to investigate thrombosis under clinically relevant medical device conditions. Therefore, an ECMO thrombosis-on-a-chip model is developed that enables highly customizable biomaterial and flow combinations to evaluate ECMO thrombosis in real-time with low blood volume. It is observed that low flow rates, decelerating conditions, and flow stasis significantly increased platelet adhesion, correlating with clinical thrombus formation. For the first time, it is found that tubing material, polyvinyl chloride, caused increased platelet P-selectin activation compared to connector material, polycarbonate. This ECMO thrombosis-on-a-chip model can be used to guide ECMO operation, inform medical device design, investigate embolism, occlusion and platelet activation mechanisms, and develop anti-thrombotic biomaterials to ultimately reduce medical device thrombosis, anti-thrombotic drug use and therefore bleeding complications, leading to safer blood-contacting medical devices.
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Affiliation(s)
- Tiffany Goh
- School of Medical Sciences, Faculty of Medicine and HealthThe University of SydneySydneyNSW2006Australia
- Heart Research InstituteNewtownNSW2042Australia
- Charles Perkins CentreThe University of SydneySydneyNSW2006Australia
- The University of Sydney Nano InstituteThe University of SydneySydneyNSW2006Australia
| | - Lingzi Gao
- School of Medical Sciences, Faculty of Medicine and HealthThe University of SydneySydneyNSW2006Australia
- Heart Research InstituteNewtownNSW2042Australia
- Charles Perkins CentreThe University of SydneySydneyNSW2006Australia
- The University of Sydney Nano InstituteThe University of SydneySydneyNSW2006Australia
| | - Jasneil Singh
- School of Medical Sciences, Faculty of Medicine and HealthThe University of SydneySydneyNSW2006Australia
- Heart Research InstituteNewtownNSW2042Australia
- Charles Perkins CentreThe University of SydneySydneyNSW2006Australia
- The University of Sydney Nano InstituteThe University of SydneySydneyNSW2006Australia
| | - Richard Totaro
- Faculty of Medicine and HealthThe University of SydneySydneyNSW2006Australia
- Intensive Care DepartmentRoyal Prince Alfred HospitalMissenden Road, CamperdownSydneyNSW2050Australia
| | - Ruaidhri Carey
- Intensive Care DepartmentRoyal Prince Alfred HospitalMissenden Road, CamperdownSydneyNSW2050Australia
| | - Kevin Yang
- Intensive Care DepartmentRoyal Prince Alfred HospitalMissenden Road, CamperdownSydneyNSW2050Australia
| | - Bruce Cartwright
- Faculty of Medicine and HealthThe University of SydneySydneyNSW2006Australia
- Anaesthetics DepartmentRoyal Prince Alfred HospitalCamperdownSydneyNSW2050Australia
| | - Mark Dennis
- Faculty of Medicine and HealthThe University of SydneySydneyNSW2006Australia
- Cardiology DepartmentRoyal Prince Alfred HospitalMissenden Road, CamperdownSydneyNSW2050Australia
| | - Lining Arnold Ju
- Heart Research InstituteNewtownNSW2042Australia
- Charles Perkins CentreThe University of SydneySydneyNSW2006Australia
- The University of Sydney Nano InstituteThe University of SydneySydneyNSW2006Australia
- School of Biomedical EngineeringFaculty of EngineeringThe University of SydneyDarlingtonNSW2008Australia
| | - Anna Waterhouse
- School of Medical Sciences, Faculty of Medicine and HealthThe University of SydneySydneyNSW2006Australia
- Charles Perkins CentreThe University of SydneySydneyNSW2006Australia
- The University of Sydney Nano InstituteThe University of SydneySydneyNSW2006Australia
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Zhang J, Han D, Chen Z, Wang S, Sun W, Griffith BP, Wu ZJ. Linking Computational Fluid Dynamics Modeling to Device-Induced Platelet Defects in Mechanically Assisted Circulation. ASAIO J 2024:00002480-990000000-00490. [PMID: 38768482 DOI: 10.1097/mat.0000000000002242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Thrombotic and bleeding events are the most common hematologic complications in patients with mechanically assisted circulation and are closely related to device-induced platelet dysfunction. In this study, we sought to link computational fluid dynamics (CFD) modeling of blood pumps with device-induced platelet defects. Fresh human blood was circulated in circulatory loops with four pumps (CentriMag, HVAD, HeartMate II, and CH-VAD) operated under a total of six clinically representative conditions. Blood samples were collected and analyzed for glycoprotein (GP) IIb/IIIa activation and receptor shedding of GPIbα and GPVI. In parallel, CFD modeling was performed to characterize the blood flow in these pumps. Numerical indices of platelet defects were derived from CFD modeling incorporating previously derived power-law models under constant shear conditions. Numerical results were correlated with experimental results by regression analysis. The results suggested that a scalar shear stress of less than 75 Pa may have limited contribution to platelet damage. The platelet defect indices predicted by the CFD power-law models after excluding shear stress <75 Pa correlated excellently with experimentally measured indices. Although numerical prediction based on the power-law model cannot directly reproduce the experimental data. The power-law model has proven its effectiveness, especially for quantitative comparisons.
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Affiliation(s)
- Jiafeng Zhang
- From the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Dong Han
- From the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Zengsheng Chen
- From the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shigang Wang
- From the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Wenji Sun
- From the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bartley P Griffith
- From the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Zhongjun J Wu
- From the Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
- Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland
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Liu S, Chen S, Xiao L, Zhang K, Qi Y, Li H, Cheng Y, Hu Z, Lin C. Unraveling the motion and deformation characteristics of red blood cells in a deterministic lateral displacement device. Comput Biol Med 2024; 168:107712. [PMID: 38006825 DOI: 10.1016/j.compbiomed.2023.107712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/16/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023]
Abstract
Deterministic Lateral Displacement (DLD) device has gained widespread recognition and trusted for filtering blood cells. However, there remains a crucial need to explore the complex interplay between deformable cells and flow within the DLD device to improve its design. This paper presents an approach utilizing a mesoscopic cell-level numerical model based on dissipative particle dynamics to effectively capture this complex phenomenon. To establish the model's credibility, a series of numerical simulations were conducted and the numerical results were validated with nominal experimental data from the literature. These include single cell stretching experiment, comparisons of the morphological characteristics of cells in DLD, and comparison the specific row-shift fraction of DLD required to initiate the zigzag mode. Additionally, we investigate the effect of cell rigidity, which serves as an indicator of cell health, on average flow velocity, trajectory, and asphericity. Moreover, we extend the existing theory of predicting zigzag mode for solid spherical particles to encompass the behavior of red blood cells. To achieve this, we introduce a new concept of effective diameter and demonstrate its applicability in providing highly accurate predictions across a wide range of conditions.
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Affiliation(s)
- Shuai Liu
- School of Aerospace Engineering and Applied Mechanics, Tongji University, Shanghai, 200092, China
| | - Shuo Chen
- School of Aerospace Engineering and Applied Mechanics, Tongji University, Shanghai, 200092, China.
| | - Lanlan Xiao
- School of Mechanical and Automotive Engineering, Shanghai University of Engineering Science, Shanghai, 201620, China
| | - Kaixuan Zhang
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Yuan Qi
- Artificial Intelligence Innovation and Incubation Institute, Fudan University, Shanghai, 200433, China
| | - Hao Li
- Artificial Intelligence Innovation and Incubation Institute, Fudan University, Shanghai, 200433, China
| | - Yuan Cheng
- Artificial Intelligence Innovation and Incubation Institute, Fudan University, Shanghai, 200433, China
| | - Zixin Hu
- Artificial Intelligence Innovation and Incubation Institute, Fudan University, Shanghai, 200433, China; Fudan Zhangjiang Institute, Shanghai, 201203, China; Shanghai Pudong Hospital, Shanghai, 201399, China
| | - Chensen Lin
- Artificial Intelligence Innovation and Incubation Institute, Fudan University, Shanghai, 200433, China; Fudan Zhangjiang Institute, Shanghai, 201203, China; Shanghai Pudong Hospital, Shanghai, 201399, China.
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Chalkias A. Shear Stress and Endothelial Mechanotransduction in Trauma Patients with Hemorrhagic Shock: Hidden Coagulopathy Pathways and Novel Therapeutic Strategies. Int J Mol Sci 2023; 24:17522. [PMID: 38139351 PMCID: PMC10743945 DOI: 10.3390/ijms242417522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Massive trauma remains a leading cause of death and a global public health burden. Post-traumatic coagulopathy may be present even before the onset of resuscitation, and correlates with severity of trauma. Several mechanisms have been proposed to explain the development of abnormal coagulation processes, but the heterogeneity in injuries and patient profiles makes it difficult to define a dominant mechanism. Regardless of the pattern of death, a significant role in the pathophysiology and pathogenesis of coagulopathy may be attributed to the exposure of endothelial cells to abnormal physical forces and mechanical stimuli in their local environment. In these conditions, the cellular responses are translated into biochemical signals that induce/aggravate oxidative stress, inflammation, and coagulopathy. Microvascular shear stress-induced alterations could be treated or prevented by the development and use of innovative pharmacologic strategies that effectively target shear-mediated endothelial dysfunction, including shear-responsive drug delivery systems and novel antioxidants, and by targeting the venous side of the circulation to exploit the beneficial antithrombogenic profile of venous endothelial cells.
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Affiliation(s)
- Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104-5158, USA;
- Outcomes Research Consortium, Cleveland, OH 44195, USA
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Laou E, Papagiannakis N, Ntalarizou N, Choratta T, Angelopoulou Z, Annousis K, Sakellakis M, Kyriakaki A, Ragias D, Michou A, Chalkias A. The Relation of Calculated Plasma Volume Status to Sublingual Microcirculatory Blood Flow and Organ Injury. J Pers Med 2023; 13:1085. [PMID: 37511698 PMCID: PMC10381119 DOI: 10.3390/jpm13071085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The calculated plasma volume status (cPVS) was validated as a surrogate of intravascular filling. The aim of this study is to assess the cPVS in relation to sublingual perfusion and organ injury. METHODS Pre- and postoperative cPVS were obtained by determining the actual and ideal plasma volume levels in surgical patients. The sublingual microcirculation was assessed using SDF imaging, and we determined the De Backer score, the Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Our primary outcome was the assessment of the distribution of cPVS and its association with intraoperative sublingual microcirculation and postoperative complications. RESULTS The median pre- and postoperative cPVS were -7.25% (IQR -14.29--1.88) and -0.4% (IQR -5.43-6.06), respectively (p < 0.001). The mean intraoperative administered fluid volume was 2.5 ± 2.5 L (1.14 L h-1). No statistically significant correlation was observed between the pre- or postoperative cPVS and sublingual microcirculation variables. Higher preoperative (OR = 1.04, p = 0.098) and postoperative cPVS (OR = 1.057, p = 0.029) were associated with postoperative organ injury and complications (sepsis (30%), anemia (24%), respiratory failure (13%), acute kidney injury (6%), hypotension (6%), stroke (3%)). CONCLUSIONS The calculated PVS was associated with an increased risk of organ injury and complications in this cohort.
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Affiliation(s)
- Eleni Laou
- Department of Anesthesiology, Agia Sophia Children's Hospital, 11527 Athens, Greece
| | - Nikolaos Papagiannakis
- First Department of Neurology, Eginition University Hospital, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Nicoletta Ntalarizou
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece
| | - Theodora Choratta
- First Department of Surgery, Metaxa Cancer Hospital, 18537 Piraeus, Greece
| | - Zacharoula Angelopoulou
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece
| | | | - Minas Sakellakis
- Department of Medical Oncology, Metropolitan Hospital, 10461 Piraeus, Greece
| | - Aikaterini Kyriakaki
- High Dependency Unit, General Hospital of Syros Vardakeio and Proio, 84100 Syros, Greece
| | - Dimitrios Ragias
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece
| | - Anastasia Michou
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece
| | - Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece
- Institute for Translational Medicine and Therapeutics, School of Medicine, University of Pennsylvania Perelman, Philadelphia, PA 19104, USA
- Outcomes Research Consortium, Cleveland, OH 44195, USA
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