Microfluidics for simultaneous quantification of platelet adhesion and blood viscosity

Engineering Organ-on-a-Chip Systems for Vascular Diseases

Vascular diseases, such as atherosclerosis and thrombosis, are major causes of morbidity and mortality worldwide. Traditional in vitro models for studying vascular diseases have limitations, as they do not fully recapitulate the complexity of the in vivo microenvironment. Organ-on-a-chip systems have emerged as a promising approach for modeling vascular diseases by incorporating multiple cell types, mechanical and biochemical cues, and fluid flow in a microscale platform. This review provides an overview of recent advancements in engineering organ-on-a-chip systems for modeling vascular diseases, including the use of microfluidic channels, ECM (extracellular matrix) scaffolds, and patient-specific cells. We also discuss the limitations and future perspectives of organ-on-a-chip for modeling vascular diseases.

Microfluidic techniques for mechanical measurements of biological samples

The use of microfluidics to make mechanical property measurements is increasingly common. Fabrication of microfluidic devices has enabled various types of flow control and sensor integration at micrometer length scales to interrogate biological materials. For rheological measurements of biofluids, the small length scales are well suited to reach high rates, and measurements can be made on droplet-sized samples. The control of flow fields, constrictions, and external fields can be used in microfluidics to make mechanical measurements of individual bioparticle properties, often at high sampling rates for high-throughput measurements. Microfluidics also enables the measurement of bio-surfaces, such as the elasticity and permeability properties of layers of cells cultured in microfluidic devices. Recent progress on these topics is reviewed, and future directions are discussed.

Thrombosis Models: An Overview of Common In Vivo and In Vitro Models of Thrombosis

Occlusions in the blood vessels caused by blood clots, referred to as thrombosis, and the subsequent outcomes are leading causes of morbidity and mortality worldwide. In vitro and in vivo models of thrombosis have advanced our understanding of the complex pathways involved in its development and allowed the evaluation of different therapeutic approaches for its management. This review summarizes different commonly used approaches to induce thrombosis in vivo and in vitro, without detailing the protocols for each technique or the mechanism of thrombus development. For ease of flow, a schematic illustration of the models mentioned in the review is shown below. Considering the number of available approaches, we emphasize the importance of standardizing thrombosis models in research per study aim and application, as different pathophysiological mechanisms are involved in each model, and they exert varying responses to the same carried tests. For the time being, the selection of the appropriate model depends on several factors, including the available settings and research facilities, the aim of the research and its application, and the researchers' experience and ability to perform surgical interventions if needed.

Normalization of Blood Viscosity According to the Hematocrit and the Shear Rate

The rheological properties of blood depend highly on the properties of its red blood cells: concentration, membrane elasticity, and aggregation. These properties affect the viscosity of blood as well as its shear thinning behavior. Using an experimental analysis of the interface advancement of blood in a microchannel, we determine the viscosity of different samples of blood. In this work, we present two methods that successfully normalize the viscosity of blood for a single and for different donors, first according to the concentration of erythrocytes and second according to the shear rate. The proposed methodology is able to predict the health conditions of the blood samples by introducing a non-dimensional coefficient that accounts for the response to shear rate of the different donors blood samples. By means of these normalization methods, we were able to determine the differences between the red blood cells of the samples and define a range where healthy blood samples can be described by a single behavior.

Microfluidics Approach to the Mechanical Properties of Red Blood Cell Membrane and Their Effect on Blood Rheology

In this article, we describe the general features of red blood cell membranes and their effect on blood flow and blood rheology. We first present a basic description of membranes and move forward to red blood cell membranes’ characteristics and modeling. We later review the specific properties of red blood cells, presenting recent numerical and experimental microfluidics studies that elucidate the effect of the elastic properties of the red blood cell membrane on blood flow and hemorheology. Finally, we describe specific hemorheological pathologies directly related to the mechanical properties of red blood cells and their effect on microcirculation, reviewing microfluidic applications for the diagnosis and treatment of these diseases.

Blood rheometer based on microflow manipulation of continuous blood flows using push-and-back mechanism

To understand the contributions of rheological properties to microcirculation, the simultaneous measurement of multiple rheological properties under continuous blood flows has been emphasized. However, existing methods exhibit limitations in terms of continuous and simultaneous monitoring. In this study, a simple method is suggested for simultaneously measuring four rheological properties (i.e., red blood cell (RBC) aggregation, blood viscosity, blood junction pressure, and RBC sedimentation) under a continuous blood flow. Using the push-and-back mechanism, which comprises a co-flowing channel, a test chamber, and an air compliance unit (ACU), blood is supplied to the test chamber and restored into the co-flowing channel periodically and reversely. First, RBC aggregation is quantified based on the intensity of the blood image in the test chamber. Second, blood viscosity and blood junction pressure are determined by analyzing the interface in the co-flowing channel. Lastly, RBC sedimentation is evaluated by analyzing the intensity of the blood image in the blood chamber. Based on quantitative studies involving several vital factors, the tubing length of ACU is set to L = 30 mm. The reference fluid (glycerin [20%]) is controlled in a periodic on-off manner (period = 240 s, and flow rate = 1 mL h^-1). The blood flow rate is maintained at 1 mL h^-1. Subsequently, the present method is used to determine the rheological properties of several blood samples with different hematocrits or diluents. Compared with previous studies, the present method yields sufficiently consistent trends with respect to the hematocrit level or concentration of dextran solution. The experimental results imply that the present method enables simultaneous and consistent measurements of four rheological properties of blood under continuous blood flows. This method can be regarded as a promising method for monitoring multiple rheological properties of blood circulating under an in vitro closed fluidic circuit.

Super-resolution imaging and quantification of megakaryocytes and platelets

Recent advances in super-resolution (sub-diffraction limited) microscopy have yielded remarkable insights into the nanoscale architecture and behavior of cells. In addition to the capacity to provide sub 100 nm resolution, these technologies offer unique quantitative opportunities with particular relevance to platelet and megakaryocyte biology. In this review, we provide a short introduction to modern super-resolution microscopy, its applications in the field of platelet and megakaryocyte biology, and emerging quantitative approaches which will allow for unprecedented insights into the biology of these unique cell types.

Technology Advancements in Blood Coagulation Measurements for Point-of-Care Diagnostic Testing

In recent years, blood coagulation monitoring has become crucial to diagnosing causes of hemorrhages, developing anticoagulant drugs, assessing bleeding risk in extensive surgery procedures and dialysis, and investigating the efficacy of hemostatic therapies. In this regard, advanced technologies such as microfluidics, fluorescent microscopy, electrochemical sensing, photoacoustic detection, and micro/nano electromechanical systems (MEMS/NEMS) have been employed to develop highly accurate, robust, and cost-effective point of care (POC) devices. These devices measure electrochemical, optical, and mechanical parameters of clotting blood. Which can be correlated to light transmission/scattering, electrical impedance, and viscoelastic properties. In this regard, this paper discusses the working principles of blood coagulation monitoring, physical and sensing parameters in different technologies. In addition, we discussed the recent progress in developing nanomaterials for blood coagulation detection and treatments which opens up new area of controlling and monitoring of coagulation at the same time in the future. Moreover, commercial products, future trends/challenges in blood coagulation monitoring including novel anticoagulant therapies, multiplexed sensing platforms, and the application of artificial intelligence in diagnosis and monitoring have been included.

Laser speckle decorrelation time-based platelet function testing in microfluidic system

Platelet aggregation and adhesion are critically involved in both normal hemostasis and thrombosis during vascular injury. Before any surgery, it is important to identify the number of platelets and their functionality to reduce the risk of bleeding; therefore, platelet function testing is a requirement. We introduce a novel evaluation method of assessing platelet function with laser speckle contrast imaging. The speckle decorrelation time (SDT) of the blood flowing through a microfluidic channel chip provides a quantitative measure of platelet aggregation. We compared SDTs of whole blood and platelet-poor blood, i.e., whole blood stripped of its buffy coat region, and found a marked reduction in decorrelation time for platelet-poor blood. The measured SDT of platelet-poor blood was 1.04 ± 0.21 ms, while that of whole blood was 2.64 ± 0.83 ms. To further characterize the sensitivity of our speckle decorrelation time-based platelet function testing (SDT-PFT), we added various agonists involved in platelet aggregation, including adenosine diphosphate (ADP), epinephrine (EPI), and arachidonic acid (AA). In this study, the results show that whole blood with ADP resulted in the largest SDT, followed by whole blood with AA, whole blood with EPI, whole blood without agonist, and platelet-poor blood with or without agonist. These findings show that SDT-PFT has the potential for rapid screening of bleeding disorders and monitoring of anti-platelet therapies with only a small volume of blood.

A dual-responsive biosensor for blood lead detection

Simple and accurate detection of trace heavy metals in blood is very important. A novel dual-responsive electrochemical/fluorescent biosensor based on magnetic hyperbranched polyamide with heparin modification (MHPAM-H) for blood lead detection has been successfully developed. Upon conjugated with blood lead ions, dual-biosensor could not only display electrochemical signal but also fluorescence signal owing to the enriched amino groups, cavity structure, and good fluorescence properties of HPAM. Blood biocompatibility, construction of the dual-responsive biosensor, electrochemical/fluorescent detection of lead ions in water phase and blood condition, selectivity and stability of the dual-responsive biosensor were investigated in detail. The proposed dual-responsive biosensor displays good linear relationship (1.5 pM- 4.8 × 10³ pM for electrochemical detection and 0.5 pM-4.8 × 10³ pM for fluorescent detection) with low detection limit (4.4 pM for electrochemical detection and 1.0 pM for fluorescent detection) for blood lead, providing potential application for blood lead detection in the future.

Effect of leukoreduction and pathogen reduction on the hemostatic function of whole blood

BACKGROUND

There is renewed interest in the use of whole blood (WB) for resuscitation of patients in hemorrhagic shock. Leukoreduction with platelet-sparing filters and pathogen reduction may be used to improve the safety profile of WB, yet the effects of leukoreduction and pathogen reduction on WB hemostatic function are not well characterized.

STUDY DESIGN AND METHODS

Blood from 32 healthy group O donors was divided into treatment groups (n = 8 for each group): untreated, pathogen reduced (PR⁺ ), leukoreduced using an in-line filter (LR⁺ ), or PR⁺ LR⁺ . Units were stored without agitation for 21 days between 1° and 6°C, with sampling on days 0 (pre- and post-treatments), 1, 3, 5, 10, 15, and 21 for hemostatic function as assessed by thromboelastometry, thrombin generation, platelet activation factors, and platelet impedance aggregometry.

RESULTS

From day 3 (D3) to D15 of storage, platelet count was reduced in PR⁺ /LR⁺ units compared to PR^- /LR^- units. From D10 to D21 of storage, maximum clot firmness (MCF) was reduced in PR⁺ /LR⁺ units compared to PR^- /LR^- units. From D3 to D21 of storage, platelet aggregation was reduced in PR⁺ /LR⁺ units compared to PR^- /LR^- units. Total thrombin generation was similar in all groups from D0 to D21.

CONCLUSIONS

The combination of LR with a platelet-sparing filter and PR significantly reduces hemostatic function compared to either treatment alone or untreated WB. The clinical consequences of LR and PR of WB in patients with severe bleeding should be examined in trials before both are used in combination in patients.

TNF-α-driven inflammation and mitochondrial dysfunction define the platelet hyperreactivity of aging

Aging and chronic inflammation are independent risk factors for the development of atherothrombosis and cardiovascular disease. We hypothesized that aging-associated inflammation promotes the development of platelet hyperreactivity and increases thrombotic risk during aging. Functional platelet studies in aged-frail adults and old mice demonstrated that their platelets are hyperreactive and form larger thrombi. We identified tumor necrosis factor α (TNF-α) as the key aging-associated proinflammatory cytokine responsible for platelet hyperreactivity. We further showed that platelet hyperreactivity is neutralized by abrogating signaling through TNF-α receptors in vivo in a mouse model of aging. Analysis of the bone marrow compartments showed significant platelet-biased hematopoiesis in old mice reflected by increased megakaryocyte-committed progenitor cells, megakaryocyte ploidy status, and thrombocytosis. Single-cell RNA-sequencing analysis of native mouse megakaryocytes showed significant reprogramming of inflammatory, metabolic, and mitochondrial gene pathways in old mice that appeared to play a significant role in determining platelet hyperreactivity. Platelets from old mice (where TNF-α was endogenously increased) and from young mice exposed to exogenous TNF-α exhibited significant mitochondrial changes characterized by elevated mitochondrial mass and increased oxygen consumption during activation. These mitochondrial changes were mitigated upon TNF-α blockade. Similar increases in platelet mitochondrial mass were seen in platelets from patients with myeloproliferative neoplasms, where TNF-α levels are also increased. Furthermore, metabolomics studies of platelets from young and old mice demonstrated age-dependent metabolic profiles that may differentially poise platelets for activation. Altogether, we present previously unrecognized evidence that TNF-α critically regulates megakaryocytes resident in the bone marrow niche and aging-associated platelet hyperreactivity and thrombosis.

In vitro and ex vivo measurement of the biophysical properties of blood using microfluidic platforms and animal models

Haemorheologically impaired microcirculation, such as blood clotting or abnormal blood flow, causes interrupted blood flows in vascular networks. The biophysical properties of blood, including blood viscosity, blood viscoelasticity, haematocrit, red blood bell (RBC) aggregation, erythrocyte sedimentation rate and RBC deformability, have been used to monitor haematological diseases. In this review, we summarise several techniques for measuring haemorheological properties, such as blood viscosity, RBC deformability and RBC aggregation, using in vitro microfluidic platforms. Several methodologies for the measurement of haemorheological properties with the assistance of an extracorporeal rat bypass loop are also presented. We briefly discuss several emerging technologies for continuous, long-term, multiple measurements of haemorheological properties under in vitro or ex vivo conditions.

3D printed microfluidic viscometer based on the co-flowing stream

Considering the role of viscosity in the dynamics of physical, chemical, and biological systems, accurate measurement of viscosity is essential. Although many conventional viscometers have been widely used, these conventional viscometers suffer from some drawbacks. In this study, a three-dimensional (3D) printed microfluidic viscometer was proposed based on the estimation of the pressure between two fluids to easily measure viscosity with small samples. The 3D printed microfluidic viscometer can be fabricated through amine-epoxy bonding on 3D printed blocks. By separately delivering samples and reference fluids into two inlets, an interfacial line could be induced. Based on the relation between the pressure ratio and the width of the reference flow, the viscosity (μ) of the sample can be estimated by measuring the relative width of the reference flow. The relation between the pressure and interfacial width between test samples and reference flows in the 3D printed microfluidic viscometers was analyzed by experiment and simulation to determine the effects of the mesh-like pattern of the 3D printed viscometers on the pressure estimation. To validate the proposed method, the viscosity values of glycerol mixtures measured by the 3D printed viscometer were compared with those measured by a conventional viscometer. As an application of the 3D printed viscometer, the viscosity curves for blood samples collected from diabetic and non-diabetic patients depending on their shear rates were compared. As expected, a high blood viscosity in the diabetic group was observed. Based on the experimental demonstrations, the 3D printed viscometer has strong potential to develop portable viscometers that can be translated to commercial outcomes.

Plasmapheresis for hypertriglyceridemia: The association between blood viscosity and triglyceride clearance rate

OBJECTIVES

Several factors in double filtration plasmapheresis (DFPP) were associated with triglyceride (TG) clearance rate. This study examines whether baseline whole blood viscosity was a predictor for efficient TG removal.

METHODS

Adult subjects who receiving DFPP for hyperlipidemia in Taoyuan General Hospital from January 2015 to March 2018 were classified into efficient and inefficient TG removal according to TG removal rate ≥50% vs <50%. TG removal rate was defined as following formula: (pre-apheresis TG- post-apheresis TG)/pre-apheresis TG. Whole blood viscosity (WBV) was estimated by following equation: WBV = 0.12 × hematocrit +0.17 × (total protein -2.07). Univariate linear regression was used to assess the association between TG removal rate and WBV. Odds ratios (ORs) and 95% confidence interval (95%CI) for associations between variables and efficient TG removal were evaluated by logistic regression model to including univariate and multivariate adjustment.

RESULTS

From a total of 66 subjects receiving DFPP, 37 subjects reached efficient TG removal. The difference in pre-apheresis TG levels, hematocrit, and WBV between efficient vs. inefficient TG removal groups was 4.1 vs 6.7 mmol/L; 43.1% vs 39.5%; and 6.0cP vs 5.cP (Ps <0.05). After multivariate adjustment, WBC was a significant predictor for efficient TG removal (ORs and 95% CI were 3.192 (1.300-7.838), P < 0.05). The correlation between WBV and extraction of TG was significant (r = -0.255, P = 0.039).

CONCLUSION

Hyperviscosity reduced the efficiency of TG removal in those receiving DFPP.

Characteristics of pulsatile flows in curved stenosed channels

Spatial and temporal variations of the hemodynamic features occur under pulsatile conditions in complex vessel geometry. Wall shear stress affected by the disturbed flow can result in endothelial cell dysfunction, which leads to atherogenesis and thrombosis. Therefore, detailed understanding of the hemodynamic characteristics in a curved stenosed channel is highly important when examining the pathological effects of hemodynamic phenomena on the progression of atherosclerosis. The present study measures the velocity fields of pulsatile flows with three different Reynolds numbers in 3D curved vessel models with stenosis using time-resolved particle image velocimetry (PIV). Three different models were cast in PDMS polymer using models made by a 3D printer with different bend angles of 0°, 10°, and 20° between the longitudinal axes at the upstream and downstream of the stenosis. To investigate the 3D flow structures, a stack of 2D velocity fields was obtained by adjusting the position of the laser sheet along the Z-direction. The structures of flow fields in the stenosed models were analyzed using the distribution of the shearing strain as well as the skewness and full width at half maximum of the velocity profile. To support experiment results, distributions of pressure and 3D vortex in the curved stenosed channels were estimated by conducting the numerical simulation. These results indicate that the curvature of the tube considerably influences the skewness of the flow, and the shear stress is intensified near the outer curvature wall due to centrifugal force. The results would be helpful in understanding the effects of geometrical factors on plaque rupture and severe cardiovascular diseases.

Microfluidic system for monitoring temporal variations of hemorheological properties and platelet adhesion in LPS-injected rats

Sepsis causes multiple organs failures and eventually death. Changes in blood constituents due to sepsis lead to alterations in hemorheological properties, and cell adhesiveness. In this study, a new microfluidic system is proposed to measure temporal variations in biophysical properties of blood after injecting lipopolysaccharide (LPS) into a rat extracorporeal model under ex vivo condition. To measure blood viscosity, the interfacial line between blood and a reference fluid is formed in a Y-shaped channel. Based on the relation between interfacial width and pressure ratio, the temporal variation in blood viscosity is estimated. Optical images of blood flows are analyzed by decreasing flow rate for examination of red blood cell (RBC) aggregation. Platelets initiated by shear acceleration around the stenosis adhere to the post-stenosed region. By applying a correlation map that visualizes the decorrelation of the streaming blood flow, the area of adhered platelets can be quantitatively attained without labeling of platelets. To assess sepsis inflammation, conventional biomarkers (PCT and IL-8) are also monitored. The increasing tendency for blood viscosity, RBC aggregation, platelet adhesion, and septic biomarkers are observed after LPS injection. This microfluidic system would be beneficial for monitoring the changes in hemorheological properties and platelet activation caused by sepsis.

Utility of microfluidic devices to study the platelet-endothelium interface

The integration of biomaterials and understanding of vascular biology has led to the development of perfusable endothelialized flow models, which have been used as valuable tools to study the platelet-endothelium interface under shear. In these models, the parameters of geometry, compliance, biorheology, and cellular complexity are varied to recapitulate the physical biology of platelet recruitment and activation under physiologically relevant conditions of blood flow. In this review, we summarize the mechanistic insights learned from perfusable microvessel models and discuss the potential utility as well as challenges of endothelialized microfluidic devices to study platelet function in the bloodstream in vitro.

Microfluidic measurement for blood flow and platelet adhesion around a stenotic channel: Effects of tile size on the detection of platelet adhesion in a correlation map

Platelet aggregation affects the surrounding blood flow and usually occurs where a blood vessel is narrowed as a result of atherosclerosis. The relationship between blood flow and platelet aggregation is not yet fully understood. This study proposes a microfluidic method to measure the velocity and platelet aggregation simultaneously by combining the micro-particle image velocimetry technique and a correlation mapping method. The blood flow and platelet adhesion procedure in a stenotic micro-channel with 90% severity were observed for a relatively long period of 4 min. In order to investigate the effect of tile size on the detection of platelet adhesion, 2D correlation coefficients were evaluated with binary images obtained by manual labeling and the correlation mapping method with different sizes of the square tile ranging from 3 to 50 pixels. The maximum 2D correlation coefficient occurred with the optimum tile size of 5 × 5 pixels. Since the blood flow and platelet aggregation are mutually influenced by each other, blood flow and platelet adhesion were continuously varied. When there was no platelet adhesion (t = 0 min), typical blood flow is observed. The blood flow passes through the whole channel smoothly, and jet-like flow occurs in the post-stenosis region. However, the flow pattern changes when platelet adhesion starts at the stenosis apex and after the stenosis. These adhesions induce narrow high velocity regions to become wider over a range of area from upstream to downstream of the stenosis. Separated jet-like flows with two high velocity regions are also created. The changes in flow patterns may alter the patterns of platelet adhesion. As the area of the plate adhesion increases, the platelets plug the micro-channel and there is only a small amount of blood flow, finally. The microfluidic method could provide new insights for better understanding of the interactions between platelet aggregation and blood flow in various physiological conditions.