Hemodynamics Affects Factor XI/XII Anticoagulation Efficacy in Patient-Specific Left Atrial Models

Guerrero-Hurtado, M.; Garcia-Villalba, M.; Gonzalo, A.; Duran, E.; Martinez-Legazpi, P.; Kahn, A. M.; Chen, M. Y.; McVeigh, E.; Bermejo, J.; del Alamo, J. C.; Flores, O.

doi:10.1101/2024.08.27.609969

bioRxiv · 10.1101/2024.08.27.609969

Hemodynamics Affects Factor XI/XII Anticoagulation Efficacy in Patient-Specific Left Atrial Models

Guerrero-Hurtado, M.·Garcia-Villalba, M.·Gonzalo, A.·Duran, E.·Martinez-Legazpi, P.·Kahn, A. M.·Chen, M. Y.·McVeigh, E.·Bermejo, J.·del Alamo, J. C.·Flores, O.

View original source ↗Export metadata ↓

Abstract

Atrial fibrillation (AF) disrupts the circulation of blood through the left atrium (LA), and may result in relative stasis in the left atrial appendage (LAA), increasing thromboembolic risk. Anticoagulant agents can lower this risk, but currently used agents target the common pathway central to the coagulation cascade, increasing bleeding risk. Anticoagulants such as factor XI/XII inhibitors target the initial phase of the intrinsic pathway, with a significantly lower associated bleeding risk. However, these agents efficacy in preventing thrombosis in patient-specific flow conditions is not fully understood. We hypothesized that patient-specific flow patterns in the LA and LAA not only influence the risk of thrombosis but also the effectiveness of anticoagulation agents. We simulated blood flow and the intrinsic coagulation pathway in patient-specific LA anatomies with and without factor XI/XII inhibition to test this hypothesis. We considered thirteen patients in sinus rhythm and AF, several of whom had an LAA clot or a history of transient ischemic attacks. We used computational fluid dynamics based on 4D CT imaging and a detailed 32-species coagulation system to run 247 simulations for 13 patients, systematically sweeping over a wide range of factor XI/XII inhibition levels. Implementing a novel multi-fidelity coagulation modeling approach accelerated computations by two orders of magnitude, enabling the large number of simulations performed. Our simulations provide spatiotemporally resolved maps of thrombin concentration throughout the LA, showing it peaks inside the LAA. Coagulation metrics based on peak LAA thrombin dynamics suggested patients could be classified as non-coagulating, moderately and severely coagulating cases. Severely coagulating cases had significantly slower flow and higher residence time than moderately coagulating patients inside the LAA, requiring stronger factor XI/XII inhibition to blunt thrombin growth. The methodology outlined in this study has the potential to enable personalized assessments of coagulation risk and tailor anticoagulation therapy based on medical imaging.

Explore related subjects

bioengineering Preprint

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

Guerrero-Hurtado, M., Garcia-Villalba, M., Gonzalo, A., Duran, E., Martinez-Legazpi, P., Kahn, A. M., Chen, M. Y., McVeigh, E., Bermejo, J., del Alamo, J. C., Flores, O.. 2024-08-28. Hemodynamics Affects Factor XI/XII Anticoagulation Efficacy in Patient-Specific Left Atrial Models. https://doi.org/10.1101/2024.08.27.609969

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related preprints

bioRxiv2026

Comparative study of chlorophyll measurement in Physcomitrium patens moss using a conventional microscope adapted for combined 2D+1D imaging and spectral analysis

Imaging spectroscopy often requires expensive and complex equipment. Here we show a simple procedure for attaching a standard miniature fiber spectrometer to a conventional microscope, allowing easy integration of 2D imaging with 1D high-resolution spectral measurements. This combination provides much of the benefit of a full imaging spectrometer without the large equipment investment, and we provide instructions for modifying microscopes to this setup and the present measurements of living cells that demonstrate their performance. Using this setup, we compare the quantitative measurement of chlorophyll concentration in Physcomitrium patens moss using color imaging and spectral sampling.

bioengineering↗

bioRxiv2026

De novo designed single-domain antibodies protect against lethal cobra venom neurotoxicity in vivo

Generative protein design can now rapidly produce de novo binders with high affinity and functional activity against a wide range of targets, including lethal snake venom toxins. However, so far most reported successes rely on new-to-nature scaffolds with limited therapeutic precedent. Single-domain antibodies (VHHs) offer a clinically validated alternative scaffold that can bind and neutralize long-chain -neurotoxins, which are some of the most lethal components in snake venoms. Here we compare three recently established de novo design models with VHH-design capabilities (Germinal, RFantibody, and BoltzGen) for their ability to generate VHHs against the neurotoxin -cobratoxin from the monocled cobra (Naja kaouthia). Using standardized model inputs and evaluation criteria based on AlphaFold3 interface confidence (ipTM) and RMSD self-consistency, we find that Germinal was the only method to generate designs passing stringent in silico criteria for experimental testing. We therefore performed a larger Germinal design campaign employing three different VHH frameworks and experimentally validated 46 designs in vitro. Of these, 42 expressed as soluble proteins and we identified four binding hits derived from two of the three tested frameworks. Of the four binders, two lead candidates were further characterized and demonstrated high affinity (KDs of 4.1 nM and 10.8 nM), monomeric behavior and low polyreactivity, indicating favorable biophysical and developability properties, as well as functional toxin neutralization in vitro. To assess their therapeutic potential we investigated their ability to protect against -cobratoxin toxicity in vivo. Both candidates fully protected mice after -cobratoxin challenge, with 100% survival compared to a lethal control. One candidate also retained notable neutralization capacity against whole venom of Naja kaouthia with a survival of 56%, while the other protected 22% when tested in a rescue setting. Together, we demonstrate that de novo VHH design can generate high affinity single-domain antibodies with in vivo protection against lethal cobra venom neurotoxicity, and provide practical insights into method- and framework-dependent performance.

bioengineering↗

bioRxiv2026

Simple Feedback for Complex Movement: Capturing Whole-Limb Reorganization during Single-IMU Gait Retraining

Clinical gait retraining typically relies on multi-sensor arrays and high-dimensional feedback displays, imposing setup and interpretation burdens that limit routine clinical deployment. We developed a single-IMU visual biofeedback system that delivers real-time feedback of Lower Limb Trajectory Error (LLTE), a composite kinematic error metric integrating knee position and shank angle across the stance phase. Twenty able-bodied adults walked on a treadmill under two visual biofeedback targets (flexed-knee, extended-knee) while receiving either corrected (n=10) or uncorrected (n=8) feedback, where the correction accounted for limb orientation at initial contact. LLTE and stance-phase knee kinematics adapted consistently under the flexed-knee target for both feedback groups, with feedback formulation moderating the temporal trajectory of change. Adaptation toward the extended-knee target was limited, likely because participants were already operating near terminal knee extension and because the scalar error metric provided limited directional information for correction. Ankle range of motion (ROM) changed significantly across the stance phase under both target conditions, while hip ROM did not. Multiscale multivariate sample entropy (MSMVSE) increased monotonically with time scale across all conditions, with no statistically distinguishable difference between corrected and uncorrected feedback. These results suggest that single-IMU LLTE biofeedback can modify gait mechanics and that adaptation was expressed across multiple lower-limb segments rather than through changes at a single joint.

bioengineering↗