Collaborative Research: Blood Clotting at the Extreme -- Mathematical and Experimental Investigation of Platelet Deposition in Stenotic Arteries

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This project brings together mathematical and computational scientists and bioengineers to study the fundamental biophysical and biochemical mechanisms underlying the formation of blood clots within stenosed (constricted) arteries. These are the blood clots responsible for most heart attacks and many strokes, and understanding how they can form under the extreme physical conditions in a stenotic artery may lead to new ideas for how to prevent them. The very fast blood flow in severely stenosed arteries means that many of the well-studied processes responsible for blood clotting in more physiologically typical situations can play at most a minor role in these arteries. Recent experiments, including ones from the laboratory of one of the current investigators, suggest the importance of a specific flow-sensitive protein in the blood in allowing blood platelets to clump together to form a clot in stenotic arteries. This project involves incorporating the hypothesized role of this protein into a novel and sophisticated computational model of arterial blood clot formation, developed by this project's other investigators, and to use the expanded model to characterize the conditions under which that protein's known properties could explain clot formation in stenotic arteries. Through comparisons of the new model's predictions with further laboratory experiments, the model will be refined and its predictive capabilities improved, and our understanding of how blood clots form under the extreme physical conditions in stenotic arteries will be increased. Because the challenges of forming a blood clot under the conditions in a stenotic artery are similar to those of stanching hemorrhage from a major artery, understanding of how such clots form may also aid in development of interventions to limit bleeding following trauma.Most arterial blood clots are formed by the adhesion of blood cells known as platelets to an injured blood vessel wall and by platelets? cohesion to one another. Platelet adhesion and cohesion are both accomplished through the formation of molecular bonds that involve specific proteins on the platelets? surfaces binding to other specific proteins on the vascular wall or in the blood plasma. To hold the platelets together, the bonds must collectively be able to withstand the forces imposed on the platelet clump by the blood flow. For many types of platelet-platelet bonds, a platelet can form that type of bond only if the platelet has already become activated in response to appropriate chemical or physical stimuli. The platelet activation process takes time. For a platelet moving through a highly constricted artery, there is not enough time to respond to activation stimuli and the forces that the fluid exerts on it if it tries to attach to the vessel wall are enormous. How clots form in this situation is poorly understood, but recent experiments lead to the hypothesis that bonds mediated by a uniquely flow-sensitive protein (von Willebrand factor) in the blood are critical. This project will explore that hypothesis through a combination of mathematical modeling, computer simulation, and laboratory experimentation. A novel multiphase model will be developed of the mechanical interactions between a viscous fluid representing the blood and a permeable, viscoelastic, fracturable material representing a growing platelet clot. Development of robust and efficient numerical methods will allow exploration of the model?s behavior. Model results will be compared with results from an in vitro physical model of a stenotic artery. The comparison will lead to model refinements and to the design and interpretation of the physical experiments. Such interplay between modeling and experiments provides a powerful engine for driving scientific discovery.