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Zong J, He Q, Liu Y, Qiu M, Wu J, Hu B. Advances in the development of biodegradable coronary stents: A translational perspective. Mater Today Bio 2022; 16:100368. [PMID: 35937578 PMCID: PMC9352968 DOI: 10.1016/j.mtbio.2022.100368] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/25/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Implantation of cardiovascular stents is an important therapeutic method to treat coronary artery diseases. Bare-metal and drug-eluting stents show promising clinical outcomes, however, their permanent presence may create complications. In recent years, numerous preclinical and clinical trials have evaluated the properties of bioresorbable stents, including polymer and magnesium-based stents. Three-dimensional (3D) printed-shape-memory polymeric materials enable the self-deployment of stents and provide a novel approach for individualized treatment. Novel bioresorbable metallic stents such as iron- and zinc-based stents have also been investigated and refined. However, the development of novel bioresorbable stents accompanied by clinical translation remains time-consuming and challenging. This review comprehensively summarizes the development of bioresorbable stents based on their preclinical/clinical trials and highlights translational research as well as novel technologies for stents (e.g., bioresorbable electronic stents integrated with biosensors). These findings are expected to inspire the design of novel stents and optimization approaches to improve the efficacy of treatments for cardiovascular diseases. Bioresorbable stents can overcome the limitations of non-degradable stents. 3D printing of shape-memory polymeric stents can lead to better clinical outcomes. Advances in Mg-, Fe- and Zn-based stents from a translational perspective. Electronic stents integrated with biosensors can covey stent status in real time. Development in the assessment of stent performance in vivo.
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Affiliation(s)
- Jiabin Zong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Quanwei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuxiao Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Min Qiu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiehong Wu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Corresponding author.
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Corresponding author.
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2
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Arza CR, Li X, İlk S, Liu Y, Demircan D, Zhang B. Biocompatible non-leachable antimicrobial polymers with a nonionic hyperbranched backbone and phenolic terminal units. J Mater Chem B 2022; 10:8064-8074. [PMID: 36111601 DOI: 10.1039/d2tb01233b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This work aimed to develop biocompatible non-leachable antimicrobial polymers without ionic structures. A series of nonionic hyperbranched polymers (HBPs) with an isatin-based backbone and phenolic terminal units were synthesized and characterized. The molecular structures and thermal properties of the obtained HBPs were characterized by SEC, NMR, FTIR, TGA and DSC analyses. Disk diffusion assay revealed significant antibacterial activity of the obtained phenolic HBPs against nine different pathogenic bacteria. The presence of a methoxy or long alkyl group close to the phenolic unit enhanced the antibacterial effect against certain Gram positive and negative bacteria. The obtained nonionic HBPs were blended in polyester poly(hexamethylene terephthalate) films, which showed no noticeable leakage after being immersed in water for 5 days. Finally, these HBPs showed no cytotoxicity effect to MG-63 osteoblast-like human cells according to MTT analysis, and negligible hemolytic effect.
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Affiliation(s)
- Carlos R Arza
- Centre for Analysis and Synthesis, Department of Chemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden.
| | - Xiaoya Li
- Centre for Analysis and Synthesis, Department of Chemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden.
| | - Sedef İlk
- Niğde Ömer Halisdemir University, Faculty of Medicine, Department of Immunology, TR-51240 Niğde, Turkey
| | - Yang Liu
- Faculty of Medicine, Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - Deniz Demircan
- Centre for Analysis and Synthesis, Department of Chemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden.
| | - Baozhong Zhang
- Centre for Analysis and Synthesis, Department of Chemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden.
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3
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Seidi F, Zhong Y, Xiao H, Jin Y, Crespy D. Degradable polyprodrugs: design and therapeutic efficiency. Chem Soc Rev 2022; 51:6652-6703. [PMID: 35796314 DOI: 10.1039/d2cs00099g] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Prodrugs are developed to increase the therapeutic properties of drugs and reduce their side effects. Polyprodrugs emerged as highly efficient prodrugs produced by the polymerization of one or several drug monomers. Polyprodrugs can be gradually degraded to release therapeutic agents. The complete degradation of polyprodrugs is an important factor to guarantee the successful disposal of the drug delivery system from the body. The degradation of polyprodrugs and release rate of the drugs can be controlled by the type of covalent bonds linking the monomer drug units in the polymer structure. Therefore, various types of polyprodrugs have been developed based on polyesters, polyanhydrides, polycarbonates, polyurethanes, polyamides, polyketals, polymetallodrugs, polyphosphazenes, and polyimines. Furthermore, the presence of stimuli-responsive groups, such as redox-responsive linkages (disulfide, boronate ester, metal-complex, and oxalate), pH-responsive linkages (ester, imine, hydrazone, acetal, orthoester, P-O and P-N), light-responsive (metal-complex, o-nitrophenyl groups) and enzyme-responsive linkages (ester, peptides) allow for a selective degradation of the polymer backbone in targeted tumors. We envision that new strategies providing a more efficient synergistic therapy will be developed by combining polyprodrugs with gene delivery segments and targeting moieties.
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Affiliation(s)
- Farzad Seidi
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources and International Innovation Center for Forest Chemicals and Materials, Nanjing Forestry University, Nanjing 210037, China. .,Department of Materials Science and Engineering, School of Molecular Science and Engineering, Vidyasirimedhi Institute of Science and Technology (VISTEC), Rayong 21210, Thailand.
| | - Yajie Zhong
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources and International Innovation Center for Forest Chemicals and Materials, Nanjing Forestry University, Nanjing 210037, China.
| | - Huining Xiao
- Department of Chemical Engineering, University of New Brunswick, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Yongcan Jin
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources and International Innovation Center for Forest Chemicals and Materials, Nanjing Forestry University, Nanjing 210037, China.
| | - Daniel Crespy
- Department of Materials Science and Engineering, School of Molecular Science and Engineering, Vidyasirimedhi Institute of Science and Technology (VISTEC), Rayong 21210, Thailand.
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4
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Liu Y, Zheng B, Zhang B, Ndondo-lay R, Nie F, Tang N, Miao Y, Li J, Huo Y. Five-year comparative study of thin-strut rapamycin-eluting bioabsorbable scaffold with metallic drug-eluting stent in porcine coronary artery. Front Cardiovasc Med 2022; 9:938519. [PMID: 35935636 PMCID: PMC9355424 DOI: 10.3389/fcvm.2022.938519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives Using quantitative coronary angiography (QCA), optical coherence tomography (OCT), histomorphometry, and pharmacokinetics, this study tried to evaluate the safety and efficacy of Biomagic rapamycin-eluting bioabsorbable scaffold (BVS) in non-atherosclerotic porcine coronary arteries. Background Biomagic BVS is a new generation of thin-strut bioabsorbable scaffold. We conducted comparative study detailing pathological response, safety and efficacy of Biomagic BVS and the Firebird2 rapamycin-eluting cobalt-based alloy stent (DES) in a porcine coronary artery model. The animals were followed up at 14 days, 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months after stent implantation. Methods A total of 143 devices (95 Biomagic and 48 Firebird2) were implanted in 2 or 3 main coronary arteries of 76 nonatherosclerotic swine and examined by QCA, OCT, light microscopy, and pharmacokinetics analyses at various time points. Results Vascular responses to Biomagic and Firebird2 were largely comparable at all time points, with struts being sequestered within the neointima. The degree of inflammation of both devices was mild to moderate, although the Biomagic score was higher at 14 days to 24 months. However, there was no statistical difference between the two groups except 14 days. At each follow-up time point, the percentage of area stenosis in the Biomagic group was greater than that in the Firebird 2 group, but there was no statistical difference between the two groups at 3 and 12 months. The extent of fibrin deposition was similar between Biomagic and Firebird2, which peaked at 1 month and decreased rapidly thereafter. Pharmacokinetic study showed that coronary tissue sirolimus concentration remained above 2 ng/mg of tissue at 28 day. Histomorphometry showed expansile remodeling of Biomagic-implanted arteries starting after 12 months, and lumen area was significantly greater in Biomagic than Firebird2 at 36 and 42 months. These changes correlated with dismantling of Biomagic seen after 12 months. OCT images confirmed that degradation of Biomagic was complete by 36 months. Conclusions Biomagic demonstrates comparable long-term safety to Firebird2 in porcine coronary arteries with mild to moderate inflammation. Although Biomagic was associated with greater percent stenosis relative to Firebird2 within 36 months, expansile remodeling was observed after 12 months in Biomagic with significantly greater lumen area at ≥36 months. Scaffold resorption is considered complete at 36 months.
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Affiliation(s)
- Yaokun Liu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | | | - Fangfang Nie
- Shanghai Biomagic Medical Devices Company Limited, Shanghai, China
| | - Naijie Tang
- Shanghai Biomagic Medical Devices Company Limited, Shanghai, China
| | - Yongsheng Miao
- Shanghai Biomagic Medical Devices Company Limited, Shanghai, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
- *Correspondence: Jianping Li
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
- Yong Huo
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5
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Li X, İlk S, Liu Y, Raina DB, Demircan D, Zhang B. Nonionic nontoxic antimicrobial polymers: indole-grafted poly(vinyl alcohol) with pendant alkyl or ether groups. Polym Chem 2022. [DOI: 10.1039/d1py01504d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A series of new nonionic antimicrobial polymers with a biodegradable polyvinyl alcohol (PVA) backbone grafted with indole units and different hydrophobic alkyl or ether groups were synthesized by facile esterification.
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Affiliation(s)
- Xiaoya Li
- Lund University, Centre for Analysis and Synthesis, Department of Chemistry, P. O. Box 124, SE-22100 Lund, Sweden
| | - Sedef İlk
- Niğde Ömer Halisdemir University, Faculty of Medicine, Department of Immunology, TR-51240, Niğde, Turkey
- KTH Royal Institute of Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, Department of Chemistry, Division of Glycoscience, SE-10691 Stockholm, Sweden
| | - Yang Liu
- Faculty of Medicine, Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - Deepak Bushan Raina
- Faculty of Medicine, Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - Deniz Demircan
- Lund University, Centre for Analysis and Synthesis, Department of Chemistry, P. O. Box 124, SE-22100 Lund, Sweden
| | - Baozhong Zhang
- Lund University, Centre for Analysis and Synthesis, Department of Chemistry, P. O. Box 124, SE-22100 Lund, Sweden
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6
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Li X, İlk S, Linares-Pastén JA, Liu Y, Raina DB, Demircan D, Zhang B. Synthesis, Enzymatic Degradation, and Polymer-Miscibility Evaluation of Nonionic Antimicrobial Hyperbranched Polyesters with Indole or Isatin Functionalities. Biomacromolecules 2021; 22:2256-2271. [PMID: 33900740 PMCID: PMC8382248 DOI: 10.1021/acs.biomac.1c00343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
![]()
Most macromolecular
antimicrobials are ionic and thus lack miscibility/compatibility
with nonionic substrate materials. In this context, nonionic hyperbranched
polyesters (HBPs) with indole or isatin functionality were rationally
designed, synthesized, and characterized. Antimicrobial disk diffusion
assay indicated that these HBPs showed significant antibacterial activity
against 8 human pathogenic bacteria compared to small molecules with
indole or isatin groups. According to DSC measurements, up to 20%
indole-based HBP is miscible with biodegradable polyesters (polyhydroxybutyrate
or polycaprolactone), which can be attributed to the favorable hydrogen
bonding between the N–H moiety of indole and the C=O
of polyesters. HBPs with isatin or methylindole were completely immiscible
with the same matrices. None of the HBPs leaked out from plastic matrix
after being immersed in water for 5 days. The incorporation of indole
into HBPs as well as small molecules facilitated their enzymatic degradation
with PETase from Ideonella sakaiensis, while isatin
had a complex impact. Molecular docking simulations of monomeric molecules
with PETase revealed different orientations of the molecules at the
active site due to the presence of indole or isatin groups, which
could be related to the observed different enzymatic degradation behavior.
Finally, biocompatibility analysis with a mammalian cell line showed
the negligible cytotoxic effect of the fabricated HBPs.
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Affiliation(s)
- Xiaoya Li
- Centre for Analysis and Synthesis, Department of Chemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden
| | - Sedef İlk
- Faculty of Medicine, Department of Immunology, Niğde Ömer Halisdemir University, 51240 Niǧde, Turkey.,School of Engineering Sciences in Chemistry, Biotechnology and Health, Department of Chemistry, Division of Glycoscience, KTH Royal Institute of Technology, SE-10691 Stockholm, Sweden
| | - Javier A Linares-Pastén
- Division of Biotechnology, Department of Chemistry, Lund University, P.O. Box 124, 22100 Lund, Sweden
| | - Yang Liu
- Faculty of Medicine, Department of Clinical Sciences, Orthopedics, Lund University, 22100 Lund, Sweden
| | - Deepak Bushan Raina
- Faculty of Medicine, Department of Clinical Sciences, Orthopedics, Lund University, 22100 Lund, Sweden
| | - Deniz Demircan
- Centre for Analysis and Synthesis, Department of Chemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden
| | - Baozhong Zhang
- Centre for Analysis and Synthesis, Department of Chemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden
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7
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McQueen A, Escuer J, Aggarwal A, Kennedy S, McCormick C, Oldroyd K, McGinty S. Do we really understand how drug eluted from stents modulates arterial healing? Int J Pharm 2021; 601:120575. [PMID: 33845150 DOI: 10.1016/j.ijpharm.2021.120575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023]
Abstract
The advent of drug-eluting stents (DES) has revolutionised the treatment of coronary artery disease. These devices, coated with anti-proliferative drugs, are deployed into stenosed or occluded vessels, compressing the plaque to restore natural blood flow, whilst simultaneously combating the evolution of restenotic tissue. Since the development of the first stent, extensive research has investigated how further advancements in stent technology can improve patient outcome. Mathematical and computational modelling has featured heavily, with models focussing on structural mechanics, computational fluid dynamics, drug elution kinetics and subsequent binding within the arterial wall; often considered separately. Smooth Muscle Cell (SMC) proliferation and neointimal growth are key features of the healing process following stent deployment. However, models which depict the action of drug on these processes are lacking. In this article, we start by reviewing current models of cell growth, which predominantly emanate from cancer research, and available published data on SMC proliferation, before presenting a series of mathematical models of varying complexity to detail the action of drug on SMC growth in vitro. Our results highlight that, at least for Sodium Salicylate and Paclitaxel, the current state-of-the-art nonlinear saturable binding model is incapable of capturing the proliferative response of SMCs across a range of drug doses and exposure times. Our findings potentially have important implications on the interpretation of current computational models and their future use to optimise and control drug release from DES and drug-coated balloons.
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Affiliation(s)
- Alistair McQueen
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK
| | - Javier Escuer
- Aragón Institute for Engineering Research (I3A), University of Zaragoza, Spain
| | - Ankush Aggarwal
- Glasgow Computational Engineering Centre, Division of Infrastructure and Environment, University of Glasgow, Glasgow, UK
| | - Simon Kennedy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Keith Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sean McGinty
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK; Glasgow Computational Engineering Centre, Division of Infrastructure and Environment, University of Glasgow, Glasgow, UK.
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8
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Wei Z, Wang W, Zhou C, Jin C, Leng X, Li Y, Zhang X, Chen S, Zhang B, Yang K. In vitro degradation and biocompatibility evaluation of fully biobased thermoplastic elastomers consisting of poly(β-myrcene) and poly( -lactide) as stent coating. Polym Degrad Stab 2020. [DOI: 10.1016/j.polymdegradstab.2020.109254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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9
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Biodegradable stents for coronary artery disease treatment: Recent advances and future perspectives. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 91:163-178. [DOI: 10.1016/j.msec.2018.04.100] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 04/11/2018] [Accepted: 04/28/2018] [Indexed: 12/24/2022]
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10
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Wacker KT, Weems AC, Lim SM, Khan S, Felder SE, Dove AP, Wooley KL. Harnessing the Chemical Diversity of the Natural Product Magnolol for the Synthesis of Renewable, Degradable Neolignan Thermosets with Tunable Thermomechanical Characteristics and Antioxidant Activity. Biomacromolecules 2018; 20:109-117. [DOI: 10.1021/acs.biomac.8b00771] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kevin T. Wacker
- Departments of Chemistry, Chemical Engineering, and Materials Science and Engineering and the Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, Texas 77842-3012, United States
| | - Andrew C. Weems
- School of Chemistry, The University of Birmingham, Edgbaston, Birmingham, United Kingdom, B15 2TT
| | - Soon-Mi Lim
- Departments of Chemistry, Chemical Engineering, and Materials Science and Engineering and the Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, Texas 77842-3012, United States
| | - Sarosh Khan
- Departments of Chemistry, Chemical Engineering, and Materials Science and Engineering and the Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, Texas 77842-3012, United States
| | - Simcha E. Felder
- Departments of Chemistry, Chemical Engineering, and Materials Science and Engineering and the Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, Texas 77842-3012, United States
| | - Andrew P. Dove
- School of Chemistry, The University of Birmingham, Edgbaston, Birmingham, United Kingdom, B15 2TT
| | - Karen L. Wooley
- Departments of Chemistry, Chemical Engineering, and Materials Science and Engineering and the Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, Texas 77842-3012, United States
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11
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Abstract
The human body is endowed with an uncanny ability to distinguish self from foreign. The implantation of a foreign object inside a mammalian host activates complex signaling cascades, which lead to biological encapsulation of the implant. This reaction by the host system to a foreign object is known as foreign body response (FBR). Over the last few decades, it has been increasingly important to have a deeper insight into the mechanisms of FBR is needed to develop biomaterials for better integration with living systems. In the light of recent advances in tissue engineering and regenerative medicine, particularly in the field of biosensors and biodegradable tissue engineering scaffolds, the classical concepts related to the FBR have acquired new dimensions. The aim of this review is to provide a holistic view of the FBR, while critically analyzing the challenges, which need to be addressed in the future to overcome this innate response. In particular, this review discusses the relevant experimental methodology to assess the host response. The role of erosion and degradation behavior on FBR with biodegradable polymers is largely explored. Apart from the discussion on temporal progression of FBR, an emphasis has been given to the design of next-generation biomaterials with favorable host response.
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12
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Hytönen JP, Taavitsainen J, Tarvainen S, Ylä-Herttuala S. Biodegradable coronary scaffolds: their future and clinical and technological challenges. Cardiovasc Res 2018; 114:1063-1072. [DOI: 10.1093/cvr/cvy097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/27/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract
Angioplasty and stenting are standard treatment options for both stabile occlusive coronary artery disease and acute myocardial infarctions. Over the last years, several biodegradable stent systems have entered pre-clinical and clinical evaluation and into clinical practice. A strong supporting scaffold is necessary after angioplasty to prevent elastic recoil of the vessel but in the long term a permanent metallic stent will only impair normal physiology of the artery wall. Thus, the main advantage of a resorbable system is the potential for better vessel recovery and function in the long term. The new stent systems differ from traditional stents in size and biological responses and questions have risen regarding their mechanical strength and increased risk of stent thrombosis. Here, we present current treatment options with biodegradable scaffolds, discuss further key areas for improvements and review novel technological advances in the context of all up-to-date clinical trial information. New material choices are also covered as well as special considerations for pre-clinical testing.
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Affiliation(s)
- Jarkko P Hytönen
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Jouni Taavitsainen
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Santeri Tarvainen
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
- Heart Center
- Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
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13
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Regazzoli D, Leone PP, Colombo A, Latib A. New generation bioresorbable scaffold technologies: an update on novel devices and clinical results. J Thorac Dis 2017; 9:S979-S985. [PMID: 28894604 DOI: 10.21037/jtd.2017.07.104] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Bioresorbable scaffolds (BRS) represent a novel horizon in interventional cardiology and may lead to some potential long-term advantages including the restoration of vasomotion, positive remodeling and a reduced incidence of late and very-late scaffold thrombosis (ScT). This technology, introduced to overcome limitations of current metallic drug-eluting stents (DES), is constantly and rapidly evolving with many companies working on bioresorbable devices. The aim of this review is to present an update on the most promising scaffolds that are under development.
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Affiliation(s)
- Damiano Regazzoli
- Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Pier Pasquale Leone
- Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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14
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Kalra A, Rehman H, Khera S, Thyagarajan B, Bhatt DL, Kleiman NS, Yeh RW. New-Generation Coronary Stents: Current Data and Future Directions. Curr Atheroscler Rep 2017; 19:14. [DOI: 10.1007/s11883-017-0654-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Weintraub S, Shpigel T, Harris LG, Schuster R, Lewis EC, Lewitus DY. Astaxanthin-based polymers as new antimicrobial compounds. Polym Chem 2017. [DOI: 10.1039/c7py00663b] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this work, we describe the development of a library of polyastaxanthin, new polyester compounds with significant antimicrobial activity.
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Affiliation(s)
- S. Weintraub
- Plastics and Polymer Engineering Department
- Shenkar – Engineering Art Design
- Ramat-Gan
- Israel
| | - T. Shpigel
- Plastics and Polymer Engineering Department
- Shenkar – Engineering Art Design
- Ramat-Gan
- Israel
| | - L. G. Harris
- Microbiology and Infectious Diseases
- Institute of Life Science
- Swansea University Medical School
- Swansea
- UK
| | - R. Schuster
- Department of Clinical Biochemistry and Pharmacology
- Faculty of Health Sciences
- Ben-Gurion University of the Negev
- Beer-Sheva
- Israel
| | - E. C. Lewis
- Department of Clinical Biochemistry and Pharmacology
- Faculty of Health Sciences
- Ben-Gurion University of the Negev
- Beer-Sheva
- Israel
| | - D. Y. Lewitus
- Plastics and Polymer Engineering Department
- Shenkar – Engineering Art Design
- Ramat-Gan
- Israel
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16
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Dave B. Bioresorbable Scaffolds: Current Evidences in the Treatment of Coronary Artery Disease. J Clin Diagn Res 2016; 10:OE01-OE07. [PMID: 27891384 DOI: 10.7860/jcdr/2016/21915.8429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/10/2016] [Indexed: 01/12/2023]
Abstract
Percutaneous coronary revascularization strategies have gradually progressed over a period of last few decades. The advent of newer generation drug-eluting stents has significantly improved the outcomes of Percutaneous Coronary Intervention (PCI) by substantially reducing in-stent restenosis and stent thrombosis. However, vascular inflammation, restenosis, thrombosis, and neoatherosclerosis due to the permanent presence of a metallic foreign body within the artery limit their usage in complex Coronary Artery Disease (CAD). Bioresorbable Scaffolds (BRS) represent a novel approach in coronary stent technology. Complete resorption of the scaffold liberates the treated vessel from its cage and restores pulsatility, cyclical strain, physiological shear stress, and mechanotransduction. In this review article, we describe the advances in this rapidly evolving technology, present the evidence from the pre-clinical and clinical evaluation of these devices, and provide an overview of the ongoing clinical trials that were designed to examine the effectiveness of BRS in the clinical setting.
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Affiliation(s)
- Bhargav Dave
- Clinical Research Analyst and Professor, Srinivas University , Mangaluru, Karnataka, India
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Caiazzo G, Mattesini A, Indolfi C, Di Mario C. Bioresorbable Stents. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Gianluca Caiazzo
- Division of Cardiology, Department of Medical and Surgical Sciences; Magna Graecia University; Catanzaro Italy
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
| | | | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences; Magna Graecia University; Catanzaro Italy
| | - Carlo Di Mario
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
- National Heart & Lung Institute; Imperial College London; London UK
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Tenekecioglu E, Farooq V, Bourantas CV, Silva RC, Onuma Y, Yılmaz M, Serruys PW. Bioresorbable scaffolds: a new paradigm in percutaneous coronary intervention. BMC Cardiovasc Disord 2016; 16:38. [PMID: 26868826 PMCID: PMC4751731 DOI: 10.1186/s12872-016-0207-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/29/2016] [Indexed: 12/22/2022] Open
Abstract
Numerous advances and innovative therapies have been introduced in interventional cardiology over the recent years, since the first introduction of balloon angioplasty, but bioresorbable scaffold is certainly one of the most exciting and attracting one. Despite the fact that the metallic drug-eluting stents have significantly diminished the re-stenosis ratio, they have considerable limitations including the hypersensitivity reaction to the polymer that can cause local inflammation, the risk of neo-atherosclerotic lesion formation which can lead to late stent failure as well as the fact that they may preclude surgical revascularization and distort vessel physiology. Bioresorbable scaffolds overcome these limitations as they have the ability to dissolve after providing temporary scaffolding which safeguards vessel patency. In this article we review the recent developments in the field and provide an overview of the devices and the evidence that support their efficacy in the treatment of CAD. Currently 3 devices are CE marked and in clinical use. Additional 24 companies are developing these kind of coronary devices. Most frequently used material is PLLA followed by magnesium.
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Affiliation(s)
| | - Vasim Farooq
- Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University, Hospitals NHS Trust, Manchester, UK.
- Institute of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | - Christos V Bourantas
- Institute of Cardiovascular Sciences, University College of London, London, UK.
- Department of Cardiology, Barts Health NHS Trust, London, UK.
| | | | - Yoshinobu Onuma
- ThoraxCentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Mustafa Yılmaz
- Department of Cardiology, Bursa Postgraduate Education and Research Hospital, Bursa, Turkey.
| | - Patrick W Serruys
- ThoraxCentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
- International Centre for Circulatory Health, Imperial College, London, UK.
- Interventional Cardiology Department, Erasmus MC, 's-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
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Tenekecioglu E, Bourantas C, Abdelghani M, Zeng Y, Silva RC, Tateishi H, Sotomi Y, Onuma Y, Yılmaz M, Serruys PW. From drug eluting stents to bioresorbable scaffolds; to new horizons in PCI. Expert Rev Med Devices 2016; 13:271-86. [DOI: 10.1586/17434440.2016.1143356] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gogas BD. Bioresorbable scaffolds for percutaneous coronary interventions. Glob Cardiol Sci Pract 2014; 2014:409-27. [PMID: 25780795 PMCID: PMC4355515 DOI: 10.5339/gcsp.2014.55] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/11/2014] [Indexed: 12/23/2022] Open
Abstract
Innovations in drug-eluting stents (DES) have substantially reduced rates of in-segment restenosis and early stent thrombosis, improving clinical outcomes following percutaneous coronary interventions (PCI). However a fixed metallic implant in a vessel wall with restored patency and residual disease remains a precipitating factor for sustained local inflammation, in-stent neo-atherosclerosis and impaired vasomotor function increasing the risk for late complications attributed to late or very late stent thrombosis and late target lesion revascularization (TLR) (late catch-up). The quest for optimal coronary stenting continues by further innovations in stent design and by using biocompatible materials other than cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding, local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics have been recently developed. These devices have been utilized in selected clinical applications so far providing preliminary evidence of safety showing comparable performance with current generation drug-eluting stents (DES). Herein we provide a comprehensive overview of the current status of these technologies, we elaborate on the potential benefits of transient coronary scaffolds over permanent stents in the context of vascular reparation therapy, and we further focus on the evolving challenges these devices have to overcome to compete with current generation DES. Condensed Abstract:: The quest for optimizing percutaneous coronary interventions continues by iterative innovations in device materials beyond cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding; local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics were recently developed. These devices have been utilized in selected clinical applications providing preliminary evidence of safety showing comparable intermediate term clinical outcomes with current generation drug-eluting stents.
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Affiliation(s)
- Bill D Gogas
- Andreas Gruentzig Cardiovascular Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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Luo Q, Huang C, Wang S, Meng J, Li Z, Chang Z, Zhu Y, Hua Z. Comparative Study of Degradation Behavior of Bioresorbable Cardiovascular Scaffolds. Cardiovasc Eng Technol 2014; 6:71-9. [DOI: 10.1007/s13239-014-0199-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/28/2014] [Indexed: 11/24/2022]
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Luo Q, Liu X, Li Z, Huang C, Zhang W, Meng J, Chang Z, Hua Z. Degradation model of bioabsorbable cardiovascular stents. PLoS One 2014; 9:e110278. [PMID: 25365310 PMCID: PMC4217724 DOI: 10.1371/journal.pone.0110278] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/15/2014] [Indexed: 12/03/2022] Open
Abstract
This study established a numerical model to investigate the degradation mechanism and behavior of bioabsorbable cardiovascular stents. In order to generate the constitutive degradation material model, the degradation characteristics were characterized with user-defined field variables. The radial strength bench test and analysis were used to verify the material model. In order to validate the numerical degradation model, in vitro bench test and in vivo implantation studies were conducted under physiological and normal conditions. The results showed that six months of degradation had not influenced the thermodynamic properties and mechanical integrity of the stent while the molecular weight of the stents implanted in the in vivo and in vitro models had decreased to 61.8% and 68.5% respectively after six month's implantation. It was also found that the degradation rate, critical locations and changes in diameter of the stents in the numerical model were in good consistency in both in vivo and in vitro studies. It implies that the numerical degradation model could provide useful physical insights and prediction of the stent degradation behavior and evaluate, to some extent, the in-vivo performance of the stent. This model could eventually be used for design and optimization of bioabsorbable stent.
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Affiliation(s)
- Qiyi Luo
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
- * E-mail:
| | - Xiangkun Liu
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - Zhonghua Li
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - Chubo Huang
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - Wen Zhang
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - Juan Meng
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - Zhaohua Chang
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - Zezhao Hua
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
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Abstract
The introduction of percutaneous coronary intervention (PCI) in the late 1970s revolutionized the management of stable and unstable coronary artery disease, providing an effective, quick, safe, and increasingly widely available method for coronary revascularization for many patients. Rapid development in this field led to the introduction of a number of new technologies, including intracoronary stents that have resulted in improved efficacy and long-term safety. In this manuscript we review the experience with the 2 major available classes of stents (bare metal [BMS], drug-eluting [DES]) and describe the delivery systems for these stents. An evidence review of the large trial data comparing balloon angioplasty, BMS, and DES demonstrates the incremental advances over time, with the latest generation of DES achieving the lowest rates of restenosis, stent thrombosis, and recurrent myocardial infarction. In addition, we provide an overview of the latest developments in stent technology, including the introduction of bioresorbable stents and new stent delivery systems. These latest advances are hoped to further improve outcomes while reducing costs due to a reduction in the need for future procedures and hospitalizations due to recurrent coronary disease.
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Affiliation(s)
- Sameer D Sheth
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Kraak RP, Grundeken MJ, Koch KT, de Winter RJ, Wykrzykowska JJ. Bioresorbable scaffolds for the treatment of coronary artery disease: current status and future perspective. Expert Rev Med Devices 2014; 11:467-80. [DOI: 10.1586/17434440.2014.941812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chandorkar Y, Bhagat RK, Madras G, Basu B. Cross-linked, biodegradable, cytocompatible salicylic acid based polyesters for localized, sustained delivery of salicylic acid: an in vitro study. Biomacromolecules 2014; 15:863-75. [PMID: 24517727 DOI: 10.1021/bm401715z] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In order to suppress chronic inflammation while supporting cell proliferation, there has been a continuous surge toward development of polymers with the intention of delivering anti-inflammatory molecules in a sustained manner. In the above backdrop, we report the synthesis of a novel, stable, cross-linked polyester with salicylic acid (SA) incorporated in the polymeric backbone and propose a simple synthesis route by melt condensation. The as-synthesized polymer was hydrophobic with a glass transition temperature of 1 °C, which increases to 17 °C upon curing. The combination of NMR and FT-IR spectral techniques established the ester linkages in the as-synthesized SA-based polyester. The pH-dependent degradation rate and the rate of release of salicylic acid from the as-synthesized SA-based polymer were studied at physiological conditions in vitro. The polyester underwent surface erosion and exhibited linear degradation kinetics in which a change in degradation rate is observed after 4-10 days and 24% mass loss was recorded after 4 months at 37 °C and pH 7.4. The delivery of salicylic acid also showed a similar change in slopes, with a sustained release rate of 3.5% in 4 months. The cytocompatibility studies of these polyesters were carried out with C2C12 murine myoblast cells using techniques like MTT assay and flow cytometry. Our results strongly suggest that SA-based polyester supports cell proliferation for 3 days in culture and do not cause cell death (<7%), as quantified by propidium iodide (PI) stained cells. Hence, these polyesters can be used as implant materials for localized, sustained delivery of salicylic acid and have applications in adjuvant cancer therapy, chronic wound healing, and as an alternative to commercially available polymers like poly(lactic acid) and poly(glycolic acid) or their copolymers.
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Affiliation(s)
- Yashoda Chandorkar
- Laboratory for biomaterials, Materials Research Centre and ‡Department of Chemical Engineering, Indian Institute of Science , Bangalore, India
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Iqbal J, Onuma Y, Ormiston J, Abizaid A, Waksman R, Serruys P. Bioresorbable scaffolds: rationale, current status, challenges, and future. Eur Heart J 2013; 35:765-76. [PMID: 24366915 DOI: 10.1093/eurheartj/eht542] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Current generation of drug-eluting stents has significantly improved the outcomes of percutaneous coronary intervention by substantially reducing in-stent restenosis and stent thrombosis. However, a potential limitation of these stents is the permanent presence of a metallic foreign body within the artery, which may cause vascular inflammation, restenosis, thrombosis, and neoatherosclerosis. The permanent stents also indefinitely impair the physiological vasomotor function of the vessel and future potential of grafting the stented segment. Bioresorbable scaffolds (BRSs) have the potential to overcome these limitations as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage and restoring pulsatility, cyclical strain, physiological shear stress, and mechanotransduction. While a number of BRSs are under development, two devices with substantial clinical data have already received a Conformité Européenne marking. This review article presents the current status of these devices and evaluates the challenges that need to be overcome before BRSs can become the workhorse device in coronary intervention.
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Affiliation(s)
- Javaid Iqbal
- Thorax Centre, Erasmus Medical Centre, Rotterdam, the Netherlands
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Materials and manufacturing technologies available for production of a pediatric bioabsorbable stent. BIOMED RESEARCH INTERNATIONAL 2013; 2013:137985. [PMID: 24089660 PMCID: PMC3780513 DOI: 10.1155/2013/137985] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/06/2013] [Indexed: 11/18/2022]
Abstract
Transcatheter treatment of children with congenital heart disease such as coarctation of the aorta and pulmonary artery stenosis currently involves the use of metal stents. While these provide good short term results, there are long term complications with their use. Children outgrow metal stents, obligating them to future transcatheter dilations and eventual surgical removal. A bioabsorbable stent, or a stent that goes away with time, would solve this problem. Bioabsorbable stents are being developed for use in coronary arteries, however these are too small for use in pediatric congenital heart disease. A bioabsorbable stent for use in pediatric congenital heart disease needs to be low profile, expandable to a diameter 8 mm, provide sufficient radial strength, and absorb quickly enough to allow vessel growth. Development of absorbable coronary stents has led to a great understanding of the available production techniques and materials such as bioabsorbable polymers and biocorrodable metals. Children with congenital heart disease will hopefully soon benefit from the current generation of bioabsorbable and biocorrodable materials and devices.
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Bourantas CV, Onuma Y, Farooq V, Zhang Y, Garcia-Garcia HM, Serruys PW. Bioresorbable scaffolds: Current knowledge, potentialities and limitations experienced during their first clinical applications. Int J Cardiol 2013; 167:11-21. [DOI: 10.1016/j.ijcard.2012.05.093] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/27/2012] [Indexed: 12/21/2022]
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Avci-Adali M, Kobba J, Neumann B, Lescan M, Perle N, Wilhelm N, Wiedmaier H, Schlensak C, Wendel HP. Application of a rotating bioreactor consisting of low-cost and ready-to-use medical disposables forin vitroevaluation of the endothelialization efficiency of small-caliber vascular prostheses. J Biomed Mater Res B Appl Biomater 2013; 101:1061-8. [DOI: 10.1002/jbm.b.32916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 11/30/2012] [Accepted: 01/30/2013] [Indexed: 11/08/2022]
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Muramatsu T, Onuma Y, Zhang YJ, Bourantas CV, Kharlamov A, Diletti R, Farooq V, Gogas BD, Garg S, García-García HM, Ozaki Y, Serruys PW. Progress in treatment by percutaneous coronary intervention: the stent of the future. ACTA ACUST UNITED AC 2013; 66:483-96. [PMID: 24776051 DOI: 10.1016/j.rec.2012.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/12/2012] [Indexed: 12/24/2022]
Abstract
First generation drug-eluting stents have considerably reduced in-stent restenosis and broadened the applications of percutaneous coronary interventions for the treatment of coronary artery disease. The polymer is an integral part of drug-eluting stents in that, it controls the release of an antiproliferative drug. The main safety concern of first generation drug-eluting stents with permanent polymers--stent thrombosis--has been caused by local hypersensitivity, delayed vessel healing, and endothelial dysfunction. This has prompted the development of newer generation drug-eluting stents with biodegradable polymers or even polymer-free drug-eluting stents. Recent clinical trials have shown the safety and efficacy of drug-eluting stents with biodegradable polymer, with proven reductions in very late stent thrombosis as compared to first generation drug-eluting stents. However, the concept of using a permanent metallic prosthesis implies major drawbacks, such as the presence of a foreign material within the native coronary artery that causes vascular inflammation and neoatherosclerosis, and also impedes the restoration of the vasomotor function of the stented segment. Bioresorbable scaffolds have been introduced to overcome these limitations, since they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. This update article presents the current status of these new technologies and highlights their future perspectives in interventional cardiology.
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Affiliation(s)
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yao-Jun Zhang
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vasim Farooq
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bill D Gogas
- Department of Interventional Cardiology, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Scot Garg
- Department of Cardiology, East Lancashire, NHS Trust, Lancashire, United Kingdom
| | | | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, Toyoake, Japan
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Zhang Y, Bourantas CV, Farooq V, Muramatsu T, Diletti R, Onuma Y, Garcia-Garcia HM, Serruys PW. Bioresorbable scaffolds in the treatment of coronary artery disease. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2013; 6:37-48. [PMID: 23662091 PMCID: PMC3647349 DOI: 10.2147/mder.s22547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Indexed: 12/23/2022] Open
Abstract
Drug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds (BRS) were introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several BRSs are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the potential future prospects of this innovative therapy.
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Affiliation(s)
- Yaojun Zhang
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; ; Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
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Patel N, Banning AP. Bioabsorbable scaffolds for the treatment of obstructive coronary artery disease: the next revolution in coronary intervention? Heart 2013; 99:1236-43. [DOI: 10.1136/heartjnl-2012-303346] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Bourantas CV, Zhang Y, Farooq V, Garcia-Garcia HM, Onuma Y, Serruys PW. Bioresorbable scaffolds: current evidence and ongoing clinical trials. Curr Cardiol Rep 2013; 14:626-34. [PMID: 22810889 PMCID: PMC3432788 DOI: 10.1007/s11886-012-0295-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bioresorbable scaffolds (BRS) represent a novel approach in coronary stent technology. In contrast to the metallic stents, they provide transient scaffolding, thereby safeguarding early vessel patency and acute gain. Subsequently a process of “decomposition” occurs, that results in the complete absorption of the scaffold. This reduces the risk of late complications, allowing the vessel to maintain its integrity and physiological function. This unique ability has attracted interest and nowadays several BRS are available. The aim of this review article is to describe the advances in the field, present the evidence from the preclinical and clinical evaluation of these devices, and provide an overview of the ongoing clinical trials that were designed to examine the effectiveness of BRS in the clinical setting.
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Affiliation(s)
- Christos V Bourantas
- Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Vorpahl M, Finn AV, Nakano M, Virmani R. The bioabsorption process: tissue and cellular mechanisms and outcomes. EUROINTERVENTION 2012; 5 Suppl F:F28-35. [PMID: 22100673 DOI: 10.4244/eijv5ifa5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Marc Vorpahl
- CVPath, Institute Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA
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Jabara R, Pendyala L, Geva S, Chen J, Chronos N, Robinson K. Novel fully bioabsorbable salicylate-based sirolimus-eluting stent. EUROINTERVENTION 2012; 5 Suppl F:F58-64. [PMID: 22100678 DOI: 10.4244/eijv5ifa10] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The concept of fully biodegradable stents has emerged as an attractive alternative to current permanent metallic stents, mainly as a potential solution to avoid late stent thrombotic events. We sought to evaluate a novel, fully bioabsorbable sirolimus-eluting stent (SES) synthesised entirely from a unique salicylic-acid polymer, in a clinically relevant animal model. METHODS AND RESULTS Fully biodegradable balloon-expandable stents (n=45) were implanted in a porcine coronary arteries using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) to optimise stent apposition. Dose density of sirolimus was 8.3 µg/mm of stent length with in vitro studies demonstrating elution over 30 days and complete stent degradation over 12 months. Animals were terminated at 7, 14, 30, 90, and 180 days for complete histological analysis. Optical coherence tomography (OCT) was also performed for the 90- and 180-days samples. All stents were deployed successfully without notable mechanical difficulties. Angiographic diameter stenosis (DS) was 20±16%, 24±4%, and 23±17%, at one, three, and six months, respectively. In parallel, IVUS showed good stent apposition with DS of 21±9%, 25±7%, and 18±3%; and area stenosis (AS) of 35±13%, 33±7%, and 32±4% at one, three, and six months,respectively. OCT further demonstrated good stent apposition with DS of 28±7% and 20±6%, and AS of 37±10% and 33±13% at three and six months, respectively. OCT showed reduction of stent thickness by 23% from three to six months. Histologic analysis confirmed these in vivo findings and revealed a favourable healing process of absorbable stent incorporation into the arterial wall, without excessive thrombotic or inflammatory reactions. CONCLUSIONS This study shows favourable vascular compatibility and efficacy for a novel fully bioabsorbable salicylate-based SES. This device has good mechanical performance during deployment and stays well-apposed to the vessel wall at long-term follow-up. These initial results are highly encouraging and support progress into more extensive preclinical studies as well as early clinical testing.
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Affiliation(s)
- Refat Jabara
- Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
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Abstract
Coronary stents have improved very significantly the immediate and long-term results of percutaneous coronary interventions. However, once the vessel has healed, the scaffolding function of the stent is no longer needed, and the presence of a permanent metallic prosthesis poses important disadvantages. This has led to the idea of creating new devices that are able to provide mechanical support for a determined period and then disappear from the vessel, allowing its natural healing and avoiding the risks associated with having a permanent metallic cage, such as stent thrombosis. Absorbable stents currently appear as one of the most promising fields in interventional cardiology. The present article will review the available clinical evidence regarding these devices at present and their future perspectives.
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Affiliation(s)
- Nieves Gonzalo
- Interventional Cardiology, Cardiovascular Institute, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clinico San Carlos, Madrid, Spain.
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Xue L, Dai S, Li Z. Synthesis and characterization of elastic star shape-memory polymers as self-expandable drug-eluting stents. ACTA ACUST UNITED AC 2012. [DOI: 10.1039/c2jm15918j] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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41
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Feng Q, Jiang W, Sun K, Sun K, Chen S, Zhao L, Dai K, Ma N. Mechanical properties and in vivo performance of a novel sliding-lock bioabsorbable poly-p-dioxanone stent. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2011; 22:2319-2327. [PMID: 21822666 DOI: 10.1007/s10856-011-4407-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 07/28/2011] [Indexed: 05/31/2023]
Abstract
A bioabsorbable poly-p-dioxanone (PPDO) stent with a novel sliding-lock structure was fabricated to treat stenotic peripheral vessels. The sliding-lock PPDO stents have greater radial strength (107 kPa) than PPDO stents with conventional net-tube structure (32 kPa). The sliding-lock PPDO stents were implanted into the iliac arteries of pigs, and implantation success rate was 90% indicating the feasibility of this design. Additionally, we found that sliding-lock PPDO stents kept vessels patent, although by 3 and 6 months post implantation, luminal diameter decreased slightly due to intimal hyperplasia. At 1 month post implantation, the stents were sparsely covered with endothelial cells, and by 6 months, the stents were mostly absorbed and inflammatory reaction gradually decreased as the stents were absorbed. This study shows favorable mechanical strength, degradability and efficacy for the sliding-lock PPDO stents, and supports further research and development of this unique design of polymer stents for applications in vascular devices.
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Affiliation(s)
- Qimao Feng
- Children's Heart Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
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42
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Onuma Y, Serruys PW. Bioresorbable scaffold: the advent of a new era in percutaneous coronary and peripheral revascularization? Circulation 2011; 123:779-97. [PMID: 21343594 DOI: 10.1161/circulationaha.110.971606] [Citation(s) in RCA: 301] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Yosinobu Onuma
- Thoraxcenter, Erasmus Medical Center, 's Gravendijkwal 230, Rotterdam, the Netherlands
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43
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Seidlitz A, Nagel S, Semmling B, Grabow N, Martin H, Senz V, Harder C, Sternberg K, Schmitz KP, Kroemer HK, Weitschies W. Examination of drug release and distribution from drug-eluting stents with a vessel-simulating flow-through cell. Eur J Pharm Biopharm 2010; 78:36-48. [PMID: 21182943 DOI: 10.1016/j.ejpb.2010.12.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 12/08/2010] [Accepted: 12/09/2010] [Indexed: 10/18/2022]
Abstract
The recently introduced vessel-simulating flow-through cell offers new possibilities to examine the release from drug-eluting stents in vitro. In comparison with standard dissolution methods, the additional compartment allows for the examination of distribution processes and creates dissolution conditions which simulate the physiological situation at the site of implantation. It was shown previously that these conditions have a distinct influence on the release rate from the stent coating. In this work, different preparation techniques were developed to examine the spatial distribution within the compartment simulating the vessel wall. These methods allowed for the examination of diffusion depth and the distribution resulting in the innermost layer of the compartment simulating the vessel wall. Furthermore, the in vitro release and distribution examined experimentally were modelled mathematically using finite element (FE) methods to gain further insight into the release and distribution behaviour. The FE modelling employing the experimentally determined diffusion coefficients yielded a good general description of the experimental data. The results of the modelling also provided important indications that inhomogeneous coating layer thicknesses around the strut may result from the coating process which influence release and distribution behaviour. Taken together, the vessel-simulating flow-through cell in combination with FE modelling represents a unique method to analyse drug release and distribution from drug-eluting stents in vitro with particular opportunities regarding the examination of spatial distributions within the vessel-simulating compartment.
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Affiliation(s)
- Anne Seidlitz
- Institute of Pharmacy, Biopharmaceutics and Pharmaceutical Technology, EMA University of Greifswald, Greifswald, Germany.
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44
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Garg S, Serruys PW. Coronary stents: looking forward. J Am Coll Cardiol 2010; 56:S43-78. [PMID: 20797503 DOI: 10.1016/j.jacc.2010.06.008] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 11/24/2022]
Abstract
Despite all the benefits of drug-eluting stents (DES), concerns have been raised over their long-term safety, with particular reference to stent thrombosis. In an effort to address these concerns, newer stents have been developed that include: DES with biodegradable polymers, DES that are polymer free, stents with novel coatings, and completely biodegradable stents. Many of these stents are currently undergoing pre-clinical and clinical trials; however, early results seem promising. This paper reviews the current status of this new technology, together with other new coronary devices such as bifurcation stents and drug-eluting balloons, as efforts continue to design the ideal coronary stent.
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Affiliation(s)
- Scot Garg
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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45
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Deronde BM, Carbone AL, Uhrich KE. Storage Stability Study of Salicylate-based Poly(anhydride-esters). Polym Degrad Stab 2010; 95:1778-1782. [PMID: 21152105 DOI: 10.1016/j.polymdegradstab.2010.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Storage stability was evaluated on a biodegradable salicylate-based poly(anhydride-ester) to elucidate the effects of storage conditions over time. The hydrolytically labile polymer samples were stored in powdered form at five relevant storage temperatures (-12 °C, 4 °C, 27 °C, 37 °C, 50 °C) and monitored over four weeks for changes in color, glass transition temperature, molecular weight, and extent of hydrolysis. Samples stored at lower temperatures remained relatively constant with respect to bond hydrolysis and molecular weight. Whereas, samples stored at higher temperatures displayed significant hydrolysis. For hydrolytically degradable polymers, such as these poly(anhydride-esters), samples are best stored at low temperatures under an inert atmosphere.
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Affiliation(s)
- Brittany M Deronde
- Department of Chemistry and Chemical Biology, Rutgers University, 610 Taylor Road, Piscataway, New Jersey, 08854-8087
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46
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Basalus MWZ, von Birgelen C. Benchside testing of drug-eluting stent surface and geometry. Interv Cardiol 2010. [DOI: 10.2217/ica.10.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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47
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Waksman R, Pakala R. Coating bioabsorption and chronic bare metal scaffolding versus fully bioabsorbable stent. EUROINTERVENTION 2009; 5 Suppl F:F36-42. [DOI: 10.4244/eijv5ifa6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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48
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Pendyala L, Jabara R, Robinson K, Chronos N. Passive and active polymer coatings for intracoronary stents: novel devices to promote arterial healing. J Interv Cardiol 2009; 22:37-48. [PMID: 19281521 DOI: 10.1111/j.1540-8183.2009.00423.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Coronary stent implantation is the second great advance in the treatment of obstructive coronary artery disease since the introduction of balloon catheter angioplasty. However, in-stent restenosis (ISR) caused by neointimal hyperplasia has been a major limitation of stents, occurring in up to 30% of cases. Advances in coronary stent technology both in terms of stent design and function and especially drug-eluting stents (DES) have significantly improved the safety and efficacy of percutaneous coronary intervention (PCI) with stenting, including marked reduction in ISR. This has led to use of DES for increasingly challenging clinical and lesional subsets, with potential for increased risk of stent-associated complications, especially late stent thrombosis (LST). Because restenosis and stent thrombosis are caused by multiple and often interrelated factors, ideal agents for stent coatings should inhibit thrombus formation, inflammatory reaction, and cellular proliferation, while supporting reendothelialization. To avoid undesirable effects of currently applied (durable) polymers, biocompatible, and bioabsorbable polymers as well as DES delivery systems that minimize polymer burden have been produced and tested. Bioabsorbable stents, both polymeric and metallic, have been developed to decrease potential late complications after stent implantation. Novel strategies to address some of these challenges are in various stages of research and development. In this article we outline developments in the field of passive and active stent coatings and evaluate the ongoing role of such coatings in the contemporary era of DES.
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Affiliation(s)
- Lakshmana Pendyala
- Saint Joseph's Translational Research Institute/Saint Joseph's Hospital of Atlanta, Georgia 30342, USA
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49
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Abstract
Fast-degrading, salicylate-based poly(anhydride-esters) were designed to degrade and release the active component, salicylic acid (SA), within 1 week. The polymer degradation was enhanced by using shorter or oxygen-containing aliphatic chains. A copolymer of diglycolic acid was also made with a salicylate-based diacid for comparison of polymer properties, including SA release. Both methods resulted in polyanhydrides with molecular weights ranging from 14 500 to 27 800 Da and displayed glass transition temperatures near physiological conditions, namely 33-40 degrees C. the homo- and copolymers completely degraded within one week releasing the chemically incorporated SA.
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Affiliation(s)
- Ashley L. Carbone
- Department of Chemistry and Chemical Biology, Rutgers University, Piscataway, New Jersy 08854-8087, USA Fax: (+1) 732-445-7036
| | - Kathryn E. Uhrich
- Department of Chemistry and Chemical Biology, Rutgers University, Piscataway, New Jersy 08854-8087, USA Fax: (+1) 732-445-7036
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