Effect of fractional blood flow on plasma skimming in the microvasculature

The interaction between particles and vascular endothelium in blood flow

Particle-based drug delivery systems have shown promising application potential to treat human diseases; however, an incomplete understanding of their interactions with vascular endothelium in blood flow prevents their inclusion into mainstream clinical applications. The flow performance of nano/micro-sized particles in the blood are disturbed by many external/internal factors, including blood constituents, particle properties, and endothelium bioactivities, affecting the fate of particles in vivo and therapeutic effects for diseases. This review highlights how the blood constituents, hemodynamic environment and particle properties influence the interactions and particle activities in vivo. Moreover, we briefly summarized the structure and functions of endothelium and simulated devices for studying particle performance under blood flow conditions. Finally, based on particle-endothelium interactions, we propose future opportunities for novel therapeutic strategies and provide solutions to challenges in particle delivery systems for accelerating their clinical translation. This review helps provoke an increasing in-depth understanding of particle-endothelium interactions and inspires more strategies that may benefit the development of particle medicine.

Enhanced perfusion following exposure to radiotherapy: A theoretical investigation

Tumour angiogenesis leads to the formation of blood vessels that are structurally and spatially heterogeneous. Poor blood perfusion, in conjunction with increased hypoxia and oxygen heterogeneity, impairs a tumour's response to radiotherapy. The optimal strategy for enhancing tumour perfusion remains unclear, preventing its regular deployment in combination therapies. In this work, we first identify vascular architectural features that correlate with enhanced perfusion following radiotherapy, using in vivo imaging data from vascular tumours. Then, we present a novel computational model to determine the relationship between these architectural features and blood perfusion in silico. If perfusion is defined to be the proportion of vessels that support blood flow, we find that vascular networks with small mean diameters and large numbers of angiogenic sprouts show the largest increases in perfusion post-irradiation for both biological and synthetic tumours. We also identify cases where perfusion increases due to the pruning of hypoperfused vessels, rather than blood being rerouted. These results indicate the importance of considering network composition when determining the optimal irradiation strategy. In the future, we aim to use our findings to identify tumours that are good candidates for perfusion enhancement and to improve the efficacy of combination therapies.

Mechanisms of landiolol-mediated positive inotropy in critical care settings

PURPOSE

To present the potential mechanisms by which landiolol enhances a positive inotropic response in critically ill patients.

METHODS

Analysis of preclinical, animal, and clinical data to provide novel knowledge and translate research findings into potential clinical application.

RESULTS

The super-selective β1-antagonist landiolol may increase inotropy and may be associated with positive outcomes in critically ill patients with acute decompensated heart failure or sepsis.

CONCLUSION

This review sheds light on the potential mechanisms by which landiolol enhances a positive inotropic response, potentially alleviating the long-held concern over possible negative hemodynamic effects in critically ill patients.

Microcirculatory dysfunction in cardiogenic shock

Cardiogenic shock is usually defined as primary cardiac dysfunction with low cardiac output leading to critical organ hypoperfusion, and tissue hypoxia, resulting in high mortality rate between 40% and 50% despite recent advances. Many studies have now evidenced that cardiogenic shock not only involves systemic macrocirculation, such as blood pressure, left ventricular ejection fraction, or cardiac output, but also involves significant systemic microcirculatory abnormalities which seem strongly associated with the outcome. Although microcirculation has been widely studied in the context of septic shock showing heterogeneous alterations with clear evidence of macro and microcirculation uncoupling, there is now a growing body of literature focusing on cardiogenic shock states. Even if there is currently no consensus regarding the treatment of microcirculatory disturbances in cardiogenic shock, some treatments seem to show a benefit. Furthermore, a better understanding of the underlying pathophysiology may provide hypotheses for future studies aiming to improve cardiogenic shock prognosis.

Dependence of cell-free-layer width on rheological parameters: Combining empirical data on flow separation at microvascular bifurcations with geometrical considerations

When blood flows through vessel networks, red blood cells (RBCs) are typically concentrated close to the vessel center line, creating a lubrication layer near the vessel wall. As RBCs bind oxygen, the width of this cell-free layer (CFL) impacts not only the blood rheology inside the vasculature, but also oxygen delivery to the tissues they perfuse and, hence, their function. Existing attempts to relate the width of the CFL to the rheological properties of the blood and the geometrical properties of the vessel are based on an analysis of the forces acting on RBCs suspended in the blood. However, the complexity of interactions in the blood makes this a challenging task. Here, we propose an alternative, two-step approach to derive such a functional relationship. First, we extend widely accepted empirical fits describing the minimum flow fraction needed for RBCs to enter a daughter vessel downstream of a microvascular bifurcation so that it depends not only on the diameter and discharge haematocrit of the parent vessel, but also on its average shear rate. Second, we propose a simple geometrical model for the minimum flow fraction based on the cross-sectional blood flow profile within the parent vessel upstream of the bifurcation-considering uniform, parabolic, and blunt velocity profiles-and derive the leading-order approximation to this model for small CFL widths. By equating the functional relationships obtained using these two approaches, we derive expressions relating the CFL width to the vessel diameter, discharge haematocrit, and mean shear rate. The resulting expressions are in good agreement with available in vivo data and represent a promising basis for future research.

Plasma skimming efficiency of human blood in the spiral groove bearing of a centrifugal blood pump

This work investigates the plasma skimming effect in a spiral groove bearing within a hydrodynamically levitated centrifugal blood pump when working with human blood having a hematocrit value from 0 to 40%. The present study assessed the evaluation based on a method that clarified the limitations associated with such assessments. Human blood was circulated in a closed-loop circuit via a pump operating at 4000 rpm at a flow rate of 5 L/min. Red blood cells flowing through a ridge area of the bearing were directly observed using a high-speed microscope. The hematocrit value in the ridge area was calculated using the mean corpuscular volume, the bearing gap, the cross-sectional area of a red blood cell, and the occupancy of red blood cells. The latter value was obtained from photographic images by dividing the number of pixels showing red blood cells in the evaluation area by the total number of pixels in this area. The plasma skimming efficiency was calculated as the extent to which the hematocrit of the working blood was reduced in the ridge area. For the hematocrit in the circuit from 0 to 40%, the plasma skimming efficiency was approximately 90%, meaning that the hematocrit in the ridge area became 10% as compared to that in the circuit. For a hematocrit of 20% and over, red blood cells almost completely occupied the ridge. Thus, a valid assessment of plasma skimming was only possible when the hematocrit was less than 20%.

Abnormal morphology biases hematocrit distribution in tumor vasculature and contributes to heterogeneity in tissue oxygenation

Oxygen heterogeneity in solid tumors is recognized as a limiting factor for therapeutic efficacy. This heterogeneity arises from the abnormal tumor vascular structure. We investigate the role that anomalies in red blood cell transport plays in establishing oxygen heterogeneity in tumor tissue. We introduce a metric to characterize tumor vasculature (mean vessel length-to-diameter ratio, λ) and demonstrate how it predicts tissue-oxygen heterogeneity. We also report an increase in λ following treatment with the antiangiogenic agent DC101. Together, we propose λ as an effective way of monitoring the action of antiangiogenic agents and a proxy measure of oxygen heterogeneity in tumor tissue. Unraveling the causal relationship between tumor vascular structure and tissue oxygenation will pave the way for new personalized therapeutic approaches.

Oxygen heterogeneity in solid tumors is recognized as a limiting factor for therapeutic efficacy. This heterogeneity arises from the abnormal vascular structure of the tumor, but the precise mechanisms linking abnormal structure and compromised oxygen transport are only partially understood. In this paper, we investigate the role that red blood cell (RBC) transport plays in establishing oxygen heterogeneity in tumor tissue. We focus on heterogeneity driven by network effects, which are challenging to observe experimentally due to the reduced fields of view typically considered. Motivated by our findings of abnormal vascular patterns linked to deviations from current RBC transport theory, we calculated average vessel lengths L¯ and diameters d¯ from tumor allografts of three cancer cell lines and observed a substantial reduction in the ratio λ=L¯/d¯ compared to physiological conditions. Mathematical modeling reveals that small values of the ratio λ (i.e., λ<6) can bias hematocrit distribution in tumor vascular networks and drive heterogeneous oxygenation of tumor tissue. Finally, we show an increase in the value of λ in tumor vascular networks following treatment with the antiangiogenic cancer agent DC101. Based on our findings, we propose λ as an effective way of monitoring the efficacy of antiangiogenic agents and as a proxy measure of perfusion and oxygenation in tumor tissue undergoing antiangiogenic treatment.

Simulations of blood as a suspension predicts a depth dependent hematocrit in the circulation throughout the cerebral cortex

Recent advances in modeling oxygen supply to cortical brain tissue have begun to elucidate the functional mechanisms of neurovascular coupling. While the principal mechanisms of blood flow regulation after neuronal firing are generally known, mechanistic hemodynamic simulations cannot yet pinpoint the exact spatial and temporal coordination between the network of arteries, arterioles, capillaries and veins for the entire brain. Because of the potential significance of blood flow and oxygen supply simulations for illuminating spatiotemporal regulation inside the cortical microanatomy, there is a need to create mathematical models of the entire cerebral circulation with realistic anatomical detail. Our hypothesis is that an anatomically accurate reconstruction of the cerebrocirculatory architecture will inform about possible regulatory mechanisms of the neurovascular interface. In this article, we introduce large-scale networks of the murine cerebral circulation spanning the Circle of Willis, main cerebral arteries connected to the pial network down to the microcirculation in the capillary bed. Several multiscale models were generated from state-of-the-art neuroimaging data. Using a vascular network construction algorithm, the entire circulation of the middle cerebral artery was synthesized. Blood flow simulations indicate a consistent trend of higher hematocrit in deeper cortical layers, while surface layers with shorter vascular path lengths seem to carry comparatively lower red blood cell (RBC) concentrations. Moreover, the variability of RBC flux decreases with cortical depth. These results support the notion that plasma skimming serves a self-regulating function for maintaining uniform oxygen perfusion to neurons irrespective of their location in the blood supply hierarchy. Our computations also demonstrate the practicality of simulating blood flow for large portions of the mouse brain with existing computer resources. The efficient simulation of blood flow throughout the entire middle cerebral artery (MCA) territory is a promising milestone towards the final aim of predicting blood flow patterns for the entire brain.

The brain’s astonishing cognitive capacity depends on the coordination between neurons and the cerebral circulation, a system known as the neurovascular unit. The spatial and temporal coupling between these two networks is the object of intense research. However, the concise anatomical description of the cerebral circulation has so far been intractable. This paper introduces a methodology for the in silico creation of realistic models for the entire cerebral circulation. This innovation incorporates topological data from several neuroimaging modalities covering three lengths scales as input into a computer algorithm, which assembles anatomically accurate circulatory networks. When simulating blood flow as red blood cells suspended in plasma for experimental and synthetic cortical network models, we discovered that red blood cells tend to be more concentrated in deeper layers of the cortex compared to the surface. RBC fluxes are more homogenous in deeper layers. The phenomenon of depth dependent red blood cell supply supports the notion that the intricate architecture of the cortical microcirculation serves a self-regulating function to maintain uniform oxygen perfusion to neurons. We also demonstrate the practicality of predicting blood flow patterns for the entire brain with existing computer power.

Experimentally constrained circuit model of cortical arteriole networks for understanding flow redistribution due to occlusion and neural activation

Computations are described which estimate flows in all branches of the cortical surface arteriole network from two-photon excited fluorescence (2PEF) microscopy images which provide the network topology and, in selected branches red blood cell (RBC) speeds and lumen diameters. Validation is done by comparing the flow predicted by the model with experimentally measured flows and by comparing the predicted flow redistribution in the network due to single-vessel strokes with experimental observations. The model predicts that tissue is protected from RBC flow decreases caused by multiple occlusions of surface arterioles but not penetrating arterioles. The model can also be used to study flow rerouting due to vessel dilations and constrictions.