Novel venous thromboembolism mouse model to evaluate the role of complete and partial factor XIII deficiency in pulmonary embolism risk

Background: Venous thrombosis (VT) and pulmonary embolism (PE), collectively venous thromboembolism (VIE), cause high mortality and morbidity. Factor XIII (FXIII) crosslinks fibrin to enhance thrombus stability and consequently may influence PE risk. Elucidating mechanisms contributing to PE is limited by a lack of models that recapitulate human PE characteristics. Objective: We aimed to develop a mouse model that permits embolization of red blood cell (RBC)- and fibrin-rich VT and determine the contribution of FXIII to PE risk. Methods and Results: In a thrombin-infusion PE model, F13a(+/+), F13a(+/-), and F13a(-/-) mice had similar incidence of microthrombi in the lungs; however, thrombi were small, with low RBC content (<= 7%), unlike human PEs (similar to 70%). To identify a model producing PE consistent with histological characteristics of human PE, we compared mouse femoral vein electrolytic injury, femoral vein FeCl3 injury, and infrarenal vena cava (IVC) stasis models of VT. Electrolytic and FeCl3 models produced small thrombi with few RBCs (5% and 4%, respectively), whereas IVC stasis produced large thrombi with higher RBC content (68%) that was similar to human PEs. After IVC stasis and ligature removal (de-ligation) to permit thrombus embolization, compared to F13a(+/+) mice, F13a(+/-) and F13a(-/-) mice had similar and increased PE incidence, respectively. Conclusions: Compared to thrombin infusion-, electrolytic injury-, and FeCl3-based models. IVC stasis produces thrombi that are more histologically similar to human thrombi. IVC stasis followed by de-ligation permits embolization of existing RBC- and fibrin-rich thrombi. Complete FXIII deficiency increases PE incidence, but partial deficiency does not.