Haemodynamic flow conditions at the initiation of high-shear platelet aggregation: a combined in vitro and cellular in silico study

Carotid single- and dual-layer stents reduce the wall adhesion of platelets by influencing flow and cellular transport

An ongoing thrombosis on a ruptured atherosclerotic plaque in the carotid may cause stroke. The primary treatment for patients with tandem lesion is stenting. Dual-layer stents have been introduced as an alternative to single-layer stents for elective and emergent carotid artery stenting. While the dual-layer structure shows promise in reducing plaque prolapse through the stent struts and with it the occurrence of post-procedural embolism, there are early signs that this newer generation of stents is more thrombogenic. We investigate a single- and a dual-layer stent design to assess their influence on a set of thrombosis-related flow factors in a novel setup of combined experiments and simulations. The in vitro results reveal that both stents reduce thrombus formation by approximately 50% when human anticoagulated whole blood was perfused through macrofluidic flow chambers coated with either collagen or human atherosclerotic plaque homogenates. Simulations predict that the primary cause is reduced platelet presence in the vicinity of the wall, due to the influence of stents on flow and cellular transport. Both stents significantly alter the near-wall flow conditions, modifying shear rate, shear gradient, cell-free zones, and platelet availability. Additionally, the dual-layer stent has further increased local shear rates on the inner struts. It also displays increased stagnation zones and reduced recirculation between the outer-layer struts. Finally, the dual-layer stent shows further reduced adhesion over an atherosclerotic plaque coating. The novel approach presented here can be used to improve the design optimization process of cardiovascular stents in the future by allowing an in-depth study of the emerging flow characteristics and agonist transport.

The effect of flow-derived mechanical cues on the growth and morphology of platelet aggregates under low, medium, and high shear rates

Platelet aggregation is a dynamic process that can obstruct blood flow, leading to cardiovascular diseases. While many studies have demonstrated clear connections between shear rate and platelet aggregation, the impact of flow-derived mechanical signals on this process is not fully understood. The objective of this work is to investigate the role of flow conditions on platelet aggregation dynamics, including effects on growth, shape, density composition, and their potential correlation with binding processes that are characterised by longer (e.g., via αIIbβ3 integrin) and shorter (e.g., via VWF) initial binding times. In vitro blood perfusion experiments were conducted at wall shear rates of 800, 1600 and 4000 s-1. Detailed analysis of two modalities of experimental images was performed to offer insights into the morphology of platelet aggregates. A consistent structural pattern was observed across all samples: a high-density core enveloped by a low-density outer shell. An image-based 3D computational blood flow model was subsequently employed to study the local flow conditions, including binding availability time and flow-derived mechanical signals via shear rate and rate of elongation. The results show substantial dependence of the aggregation dynamics on these flow parameters. We found that the different binding mechanisms that prefer different flow regimes do not have a monotonic cross-over in efficiency as the flow increases. There is a significant dip in the cumulative aggregation potential in-between the preferred regimes. The results suggest that treatments targeting the biomechanical pathways could benefit from creating conditions that exploit these low-efficiency zones of aggregation.

Evaluating the impact of transient shear stress on platelet activation, adhesion, and aggregation with microfluidic chip technique

BACKGROUND

When nonphysiological stenosis occurs, the transient high shear stress formed in vessels increases the risk of thrombosis and is a potential factor for cardiovascular diseases. But the platelet adhesion and aggregation behavior at nonphysiological post-stenosis and its affecting factors are not fully understood yet.

METHODS

In this experiment, platelet aggregation on collagen and fibrinogen at different shear stresses and different hematocrits were observed by microfluidic technology. Platelet activation (P-selectin, glycoprotein IIb/IIIa) and monocyte-platelet aggregate (MPA) levels under different shear stresses were analyzed by flow cytometry.

RESULTS

On fibrinogen, platelets aggregate more at higher shear stress conditions. While on collagen, it becomes more difficult for platelets to form stable aggregation at higher shear stress conditions. If platelets adhere initially at low shear stress, stable platelet aggregation can be formed at subsequent high shear stress. Moreover, when the shear stress increases, platelet activity markers (P-selectin, glycoprotein IIb/IIIa and MPAs) increase significantly. Hematocrit affects the degree of platelet aggregation, and the influence of hematocrit is obvious at high shear stress.

CONCLUSION

Transient high shear stress (46 ms) can effectively activate platelets. Platelet aggregation behavior was different for coated fibrinogen and collagen protein. Stable platelet adhesion at post-stenosis is more dependent on fibrinogen and platelet aggregation is stable on both fibrinogen and collagen. Hematocrit can significantly affect the formation of platelet aggregation.

Cellular Blood Flow Modeling with HemoCell

Many of the intriguing properties of blood originate from its cellular nature. Bulk effects, such as viscosity, depend on the local shear rates and on the size of the vessels. While empirical descriptions of bulk rheology are available for decades, their validity is limited to the experimental conditions they were observed under. These are typically artificial scenarios (e.g., perfectly straight glass tube or in pure shear with no gradients). Such conditions make experimental measurements simpler; however, they do not exist in real systems (i.e., in a real human circulatory system). Therefore, as we strive to increase our understanding on the cardiovascular system and improve the accuracy of our computational predictions, we need to incorporate a more comprehensive description of the cellular nature of blood. This, however, presents several computational challenges that can only be addressed by high performance computing. In this chapter, we describe HemoCell ( https://www.hemocell.eu ), an open-source high-performance cellular blood flow simulation, which implements validated mechanical models for red blood cells and is capable of reproducing the emergent transport characteristics of such a complex cellular system. We discuss the accuracy and the range of validity, and demonstrate applications on a series of human diseases.

Bio-inspired microfluidics: A review

Biomicrofluidics, a subdomain of microfluidics, has been inspired by several ideas from nature. However, while the basic inspiration for the same may be drawn from the living world, the translation of all relevant essential functionalities to an artificially engineered framework does not remain trivial. Here, we review the recent progress in bio-inspired microfluidic systems via harnessing the integration of experimental and simulation tools delving into the interface of engineering and biology. Development of "on-chip" technologies as well as their multifarious applications is subsequently discussed, accompanying the relevant advancements in materials and fabrication technology. Pointers toward new directions in research, including an amalgamated fusion of data-driven modeling (such as artificial intelligence and machine learning) and physics-based paradigm, to come up with a human physiological replica on a synthetic bio-chip with due accounting of personalized features, are suggested. These are likely to facilitate physiologically replicating disease modeling on an artificially engineered biochip as well as advance drug development and screening in an expedited route with the minimization of animal and human trials.

Rheology and structure of elastic capsule suspensions within rectangular channels

Three-dimensional simulations of the pressure-driven flow dynamics of elastic capsule suspensions within both slit and rectangular cross-section channels are presented. The simulations utilize the Immersed Boundary Method and the Lattice-Boltzmann Method models. The capsule volume fraction is fixed at 0.1 (i.e., a semi-dilute suspension), while the channel Reynolds number (Re), the capillary number (Ca), and the cross-sectional channel dimensions are systematically varied. Comparing results for slit and rectangular channels, it is found that multi-directional confinement hinders inertial focusing due to the capsule-free layers that develop in the two transverse directions. Furthermore, the thicknesses of the capsule-free layers in the two transverse directions differ when the height and width of the channel are not equal. Both the size and aspect ratio of the channel impact the apparent viscosity. It is found that square channels exhibit maximal viscosity and that holding one dimension fixed while increasing or decreasing the other results in a decrease in viscosity. The results therefore represent an expansion of the Fahraeus-Lindqvist effect from 1D cylindrical channels to 2D rectangular channels.

Influence of multiple stenoses on thrombosis formation: an in vitro study

Multiple lesions in the same vessel is one of the most common situations found in patients suffering from cardiovascular diseases, this complicates not only the assessment of the severity of each one but also their treatment. To date, the effect of multiple stenoses on different parameters has been simulated by numerical studies. Few others have implemented in vitro platforms for their investigation. However, visualization of thrombosis formation in this kind of lesion is still needed. This in vitro study monitors the formation of thrombus inside microchannels having one, two, and three stenoses. Whole blood was perfused through each channel at high shear rates (> 12,000 s−1), generating thrombosis. Flow changes across each lesion as well as the final percentage of aggregations were monitored. Thus, the location where total occlusion could be produced was found to be the first stenosis for all the cases. Less flow reaching the second and third stenoses was observed which demonstrates that aggregations were growing at the first one. This was verified by measuring the percentage of aggregations at the end of the test.

Application of machine learning in predicting blood flow and red cell distribution in capillary vessel networks

Capillary blood vessels in the body partake in the exchange of gas and nutrients with tissues. They are interconnected via multiple vascular junctions forming the microvascular network. Distributions of blood flow and red cells (RBCs) in such networks are spatially uneven and vary in time. Since they dictate the pathophysiology of tissues, their knowledge is important. Theoretical models used to obtain flow and RBC distribution in large networks have limitations as they treat each vessel as a one-dimensional segment and do not explicitly consider cell-cell and cell-vessel interactions. High-fidelity computational models that accurately model each individual RBC are computationally too expensive to predict haemodynamics in large vascular networks and over a long time. Here we investigate the applicability of machine learning (ML) techniques to predict blood flow and RBC distributions in physiologically realistic vascular networks. We acquire data from high-fidelity simulations of deformable RBC suspension flowing in the networks. With the flow and haematocrit specified at an inlet of vasculature, the ML models predict the time-averaged flow rate and RBC distributions in the entire network, time-dependent flow rate and haematocrit in each vessel and vascular bifurcation in isolation over a long time, and finally, simultaneous spatially and temporally evolving quantities through the vessel hierarchy in the networks.

Computational investigation of blood cell transport in retinal microaneurysms

Microaneurysms (MAs) are one of the earliest clinically visible signs of diabetic retinopathy (DR). MA leakage or rupture may precipitate local pathology in the surrounding neural retina that impacts visual function. Thrombosis in MAs may affect their turnover time, an indicator associated with visual and anatomic outcomes in the diabetic eyes. In this work, we perform computational modeling of blood flow in microchannels containing various MAs to investigate the pathologies of MAs in DR. The particle-based model employed in this study can explicitly represent red blood cells (RBCs) and platelets as well as their interaction in the blood flow, a process that is very difficult to observe in vivo. Our simulations illustrate that while the main blood flow from the parent vessels can perfuse the entire lumen of MAs with small body-to-neck ratio (BNR), it can only perfuse part of the lumen in MAs with large BNR, particularly at a low hematocrit level, leading to possible hypoxic conditions inside MAs. We also quantify the impacts of the size of MAs, blood flow velocity, hematocrit and RBC stiffness and adhesion on the likelihood of platelets entering MAs as well as their residence time inside, two factors that are thought to be associated with thrombus formation in MAs. Our results show that enlarged MA size, increased blood velocity and hematocrit in the parent vessel of MAs as well as the RBC-RBC adhesion promote the migration of platelets into MAs and also prolong their residence time, thereby increasing the propensity of thrombosis within MAs. Overall, our work suggests that computational simulations using particle-based models can help to understand the microvascular pathology pertaining to MAs in DR and provide insights to stimulate and steer new experimental and computational studies in this area.

Computational modeling of biomechanics and biorheology of heated red blood cells

Because of their compromised deformability, heat denatured erythrocytes have been used as labeled probes to visualize spleen tissue or to assess the ability of the spleen to retain stiff red blood cells (RBCs) for over three decades, e.g., see Looareesuwan et al. N. Engl. J. Med. (1987). Despite their good accessibility, it is still an open question how heated RBCs compare to certain diseased RBCs in terms of their biomechanical and biorheological responses, which may undermine their effective usage and even lead to misleading experimental observations. To help answering this question, we perform a systematic computational study of the hemorheological properties of heated RBCs with several physiologically relevant static and hemodynamic settings, including optical-tweezers test, relaxation of prestretched RBCs, RBC traversal through a capillary-like channel and a spleen-like slit, and a viscometric rheology test. We show that our in silico RBC models agree well with existing experiments. Moreover, under static tests, heated RBCs exhibit deformability deterioration comparable to certain disease-impaired RBCs such as those in malaria. For RBC traversal under confinement (through microchannel or slit), heated RBCs show prolonged transit time or retention depending on the level of confinement and heating procedure, suggesting that carefully heat-treated RBCs may be useful for studying splenic- or vaso-occlusion in vascular pathologies. For the rheology test, we expand the existing bulk viscosity data of heated RBCs to a wider range of shear rates (1-1000 s^-1) to represent most pathophysiological conditions in macro- or microcirculation. Although heated RBC suspension shows elevated viscosity comparable to certain diseased RBC suspensions under relatively high shear rates (100-1000 s^-1), they underestimate the elevated viscosity (e.g., in sickle cell anemia) at low shear rates (<10 s^-1). Our work provides mechanistic rationale for selective usage of heated RBC as a potentially useful model for studying the abnormal traversal dynamics and hemorheology in certain blood disorders.

The Effects of Micro-vessel Curvature Induced Elongational Flows on Platelet Adhesion

The emerging profile of blood flow and the cross-sectional distribution of blood cells have far reaching biological consequences in various diseases and vital internal processes, such as platelet adhesion. The effects of several essential blood flow parameters, such as red blood cell free layer width, wall shear rate, and hematocrit on platelet adhesion were previously explored to great lengths in straight geometries. In the current work, the effects of channel curvature on cellular blood flow are investigated by simulating the accurate cellular movement and interaction of red blood cells and platelets in a half-arc channel for multiple wall shear rate and hematocrit values. The results show significant differences in the emerging shear rate values and distributions between the inner and outer arc of the channel curve, while the cell distributions remain predominantly uninfluenced. The simulation predictions are also compared to experimental platelet adhesion in a similar curved geometry. The inner side of the arc shows elevated platelet adhesion intensity at high wall shear rate, which correlates with increased shear rate and shear rate gradient sites in the simulation. Furthermore, since the platelet availability for binding seems uninfluenced by the curvature, these effects might influence the binding mechanics rather than the probability. The presence of elongational flows is detected in the simulations and the link to increased platelet adhesion is discussed in the experimental results.

Point of care whole blood microfluidics for detecting and managing thrombotic and bleeding risks

Point-of-care diagnostics of platelet and coagulation function present demanding challenges. Current clinical diagnostics often use centrifuged plasmas or platelets and frozen plasma standards, recombinant protein standards, or even venoms. Almost all commercialized tests of blood do not recreate the in vivo hemodynamics where platelets accumulate to high densities and thrombin is generated from a procoagulant surface. Despite numerous drugs that target platelets, insufficient coagulation, or excess coagulation, POC blood testing is essentially limited to viscoelastic methods that provide a clotting time, clot strength, and clot lysis, while used mostly in trauma centers with specialized capabilities. Microfluidics now allows small volumes of whole blood (<1 mL) to be tested under venous or arterial shear rates with multi-color readouts to follow platelet function, thrombin generation, fibrin production, and clot stability. Injection molded chips containing pre-patterned fibrillar collagen and lipidated tissue factor can be stored dry for 6 months at 4C, thus allowing rapid blood testing on single-use disposable chips. Using only a small imaging microscope and micropump, these microfluidic devices can detect platelet inhibitors, direct oral anticoagulants (DOACs) and their reversal agents. POC microfluidics are ideal for neonatal surgical applications that involve small blood samples, rapid DOAC testing in stroke or bleeding or emergency surgery situations with patients presenting high risk cofactors for either bleeding or thrombosis.