SIPA in 10 milliseconds: VWF tentacles agglomerate and capture platelets under high shear

Shear-induced platelet aggregation (SIPA) occurs under elevated shear rates (10000 s(-1)) found in stenotic coronary and carotid arteries. The pathologically high shear environment can lead to occlusive thrombosis by SIPA from the interaction of nonactivated platelets and von Willebrand factor (VWF) via glycoprotein Ib-A1 binding. This process under high shear rates is difficult to visualize experimentally with concurrent molecular- and cellular-resolutions. To understand this fast bonding, we employ a validated multiscale in silico model incorporating measured molecular kinetics and a thrombosis-on-a-chip device to delineate the flow-mediated biophysics of VWF and platelets assembly into mural microthrombi. We show that SIPA begins with VWF elongation, followed by agglomeration of platelets in the flow by soluble VWF entanglement before mural capture of the agglomerate by immobilized VWF. The entire SIPA process occurs on the order of 10 milliseconds with the agglomerate traveling a lag distance of a few hundred microns before capture, matching in vitro results. Increasing soluble VWF concentration by similar to 20 times in silico leads to a similar to 2 to 3 times increase in SIPA rates, matching the increase in occlusion rates found in vitro. The morphology of mural aggregates is primarily controlled by VWF molecular weight (length), where normal-length VWF leads to duster or elongated aggregates and ultra-long VWF leads to loose aggregates seen by others' experiments. Finally, we present phase diagrams of SIPA, which provides biomechanistic rationales for a variety of thrombotic and hemostatic events in terms of platelet agglomeration and capture.

Automated summary

This study elucidates the biophysics of shear-induced platelet aggregation (SIPA) using a multiscale in silico model and a thrombosis-on-a-chip device. The findings show that SIPA begins with the elongation of von Willebrand factor (VWF), followed by agglomeration of platelets in the flow mediated by soluble VWF entanglement, and eventually captured by immobilized VWF. Increasing soluble VWF concentration leads to higher SIPA rates, and the morphology of mural aggregates is controlled by VWF molecular weight.