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Moore SS, O’Sullivan KJ, Verdecchia F. Shrinking the Supply Chain for Implantable Coronary Stent Devices. Ann Biomed Eng 2015; 44:497-507. [DOI: 10.1007/s10439-015-1471-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/24/2015] [Indexed: 12/13/2022]
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Hussner J, Begunk R, Boettcher K, Gliesche DG, Prestin K, Meyer Zu Schwabedissen HE. Expression of OATP2B1 as determinant of drug effects in the microcompartment of the coronary artery. Vascul Pharmacol 2015; 72:25-34. [PMID: 26091578 DOI: 10.1016/j.vph.2015.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/04/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
Clinical success of coronary drug-eluting stents (DES) is hampered by simultaneous reduction of smooth muscle cell (HCASMC) and endothelial cell proliferation due to unspecific cytotoxicity of currently used compounds. Previous in vitro data showing SMC-specific inhibition of proliferation suggested that statins may be suitable candidates for DES. It was aim of this study to further investigate statins as DES drug candidates to identify mechanisms contributing to their cell-selectivity. In vitro proliferation assays comparing the influence of various statins on HCASMC and endothelial cells confirmed that atorvastatin exhibits HCASMC-specificity. Due to similar expression levels of the drug target HMG-CoA reductase in both cell types, cellular accumulation of atorvastatin was assessed, revealing enhanced uptake in HCASMC most likely driven by significant expression of OATP2B1, a known uptake transporter for atorvastatin. In accordance with the finding that endogenous OATP2B1 influenced cellular accumulation in HCASMC we used this transporter as a tool to identify teniposide as new DES candidate drug with HCASMC-specific effects. We describe OATP2B1 as a determinant of pharmacokinetics in the coronary artery. Indeed, endogenously expressed OATP2B1 significantly influences the uptake of substrate drugs, thereby governing cell specificity. Screening of candidate drugs for interaction with OATP2B1 may be used to promote SMC-specificity.
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Affiliation(s)
- Janine Hussner
- University of Basel, Department of Pharmaceutical Sciences, Biopharmacy, Basel, Switzerland
| | - Robert Begunk
- University Medicine, Ernst Moritz Arndt University Greifswald, Center of Drug Absorption and Transport, Institute of Pharmacology, Greifswald, Germany
| | - Kerstin Boettcher
- University Medicine, Ernst Moritz Arndt University Greifswald, Center of Drug Absorption and Transport, Institute of Pharmacology, Greifswald, Germany
| | - Daniel G Gliesche
- University of Basel, Department of Pharmaceutical Sciences, Biopharmacy, Basel, Switzerland
| | - Katharina Prestin
- University of Basel, Department of Pharmaceutical Sciences, Biopharmacy, Basel, Switzerland
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Lan H, Wang Y, Yin T, Wang Y, Liu W, Zhang X, Yu Q, Wang Z, Wang G. Progress and prospects of endothelial progenitor cell therapy in coronary stent implantation. J Biomed Mater Res B Appl Biomater 2015; 104:1237-47. [PMID: 26059710 DOI: 10.1002/jbm.b.33398] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 12/20/2014] [Accepted: 02/16/2015] [Indexed: 01/04/2023]
Abstract
Drug-eluting stents (DES) have been widely used to treat coronary artery disease (CAD) since their clinical use has significantly reduced the occurrence of in-stent restenosis (ISR) as compared with the initially applied bare-metal stents (BMS). However, analyses of long-term clinical outcome have raised concerns about the serious safety problem of DES, such as ISR caused by late or very late thrombosis. Various studies showed that those complications were associated with vascular endothelial injury/dysfunction or endothelialization delaying. Recently, through biological characterization of endothelial progenitor cells (EPCs), mechanistic understanding of rapid re-endothelialization of the vascular injury sites after coronary stenting has become possible and is a new research hotspot in the prevention of ISR and late/very late stent thrombosis. It has been well recognized that the formation of a functional endothelial layer from EPCs requires a coordinated sequence of multistep and signaling events, which includes cell mobilization, adhesion, migration and finally the differentiation to vascular endothelial cells (VECs). In this review, we summarize and discuss the currently relevant information about EPCs, the mechanism of DES interfering with the natural vascular healing process in preventing or delaying the formation of a functional endothelial layer, and EPCs-mediated acceleration of re-endothelialization at vascular injury sites. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1237-1247, 2016.
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Affiliation(s)
- Hualin Lan
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, College of Bioengineering of Chongqing University, Chongqing, China
| | - Yi Wang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, College of Bioengineering of Chongqing University, Chongqing, China
| | - Tieyin Yin
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, College of Bioengineering of Chongqing University, Chongqing, China
| | - Yazhou Wang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, College of Bioengineering of Chongqing University, Chongqing, China
| | - Wanqian Liu
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, College of Bioengineering of Chongqing University, Chongqing, China
| | - Xiaojuan Zhang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, College of Bioengineering of Chongqing University, Chongqing, China
| | - Qinsong Yu
- Department of Mechanical and Aerospace Engineering, University of Missouri, Columbia, Missouri
| | - Zhaoxu Wang
- Laboratory of Biomaterials and Tissue Engineering, National Institutes for Food and Drug Control, Beijing, China
| | - Guixue Wang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, College of Bioengineering of Chongqing University, Chongqing, China
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Hiremath S, Chandra P, Desai D, Sivakumar R, Selvamani S, Srinivasan A, Paulose M, Jose S, Kalmath BC, Magarkar VP, Pathak A, Mhetre T. A prospective, multi-centric, observational registry to evaluate performance of Excel™ DES in 'real world, all comers' patient population. Indian Heart J 2015; 66:691-5. [PMID: 25634407 DOI: 10.1016/j.ihj.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/21/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aims to assess the safety and efficacy of a biodegradable polymer-coated Rapamycin-Eluting Stent (Excel) used in conjunction with six-month dual antiplatelet therapy in daily practice. BACKGROUND The polymeric material of cardiac stents has been reported to adversely affect the safety profile of the drug-eluting stents and is also suspected to cause serious long-term complications. It has been proposed that the biodegradable polymer coatings may reduce such late-stage adverse effects. METHODS This is a prospective, multi-center registry of 654 patients from across 9 cardiology centers in India, who were enrolled and exclusively treated with Excel stents between February 2008 and May 2010. The recommended antiplatelet regimen included clopidogrel and aspirin for 6 months period, followed by lifelong aspirin therapy. RESULTS The study population included 46.94% diabetics, 24.31% smokers, 48.93% hypertensives and 14.98% hyperlipidemics. The cumulative rates of major adverse cardiac events were 0.153% at discharge and 1.38% at 12 months. The mean percentage of stenosis was 88.24 ± 9.17% No events occurred between 6 and 12 months. CONCLUSIONS This multi-center registry study on "real world, all comers" has, thus, showed that EXCEL™ stent which is PLA-coated biodegradable Rapamycin-Eluting Stent exhibited high efficacy and safety profile in treatment of patients undergoing PCI as evidenced by significantly lower rates of MACE and no case of stent thrombosis. There was no event even after DAPT was discontinued after 6 months.
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Affiliation(s)
| | | | - Devang Desai
- Shree B. D. Mehta Mahavir Heart Institute, Surat, India
| | | | | | | | - Madhu Paulose
- St. Gregorios Cardio-Vascular Center Parumala, Kerala, India
| | - Sajy Jose
- St. Gregorios Cardio-Vascular Center Parumala, Kerala, India
| | | | | | | | - Tushar Mhetre
- Assistant Manager, Clinical Research Department, Biosensors Interventional Technologies (India) Pvt. Ltd, India.
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Wang Y, Zhang X. Vascular restoration therapy and bioresorbable vascular scaffold. Regen Biomater 2014; 1:49-55. [PMID: 26816624 PMCID: PMC4669005 DOI: 10.1093/rb/rbu005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 12/31/2022] Open
Abstract
This article describes the evolution of minimally invasive intervention technologies for vascular restoration therapy from early-stage balloon angioplasty in 1970s, metallic bare metal stent and metallic drug-eluting stent technologies in 1990s and 2000s, to bioresorbable vascular scaffold (BVS) technology in large-scale development in recent years. The history, the current stage, the challenges and the future of BVS development are discussed in detail as the best available approach for vascular restoration therapy. The criteria of materials selection, design and processing principles of BVS, and the corresponding clinical trial results are also summarized in this article.
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Affiliation(s)
- Yunbing Wang
- National Engineering Research Center For Biomaterials, Sichuan University, Chengdu 610064, China
| | - Xingdong Zhang
- National Engineering Research Center For Biomaterials, Sichuan University, Chengdu 610064, China
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Bae BC, Yang SG, Jeong S, Lee DH, Na K, Kim JM, Costamagna G, Kozarek RA, Isayama H, Deviere J, Seo DW, Nageshwar Reddy D. Polymeric photosensitizer-embedded self-expanding metal stent for repeatable endoscopic photodynamic therapy of cholangiocarcinoma. Biomaterials 2014; 35:8487-95. [PMID: 25043500 DOI: 10.1016/j.biomaterials.2014.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/01/2014] [Indexed: 02/07/2023]
Abstract
Photodynamic therapy (PDT) is a new therapeutic approach for the palliative treatment of malignant bile duct obstruction. In this study, we designed photosensitizer-embedded self-expanding nonvascular metal stent (PDT-stent) which allows repeatable photodynamic treatment of cholangiocarcinoma without systemic injection of photosensitizer. Polymeric photosensitizer (pullulan acetate-conjugated pheophorbide A; PPA) was incorporated in self-expanding nonvascular metal stent. Residence of PPA in the stent was estimated in buffer solution and subcutaneous implantation on mouse. Photodynamic activity of PDT-stent was evaluated through laserexposure on stent-layered tumor cell lines, HCT-116 tumor-xenograft mouse models and endoscopic intervention of PDT-stent on bile duct of mini pigs. Photo-fluorescence imaging of the PDT-stent demonstrated homogeneous embedding of polymeric Pheo-A (PPA) on stent membrane. PDT-stent sustained its photodynamic activities at least for 2 month. And which implies repeatable endoscopic PDT is possible after stent emplacement. The PDT-stent after light exposure successfully generated cytotoxic singlet oxygen in the surrounding tissues, inducing apoptotic degradation of tumor cells and regression of xenograft tumors on mouse models. Endoscopic biliary in-stent photodynamic treatments on minipigs also suggested the potential efficacy of PDT-stent on cholangiocarcinoma. In vivo and in vitro studies revealed our PDT-stent, allows repeatable endoscopic biliary PDT, has the potential for the combination therapy (stent plus PDT) of cholangiocarcinoma.
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Affiliation(s)
- Byoung-chan Bae
- Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-743, Republic of Korea
| | - Su-Geun Yang
- Department of New Drug Development and NCEED, School of Medicine, Inha University, Incheon, Republic of Korea
| | - Seok Jeong
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Don Haeng Lee
- Utah-Inha DDS and Advanced Therapeutics, B-404, Meet-You-All Tower, Songdo-dong, Yeonsu-gu, Incheon, Republic of Korea; Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea; Department of New Drug Development and NCEED, School of Medicine, Inha University, Incheon, Republic of Korea
| | - Kun Na
- Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-743, Republic of Korea.
| | - Joon Mee Kim
- Department of Pathology, Inha University Hospital, Incheon, Republic of Korea
| | - Guido Costamagna
- Digestive Endoscopy Unit, Department of Surgery, Catholic University, Rome, Italy; Department of Radiology, Catholic University, Rome, Italy
| | - Richard A Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, USA
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jacques Deviere
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Dong Wan Seo
- Division of Gastroenterology, Asan Medical Center, Seoul, Republic of Korea
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Meyer Zu Schwabedissen HE, Begunk R, Hussner J, Juhnke BO, Gliesche D, Böttcher K, Sternberg K, Schmitz KP, Kroemer HK. Cell-Specific Expression of Uptake Transporters—A Potential Approach for Cardiovascular Drug Delivery Devices. Mol Pharm 2014; 11:665-72. [DOI: 10.1021/mp400245g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Barkam S, Saraf S, Seal S. Fabricated micro-nano devices for in vivo and in vitro biomedical applications. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2013; 5:544-68. [PMID: 23894041 DOI: 10.1002/wnan.1236] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/04/2013] [Accepted: 06/19/2013] [Indexed: 12/11/2022]
Abstract
In recent years, the innovative use of microelectromechanical systems (MEMSs) and nanoelectromechanical systems (NEMSs) in biomedical applications has opened wide opportunities for precise and accurate human diagnostics and therapeutics. The introduction of nanotechnology in biomedical applications has facilitated the exact control and regulation of biological environments. This ability is derived from the small size of the devices and their multifunctional capabilities to operate at specific sites for selected durations of time. Researchers have developed wide varieties of unique and multifunctional MEMS/NEMS devices with micro and nano features for biomedical applications (BioMEMS/NEMS) using the state of the art microfabrication techniques and biocompatible materials. However, the integration of devices with the biological milieu is still a fundamental issue to be addressed. Devices often fail to operate due to loss of functionality, or generate adverse toxic effects inside the body. The in vitro and in vivo performance of implantable BioMEMS such as biosensors, smart stents, drug delivery systems, and actuation systems are researched extensively to understand the interaction of the BioMEMS devices with physiological environments. BioMEMS developed for drug delivery applications include microneedles, microreservoirs, and micropumps to achieve targeted drug delivery. The biocompatibility of BioMEMS is further enhanced through the application of tissue and smart surface engineering. This involves the application of nanotechnology, which includes the modification of surfaces with polymers or the self-assembly of monolayers of molecules. Thereby, the adverse effects of biofouling can be reduced and the performance of devices can be improved in in vivo and in vitro conditions.
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Affiliation(s)
- Swetha Barkam
- Advanced Materials Processing and Analysis Center, Nanoscience Technology Center, Materials Science and Engineering, University of Central Florida, Orlando, FL, USA
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Shimamura T, Jeng D, Lucas A, Essani K. Suppression of neointimal hyperplasia following angioplasty-induced vascular injury in pigs infected with swinepox virus. Open Virol J 2012; 6:91-6. [PMID: 23136622 PMCID: PMC3486964 DOI: 10.2174/1874357901206010091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/07/2012] [Accepted: 09/10/2012] [Indexed: 11/22/2022] Open
Abstract
Many patients suffering from angina pectoris are treated with percutaneous coronary intervention (PCI) and quickly develop angiographic renarrowing, or restenosis, at the site of PCI treatment. Restenosis is thought to arise from the combinatorial activation of thrombotic and inflammatory responses. The inflammatory response responsible for restenosis is also thought to involve the activation of a cascade of serine proteases and its subsequent regulation. Poxviruses are known to possess a variety of immunomodulatory strategies, some of which target serine proteases, cytokines, and chemokines. To this end we evaluated whether systemic species-specific swinepox virus (SPV) infection could induce sufficient host-immune modulation to promote an anti-inflammatory and anti-proliferative effect, thereby preventing restenosis. Two groups of domestic feeder pigs were used - the first group was experimentally infected with SPV (n= 11) and the second group served as an uninfected control (n= 5). A week after infection, the pigs were anesthetized and percutaneous transluminal coronary angioplasty (PTCA) was performed in the left anterior descending coronary artery using X-ray fluoroscopy to visualize the balloon and record angiograms. Three weeks post infection, the pigs were euthanized and balloon angioplasty injured arteries were harvested and examined. We observed a statistically significant reduction of restenosis in SPV-infected pigs (p = 0.05) compared to control pigs and conclude that systemic swinepox virus infection causes sufficient host immune suppression to significantly reduce restenosis in pigs after balloon angioplasty injury.
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Affiliation(s)
- Takeshi Shimamura
- Laboratory of Virology, Department of Biological Sciences, Western Michigan University, 1903 West Michigan Ave, 3441 Wood Hall, Kalamazoo, MI 49008-5410, USA
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Delgadillo H, Vargas-Alarcón G, Gómez-Monterrosas O, Martínez-Rodríguez N, Ramírez-Fuentes S, Carrillo-Sánchez S, Peña-Duque MA, Martínez-Ríos MA, Pérez-Méndez O, Fragoso JM. The MHC2TA gene polymorphisms are not associated with restenosis after coronary stenting in Mexican patients. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2012; 82:208-13. [DOI: 10.1016/j.acmx.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 02/15/2012] [Accepted: 04/17/2012] [Indexed: 11/30/2022] Open
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Comparative vascular responses three months after paclitaxel and everolimus-eluting stent implantation in streptozotocin-induced diabetic porcine coronary arteries. Cardiovasc Diabetol 2012; 11:75. [PMID: 22716997 PMCID: PMC3413520 DOI: 10.1186/1475-2840-11-75] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/21/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diabetes remains a significant risk factor for restenosis/thrombosis following stenting. Although vascular healing responses following drug-eluting stent (DES) treatment have been characterized previously in healthy animals, comparative assessments of different DES in a large animal model with isolated features of diabetes remains limited. We aimed to comparatively assess the vascular response to paclitaxel-eluting (PES) and everolimus-eluting (EES) stents in a porcine coronary model of streptozotocin (STZ)-induced type I diabetes. METHOD Twelve Yucatan swine were induced hyperglycemic with a single STZ dose intravenously to ablate pancreatic β-cells. After two months, each animal received one XIENCE V® (EES) and one Taxus Liberte (PES) stent, respectively, in each coronary artery. After three months, vascular healing was assessed by angiography and histomorphometry. Comparative in vitro effects of everolimus and paclitaxel (10-5 M-10-12 M) after 24 hours on carotid endothelial (EC) and smooth muscle (SMC) cell viability under hyperglycemic (42 mM) conditions were assayed by ELISA. Caspase-3 fluorescent assay was used to quantify caspase-3 activity of EC treated with everolimus or paclitaxel (10-5 M, 10-7 M) for 24 hours. RESULTS After 3 months, EES reduced neointimal area (1.60 ± 0.41 mm, p < 0.001) with trends toward reduced % diameter stenosis (11.2 ± 9.8%, p = 0.12) and angiographic late-loss (0.28 ± 0.30 mm, p = 0.058) compared to PES (neointimal area: 2.74 ± 0.58 mm, % diameter stenosis: 19.3 ± 14.7%, late loss: 0.55 ± 0.53 mm). Histopathology revealed increased inflammation scores (0.54 ± 0.21 vs. 0.08 ± 0.05), greater medial necrosis grade (0.52 ± 0.26 vs. 0.0 ± 0.0), and persistently elevated fibrin scores (1.60 ± 0.60 vs. 0.63 ± 0.41) with PES compared to EES (p < 0.05). In vitro, paclitaxel significantly increased (p < 0.05) EC/SMC apoptosis/necrosis at high concentrations (≥ 10-7 M), while everolimus did not affect EC/SMC apoptosis/necrosis within the dose range tested. In ECs, paclitaxel (10-5 M) significantly increased caspase-3 activity (p < 0.05) while everolimus had no effect. CONCLUSION After 3 months, both DES exhibited signs of delayed healing in a STZ-induced diabetic swine model. PES exhibited greater neointimal area, increased inflammation, greater medial necrosis, and persistent fibrin compared to EES. Differential effects of everolimus and paclitaxel on vascular cell viability may potentially be a factor in regulating delayed healing observed with PES. Further investigation of molecular mechanisms may aid future development of stent-based therapies in treating coronary artery disease in diabetic patients.
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Lee CH, Chen CJ, Liu SJ, Hsiao CY, Chen JK. The Development of Novel Biodegradable Bifurcation Stents for the Sustainable Release of Anti-Proliferative Sirolimus. Ann Biomed Eng 2012; 40:1961-70. [DOI: 10.1007/s10439-012-0556-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 03/21/2012] [Indexed: 12/18/2022]
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In-vitro release of anti-proliferative paclitaxel from novel balloon-expandable polycaprolactone stents. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2011. [DOI: 10.1016/j.msec.2011.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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64
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Leadership in cardiac surgery. Eur J Cardiothorac Surg 2011; 39:905-11. [DOI: 10.1016/j.ejcts.2010.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 08/10/2010] [Accepted: 08/16/2010] [Indexed: 11/23/2022] Open
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Abstract
Inflammatory mediators, adhesion molecules of neutrophils and monocytes, have been shown to be increased in the plasma of patients presenting with acute coronary syndromes. Anaphylaxis is a systemic, immediate hypersensitivity reaction caused by rapid IgE-mediated release of mediators from mast cells and basophils. Kounis syndrome is the coincidental occurrence of these two distinct conditions accompanied by clinical and laboratory findings of angina pectoris caused by inflammatory mediators released during an allergic insult. Allergic angina can progress to acute myocardial infarction, which is termed 'allergic myocardial infarction'. There are several causes reported to be capable of inducing Kounis syndrome. These include a number of conditions, several drugs, foods and insect stings, among others. In this article, the clinical aspects, diagnosis, pathogenesis, incidence and epidemiology, related conditions and therapeutic management of this important syndrome are discussed.
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Affiliation(s)
- Murat Biteker
- Department of Cardiology, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey.
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66
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Capodanno D, Dipasqua F, Tamburino C. Novel drug-eluting stents in the treatment of de novo coronary lesions. Vasc Health Risk Manag 2011; 7:103-18. [PMID: 21415924 PMCID: PMC3049546 DOI: 10.2147/vhrm.s11444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Indexed: 11/01/2022] Open
Abstract
Due to safety concerns in recent years, much effort has been devoted to improving the outcomes associated with drug-eluting stents (DESs). This review summarizes the current status of methodological and technical achievements reported in second-generation DES. Novel stents are described based on the component (the platform, the polymer, and the drug) that has undergone the most significant changes compared to earlier generation DES. An overview of the currently available evidence on the use of novel coronary devices in patients undergoing coronary revascularization is also reviewed.
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Affiliation(s)
- Davide Capodanno
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
- ETNA Foundation, Catania, Italy
| | - Fabio Dipasqua
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
- ETNA Foundation, Catania, Italy
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An acetylated polysaccharide-PTFE membrane-covered stent for the delivery of gemcitabine for treatment of gastrointestinal cancer and related stenosis. Biomaterials 2011; 32:3603-10. [PMID: 21334742 DOI: 10.1016/j.biomaterials.2011.01.070] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 01/28/2011] [Indexed: 12/23/2022]
Abstract
Gemcitabine (Gem) eluting metal stents were prepared for potential application as drug delivery systems for localized treatment of malignant tumors. Pullulan, a natural polysaccharide, was chemically acetylated (pullulan acetate; PA) by different degrees (1.18, 1.71, and 2.10 acetyl groups per glucose unit of pullulan), layered on polytetrafluoroethylene (PTFE), and applied as part of a Gem-loaded controlled-release membrane for drug-eluting non-vascular stents. PA with a higher degree of acetylation had greater drug-loading capacity with more extended release of Gem over 30 days. The released Gem accumulated in CT-26 colon cancer without systemic exposure inducing total regression of tumors. The long-term biological activity of the released Gem and apoptosis of tumor tissues following localized delivery were confirmed by annexin V binding assays and histology. The controlled release of Gem from PA-PTFE covered drug-eluting stents (DES) may increase the patency of these stents for the treatment of malignant gastrointestinal cancer as well as cancer-related stenosis.
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Barrett DG, Merkel TJ, Luft JC, Yousaf MN. One-Step Syntheses of Photocurable Polyesters Based on a Renewable Resource. Macromolecules 2010. [DOI: 10.1021/ma1015424] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Devin G. Barrett
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Timothy J. Merkel
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - J. Christopher Luft
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Muhammad N. Yousaf
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
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Weiss DR, Juchem G, Kemkes BM, Gansera B, Nees S. Extensive deendothelialization and thrombogenicity in routinely prepared vein grafts for coronary bypass operations: facts and remedy. Int J Clin Exp Med 2009; 2:95-113. [PMID: 19684884 PMCID: PMC2719701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Accepted: 05/25/2009] [Indexed: 05/28/2023]
Abstract
The objective of this study was to gain deeper insight into the early reasons for saphenous vein graft disease and to find a practical approach to obviate it. Intraoperative storage of freshly explanted venous grafts (45 min, 20 degrees C; n=25 in each case) in saline, saline + 5% albumin, or HTK-solution and also in heparinized autologous blood was poorly tolerated by the endothelium. Large endothelial areas (mostly >75% of total surface) were detached already during brief non-pulsatile flushing just before the transplantation. Contact of deendothelialized areas in graft remnants with defined mixtures of coagulation factors or blood (n=11-17) caused rapid coagulatory processes via expression of tissue factor and assembly of prothrombinase in the subendothelium. Attached platelets and leukocytes accelerated the procoagulatory processes further, and endothelium-dependent anticoagulatory activities were significantly abolished. During pulsatile arterial flow, the resulting blood clots exacerbated the damage of the intima markedly, because they were flushed away tearing off further endothelium. In contrast, storage of venous grafts in a plasma preparation freed from isoagglutinins and coagulation factors preserved the endothelium, which resisted arterial flow and revealed anticoagulatory activity in the presence of antithrombin III and/or protein C. We conclude that gentle preparation and preservation of the vascular endothelium with a suitable storage solution during bypass surgery is a decisive first step to obviate saphenous vein graft disease.
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Affiliation(s)
- Dominik R. Weiss
- Department of Transfusion Medicine and Hemostaseology, University of Erlangen-Nuremberg (FAU)91054 Erlangen, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, University of Munich (LMU)81377 Munich, Germany
| | - Bernhard M. Kemkes
- Department of Cardiac Surgery, Hospital Bogenhausen81925 Munich, Germany
| | - Brigitte Gansera
- Department of Cardiac Surgery, Hospital Bogenhausen81925 Munich, Germany
| | - Stephan Nees
- Department of Physiology, University of Munich (LMU)80336 Munich, Germany
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Dörr R. [Acute coronary syndrome - a challenge for the cooperation between outpatient and inpatient care]. Herz 2009; 33:395-401. [PMID: 19156374 DOI: 10.1007/s00059-008-3163-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute coronary syndrome (ACS) summarizes all phases of coronary heart disease, which are imminently life-threatening. In clinical practice, these are unstable angina pectoris, acute myocardial infarction, and sudden cardiac death. As the transitions between these clinical entities are smooth, it has been established during the last years to distinguish patients based on ECG findings in groups with (STEMI) and without ST segment elevation (NSTEMI/unstable angina pectoris). Because of the life-threatening character of this disease, continuous monitoring and immediate diagnostic evaluation are mandatory in all patients with suspected ACS. Regularly, this has to be done in the emergency department of a hospital. As the diagnostic and therapeutic management of ACS necessitates rapid decision-making, an optimal cooperation between outpatient and inpatient departments is essential for maximal therapeutic performance. However, it has been shown that only 20-30% of patients admitted to an emergency department with acute chest pain have ACS and only 10-15% have acute myocardial infarction. About 50% of patients presenting with acute chest pain are part of a low-risk group and do not need hospital admission. On the other hand, 2-8% of patients with acute myocardial infarction are misdiagnosed in interdisciplinary emergency departments and discharged too early in spite of an ongoing life-threatening risk. Therefore, chest pain units (CPUs) were founded in many hospitals to optimize the diagnosis and treatment of ACS and the related consumption of financial resources. A task force of the German Society of Cardiology is presently preparing a consensus paper on the basic requirements for CPUs in Germany. The positioning of CPUs at the gateway between outpatient and inpatient care and the additional need for short-term outpatient exercise testing (stress ECG, stress echocardiography, scintigraphy, stress MRI) after ruling out ACS and myocardial infarction, predestine these facilities for new models of managed care including cardiologists in private practice.
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Affiliation(s)
- Rolf Dörr
- Praxisklinik Herz und Gefässe, Dresden.
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Abstract
Cardiovascular medicine has evolved over the last few decades, with the advent of percutaneous interventional treatments. In particular, balloon angioplasty and, subsequently, coronary stenting has revolutionized our current perspective of stable and unstable coronary artery disease management. However, the long-term results of stent usage have been blighted by the dual problems of in-stent restenosis and stent thrombosis. Whilst stent thrombosis became much less frequent with the introduction of dual-antiplatelet therapy, restenosis remained a significant problem. Intense work on stent development has successfully led to the introduction of drug-eluting stents (DES) in an effort to address this problem. Randomized trials have consistently proven the superior efficacy of DES over bare metal stents, in elective patients, acute coronary syndromes and patients with diabetes mellitus. Nevertheless, the routine use of DES in by-pass venous graft disease remains debatable. The initial DES used sirolimus and paclitaxel are now being joined by newer stents releasing drugs, such as everolimus, zotarolimus and tacrolimus. Ongoing developments with the stent platform and the polymer coating are also gradually improving the performance of these stents in clinical practice. More recently, the idea of antibody-coated stents that would encourage epithelialization of stent struts by endothelial progenitor cells recruitment has gained attraction among interventionists, with a possible beneficial impact on reducing the incidence of restenosis.
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Affiliation(s)
- Mehmood Butt
- University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK
| | - Derek Connolly
- Department of Cardiology, City Hospital, Birmingham, B18 7QH, UK
| | - Gregory YH Lip
- University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK
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