Shear-mediated platelet activation in the free flow: Perspectives on the emerging spectrum of cell mechanobiological mechanisms mediating cardiovascular implant thrombosis |
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| Affiliation: | 1. Clinical and Interventional Cardiology Unit, Sant''Ambrogio Cardio-Thoracic Center, Milan, Italy;2. Department of Cardiology, Montefiore Medical Center, New York, NY, United States;3. Cardiac Surgery Unit, Sant''Ambrogio Cardio-Thoracic Center, Milan, Italy;4. Chair of Cardiac Surgery, University of Milan, Milan, Italy;1. Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy;2. Politecnico di Milano Research Unit, National Interuniversity Consortium of Materials Science and Technology, Milano, Italy;3. Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA;4. Anesthesia and Intensive Care, Sant''Ambrogio Cardiothoracic Center, Milano, Italy;5. Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA;6. Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Milano, Italy;7. Università Vita Salute San Raffaele, Milano, Italy;8. Biocompatibility and Cell Culture Laboratory “BioCell,” Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milano, Italy |
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| Abstract: | Shear-mediated platelet activation (SMPA) is central in thrombosis of implantable cardiovascular therapeutic devices. Despite the morbidity and mortality associated with thrombosis of these devices, our understanding of mechanisms operative in SMPA, particularly in free flowing blood, remains limited. Herein we present and discuss a range of emerging mechanisms for consideration for “free flow” activation under supraphysiologic shear. Further definition and manipulation of these mechanisms will afford opportunities for novel pharmacologic and mechanical strategies to limit SMPA and enhance overall implant device safety. |
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| Keywords: | Mechanotransduction Platelet activation Mechanical circulatory support Thrombosis Fluid shear stress |
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