Pathologic Shear and Elongation Rates Do Not Cause Cleavage of Von Willebrand Factor by ADAMTS13 in a Purified System
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Cellular and Molecular Bioengineering (Ó 2020) https://doi.org/10.1007/s12195-020-00631-2
Original Article
Pathologic Shear and Elongation Rates Do Not Cause Cleavage of Von Willebrand Factor by ADAMTS13 in a Purified System MARIA BORTOT,1,2 ALIREZA SHARIFI,3 KATRINA ASHWORTH,1 FAYE WALKER,1 ALLAURA COX,1 KATHERINE RUEGG,4 NATHAN CLENDENEN,5 KEITH B. NEEVES,1,2 DAVID BARK JR.,1,3,6 and JORGE DI PAOLA 7 1
Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; 2Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; 3Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA; 4Hemophilia Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; 5Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; 6School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA; and 7 Department of Pediatrics, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8208, 5th floor MPRB, St. Louis, MO 63110, USA (Received 5 January 2020; accepted 18 June 2020) Associate Editor Michael R. King oversaw the review of this article.
Abstract Introduction—Pathological flows in patients with severe aortic stenosis are associated with acquired von Willebrand syndrome. This syndrome is characterized by excessive cleavage of von Willebrand factor by its main protease, A Disintegrin and Metalloproteinase with a Thrombospondin Type 1 Motif, Member 13 (ADAMTS13) leading to decreased VWF function and mucocutaneous bleeding. Aortic valve replacement and correction of the flow behavior to physiological levels reverses the syndrome, supporting the association between pathological flow and acquired von Willebrand syndrome. We investigated the effects of shear and elongational rates on von Willebrand factor cleavage in the presence of ADAMTS13. Methods—We identified acquired von Willebrand syndrome in five patients with severe aortic stenosis. Doppler echography values from these patients were used to develop three computational fluid dynamic (CFD) aortic valve models (normal, mild and severe stenosis). Shear, elongational rates and exposure times identified in the CFD simulations were used as parameters for the design of microfluidic devices to test the effects of pathologic shear and elongational rates on the structure and function of von Willebrand factor. Results—The shear rates (0–10,000s1), elongational rates (0–1000 s1) and exposure times (1–180 ms) tested in our microfluidic designs mimicked the flow features identified in patients with aortic stenosis. The shear and elongational rates tested in vitro did not lead to excessive cleavage or
Address correspondence to Jorge Di Paola, Department of Pediatrics, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8208, 5th floor MPRB, St. Louis, MO 63110, USA. Electronic mail: [email protected]
decreased function of von Willebrand factor in the presence of the protea
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