Effect of the endothelial glycocalyx layer on arterial LDL transport under normal and high pressure

The counterbalance of endothelial glycocalyx and high wall shear stress to low-density lipoprotein concentration polarization in mouse ear skin arterioles

BACKGROUND AND AIMS

Atherosclerosis preferentially occurs at regions in arterial branching, curvature, and stenosis, which may be explained by the geometric predilection of low-density lipoprotein (LDL) concentration polarization that has been investigated in major arteries in previous studies. Whether this also happens in arterioles remains unknown.

METHODS

Herein, a radially non-uniform distribution of LDL particles and a heterogeneous endothelial glycocalyx layer in the mouse ear arterioles, as shown by fluorescein isothiocyanate labeled wheat germ agglutinin (WGA-FITC), were successfully observed by a non-invasive two-photon laser-scanning microscopy (TPLSM) technique. The stagnant film theory was applied as the fitting function to evaluate LDL concentration polarization in arterioles.

RESULTS

The concentration polarization rate (CPR, the ratio of the number of polarized cases to that of total cases) in the inner walls of curved and branched arterioles was 22% and 31% higher than the outer counterparts, respectively. Results from the binary logistic regression and multiple linear regression analysis showed that endothelial glycocalyx thickness increases CPR and the thickness of the concentration polarization layer (CPL). Flow field computation indicates no obvious disturbances or vortex in modeled arterioles with different geometries and the mean wall shear stress is about 7.7-9.0 Pa.

CONCLUSIONS

These findings suggest a geometric predilection of LDL concentration polarization in arterioles for the first time, and the existence of an endothelial glycocalyx, acting together with a relatively high wall shear stress in arterioles, may explain to some extent why atherosclerosis rarely occurs in these regions.

The effects of female sexual hormones on the endothelial glycocalyx

The glycocalyx is a layer composed of carbohydrate side chains bound to core proteins that lines the vascular endothelium. The integrity of the glycocalyx is essential for endothelial cells' performance and vascular homeostasis. The neuroendocrine and immune systems influence the composition, maintenance, activity and degradation of the endothelial glycocalyx. The female organism has unique characteristics, and estrogen and progesterone, the main female hormones are essential to the development and physiology of the reproductive system and to the ability to develop a fetus. Female sex hormones also exert a wide variety of effects on other organs, including the vascular endothelium. They upregulate nitric oxide synthase expression and activity, decrease oxidative stress, increase vasodilation, and protect from vascular injury. This review will discuss how female hormones and pregnancy, which prompts to high levels of estrogen and progesterone, modulate the endothelial glycocalyx. Diseases prevalent in women that alter the glycocalyx, and therapeutic forms to prevent glycocalyx degradation and potential treatments that can reconstitute its structure and function will also be discussed.

Simulation of LDL permeation into multilayer wall of a coronary bifurcation using WSS-dependent model: effects of hemorheology

Atherosclerosis, due to the permeation of low-density lipoprotein (LDL) particles into the arterial wall, is one of the most common and deadly diseases in today's world. Due to its importance, numerous studies have been conducted on the factors affecting this disease. In this study, using numerical simulation, the effects of Wall Shear Stress (WSS), non-Newtonian behavior of blood, different values of hematocrit and blood pressure on LDL permeation into the arterial wall layers are investigated in a 4-layer wall model of a coronary bifurcation. To obtain the velocity and concentration fields in the fluid domain, the Navier-Stokes, Brinkman, and mass transfer equations are numerically solved in the lumen and wall layers. Results show that it is important to consider the effects of WSS on transport properties of endothelium layer in bifurcations and this leads to completely different concentration profiles compared to the constant properties model. Our computations show that a giant accumulation of LDL in the intima layer of the outer wall of the left anterior descending artery, especially in low WSS regions, may lead to atherosclerosis. It is also, necessary to consider the non-Newtonian behavior of blood in bifurcations due to its direct effect on WSS. A pressure-induced increase in the half-width of leaky junctions may be responsible for the higher risk of atherosclerosis in hypertension. In addition, it is shown that the dominant mechanism in LDL permeation into the wall is convection, and also, hypertension increases the effect of mass transfer by convection mechanism more than the diffusion mechanism. Furthermore, our results are consistent with various clinical studies.

Arterial hypertension as a consequence of endothelial glycocalyx dysfunction: a modern view of the problem of cardiovascular diseases

Arterial hypertension (AH) is a leading risk factor for the development of cardiovascular, cerebrovascular, and renal diseases, which are among the top 10 most common causes of death in the world. The etiology of hypertension has not been fully elucidated, but it has been established that endothelial dysfunction is the most significant pathogenetic link in the formation and progression of the disease. The data obtained in the last 10-15 years on endothelial glycocalyx (eGC) studies indicate that endothelial dysfunction is preceded 

by destabilization and shedding of eGC with the appearance of its soluble components in the blood, which is equivalent to a process that can be designated as eGC dysfunction. Signs of eGC dysfunction are expressed in the development of hypertension, diseases of the cardiovascular system, and their complications. The purpose of this review is to analyze and substantiate the pathophysiological role of eGC dysfunction in hypertension and cardiovascular diseases and to describe approaches for its assessment and pharmacological correction. Abstracts and full-size articles of 425 publications in Pubmed/MEDLINE databases over 20 years were studied. The review discusses the role of eGC in the regulation of vascular tone, endothelial barrier function, and anti-adhesive properties of eGC. Modifications of eGC under the influence of pro-inflammatory stimuli, changes in eGC with age, and with increased salt load are considered. The aspect associated with eGC dysfunction in atherosclerosis, hyperglycemia and hypertension is covered. Assessment of eGC dysfunction is difficult but can be performed by indirect methods, in particular by detecting eGC components in blood. A brief description of the main approaches to pharmacoprevention and pharmacocorrection of hypertension is given from the position of exposure effects on eGC, which currently has more a fundamental than practical orientation. This opens up great opportunities for clinical studies of eGC dysfunction for the prevention and treatment of hypertension and justifies a new direction in the clinical pharmacology of antihypertensive drugs.

Spatiotemporal changes of local hemodynamics and plaque components during atherosclerotic progression in rabbit

BACKGROUND AND OBJECTIVE

Recent evidence demonstrates that the atherogenic process is discontinuous. Our goal is to study changes of plaque components and local hemodynamics during atherosclerotic progression.

METHODS

The histological and immunohistochemical staining of high-fat diet rabbit aorta were evaluated at 0, 8, 10 and 12 weeks, respectively. In addition, the blood flow and LDL transport were simulated at the above four time points.

RESULTS

The plaque thickness at different characteristic regions increased at different rates. The collagen continued to increase, while the elastin, fibronectin, macrophages and smooth muscle cells increased first and then decreased. The relative surface LDL concentration decreased at 8 weeks, and then it increased first and decreased slightly. Meanwhile, the hemodynamic environment became better firstly at 8 weeks, then got slightly worse and lastly improved again.

CONCLUSIONS

The local hemodynamics and plaque components vary nonlinearly during atherosclerotic progression in rabbit aorta.

Effect of endothelial glycocalyx on water and LDL transport through the rat abdominal aorta

The surface of vascular endothelial cells (ECs) is covered by a protective negatively charged layer known as the endothelial glycocalyx. Herein, we hypothesized its transport barrier and mechanosensory role in transmural water flux and low-density lipoprotein (LDL) transport in an isolated rat abdominal aorta perfused under 85 mmHg and 20 dyn/cm2 ex vivo. The endothelial glycocalyx was digested by hyaluronidase (HAase) from bovine tests. Water infiltration velocity (Vw) was measured by a graduated pipette. LDL coverage and mean maximum infiltration distance (MMID) in the vessel wall were quantified by confocal laser scanning microscopy. EC apoptosis was determined by the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) technique, and leaky junction rates were evaluated by electron microscopy. The results showed that a 42% degradation of the endothelial glycocalyx by HAase treatment increased Vw, LDL coverage, and MMID. Shear stress increased Vw, which cannot be inhibited by HAase treatment. Four hour-shear application increased about fourfolds of LDL coverage, whereas exerted no significant effects on its MMID, EC apoptosis, and the leaky junctions. On the contrary, 24-h shear exposure has no significant effects on LDL coverage, whereas increased 2.74-folds of MMID and about 53% of EC apoptotic rates that could be inhibited by HAase treatment. These results suggest endothelial glycocalyx acts as a transport barrier by decreasing water and LDL transport, as well as a mechanosensor of shear to regulate EC apoptosis, thus affecting leaky junctions and regulating LDL transport into the vessel wall.NEW & NOTEWORTHY A 42% degradation of the endothelial glycocalyx by hyaluronidase of the isolated rat abdominal aorta facilitated water and LDL transport across the vessel wall, suggesting endothelial glycocalyx as a transport barrier. A 24-h shear exposure increased LDL mean maximum infiltration distance, and enhanced EC apoptosis, which could be both inhibited by hyaluronidase treatment, suggesting endothelial glycocalyx may also act as a mechanosensor of shear to regulate EC apoptosis, thus affecting leaky junctions and regulating LDL transport.

Flow shear stress controls the initiation of neovascularization via heparan sulfate proteoglycans within a biomimetic microfluidic model

Endothelial cells (ECs) in vivo are subjected to three forms of shear stress induced by luminal blood flow, transendothelial flow and interstitial flow simultaneously. It is controversial that shear stress, especially the component induced by luminal flow, was thought to inhibit the initialization of angiogenesis and trigger arteriogenesis. Here, we combined microfabrication techniques and delicate numerical simulations to reconstruct the initial physiological microenvironment of neovascularization in vitro, where ECs experience high luminal shear stress, physiological transendothelial flow and various vascular endothelial growth factor (VEGF) distributions simultaneously. With the biomimetic microfluidic model, cell alignment and endothelial sprouting assays were carried out. We found that luminal shear stress inhibits endothelial sprouting and tubule formation in a dose-dependent manner. Although a high concentration of VEGF increases EC sprouting, neither a positive nor a negative VEGF gradient additionally affects the degree of sprouting, and luminal shear stress significantly attenuates neovascularization even in the presence of VEGF. Heparinase was used to selectively degrade the heparan sulfate proteoglycan (HSPG) coating on ECs and messenger RNA profiles in ECs were analyzed. It turned out that HSPGs could act as a mechanosensor to sense the change of fluid shear stress, modulate multiple EC gene expressions, and hence affect neovascularization. In summary, distraction from the stabilized state, such as decreased luminal shear stress, increased VEGF and the destructed mechanotransduction of HSPGs would induce the initiation of neovascularization. Our study highlights the key role of the magnitude and forms of shear stress in neovascularization.

Endothelial permeability, LDL deposition, and cardiovascular risk factors-a review

Early atherosclerosis features functional and structural changes in the endothelial barrier function that affect the traffic of molecules and solutes between the vessel lumen and the vascular wall. Such changes are mechanistically related to the development of atherosclerosis. Proatherogenic stimuli and cardiovascular risk factors, such as dyslipidaemias, diabetes, obesity, and smoking, all increase endothelial permeability sharing a common signalling denominator: an imbalance in the production/disposal of reactive oxygen species (ROS), broadly termed oxidative stress. Mostly as a consequence of the activation of enzymatic systems leading to ROS overproduction, proatherogenic factors lead to a pro-inflammatory status that translates in changes in gene expression and functional rearrangements, including changes in the transendothelial transport of molecules, leading to the deposition of low-density lipoproteins (LDL) and the subsequent infiltration of circulating leucocytes in the intima. In this review, we focus on such early changes in atherogenesis and on the concept that proatherogenic stimuli and risk factors for cardiovascular disease, by altering the endothelial barrier properties, co-ordinately trigger the accumulation of LDL in the intima and ultimately plaque formation.

Hydraulic conductivity and low-density lipoprotein transport of the venous graft wall in an arterial bypass

Background

Blood flow condition may have influence upon the hydraulic conductivity of venous graft (L_p,vein) in an arterial bypass, then affecting the accumulation of low-density lipoproteins (LDLs) within the graft wall. To probe this possibility, we first measured in vitro the filtration rates of swine lateral saphenous vein segments under different flow rates, and the correlation of L_p,vein with wall shear stress (WSS) was then obtained.

Results

The experimental results showed that when WSS was very low, L_p,vein would increase drastically with WSS from 1.16 ± 0.15 × 10⁻¹¹ m/s Pa at 0 dyn/cm² to 2.17 ± 0.20 × 10⁻¹¹ m/s Pa at 0.7 dyn/cm², then became constant of approximately 2.33 × 10⁻¹¹ m/s Pa as the WSS increased further. Based on the experimental results, we assumed three different cases of L_p,vein and numerically simulated the LDLs transport in an arterial bypass model with venous graft. Case A: L_p,vein = 2.33 × 10⁻¹¹ m/s Pa; Case B: L_p,vein = 1.16 × 10⁻¹¹ m/s Pa (static condition with WSS of 0); Case C: L_p,vein was shear dependent. The simulation showed that the deposition/accumulation of LDLs within the venous graft wall in Case A was greatly enhanced when compared with that in Case B. However, the LDL accumulation in the graft wall was similar for Case A and Case C.

Conclusions

Our study, therefore, indicates that when the venous graft was implanted as a bypass graft, the L_p,vein might remain nearly constant along its whole length except for very few areas where the value of WSS was extremely low (less than 0.7 dyn/cm²) and the effects of L_p,vein modulated by blood flow on LDL transport may be neglected.

Numerical simulation of haemodynamics and low-density lipoprotein transport in the rabbit aorta and their correlation with atherosclerotic plaque thickness

Two mechanisms of shear stress and mass transport have been recognized to play an important role in the development of localized atherosclerosis. However, their relationship and roles in atherogenesis are still obscure. It is necessary to investigate quantitatively the correlation among low-density lipoproteins (LDL) transport, haemodynamic parameters and plaque thickness. We simulated blood flow and LDL transport in rabbit aorta using computational fluid dynamics and evaluated plaque thickness in the aorta of a high-fat-diet rabbit. The numerical results show that regions with high luminal LDL concentration tend to have severely negative haemodynamic environments (HEs). However, for regions with moderately and slightly high luminal LDL concentration, the relationship between LDL concentration and the above haemodynamic indicators is not clear cut. Point-by-point correlation with experimental results indicates that severe atherosclerotic plaque corresponds to high LDL concentration and seriously negative HEs, less severe atherosclerotic plaque is related to either moderately high LDL concentration or moderately negative HEs, and there is almost no atherosclerotic plaque in regions with both low LDL concentration and positive HEs. In conclusion, LDL distribution is closely linked to blood flow transport, and the synergetic effects of luminal surface LDL concentration and wall shear stress-based haemodynamic indicators may determine plaque thickness.

Low-density lipoprotein transport through an arterial wall under hypertension - A model with time and pressure dependent fraction of leaky junction consistent with experiments

The influence of hypertension on low-density lipoproteins intake into the arterial wall is an important factor for understanding mechanisms of atherosclerosis. It has been experimentally observed that the increased pressure leads to the higher level of the LDL inside the wall. In this paper we attempt to construct a model of the LDL transport which reproduces quantitatively experimental outcomes. We supplement the well-known four-layer arterial wall model to include two pressure induced effects: the compression of the intima tissue and the increase of the fraction of leaky junctions. We demonstrate that such model can reach the very good agreement with experimental data.

Application of a lattice Boltzmann-immersed boundary method for fluid-filament dynamics and flow sensing

Complex fluid-structure interactions between elastic filaments, or cilia, immersed in viscous flows are commonplace in nature and bear important roles. Some biological systems have evolved to interpret flow-induced motion into signals for the purpose of feedback response. Given the challenges associated with extracting meaningful experimental data at this scale, there has been particular focus on the numerical study of these effects. Porous models have proven useful where cilia arrangements are relatively dense, but for more sparse configurations the dynamic interactions of individual structures play a greater role and direct modelling becomes increasingly necessary. The present study reports efforts towards explicit modelling of regularly spaced wall-mounted cilia using a lattice Boltzmann-immersed boundary method. Both steady and forced unsteady 2D channel flows at different Reynolds numbers are investigated, with and without the presence of a periodic array of elastic inextensible filaments. It is demonstrated that the structure response depends significantly on Reynolds number. For low Reynolds flow, the recirculation vortex aft of successive filaments is small relative to the cilia spacing and does not fully bridge the gap, in which case the structure lags the flow. At higher Reynolds number, when this gap is fully bridged the structure and flow move in phase. The trapping of vortices between cilia is associated with relatively lower wall shear stress. At low to intermediate Reynolds, vortex bridging is incomplete and large deflection is still possible, which is reflected in the tip dynamics and wall shear stress profiles.

Aquaporin-1 shifts the critical transmural pressure to compress the aortic intima and change transmural flow: theory and implications

Transmural-pressure (ΔP)-driven plasma advection carries macromolecules into the vessel wall, the earliest prelesion atherosclerotic event. The wall's hydraulic conductivity, LP, the water flux-to-ΔP ratio, is high at low pressures, rapidly decreases, and remains flat to high pressures (Baldwin AL, Wilson LM. Am J Physiol Heart Circ Physiol 264: H26-H32, 1993; Nguyen T, Toussaint, Xue JD, Raval Y, Cancel CB, Russell LM, Shou S, Sedes Y, Sun O, Yakobov Y, Tarbell JM, Jan KM, Rumschitzki DS. Am J Physiol Heart Circ Physiol 308: H1051-H1064, 2015; Tedgui A, Lever MJ. Am J Physiol Heart Circ Physiol. 247: H784-H791, 1984. Shou Y, Jan KM, Rumschitzki DS. Am J Physiol Heart Circ Physiol 291: H2758-H2771, 2006) due to pressure-induced subendothelial intima (SI) compression that causes endothelial cells to partially block internal elastic laminar fenestrae. Nguyen et al. showed that rat and bovine aortic endothelial cells express the membrane protein aquaporin-1 (AQP1) and transmural water transport is both transcellular and paracellular. They found that LP lowering by AQP1 blocking was perplexingly ΔP dependent. We hypothesize that AQP1 blocking lowers average SI pressure; therefore, a lower ΔP achieves the critical force/area on the endothelium to partially block fenestrae. To test this hypothesis, we improve the approximate model of Huang et al. (Huang Y, Rumschitzki D, Chien S, Weinbaum SS. Am J Physiol Heart Circ Physiol 272: H2023-H2039, 1997) and extend it by including transcellular AQP1 water flow. Results confirm the observation by Nguyen et al.: wall LP and water transport decrease with AQP1 disabling. The model predicts 1) low-pressure LP experiments correctly; 2) AQP1s contribute 30-40% to both the phenomenological endothelial + SI and intrinsic endothelial LP; 3) the force on the endothelium for partial SI decompression with functioning AQP1s at 60 mmHg equals that on the endothelium at ∼43 mmHg with inactive AQP1s; and 4) increasing endothelial AQP1 expression increases wall LP and shifts the ΔP regime where LP drops to significantly higher ΔP than in Huang et al. Thus AQP1 upregulation (elevated wall LP) might dilute and slow low-density lipoprotein binding to SI extracellular matrix, which may be beneficial for early atherogenesis.

Low-density lipoprotein accumulation within a carotid artery with multilayer elastic porous wall: fluid-structure interaction and non-Newtonian considerations

Low-density lipoprotein (LDL), which is recognized as bad cholesterol, typically has been regarded as a main cause of atherosclerosis. LDL infiltration across arterial wall and subsequent formation of Ox-LDL could lead to atherogenesis. In the present study, combined effects of non-Newtonian fluid behavior and fluid-structure interaction (FSI) on LDL mass transfer inside an artery and through its multilayer arterial wall are examined numerically. Navier-Stokes equations for the blood flow inside the lumen and modified Darcy's model for the power-law fluid through the porous arterial wall are coupled with the equations of mass transfer to describe LDL distributions in various segments of the artery. In addition, the arterial wall is considered as a heterogeneous permeable elastic medium. Thus, elastodynamics equation is invoked to examine effects of different wall elasticity on LDL distribution in the artery. Findings suggest that non-Newtonian behavior of filtrated plasma within the wall enhances LDL accumulation meaningfully. Moreover, results demonstrate that at high blood pressure and due to the wall elasticity, endothelium pores expand, which cause significant variations on endothelium physiological properties in a way that lead to higher LDL accumulation. Additionally, results describe that under hypertension, by increasing angular strain, endothelial junctions especially at leaky sites expand more dramatic for the high elastic model, which in turn causes higher LDL accumulation across the intima layer and elevates atherogenesis risk.

Analysis of flow and LDL concentration polarization in siphon of internal carotid artery: Non-Newtonian effects

Carotid siphon is known as one of the risky sites among the human intracranial arteries, which is prone to formation of atherosclerotic lesions. Indeed, scientists believe that accumulation of low density lipoprotein (LDL) inside the lumen is the major cause of atherosclerosis. To this aim, three types of internal carotid artery (ICA) siphon have been constructed to examine variations of hemodynamic parameters in different regions of the arteries. Providing real physiological conditions, blood considered as non-Newtonian fluid and real velocity and pressure waveforms have been employed as flow boundary conditions. Moreover, to have a better estimation of risky sites, the accumulation of LDL particles has been considered, which has been usually ignored in previous relevant studies. Governing equations have been discretized and solved via open source OpenFOAM software. A new solver has been built to meet essential parameters related to the flow and mass transfer phenomena. In contrast to the common belief regarding negligible effect of blood non-Newtonian behavior inside large arteries, current study suggests that the non-Newtonian blood behavior is notable, especially on the velocity field of the U-type model. In addition, it is concluded that neglecting non-Newtonian effects underestimates the LDL accumulation up to 3% in the U-type model at the inner side of both its bends. However, in the V and C type models, non-Newtonian effects become relatively small. Results also emphasize that the outer part of the second bend at the downstream is also at risk similar to the inner part of the carotid bends. Furthermore, from findings it can be implied that the risky sites strongly depend on the ICA shape since the extension of the risky sites are relatively larger for the V-type model, while the LDL concentrations are higher for the C-type model.

Simulation of contrast agent transport in arteries with multilayer arterial wall: impact of arterial transmural transport on the bolus delay and dispersion

One assumption of DSC-MRI is that the injected contrast agent is kept totally intravascular and the arterial wall is impermeable to contrast agent. The assumption is unreal for such small contrast agent as Gd-DTPA can leak into the arterial wall. To investigate whether the unreal assumption is valid for the estimation of the delay and dispersion of the contrast agent bolus, we simulated flow and Gd-DTPA transport in a model with multilayer arterial wall and analyzed the bolus delay and dispersion qualified by mean vascular transit time (MVTT) and the variance of the vascular transport function. Factors that may affect Gd-DTPA transport hence the delay and dispersion were further investigated, such as integrity of endothelium and disturbed flow. The results revealed that arterial transmural transport would slightly affect MVTT and moderately increase the variance. In addition, although the integrity of endothelium can significantly affect the accumulation of contrast agent in the arterial wall, it had small effects on the bolus delay and dispersion. However, the disturbed flow would significantly increase both MVTT and the variance. In conclusion, arterial transmural transport may have a small effect on the bolus delay and dispersion when compared to the flow pattern in the artery.

Modelling and simulation of low-density lipoprotein transport through multi-layered wall of an anatomically realistic carotid artery bifurcation

A high concentration of low-density lipoprotein (LDL) is recognized as one of the principal risk factors for development of atherosclerosis. This paper reports on modelling and simulations of the coupled mass (LDL concentration) and momentum transport through the arterial lumen and the multi-layered arterial wall of an anatomically realistic carotid bifurcation. The mathematical model includes equations for conservation of mass, momentum and concentration, which take into account a porous layer structure, the biological membranes and reactive source/sink terms in different layers of the arterial wall, as proposed in Yang & Vafai (2006). A four-layer wall model of an arterial wall with constant thickness is introduced and initially tested on a simple cylinder geometry where realistic layer properties are specified. Comparative assessment with previously published results demonstrated proper implementation of the mathematical model. Excellent agreement for the velocity and LDL concentration distributions in the arterial lumen and in the artery wall are obtained. Then, an anatomically realistic carotid artery bifurcation is studied. This is the main novelty of the presented research. We find a strong dependence between underlying blood flow pattern (and consequently the wall shear stress distributions) and the uptake of the LDL concentration in the artery wall. The radial dependency of interactions between the diffusion, convection and chemical reactions within the multi-layered artery wall is crucial for accurate predictions of the LDL concentration in the media. It is shown that a four-layer wall model produced qualitatively good agreement with the experimental results of Meyer et al. (1996) in predicting levels of LDL within the media of a rabbit aorta under identical transmural pressure conditions. Finally, it is demonstrated that the adopted model represents a good initial platform for future numerical investigations of the initial stage of atherosclerosis for patient-specific geometries.

Numerical simulation of nucleotide transport in the human thoracic aorta

Extracellular adenine nucleotides ATP and ADP on vascular endothelial cells may play a role in the localization of atherogenesis by regulating the release of nitric oxide from endothelial cells and modulating intracellular calcium levels. To quantitatively investigate the concentration distribution of nucleotides on the luminal surface of the human thoracic aorta, we numerically simulated the transport of nucleotides using an aorta model constructed based on MRI images and analyzed the effects of different factors on nucleotide transport, such as ATP release rate (S(ATP)), pulsatile flow and the absence of ATP in the main blood stream. The numerical results revealed that the combined concentration of ATP and ADP (c(w-ATP+ADP)) on the aortic surface varied from place to place, being relatively low in disturbed flow regions. In addition, c(w-ATP+ADP) was significantly affected by S(ATP). For relatively slow S(ATP), such as the moderate sigmoidal release model, c(w-ATP+ADP) was very low in certain flow regions with low wall shear stress. However, for very rapid S(ATP), such as the rapid linear release model, c(w-ATP+ADP) was relatively high in these same regions. The results also demonstrated that for relatively slow S(ATP), pulsatile blood flow enhanced c(w-ATP+ADP). However, for very rapid S(ATP), pulsatile blood flow would reduce c(w-ATP+ADP). Moreover, the absence of ATP within the main blood stream would not influence the distribution of c(w-ATP+ADP). In conclusion, the concentration distribution of nucleotides along the aortic wall was quite uneven and determined by both the ATP release rate and the blood flow pattern in the aorta.

Nitric oxide transport in an axisymmetric stenosis

To test the hypothesis that disturbed flow can impede the transport of nitric oxide (NO) in the artery and hence induce atherogenesis, we used a lumen-wall model of an idealized arterial stenosis with NO produced at the blood vessel-wall interface to study the transport of NO in the stenosis. Blood flows in the lumen and through the arterial wall were simulated by Navier-Stokes equations and Darcy's Law, respectively. Meanwhile, the transport of NO in the lumen and the transport of NO within the arterial wall were modelled by advection-diffusion reaction equations. Coupling of fluid dynamics at the endothelium was achieved by the Kedem-Katchalsky equations. The results showed that both the hydraulic conductivity of the endothelium and the non-Newtonian viscous behaviour of blood had little effect on the distribution of NO. However, the blood flow rate, stenosis severity, red blood cells (RBCs), RBC-free layer and NO production rate at the blood vessel-wall interface could significantly affect the transport of NO. The theoretical study revealed that the transport of NO was significantly hindered in the disturbed flow region distal to the stenosis. The reduced NO concentration in the disturbed flow region might play an important role in the localized genesis and development of atherosclerosis.