Exploring the thrombus niche: lessons learned and potential therapeutic opportunities

Area of Science:

• Biomedical Engineering
• Pathology
• Materials Science

Background:

• Thrombus structure and composition significantly influence thrombosis severity, progression, and patient outcomes.
• Mechanical thrombectomy enables the retrieval of fresh thrombi for detailed morphological analysis using scanning electron microscopy.

Purpose of the Study:

• To review recent research on the quantitative and qualitative morphological characteristics of arterial and venous thrombi.
• To establish a basis for novel therapeutic strategies targeting thrombosis by understanding thrombus components.

Main Methods:

• Analysis of thrombus morphology through scanning electron microscopy of patient-derived thrombi.
• Review of current literature on the structural and functional roles of thrombus components.

Main Results:

• Major thrombus components include platelets (responsible for contraction and stiffness), erythrocytes (deformed into piezocytes), and fibrin (the structural scaffold).
• Minor components like neutrophils, monocytes, and cellular microvesicles also contribute to thrombus properties.
• Variations in the relative volume fractions and forms of these components underlie diverse pathogenic mechanisms and clinical presentations of thrombosis.

Conclusions:

• The detailed morphology of thrombi, characterized by its major and minor components, provides critical insights into thrombosis pathogenesis.
• Modulating specific thrombus components presents promising avenues for developing new therapeutic interventions for thrombosis.