Karin Leiderman

Grow with the flow: A spatial-temporal model of platelet deposition and blood coagulation under flow

The bodys response to vascular injury involves two intertwined processes: platelet aggregation and coagulation. Platelet aggregation is a predominantly physical process, whereby platelets clump together, and coagulation is a cascade of biochemical enzyme reactions. Thrombin, the major product of coagulation, directly couples the biochemical system to platelet aggregation by activating platelets and by cleaving fibrinogen into fibrin monomers that polymerize to form a mesh that stabilizes platelet aggregates. Together, the fibrin mesh and the platelet aggregates comprise a thrombus that can grow to occlusive diameters. Transport of coagulation proteins and platelets to and from an injury is controlled largely by the dynamics of the blood flow. To explore how blood flow affects the growth of thrombi and how the growing masses, in turn, feed back and affect the flow, we have developed the first spatial-temporal mathematical model of platelet aggregation and blood coagulation under flow that includes detailed descriptions of coagulation biochemistry, chemical activation and deposition of blood platelets, as well as the two-way interaction between the fluid dynamics and the growing platelet mass. We present this model and use it to explain what underlies the threshold behaviour of the coagulation systems production of thrombin and to show how wall shear rate and near-wall enhanced platelet concentrations affect the development of growing thrombi. By accounting for the porous nature of the thrombus, we also demonstrate how advective and diffusive transport to and within the thrombus affects its growth at different stages and spatial locations.

The Influence of Hindered Transport on the Development of Platelet Thrombi Under Flow

Vascular injury triggers two intertwined processes, platelet deposition and coagulation, and can lead to the formation of an intravascular clot (thrombus) that may grow to occlude the vessel. Formation of the thrombus involves complex biochemical, biophysical, and biomechanical interactions that are also dynamic and spatially-distributed, and occur on multiple spatial and temporal scales. We previously developed a spatial-temporal mathematical model of these interactions and looked at the interplay between physical factors (flow, transport to the clot, platelet distribution within the blood) and biochemical ones in determining the growth of the clot. Here, we extend this model to include reduction of the advection and diffusion of the coagulation proteins in regions of the clot with high platelet number density. The effect of this reduction, in conjunction with limitations on fluid and platelet transport through dense regions of the clot can be profound. We found that hindered transport leads to the formation of smaller and denser clots compared to the case with no protein hindrance. The limitation on protein transport confines the important activating complexes to small regions in the interior of the thrombus and greatly reduces the supply of substrates to these complexes. Ultimately, this decreases the rate and amount of thrombin production and leads to greatly slowed growth and smaller thrombus size. Our results suggest a possible physical mechanism for limiting thrombus growth.

Blood Clot Formation under Flow: The Importance of Factor XI Depends Strongly on Platelet Count

A previously validated mathematical model of intravascular platelet deposition and tissue factor (TF)-initiated coagulation under flow is extended and used to assess the influence on thrombin production of the activation of factor XI (fXI) by thrombin and of the activation of factor IX (fIX) by fXIa. It is found that the importance of the thrombin-fXIa-fIXa feedback loop to robust thrombin production depends on the concentration of platelets in the blood near the injury. At a near-wall platelet concentration of ~250,000/μL, typical in vessels in which the shear rate is <200 s(-1), thrombin activation of fXI makes a significant difference only at low densities of exposed TF. If the near-wall platelet concentration is significantly higher than this, either because of a higher systemic platelet count or because of the redistribution of platelets toward the vessel walls at high shear rates, then thrombin activation of fXI makes a major difference even for relatively high densities of exposed TF. The model predicts that the effect of a severe fXI deficiency depends on the platelet count, and that fXI becomes more important at high platelet counts.

The Effect of Factor VIII Deficiencies and Replacement and Bypass Therapies on Thrombus Formation under Venous Flow Conditions in Microfluidic and Computational Models

Clinical evidence suggests that individuals with factor VIII (FVIII) deficiency (hemophilia A) are protected against venous thrombosis, but treatment with recombinant proteins can increase their risk for thrombosis. In this study we examined the dynamics of thrombus formation in individuals with hemophilia A and their response to replacement and bypass therapies under venous flow conditions. Fibrin and platelet accumulation were measured in microfluidic flow assays on a TF-rich surface at a shear rate of 100 s−1. Thrombin generation was calculated with a computational spatial-temporal model of thrombus formation. Mild FVIII deficiencies (5–30% normal levels) could support fibrin fiber formation, while severe (<1%) and moderate (1–5%) deficiencies could not. Based on these experimental observations, computational calculations estimate an average thrombin concentration of ∼10 nM is necessary to support fibrin formation under flow. There was no difference in fibrin formation between severe and moderate deficiencies, but platelet aggregate size was significantly larger for moderate deficiencies. Computational calculations estimate that the local thrombin concentration in moderate deficiencies is high enough to induce platelet activation (>1 nM), but too low to support fibrin formation (<10 nM). In the absence of platelets, fibrin formation was not supported even at normal FVIII levels, suggesting platelet adhesion is necessary for fibrin formation. Individuals treated by replacement therapy, recombinant FVIII, showed normalized fibrin formation. Individuals treated with bypass therapy, recombinant FVIIa, had a reduced lag time in fibrin formation, as well as elevated fibrin accumulation compared to healthy controls. Treatment of rFVIIa, but not rFVIII, resulted in significant changes in fibrin dynamics that could lead to a prothrombotic state.

An overview of mathematical modeling of thrombus formation under flow

In the last decade numerous mathematical models have been formulated to investigate specific components of the clotting system such as the tissue factor pathway of coagulation. Sophisticated, multiscale models were developed to better understand the interplay of flow-mediated transport, platelet deposition, and coagulation kinetics, and their overall effect on thrombus formation. Promotion of thrombus growth is partially due to the well-known pro-coagulant roles of platelets like the surface-dependent coagulation reactions. Iterations of theoretical model predictions and experiment have helped to elucidate anticoagulant roles of platelets as well. These roles include paving over the subendothelium and hindering transport of substrates to and from enzyme complexes which can strongly affect thrombus formation. In this review, we give a brief overview of theoretical models of thrombus formation under flow and some of the experiments that motivated them and were motivated by them.

The effects of spatial inhomogeneities on flow through the endothelial surface layer

Flow through the endothelial surface layer (the glycocalyx and adsorbed plasma proteins) plays an important but poorly understood role in cell signaling through a process known as mechanotransduction. Characterizing the flow rates and shear stresses throughout this layer is critical for understanding how flow-induced ionic currents, deformations of transmembrane proteins, and the convection of extracellular molecules signal biochemical events within the cell, including cytoskeletal rearrangements, gene activation, and the release of vasodilators. Previous mathematical models of flow through the endothelial surface layer are based upon the assumptions that the layer is of constant hydraulic permeability and constant height. These models also assume that the layer is continuous across the endothelium and that the layer extends into only a small portion of the vessel lumen. Results of these models predict that fluid shear stress is dissipated through the surface layer and is thus negligible near endothelial cell membranes. In this paper, such assumptions are removed, and the resultant flow rates and shear stresses through the layer are described. The endothelial surface layer is modeled as clumps of a Brinkman medium immersed in a Newtonian fluid. The width and spacing of each clump, hydraulic permeability, and fraction of the vessel lumen occupied by the layer are varied. The two-dimensional Navier-Stokes equations with an additional Brinkman resistance term are solved using a projection method. Several fluid shear stress transitions in which the stress at the membrane shifts from low to high values are described. These transitions could be significant to cell signaling since the endothelial surface layer is likely dynamic in its composition, density, and height.

Computation of three-dimensional Brinkman flows using regularized methods

The Brinkman equations of fluid motion are a model of flows in a porous medium. We develop the exact solution of the Brinkman equations for three-dimensional incompressible flow driven by regularized forces. Two different approaches to the regularization are discussed and compared on test problems. The regularized Brinkman model is also applied to the unsteady Stokes equation for oscillatory flows since the latter leads to the Brinkman equations with complex permeability parameter. We provide validation studies of the method based on the flow and drag of a solid sphere translating in a Brinkman medium and the flow inside a cylindrical channel of circular cross-section. We present a numerical example of a swimming organism in a Brinkman flow which shows that the maximum swimming speed is obtained with a small but non-zero value of the porosity. We also demonstrate that unsteady Stokes flows with oscillatory forcing fall within the same framework and are computed with the same method by applying it to the motion of the oscillating feeding appendage of a copepod.

Flow Induced by Bacterial Carpets and Transport of Microscale Loads

In this paper we utilize the method of regularized Stokeslets to explore flow fields induced by ‘carpets’ of rotating flagella. We model each flagellum as a rigid, rotating helix attached to a wall, and study flows around both a single helix and a small patch of multiple helices. To test our numerical method and gain intuition about flows induced by a single rotating helix, we first perform a numerical time-reversibility experiment. Next, we investigate the hypothesis put forth in (Darnton et al., Biophys J 86, 1863–1870, 2004) that a small number of rotating flagella could produce “whirlpools” and “rivers” a small distance above them. Using our model system, we are able to produce “whirlpools” and “rivers” when the helices are rotating out of phase. Finally, to better understand the transport of microscale loads by flagellated microorganisms, we model a fully coupled helix-vesicle system by placing a finite-sized vesicle held together by elastic springs in fluid near one or two rotating helices. We compare the trajectories of the vesicle and a tracer particle initially placed at the centroid of vesicle and find that the two trajectories can diverge significantly within a short amount of time. Interestingly, the divergent behavior is extremely sensitive to the initial position within the fluid.

Swimming in a two-dimensional Brinkman fluid: Computational modeling and regularized solutions

The incompressible Brinkman equation represents the homogenized fluid flow past obstacles that comprise a small volume fraction. In nondimensional form, the Brinkman equation can be characterized by a single parameter that represents the friction or resistance due to the obstacles. In this work, we derive an exact fundamental solution for 2D Brinkman flow driven by a regularized point force and describe the numerical method to use it in practice. To test our solution and method, we compare numerical results with an analytic solution of a stationary cylinder in a uniform Brinkman flow. Our method is also compared to asymptotic theory; for an infinite-length, undulating sheet of small amplitude, we recover an increasing swimming speed as the resistance is increased. With this computational framework, we study a model swimmer of finite length and observe an enhancement in propulsion and efficiency for small to moderate resistance. Finally, we study the interaction of two swimmers where attraction does not occur when the initial separation distance is larger than the screening length.

Synergy Between Tissue Factor and Exogenous Factor XIa in Initiating Coagulation

Objective—Recent evidence suggests involvement of coagulation factor XIa (FXIa) in thrombotic event development. This study was conducted to explore possible synergies between tissue factor (TF) and exogenous FXIa (E-FXIa) in thrombin generation. Approach and Results—In thrombin generation assays, for increasing concentrations of E-FXIa with low, but not with high TF concentrations, peak thrombin significantly increased whereas lag time and time to peak significantly decreased. Similar dependencies of lag times and rates of thrombin generation were found in mathematical model simulations. In both in vitro and in silico experiments that included E-FXIa, thrombin bursts were seen for TF levels much lower than those required without E-FXIa. For in silico thrombin bursts initiated by the synergistic action of TF and E-FXIa, the mechanisms leading to the burst differed substantially from those for bursts initiated by high TF alone. For the synergistic case, sustained activation of platelet-bound FIX by E-FXIa, along with the feedback-enhanced activation of platelet-bound FVIIIa and FXa, was needed to elicit a thrombin burst. Furthermore, the initiation of thrombin bursts by high TF levels relied on different platelet FIX/FIXa binding sites than those involved in bursts initiated by low TF levels with E-FXIa. Conclusions—Low concentrations of TF and exogenous FXIa, each too low to elicit a burst in thrombin production alone, act synergistically when in combination to cause substantial thrombin production. The observation about FIX/FIXa binding sites may have therapeutic implications.