Restenosis: Intracoronary Brachytherapy

FAK Activation Promotes SMC Dedifferentiation via Increased DNA Methylation in Contractile Genes

Rationale: Vascular smooth muscle cells (SMCs) exhibit remarkable plasticity and can undergo dedifferentiation upon pathological stimuli associated with disease and interventions. Objective: Although epigenetic changes are critical in SMC phenotype switching, a fundamental regulator that governs the epigenetic machineries regulating the fate of SMC phenotype has not been elucidated. Methods and Results: Using SMCs, mouse models, and human atherosclerosis specimens, we found that focal adhesion kinase (FAK) activation elicits SMC dedifferentiation by stabilizing DNA methyltransferase 3A (DNMT3A). FAK in SMCs is activated in the cytoplasm upon serum stimulation in vitro or vessel injury and active FAK prevents DNMT3A from nuclear FAK-mediated degradation. However, pharmacological or genetic FAK catalytic inhibition forced FAK nuclear localization, which reduced DNMT3A protein via enhanced ubiquitination and proteasomal degradation. Reduced DNMT3A protein led to DNA hypomethylation in contractile gene promoters, which increased SMC contractile protein expression. RNA sequencing identified SMC contractile genes as a foremost upregulated group by FAK inhibition from injured femoral artery samples compared to vehicle group. DNMT3A knockdown in injured arteries reduced DNA methylation and enhanced contractile gene expression supports the notion that nuclear FAK-mediated DNMT3A degradation via E3 ligase TRAF6 drives differentiation of SMCs. Furthermore, we observed that SMCs of human atherosclerotic lesions exhibited decreased nuclear FAK, which was associated with increased DNMT3A levels and decreased contractile gene expression. Conclusions: This study reveals that nuclear FAK induced by FAK catalytic inhibition specifically suppresses DNMT3A expression in injured vessels resulting in maintaining SMC differentiation by promoting the contractile gene expression. Thus, FAK inhibitors may provide a new treatment option to block SMC phenotypic switching during vascular remodeling and atherosclerosis.

FAK Family Kinases in Vascular Diseases

In various vascular diseases, extracellular matrix (ECM) and integrin expression are frequently altered, leading to focal adhesion kinase (FAK) or proline-rich tyrosine kinase 2 (Pyk2) activation. In addition to the major roles of FAK and Pyk2 in regulating adhesion dynamics via integrins, recent studies have shown a new role for nuclear FAK in gene regulation in various vascular cells. In particular, FAK primarily localizes within the nuclei of vascular smooth muscle cells (VSMCs) of healthy arteries. However, vessel injury increased FAK localization back to adhesions and elevated FAK activity, leading to VSMC hyperplasia. The study suggested that abnormal FAK or Pyk2 activation in vascular cells may cause pathology in vascular diseases. Here we will review several studies of FAK and Pyk2 associated with integrin signaling in vascular diseases including restenosis, atherosclerosis, heart failure, pulmonary arterial hypertension, aneurysm, and thrombosis. Despite the importance of FAK family kinases in vascular diseases, comprehensive reviews are scarce. Therefore, we summarized animal models involving FAK family kinases in vascular diseases.

Biocompatibility and Biostability of Metallic Endovascular Implants: State of the Art and Perspectives

This work was partly supported by the Natural Science and Engineering Research Council (NSERC) of Canada.

More than a million metallic endovascular devices are implanted each year, but the quest for the perfect material continues. The importance of interfacial properties in the overall biocompatibility of metals and alloys has been recognized for a long time. In particular, these properties modulate the hemocompatibility of devices in contact with blood and, in turn, strongly influence implantation outcomes. In this article, the relative properties of metallic materials commonly used in endovascular applications are reviewed. Particular emphasis is given to the corrosion behavior of metallic endovascular materials and the specific surface treatments used in the production processes. Issues relative to corrosion assays will also be reviewed in terms of their relevance to in vivo applications. The potential adverse effects of degradation products with respect to endovascular applications will be described. Finally, this review addresses future perspectives of metallic devices in endovascular procedures in view of the recent promises of antiproliferative strategies that are likely to profoundly modify current procedures.

Cardiovascular effects of radiation therapy: practical approach to radiation therapy-induced heart disease

Radiation induced heart diseases (RIHD) are increasingly recognized as more patients who received radiation therapy survive their diseases with improved management of various malignancies. Radiation affects every component of the heart, ranging from subclinical histopathologic changes to overt clinical disease. Pericardial involvement is the most common and includes asymptomatic pericardial effusion and constrictive pericarditis. The diseases involving the myocardium, valvular apparatus, and conduction system are often subclinical. When symptomatic, they are often the harbinger of more lethal, but treatable, radiation-induced coronary artery disease (CAD). Improvements in the modern radiation delivery systems have minimized irradiation of the heart. However, with increased and emerging indications for radiation therapy for various malignancies in the chest, as a part of bone marrow transplantations, and as the main agent of brachytherapy for advanced preexisting CAD, the incidence of RIHD is likely to increase. Appropriate management of RIHD, either overt or occult, must include understanding the natural history of RIHD, recognition of symptoms by careful history, and vigilant search for treatable causes of the RIHD or other diseases that might mimic RIHD. This article focuses on providing practical yet comprehensive clinical information for general internal medicine and cardiology practices.

Radionuclides-hyaluronan-conjugate thromboresistant coatings to prevent in-stent restenosis

Catheter-based brachytherapy is one of the most effective modalities to inhibit hyperplasia following revascularization procedures. Radioactive stents have failed, however, to prevent clinical hyperplasia due to excessive late lumen loss on the edge of the devices. Numerous strategies have been proposed to circumvent the drawbacks of irradiation therapies, such as the use of more appropriate radionuclides or the "hot-end" stents approach. This paper describes versatile radioactive devices obtained by coating plasma functionalized surfaces-stents or catheters-with a hyaluronan (HA)-diethylenetriamine pentaacetic acid (DTPA) conjugate (HA-DTPA) complexed with a gamma or beta radionuclide. Yttrium and indium were used as radionuclide models, due to their suitability for endovascular radiotherapy. X-ray photoelectron microscopy and time-of-flight secondary ions mass spectrometry analyses confirmed the successful immobilization of the HA-DTPA conjugate on both the metallic (NiTi) and polymeric (Teflon) plasma functionalized surfaces. HA-DTPA-coated surfaces were significantly more hydrophilic than bare surfaces (39.5 degrees vs. 67 degrees on NiTi substrate and 29 degrees vs. 128 degrees on Teflon substrate). Therapeutic doses of yttrium and indium were easily loaded onto the surfaces and remained stable over 2 weeks with a radionuclide loss of about 6%. The HA-DTPA-coated Teflon surfaces presented significantly less fibrinogen adsorption than uncoated materials in an in vitro flow model. This approach, which combines the hemocompatibility of HA-coated surfaces and the anti-proliferative effects of an appropriate radiotherapy, constitutes a promising methodology to alleviate the restenosis induced by existing devices.