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Korjian S, McCarthy KJ, Larnard EA, Cutlip DE, McEntegart MB, Kirtane AJ, Yeh RW. Drug-Coated Balloons in the Management of Coronary Artery Disease. Circ Cardiovasc Interv 2024; 17:e013302. [PMID: 38771909 DOI: 10.1161/circinterventions.123.013302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
Drug-coated balloons (DCBs) are specialized coronary devices comprised of a semicompliant balloon catheter with an engineered coating that allows the delivery of antiproliferative agents locally to the vessel wall during percutaneous coronary intervention. Although DCBs were initially developed more than a decade ago, their potential in coronary interventions has recently sparked renewed interest, especially in the United States. Originally designed to overcome the limitations of conventional balloon angioplasty and stenting, they aim to match or even improve upon the outcomes of drug-eluting stents without leaving a permanent implant. Presently, in-stent restenosis is the condition with the most robust evidence supporting the use of DCBs. DCBs provide improved long-term vessel patency compared with conventional balloon angioplasty and may be comparable to drug-eluting stents without the need for an additional stent layer, supporting their use as a first-line therapy for in-stent restenosis. Beyond the treatment of in-stent restenosis, DCBs provide an additional tool for de novo lesions for a strategy that avoids a permanent metal scaffold, which may be especially useful for the management of technically challenging anatomies such as small vessels and bifurcations. DCBs might also be advantageous for patients with high bleeding risk due to the decreased necessity for extended antiplatelet therapy, and in patients with diabetes and patients with diffuse disease to minimize long-stented segments. Further studies are crucial to confirm these broader applications for DCBs and to further validate safety and efficacy.
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Affiliation(s)
- Serge Korjian
- Division of Cardiovascular Medicine (S.K., K.J.M., E.A.L., D.E.C.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Baim Institute for Clinical Research, Boston, MA (S.K., D.E.C.)
| | - Killian J McCarthy
- Division of Cardiovascular Medicine (S.K., K.J.M., E.A.L., D.E.C.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Emily A Larnard
- Division of Cardiovascular Medicine (S.K., K.J.M., E.A.L., D.E.C.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Donald E Cutlip
- Division of Cardiovascular Medicine (S.K., K.J.M., E.A.L., D.E.C.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Baim Institute for Clinical Research, Boston, MA (S.K., D.E.C.)
| | - Margaret B McEntegart
- Division of Cardiovascular Medicine, Smith Center for Outcomes Research in Cardiology (M.B.M.E., A.J.K.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ajay J Kirtane
- Division of Cardiovascular Medicine, Smith Center for Outcomes Research in Cardiology (M.B.M.E., A.J.K.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robert W Yeh
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (R.W.Y.)
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Nugraha HG, Hilman S, Santiana L, Dewi DK, Raffaelo WM, Wibowo A, Pranata R, Aristiady EB. Drug-Coated Balloon Versus Drug-Eluting Stent in Patients With Femoropopliteal Artery Disease: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2022; 56:385-392. [PMID: 35225707 DOI: 10.1177/15385744211051491] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In this systematic review and meta-analysis, we aimed to compare drug-coated balloon (DCB) to drug-eluting stent (DES) in patients with femoropopliteal lesions in terms of restenosis, target lesion revascularization (TLR), and mortality. METHODS A comprehensive literature search was performed through PubMed, Scopus, and Embase databases. The intervention group was patients receiving percutaneous balloon angioplasty using the DCB. The control group was patients receiving percutaneous intervention using the DES. The primary outcome was restenosis, and the secondary outcomes were TLR and mortality. RESULTS There were 4 studies comprising 812 patients (906 lesions) included in this systematic review and meta-analysis. The rate of restenosis was .19 [.13, .26] in DCB and .24 [.20, .28] in DES. There was a trend toward lower rate of restenosis (OR .73 [.52, 1.03], P = .074; I2: 46.3%) for DCB use compared to DES use. The rate of TLR was .11 [.08, .14] in DCB and .17 [.14, .21] in DES. TLR was lower (OR .61 [.41, .92], P = .017; I2: 1.2%) in the DCB group compared to the DES group. There were no significant differences in mortality (OR 1.38 [.78, 2.44], P = .268; I2: 0%) among the two groups. Meta-regression analysis showed that the rate of restenosis in DCB in this pooled analysis was affected by sex (reference: male, coefficient -.004, P = .009), smoking (coefficient: .003, P = .010), and total occlusion (coefficient: .008, P = .004). CONCLUSION DCB use in patients with femoropopliteal lesion was associated with similar rate of restenosis, lower TLR, and similar mortality rate compared to DES use.
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Affiliation(s)
- Harry G Nugraha
- Department of Radiology, Faculty of Medicine, Hasan Sadikin General Hospital, 61809Universitas Padjadjaran, Bandung, Indonesia
| | - Syawaluddin Hilman
- Department of Radiology, Faculty of Medicine, Hasan Sadikin General Hospital, 61809Universitas Padjadjaran, Bandung, Indonesia
| | - Leni Santiana
- Department of Radiology, Faculty of Medicine, Hasan Sadikin General Hospital, 61809Universitas Padjadjaran, Bandung, Indonesia
| | - Dian K Dewi
- Department of Radiology, Faculty of Medicine, Hasan Sadikin General Hospital, 61809Universitas Padjadjaran, Bandung, Indonesia
| | - Wilson M Raffaelo
- Faculty of Medicine, 64749Universitas Pelita Harapan, Tangerang, Indonesia
| | - Arief Wibowo
- Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Bandung
| | - Raymond Pranata
- Faculty of Medicine, 64749Universitas Pelita Harapan, Tangerang, Indonesia
| | - Eppy B Aristiady
- Department of Radiology, Faculty of Medicine, Hasan Sadikin General Hospital, 61809Universitas Padjadjaran, Bandung, Indonesia
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Lysenko ER, Burov AI, Griaznov OG, Bushueva EV. [Use of endovascular drug-coated devices in lesions of femoropopliteoltibial arteries]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:165-172. [PMID: 34528602 DOI: 10.33529/angiq2021305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endovascular intervention is one of the main methods of treatment in atherosclerotic lesions of the infrainguinal segment in patients with chronic lower limb ischaemia. Recent years have witnessed active use of drug-eluting techniques, significantly improving the long-term outcomes of peripheral reconstructions. This article is a review of publications on the results of using modern drug-eluting balloon catheters and stents in the femoropopliteoltibial position. The accumulated data will help solve the main problems of the classic balloon angioplasty, reducing the incidence of restenosis, improving primary patency, and decreasing the need for repeat interventions in the remote period of follow-up.
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Affiliation(s)
- E R Lysenko
- Department of Vascular Surgery, Centre of Cardiovascular and Endovascular Surgery, Federal Clinical Centre of High Medical Technologies of the Federal Medical and Biological Agency of the RF Ministry of Public Health, Khimki, Russia
| | - A Iu Burov
- Department of Vascular Surgery, Centre of Cardiovascular and Endovascular Surgery, Federal Clinical Centre of High Medical Technologies of the Federal Medical and Biological Agency of the RF Ministry of Public Health, Khimki, Russia
| | - O G Griaznov
- Department of Vascular Surgery, Centre of Cardiovascular and Endovascular Surgery, Federal Clinical Centre of High Medical Technologies of the Federal Medical and Biological Agency of the RF Ministry of Public Health, Khimki, Russia
| | - E V Bushueva
- Department of Vascular Surgery, Centre of Cardiovascular and Endovascular Surgery, Federal Clinical Centre of High Medical Technologies of the Federal Medical and Biological Agency of the RF Ministry of Public Health, Khimki, Russia
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Lindquist J, Schramm K. Drug-Eluting Balloons and Drug-Eluting Stents in the Treatment of Peripheral Vascular Disease. Semin Intervent Radiol 2019; 35:443-452. [PMID: 30728660 DOI: 10.1055/s-0038-1676360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In the last 20 years, peripheral artery disease (PAD) has been increasingly recognized as a significant cause of morbidity and mortality in the United States. The endovascular treatment of PAD has seen a marked rise as minimally invasive techniques and devices have been refined. Two newer devices, drug-eluting stents and drug-eluting balloons, are on the forefront of the battle against limb loss from PAD. This review focuses on the data backing the use of drug-eluting technologies for use in the peripheral arterial system.
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Affiliation(s)
- Jonathan Lindquist
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Aurora, Colorado
| | - Kristofer Schramm
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Aurora, Colorado
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Yin T, Wu L, Wu T, Mao G, Nian G, Chen Z, Hu X, Wang P, Xiang Y, Yu H, Qu S, Yang W. Ultrastretchable and conductive core/sheath hydrogel fibers with multifunctionality. ACTA ACUST UNITED AC 2019. [DOI: 10.1002/polb.24781] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tenghao Yin
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
| | - Lei Wu
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
| | - Tonghao Wu
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
| | - Guoyong Mao
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
| | - Guodong Nian
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
| | - Zhe Chen
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
| | - Xiaocheng Hu
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
| | - Peng Wang
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
| | - Yuhai Xiang
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
| | - Honghui Yu
- Department of Mechanical Engineering; The City College of New York; New York New York 10031
| | - Shaoxing Qu
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
| | - Wei Yang
- State Key Laboratory of Fluid Power & Mechatronic System, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Department of Engineering Mechanics; Zhejiang University; Hangzhou 310027 China
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6
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Iyer R, Kuriakose AE, Yaman S, Su LC, Shan D, Yang J, Liao J, Tang L, Banerjee S, Xu H, Nguyen KT. Nanoparticle eluting-angioplasty balloons to treat cardiovascular diseases. Int J Pharm 2018; 554:212-223. [PMID: 30408532 DOI: 10.1016/j.ijpharm.2018.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/29/2018] [Accepted: 11/03/2018] [Indexed: 12/18/2022]
Abstract
Nanoparticles (NPs) can be used to locally deliver anti-restenosis drugs when they are infused directly to the injured arteries after intervention procedures such as angioplasty. However, the efficacy of transferring NPs via infusion to the arterial wall is limited, at least partially, due to poor NP retention on the inner artery wall. To improve NP retention, angioplasty balloons coated with drug-loaded NPs were fabricated via either layer-by-layer (LbL) electrostatic coating or acrylic-based hydrogel (AAH) coating techniques. Three types of NPs, namely poly (lactide-co-glycolide) (PLGA), biodegradable photo-luminescent PLGA and urethane doped polyester were studied. The transfer efficacy of NPs from various coatings to the arterial wall were further evaluated to find the optimal coating conditions. The ex vivo NP transfer studies showed significantly more NPs being transferred to the rat arterial wall after the angioplasty procedure by the AAH coating (95% transfer efficiency) compared to that of the LbL technique (60%) and dip coating (20%) under flow conditions (10 dyn/cm2). Our results suggest that the AAH coating of drug-loaded NPs on the angioplasty balloon could potentially provide superior retention of drug-loaded NPs onto the arterial wall for a better local delivery of drug-loaded NPs to effectively treat arterial diseases.
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Affiliation(s)
- Roshni Iyer
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Aneetta E Kuriakose
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Serkan Yaman
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Lee-Chun Su
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Dingying Shan
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
| | - Jian Yang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
| | - Jun Liao
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Liping Tang
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Subhash Banerjee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Division of Cardiology, VA North Texas Medical Center, Dallas, TX, USA
| | - Hao Xu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Kytai T Nguyen
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA.
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Zeng W, Shu L, Li Q, Chen S, Wang F, Tao XM. Fiber-based wearable electronics: a review of materials, fabrication, devices, and applications. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2014; 26:5310-36. [PMID: 24943999 DOI: 10.1002/adma.201400633] [Citation(s) in RCA: 658] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/29/2014] [Indexed: 04/14/2023]
Abstract
Fiber-based structures are highly desirable for wearable electronics that are expected to be light-weight, long-lasting, flexible, and conformable. Many fibrous structures have been manufactured by well-established lost-effective textile processing technologies, normally at ambient conditions. The advancement of nanotechnology has made it feasible to build electronic devices directly on the surface or inside of single fibers, which have typical thickness of several to tens microns. However, imparting electronic functions to porous, highly deformable and three-dimensional fiber assemblies and maintaining them during wear represent great challenges from both views of fundamental understanding and practical implementation. This article attempts to critically review the current state-of-arts with respect to materials, fabrication techniques, and structural design of devices as well as applications of the fiber-based wearable electronic products. In addition, this review elaborates the performance requirements of the fiber-based wearable electronic products, especially regarding the correlation among materials, fiber/textile structures and electronic as well as mechanical functionalities of fiber-based electronic devices. Finally, discussions will be presented regarding to limitations of current materials, fabrication techniques, devices concerning manufacturability and performance as well as scientific understanding that must be improved prior to their wide adoption.
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Affiliation(s)
- Wei Zeng
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
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8
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Sharma S, Kukreja N, Christopoulos C, Gorog DA. Drug-eluting balloon: new tool in the box. Expert Rev Med Devices 2014; 7:381-8. [DOI: 10.1586/erd.10.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cyrus T, Wickline SA, Lanza GM. Nanotechnology in interventional cardiology. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2011; 4:82-95. [PMID: 21748858 DOI: 10.1002/wnan.154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
High-grade atherosclerotic stenoses are reduced to zero or minimal residual stenosis grades by a single or a series of balloon angioplasties. Currently, stents are implanted to prevent immediate vascular recoil and elution of an antimitotic drug from the stent struts minimizes restenosis. An unwanted side-effect of this drug elution is delayed re-endothelialization which requires treatment with two anti-platelet drugs, in many cases for a minimum of 1 year to prevent acute in-stent thrombosis. Advances in stent design and drug elution technology, now in its fourth generation, have not abated this issue. Nanotechnology-based local drug delivery has the potential to achieve restenosis prevention while not impeding endothelial healing. Molecularly targeted drugs can be aimed to specifically bind to epitopes in the injured media and adventitia. Thus, endothelial healing may progress unhindered. To prevent restenosis, this technology may be used with bare metal or biodegradable stents. In this article novel nanoparticulate agents will be compared regarding their potential to deliver drugs to molecular targets within the vascular wall. Potential molecular targets, targeting mechanisms, drug-delivery propensities, and biocompatibility will be reviewed.
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Affiliation(s)
- Tillmann Cyrus
- Division of Cardiology, University of Missouri, One Hospital Drive, Columbia, MO, USA.
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10
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Affiliation(s)
- William A. Gray
- From the Department of Medicine, Columbia University Medical Center (W.A.G., J.F.G.) and Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, New York, NY
| | - Juan F. Granada
- From the Department of Medicine, Columbia University Medical Center (W.A.G., J.F.G.) and Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, New York, NY
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Gertz ZM, Wilensky RL. Local Drug Delivery for Treatment of Coronary and Peripheral Artery Disease. Cardiovasc Ther 2010; 29:e54-66. [DOI: 10.1111/j.1755-5922.2010.00187.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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12
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Mei L, Sun H, Song C. Local delivery of modified paclitaxel-loaded poly(epsilon-caprolactone)/pluronic F68 nanoparticles for long-term inhibition of hyperplasia. J Pharm Sci 2009; 98:2040-50. [PMID: 18855915 DOI: 10.1002/jps.21581] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this research is to test the possibility of localized intravascular infusion of didodecyldimethylammonium bromide (DMAB)-modified paclitaxel-loaded poly(epsilon-caprolactone)/Pluronic F68 (PCL/F68) nanoparticles to achieve long-term inhibition of hyperplasia in a balloon-injured rabbit carotid artery model. Paclitaxel-loaded nanoparticles were prepared by modified solvent displacement method using commercial poly(lactide-co-glycolide) (PLGA) and self-synthesized PCL/F68, respectively. DMAB was adsorbed on the nanoparticle surface by electrostatic attraction between positive and negative charges to enhance arterial retention. Nanoparticles were found to be of spherical shape with a mean size of around 300 nm and polydispersity of less than 0.150. The surface charge was changed to positive values after the DMAB modification. The in vitro drug release profile of all nanoparticle formulation showed a biphasic release pattern. Drug release from DMAB-modified PCL/F68 nanoparticles (DPNP) was significantly slower than DMAB-modified PLGA nanoparticles (PGNP). After 90 days, DPNP group showed very significant inhibition of neointimal proliferation (p < 0.01), and PGNP group yielded significant inhibition of neointimal proliferation (p < 0.05), when compared with drug-free nanoparticles group. In conclusion, local delivery of paclitaxel-loaded DMAB-modified PCL/F68 nanoparticles was proven an effective means of long-term inhibition of hyperplasia in the rabbits.
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Affiliation(s)
- Lin Mei
- The Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Peking Union Medical College & Chinese Academy of Medical Sciences, Tianjin 300192, China
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De Labriolle A, Pakala R, Bonello L, Lemesle G, Scheinowitz M, Waksman R. Paclitaxel-eluting balloon: From bench to bed. Catheter Cardiovasc Interv 2009; 73:643-52. [DOI: 10.1002/ccd.21895] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Stoll HP, Carlson K, Keefer LK, Hrabie JA, March KL. Pharmacokinetics and consistency of pericardial delivery directed to coronary arteries: direct comparison with endoluminal delivery. Clin Cardiol 2009; 22:I10-6. [PMID: 9929762 PMCID: PMC6655649 DOI: 10.1002/clc.4960221306] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND HYPOTHESIS Pharmacologic modulation of the contents of the pericardial space has been shown to influence the response of coronary arteries to balloon injury. Endoluminal (EL) local delivery of various drugs into coronaries has been found to be limited by short residence time, as well as by highly variable deposited agent concentration. We hypothesized that compounds placed into the pericardial space (P) would penetrate into coronary tissue with greater consistency than seen after EL delivery and provide for prolonged coronary exposure to agents. METHODS AND RESULTS 125I-labeled basic fibroblast growth factor (bFGF), platelet-derived growth factor (PDGF), albumin, or 131I-labeled diazeniumdiolated albumin (NONO-albumin) were delivered as model/therapeutic proteins into the porcine pericardial space (n = 15 pigs) or into coronaries using an EL delivery catheter (n = 48 arteries). In subjects receiving 125I-labeled proteins, the delivery target or mid-regions of the left anterior descending (LAD) and left circumflex (LCx) arteries were harvested at 1 h or 24 h for gamma-counting and autoradiography, and fractional intramural delivery (FID) or retention measured as percent agent in 100 mg artery/agent in infusate for both time points. In the animals receiving 131I-labeled NONO-albumin, serial gamma imaging was employed to evaluate the rate of redistribution in individual animals following either pericardial or endoluminal delivery. At 1 h, FID values ranged from 0.00064 to 0.0052% for P delivery (median 0.0022%), and from 0.00021 to 6.7 for EL delivery (median 0.27%). At 24 h, FID values ranged from 0.00011 to 0.003 for P delivery (median 0.0013), and from 0.0002 to 1.4 for EL delivery. The estimated T1/2 for bFGF redistribution from the vascular tissue was 22 h (P) and 7 h (EL), respectively, while the directly determined T1/2 values for NONO-albumin redistribution from the delivery region were 22.2 h (P) and 2.5 h (EL). CONCLUSIONS These data show that pericardial fluid contents can access coronary arteries with intramural concentrations which typically vary by 10-15-fold, while EL delivery results in a remarkably wide intramural concentration range with up to 33,000-fold variability. The apparent redistribution rate is more rapid following EL delivery, possibly due to sustained diffusive tissue loading from the pericardial space. Pericardial delivery appears to offer substantial advantages over EL administration with respect to residence time and reproducibility.
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Affiliation(s)
- H P Stoll
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, USA
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Mei L, Sun H, Jin X, Zhu D, Sun R, Zhang M, Song C. Modified Paclitaxel-loaded Nanoparticles for Inhibition of Hyperplasia in a Rabbit Arterial Balloon Injury Model. Pharm Res 2007; 24:955-62. [PMID: 17372684 DOI: 10.1007/s11095-006-9214-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Accepted: 12/11/2006] [Indexed: 11/24/2022]
Abstract
PURPOSE This study tested the possibility of localized intravascular infusion of positive charged paclitaxel-loaded nanoparticles (NPs) to better prevent neointimal formation in a rabbit carotid artery injury model. MATERIALS AND METHODS NPs were prepared by oil-water emulsion/solvent evaporation technique using biodegradable poly (lactide-co-glycolide) (PLGA). A cationic surfactant, didodecyldimethylammonium bromide (DMAB), was absorbed on the NP surface by electrostatic attraction between positive and negative charges. NPs were characterized in such aspects as size, surface morphology, surface charges as well as in vitro drug release profile. Balloon injured rabbit carotid arteries were treated with single infusion of paclitaxel-loaded NP suspension and observed for 28 days. The inhibitory effects of NPs on neointima formation were evaluated as end-point. RESULTS NPs showed spherical shape with a diameter ranging from 200 to 500 nm. Negatively charged PLGA NPs shifted to positive after the DMAB modification. The in vitro drug release profile showed a biphasic release pattern. Morphometric analyses on the retrieved artery samples revealed that the inhibitory effect of intima proliferation was dose-dependent. At a concentration of 30 mg ml(-1), NP infusion completely inhibited intima proliferation in a rabbit vascular injury model. CONCLUSIONS Paclitaxel-loaded NPs with DMAB modification were proven an effective means of inhibiting proliferative response to vascular injury in a rabbit model.
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MESH Headings
- Animals
- Antineoplastic Agents, Phytogenic/administration & dosage
- Antineoplastic Agents, Phytogenic/chemistry
- Antineoplastic Agents, Phytogenic/therapeutic use
- Carotid Artery Injuries/etiology
- Carotid Artery Injuries/pathology
- Carotid Artery Injuries/prevention & control
- Catheterization/adverse effects
- Catheterization/methods
- Chromatography, High Pressure Liquid
- Diffusion
- Disease Models, Animal
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/injuries
- Endothelium, Vascular/pathology
- Hyperplasia/etiology
- Hyperplasia/pathology
- Hyperplasia/prevention & control
- Microscopy, Electron, Transmission
- Nanoparticles/chemistry
- Nanoparticles/ultrastructure
- Paclitaxel/administration & dosage
- Paclitaxel/chemistry
- Paclitaxel/therapeutic use
- Particle Size
- Polyglactin 910/chemistry
- Polyvinyl Alcohol/chemistry
- Rabbits
- Solubility
- Time Factors
- Treatment Outcome
- Tunica Intima/drug effects
- Tunica Intima/injuries
- Tunica Intima/pathology
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Affiliation(s)
- Lin Mei
- The Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Peking Union Medical College & Chinese Academy of Medical Sciences, Tianjin, 300192, China
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Westedt U, Barbu-Tudoran L, Schaper AK, Kalinowski M, Alfke H, Kissel T. Effects of different application parameters on penetration characteristics and arterial vessel wall integrity after local nanoparticle delivery using a porous balloon catheter. Eur J Pharm Biopharm 2005; 58:161-8. [PMID: 15207550 DOI: 10.1016/j.ejpb.2004.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Accepted: 03/09/2004] [Indexed: 11/21/2022]
Abstract
Catheter-based local delivery of drug loaded nanoparticles agents offers a potential therapeutic approach to reducing restenosis. However, high delivery pressures and large volumes of infusates may cause severe vascular damage and increase intimal thickening. Therefore, we investigated the penetration pattern and vessel wall integrity of fluorescence-labelled nanoparticles (217 nm in diameter) into the non-atherosclerotic aorta abdominalis of New Zealand white rabbits in dependence of the volume (2.5 and 5 ml) and concentration (0.5 and 1 mg/ml) of the nanoparticle suspension, as well as the infusion pressure (2 and 4 atm) using a channelled balloon catheter (SCIMED REMEDY model RC 20/2.5). The location and penetration characteristics of nanoparticles in the arterial vessel wall were visualized using confocal laser scanning microscopy and transmission electron microscopy (TEM). Catheter design and infusion pressure form a radial particle stream through intima and media into the adventitial layer of the aorta abdominalis. Infusion pressures of 4 atm in combination with high particle concentrations lead to effective nanoparticle delivery without severe vessel wall disruptions. Endothelium of the treated vessel segments was slightly affected during catheter insertion showing partly denudation of the innermost cell layer. TEM micrographs underlines transport functional properties of the vasa vasorum inside the vessel wall. Consequently, local delivery efficiency of nanoparticulate carriers is critically affected by infusion pressure, and concentration of carrier suspensions. These factors need to be taken into consideration for the design of in vivo experiments.
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Affiliation(s)
- Ulrich Westedt
- Department of Pharmaceutics and Biopharmacy, Philipps-University, Marburg, Germany
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18
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Camenzind E, Bakker WH, Reijs A, Righetti A, van Geijlswijk IM, Boersma E, Foley D, Krenning EP, Roelandt JRTC, Serruys PW. Site-specific intracoronary delivery of octreotide in humans: a pharmacokinetic study to determine dose-efficacy in restenosis prevention. J Cardiovasc Pharmacol 2003; 43:133-9. [PMID: 14668579 DOI: 10.1097/00005344-200401000-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Somatostatin analogues have been shown to inhibit smooth muscle cell proliferation after local administration in vivo in animal models and in vitro using human coronary smooth muscle cell cultures. However, the optimal dosage for attaining effective site-specific administration remains undefined. This study was performed to determine the required theoretical dose of the somatostatin analogue, octreotide, to be delivered site specifically, for prevention of restenosis after coronary angioplasty in humans using a previously described methodology to determine regional pharmacokinetics of site-specific intracoronary administrated compounds. In 7 patients, 111In-octreotide, a gamma-labeled somatostatin analogue, was infused post angioplasty at the site of dilatation via a coil-balloon and quantified using a radio-isotopic technique. Efficiency of delivery ranged from 0.1% to 2.7% of the total infused dose of 0.18 microg, corresponding to a mean peak delivered amount of 1.8 +/- 1.9 ng. Total locally bioavailable 111In-octreotide reached 2.28 +/- 2.15 ng h. Based on current in vitro bioavailability and peak concentration data to inhibit proliferation and thymidine incorporation in human coronary smooth muscle cells, a 4000x higher averaged dose (approximately 700 microg) should be infused site specifically to obtain a biologic efficacy in 50% of the treated patients (ED50). Quantification of regional pharmacokinetics enables the determination of a theoretical site-specific dose for achieving appropriate bioavailability above the therapeutic threshold concentration for smooth muscle cell inhibition. This approach is proposed for the determination of the appropriate site-specific coronary infusion dose for the inhibition of restenosis after balloon angioplasty.
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Affiliation(s)
- Edoardo Camenzind
- Cardiac Catheterization Laboratory, University of Geneva, Switzerland.
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19
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Abstract
Gene therapy is an exciting frontier in medicine today. Many genes have been shown to be useful for treatment of various vascular diseases, including chronic cardiac and limb ischemia syndromes, vasculoproliferative disorder, hypercholesterolemia, atherosclerosis, thrombosis, and hypertension. Precise delivery of genes into target vessels, efficient transfer of genes into vascular cells of the target, and prompt assessment of gene expression over time are three challenging tasks for successful vascular gene therapy. Thus, in vivo imaging methods that can be used to monitor gene delivery and localize gene expression are needed. Modern imaging techniques provide an opportunity to monitor and direct vascular gene therapy. Radiologists play a key role not only in developing and mastering endovascular genetic interventions but also in assessing the success of vascular gene therapy and directing further refinement of vascular gene therapy technology. This article provides an overview of the current status of imaging of vascular gene therapy.
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Affiliation(s)
- Xiaoming Yang
- Department of Radiology, Johns Hopkins University School of Medicine, Traylor Bldg, Rm 330, 720 Rutland Ave, Baltimore, MD 21205, USA.
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20
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Meneveau NF, Klugherz BD, Chaquor B, Golden MA, Jouille MM, Macarek E, Weisz PB, Wilensky RL. Separate and combined effects of local and continuous intravenous administration of beta-cyclodextrin tetradecasulfate on intimal hyperplasia after angioplasty in porcine coronary arteries. J Cardiovasc Pharmacol Ther 2003; 8:53-60. [PMID: 12652330 DOI: 10.1177/107424840300800i108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Beta-Cyclodextrin tetradecasulfate binds fibroblast growth factors and possesses anticoagulant properties. This study was designed to assess the separate and combined effects of local intramural delivery and intravenous administration of beta-cyclodextrin tetrade-casulfate on neointimal formation and arterial damage following angioplasty. METHODS AND RESULTS Fifty-two pigs randomized into four groups underwent coronary artery angioplasty: 1) control, 2) continuous intravenous infusion of 100 mg/kg/d of beta-cyclodextrin tetradecasulfate, 3) intramural delivery of 1250 mg beta-cyclodextrin tetradecasulfate, 4) intramural delivery of 1250 mg beta-cyclodextrin tetradecasulfate followed by continuous intravenous infusion of 100 mg/kg/d. Fourteen days after injury, morphometric analysis revealed that arteries randomized to the intravenous beta-cyclodextrin tetradecasulfate groups had a decreased normalized neointima area: control, 3.03 +/- 0.75 mm(2); intravenous, 1.67 +/- 0.73 mm(2) (40% decrease; P < 10(-7)); intravenous plus local, 1.95 +/- 0.76 mm(2) (30% decrease; P < 10(-5)). There was no difference in neointimal response following local beta-cyclodextrin tetradecasulfate delivery only (2.82 +/- 1.14 mm(2)). Coronary arterial damage, defined as aneurysm, dissection, adventitial rupture, and retromedial hematoma was similar in all groups (12% in control and local groups, 10% in the intravenous group, 14% in the intravenous plus local; NS). Bleeding complications were more frequent in the intravenous and intravenous plus local groups compared to the local and control groups (23%vs 7.6% and 0%, respectively; P < 0.05). CONCLUSIONS Continuous intravenous administration of beta-cyclodextrin tetradecasulfate substantially reduced intimal hyperplasia, while intramural delivery had no effect, indicating that a single bolus of beta-cyclodextrin tetradecasulfate did not reduce intimal hyperplasia. There was no additive effect of local intramural delivery of beta-cyclodextrin tetradecasulfate. However, local delivery of beta-cyclodextrin tetradecasulfate induced less bleeding complications and did not lead to additional arterial injury, indicating that local delivery of an anticoagulant does not cause additional arterial injury.
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Affiliation(s)
- Nicolas F Meneveau
- Department of Medicine (Cardiovascular Division) of the University of Pennsylvania, 19104, USA
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21
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Westedt U, Barbu-Tudoran L, Schaper AK, Kalinowski M, Alfke H, Kissel T. Deposition of nanoparticles in the arterial vessel by porous balloon catheters: localization by confocal laser scanning microscopy and transmission electron microscopy. AAPS PHARMSCI 2002; 4:E41. [PMID: 12646012 PMCID: PMC2751330 DOI: 10.1208/ps040441] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Restenosis remains the major limitation of percutaneous transluminal angioplasty (PTA) and stenting in the treatment of patients with atherosclerotic disease. Catheter-based local delivery of pharmacologic agents offers a potential therapeutic approach to reducing restenosis and minimizing undesirable systemic side effects. However, the intramural retention of liquid agents is low. Therefore, to achieve a sustained and regional release of the therapeutic agent it must be encapsulated in nanoparticle carrier systems. The purpose of this study was to investigate the size dependence of the penetration of nanoparticles after local delivery into the vessel wall of the aorta abdominalis of New Zealand white rabbits. Two milliliters of a 0.025% fluorescence-labeled polystyrene nanoparticle suspension with diameters ranging from 110 to 514 nm were infused at 2 atm and at constant PTA pressure of 8 atm into the aorta abdominalis. After the infused segments were removed, the location of nanoparticles was visualized using confocal laser scanning microscopy and transmission electron microscopy. The study demonstrates a size-dependent nanoparticle penetration into the intact vessel wall. While nanoparticles of about 100 and 200 nm were deposited in the inner regions of the vessel wall, 514-nm nanoparticles accumulated primarily at the luminal surface of the aorta. The observations confirm that size plays a critical role in the distribution of particles in the arterial vessel wall. It is additionally influenced by the formation of pressure-induced infusion channels, as well as by the existence of anatomic barriers, such as plaques, at the luminal surface of the aorta or the connective elastic tissue.
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Affiliation(s)
- Ulrich Westedt
- Department of Pharmaceutics and Biopharmacy, Philipps-University, Ketzerbach 63, D-35032 Marburg, Germany
| | | | | | - Marc Kalinowski
- Department of Diagnostic Radiology, Philipps-University, D-35032 Marburg, Germany
| | - Heiko Alfke
- Department of Diagnostic Radiology, Philipps-University, D-35032 Marburg, Germany
| | - Thomas Kissel
- Department of Pharmaceutics and Biopharmacy, Philipps-University, Ketzerbach 63, D-35032 Marburg, Germany
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22
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Klugherz BD, Song C, DeFelice S, Cui X, Lu Z, Connolly J, Hinson JT, Wilensky RL, Levy RJ. Gene delivery to pig coronary arteries from stents carrying antibody-tethered adenovirus. Hum Gene Ther 2002; 13:443-54. [PMID: 11860711 DOI: 10.1089/10430340252792576] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Deployment of coronary stents to relieve atherosclerotic obstruction has benefitted millions of patients. However, gene therapy to prevent in-stent restenosis, while promising in experimental studies, remains a challenge. Conventional strategies for viral vector administration utilize catheters that deliver infusions of viral suspensions, which result in suboptimal localization and potentially dangerous distal spread of vector. Stent-based gene delivery may circumvent this problem. We hypothesized that site-specific delivery of adenoviral gene vectors from a stent could be achieved through a mechanism involving anti-viral antibody tethering. Stents were formulated with a collagen coating. Anti-adenoviral monoclonal antibodies were covalently bound to the collagen surface. These antibodies enabled tethering of replication defective adenoviruses through highly specific antigen-antibody affinity. We report for the first time successful stent-based gene delivery using antibody-tethered adenovirus encoding green fluorescent protein (GFP), demonstrating efficient and highly localized gene delivery to arterial smooth muscle cells in both cell culture and pig coronary arteries. Overall arterial wall transduction efficiency in pigs was 5.9 +/- 1.1% of total cells. However, neointimal transduction was more than 17% of total cells in this region. Importantly, when specific antibody was used to tether adenovirus, no distal spread of vector was detectable by PCR, in either distal organs, or in the downstream segments of the stented arteries. Control adenovirus stents, with nonspecific antibody plus adenovirus, demonstrated only a few isolated foci of transduction, and poor site-specific transduction with distal spread of vector. We conclude that a vascular stent is a suitable platform for a localizable viral vector delivery system that also prevents systemic spread of vector. Gene delivery using stent-based anti-viral antibody tethering of vectors should be suitable for a wide array of single or multiple therapeutic gene strategies.
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Affiliation(s)
- Bruce D Klugherz
- The Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Health System and Philadelphia Veterans Administration Medical Center, Philadelphia, PA 19104, USA
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23
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Fishbein I, Chorny M, Banai S, Levitzki A, Danenberg HD, Gao J, Chen X, Moerman E, Gati I, Goldwasser V, Golomb G. Formulation and delivery mode affect disposition and activity of tyrphostin-loaded nanoparticles in the rat carotid model. Arterioscler Thromb Vasc Biol 2001; 21:1434-9. [PMID: 11557668 DOI: 10.1161/hq0901.095567] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poor drug residence in the arterial wall hinders clinical implementation of local drug delivery strategies for the treatment of restenosis. A rat carotid model of vascular injury and intraluminal delivery of tyrphostin-containing polylactic acid (PLA) nanoparticles (NPs) were used to determine the relationship between residence properties and biological activity of different formulations and administration modes. The effects of delivery modes (denudation and delivery time) and formulation variables (adsorbed vs encapsulated drug, and NP size) on arterial drug/NP retention were examined. Antirestenotic effects of large (160 nm) and small (90 nm) tyrphostin-containing NPs, surface-absorbed tyrphostin, and systemic treatment were compared. Fluorescent NPs were used to study the spatial distribution of the carrier in the arterial wall. The decrease in arterial tyrphostin level over time fitted a biexponential model. Delivery time and pressure, endothelium integrity, particle size, and drug-polymer association affected local pharmacokinetics and the antirestenotic results after 14 days. The PLA-based tyrphostin NP formulation ensured a prolonged drug residence at the angioplasty site after single intraluminal application. Several readily adjustable formulation and procedural factors considerably modified arterial ingress of the drug-loaded NPs and governed their subsequent redistribution, tissue binding, elimination, and ensuing antirestenotic effect.
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Affiliation(s)
- I Fishbein
- Department of Pharmaceutics, School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem
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24
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Tepe G, Duda SH, Kalinowski M, Kamenz J, Brehme U, Hanke H, Claussen CD, Bares R, Baumbach A, Dinkelborg LM. Local intra-arterial drug delivery for prevention of restenosis: comparison of the efficiency of delivery of different radiopharmaceuticals through a porous catheter. Invest Radiol 2001; 36:245-9. [PMID: 11323511 DOI: 10.1097/00004424-200105000-00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES Several radiopharmaceuticals were administered through a porous balloon catheter to compare the absolute amount deposited and the retention in the vessel wall. The reported efficiency of local drug delivery ranges from 0.001% to 0.1%, with poor retention after 24 hours. METHODS An endothelin derivative (n = 6), pertechnetate (n = 6), hexamethylpropylene amineoxime (HMPAO) (n = 5), ethyl cysteinate dimer (ECD) (n = 5), and tin colloid (n = 5) were labeled with 185 MBq/mL 99m-technetium. After balloon denudation of the infrarenal aorta in 27 New Zealand White rabbits, 100 microL of each agent was administered through a porous balloon at a pressure of 4 bar. Dynamic and static whole-body scintigrams were obtained for 24 hours. The infrarenal aorta was excised and the activity calculated in a gamma counter. RESULTS Apart from their retention in the region of local administration, the radiopharmaceuticals showed different distribution patterns. The highest regional tracer retention was observed with HMPAO. After administration of HMPAO, a significant difference between regional (vessel wall plus surrounding tissue: 14.5% of injected dose [ID]/24 hours) and local (vessel wall: 1.8% ID/24 hours) delivery was found. In contrast, ECD was eliminated quickly (local retention after 24 hours = 0% ID). The retention efficiencies were HMPAO > endothelin derivative > tin colloid > pertechnetate > ECD. CONCLUSIONS The different physicochemical and pharmacokinetic properties of radiopharmaceuticals resulted in different delivery efficiencies after local application.
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Affiliation(s)
- G Tepe
- Research Laboratories of Schering AG, Berlin, Germany.
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25
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Abstract
Very limited success has been demonstrated with systemic pharmacological treatment to reduce the incidence of restenosis following angioplasty in patients. The lack of success of many of the pharmacotherapeutic agents in reducing the restenosis rates post-angioplasty and following stent implementation is believed to arise from inadequate concentrations of the agents at the lesion site. This has led to the development of various local delivery devices that would ideally deliver and retain adequate amounts of drug to the vessel wall for sufficient periods of time to ensure a therapeutic effect without inducing further injury or compromising blood flow. Local dosing would avoid systemic toxicity, and the use of modified balloon catheters or coated stents might enable percutaneous approaches.
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Affiliation(s)
- D S Ettenson
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, USA
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26
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Radioactive Microspheres for Medical Applications. PHYSICS AND CHEMISTRY BASIS OF BIOTECHNOLOGY 2001. [DOI: 10.1007/0-306-46891-3_9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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27
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DEV NAGENDUB, HOFMANN GÜNTERA, DEV SUKHENDUB, RABUSSAY DIETMARP. Intravascular Electroporation Markedly Attenuates Neointima Formation After Balloon Injury of the Carotid Artery in the Rat. J Interv Cardiol 2000. [DOI: 10.1111/j.1540-8183.2000.tb00311.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Herdeg C, Oberhoff M, Baumbach A, Blattner A, Axel DI, Schröder S, Heinle H, Karsch KR. Local paclitaxel delivery for the prevention of restenosis: biological effects and efficacy in vivo. J Am Coll Cardiol 2000; 35:1969-76. [PMID: 10841250 DOI: 10.1016/s0735-1097(00)00614-8] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the potential of paclitaxel to prevent restenosis in vivo. BACKGROUND Paclitaxel (Taxol) is a microtubule-stabilizing compound with potent antitumor activity. It influences the cytoskeleton equilibrium by increasing the assembly of altered microtubules, thereby inducing cellular modifications that result in reduced proliferation, migration and signal transduction. METHODS Before the in vivo study, delivery efficiency was determined with radiolabeled paclitaxel in porcine hearts. After induction of a defined plaque in the right carotid arteries of 76 New Zealand rabbits by electrical stimulation, 27 animals underwent balloon dilation and subsequent local paclitaxel delivery (10 ml, 10 micromol/liter) with a double-balloon catheter. Twenty-nine animals served as control with angioplasty only, 10 animals underwent local delivery of vehicle only (0.9% NaCl solution) and 10 animals were solely electrostimulated. Vessels were excised one, four, and eight weeks after intervention. RESULTS The extent of stenosis in paclitaxel-treated animals was significantly reduced compared with balloon-dilated control animals (p = 0.0012, one, four and eight weeks after intervention: 14.6%, 24.6% and 20.5%, vs. 24.9%, 33.8% and 43.1%, respectively). Marked vessel enlargement compared with balloon-dilated control animals could be observed (p = 0.0001, total vessel area after one, four and eight weeks: paclitaxel group: 1.983, 1.700 and 1.602 mm2, control: 1.071, 1.338 and 1.206 mm2, respectively). Tubulin staining and electron microscopy revealed changes in microtubule assembly, which were limited to the intimal area. Vasocontractile function after paclitaxel treatment showed major impairment. CONCLUSIONS Local delivery of paclitaxel resulted in reduced neointimal stenosis and enlargement in vessel size. Both these effects contribute to a preservation of vessel shape and are likely to be caused by a structural alteration of the cytoskeleton.
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Affiliation(s)
- C Herdeg
- Department of Medicine, University of Tuebingen, Germany.
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29
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Abstract
Successful implementation of local arterial drug delivery requires transmural distribution of drug. The physicochemical properties of the applied compound, which govern its transport and tissue binding, become as important as the mode of delivery. Hydrophilic compounds distribute freely but are cleared rapidly. Hydrophobic drugs, insoluble in aqueous solutions, bind to fixed tissue elements, potentially prolonging tissue residence and biological effect. Paclitaxel is such a hydrophobic compound, with tremendous therapeutic potential against proliferative vascular disease. We hypothesized that the recent favorable preclinical data with this compound may derive in part from preferential tissue binding as a result of unique physicochemical properties. The arterial transport of paclitaxel was quantified through application ex vivo and measurement of the subsequent transmural distribution. Arterial paclitaxel deposition at equilibrium varied across the arterial wall and was everywhere greater in concentration than in the applied drug source. Permeation into the wall increased with time, from 15 minutes to 4 hours, and varied with the origin of delivery. In contrast to hydrophilic compounds, the concentration in tissue exceeds the applied concentration and the rate of transport was markedly slower. Furthermore, endovascular and perivascular paclitaxel application led to markedly differential deposition across the blood vessel wall. These data suggest that paclitaxel interacts with arterial tissue elements as it moves under the forces of diffusion and convection and can establish substantial partitioning and spatial gradients across the tissue. The complexity of paclitaxel pharmacokinetics requires in-depth investigation if this drug is to reach its full clinical potential in proliferative vascular diseases.
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Affiliation(s)
- C J Creel
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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30
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Kalinowski M, Tepe G, Schieber A, Brehme U, Bruck B, Erley CM, Claussen CD, Duda SH. Local administration of ramiprilat is less effective than oral ramipril in preventing restenosis after balloon angioplasty in an animal model. J Vasc Interv Radiol 1999; 10:1397-404. [PMID: 10584658 DOI: 10.1016/s1051-0443(99)70251-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To test the hypothesis that local administration of angiotensin converting enzyme (ACE) inhibitor via a microporous balloon catheter would be more effective than oral administration of ACE inhibitor in preventing neointima formation after balloon angioplasty. MATERIALS AND METHODS Neointima formation was induced by balloon denudation followed by 0.5% cholesterol diet in 29 New Zealand White rabbits. Directly after denudation, local administration of 1.8 mg of ramiprilat (n = 7) or saline (n = 7) with a microporous balloon catheter at a pressure of 3 atm was performed. Both groups additionally received ramipril orally (1 mg/d). Seven animals were treated exclusively with oral ramipril. The control group was fed a 0.5% cholesterol diet and given no medication (n = 8). Six weeks after intervention, the animals were killed and morphometric and immunohistologic analyses were performed. RESULTS Oral administration of ramipril resulted in a significant reduction of placque area (-66%, P < .05). Oral and local administration of the ACE inhibitor was followed by a nonsignificant reduction of the neointimal area (-17%). Local administration of saline combined with oral ramipril failed to prevent neointimal formation (reduction of 6%, NS). CONCLUSION Oral administration of ramipril resulted in a significant reduction of neointimal proliferation in New Zealand White rabbits. The possible benefit of an additional administration of local ramiprilat was diminished by an excessive neointimal hyperplasia, which was most likely caused by the inherent vessel trauma with use of the microporous balloon catheter.
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MESH Headings
- Administration, Oral
- Angioplasty, Balloon/adverse effects
- Angiotensin-Converting Enzyme Inhibitors/administration & dosage
- Animals
- Aorta, Abdominal/pathology
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/pathology
- Graft Occlusion, Vascular/prevention & control
- Injections, Intra-Arterial
- Male
- Neovascularization, Pathologic/complications
- Neovascularization, Pathologic/pathology
- Neovascularization, Pathologic/prevention & control
- Rabbits
- Ramipril/administration & dosage
- Ramipril/analogs & derivatives
- Secondary Prevention
- Treatment Outcome
- Tunica Intima/pathology
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Affiliation(s)
- M Kalinowski
- Department of Diagnostic Radiology, Eberhard-Karls-University, Tübingen, Germany
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31
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Dick A, Kromen W, Jüngling E, Grosskortenhaus S, Kammermeier H, Vorwerk D, Günther RW. Quantification of horseradish peroxidase delivery into the arterial wall in vivo as a model of local drug treatment: comparison between a porous and a gel-coated balloon catheter. Cardiovasc Intervent Radiol 1999; 22:389-93. [PMID: 10501891 DOI: 10.1007/s002709900413] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To quantify horseradish peroxidase (HRP) delivery into the arterial wall, as a model of local drug delivery, and to compare two different percutaneous delivery balloons. METHODS Perforated and hydrophilic hydrogel-coated balloon catheters were used to deliver HRP in aqueous solution into the wall of porcine iliac arteries in vivo. HRP solutions of 1 mg/ml were used together with both perforated and hydrophilic hydrogel-coated balloon catheters and 40 mg/ml HRP solutions were used with the hydrogel-coated balloon only. The amount of HRP deposited in the arterial wall was then determined photospectrometrically. RESULTS Using the 1 mg/ml HRP solution, the hydrogel-coated balloon absorbed 0.047 mg HRP into the coating. Treatment with this balloon resulted in a mean vessel wall concentration of 7.4 microg HRP/g tissue +/- 93% (standard deviation) (n = 7). Treatment with the hydrogel-coated balloon that had absorbed 1.88 mg HRP into the coating (using the 40 mg/ml HRP solution) led to a mean vessel wall concentration of 69.5 microg HRP/g tissue +/- 74% (n = 7). Treatment with the perforated balloon using 1 mg/ml aqueous HRP solution led to a mean vessel wall concentration of 174 microg/g +/- 81% (n = 7). Differences between the hydrogel-coated and perforated balloons (1 mg/g solutions of HRP) and between hydrogel-coated balloons (0.047 mg vs 1.88 mg absorbed into the balloon coating) were significant (p < 0.05; two-sided Wilcoxon test). CONCLUSIONS The use of a perforated balloon catheter allowed the delivery of a higher total amount of HRP compared with the hydrogel-coated balloon, but at the cost of a higher systemic HRP application. To deliver 174 microg HRP per gram of vessel wall with the perforated balloon, 6.5 +/- 1.5 mg HRP were lost into the arterial blood (delivery efficiency range = 0.2%-0.3%). With 0.047 mg HRP loaded into the coating of the hydrogel balloon, 7.4 microg HRP could be applied to 1 g of vessel wall (delivery efficiency 1.7%), and with 1.88 mg HRP loaded into the coating of the hydrogel balloon, 69.5 microg HRP could be applied per gram of vessel wall (delivery efficiency 0.6%).
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Affiliation(s)
- A Dick
- Department of Diagnostic Radiology, University of Technology Aachen, Pauwelsstrasse 30, D-52057 Aachen, Germany
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32
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Baumbach A, Herdeg C, Kluge M, Oberhoff M, Lerch M, Haase KK, Wolter C, Schröder S, Karsch KR. Local drug delivery: impact of pressure, substance characteristics, and stenting on drug transfer into the arterial wall. Catheter Cardiovasc Interv 1999; 47:102-6. [PMID: 10385171 DOI: 10.1002/(sici)1522-726x(199905)47:1<102::aid-ccd22>3.0.co;2-g] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Injection parameters for local drug delivery are frequently determined by studies with marker substances. However, the pharmacologic properties of the actual drug may influence delivery efficiency and lead to different results. Aim of this study was to assess the delivery capacities of two device-drug combinations in order to verify this approach for further in vivo studies. Tritiated (3H) preparations (5 ml) of the hydrophylic low-molecular-weight heparin reviparin and the lipophilic taxane paclitaxel were injected into the left anterior descending artery of freshly explanted porcine hearts with the Infusasleeve II catheter system. A balloon support pressure of 6 atm and infusion pressures of 40, 60, 80, or 100 psi were used. In three additional groups, reviparin was injected following stent implantation and paclitaxel was injected prior to or following stent implantation. Arteries along with surrounding myocardium were harvested. The artery was carefully dissected, and artery and myocardium were separately homogenized, and activity was measured. Of the totally delivered activity, 0.09%+/-0.03% (40 psi) to 0.17%+/-0.13% (100 psi) of reviparin and 2.03%+/-0.67% (60 psi) to 2.68%+/-1.57% (100 psi) of paclitaxel were found in the vessel wall. The results for different injection pressures were not significantly different for either drug. The percentage activity delivered to the vessel wall was substantially larger in the paclitaxel group as compared to reviparin delivery (P < 0.01 at 60, 80, and 100 psi). The mean concentration of reviparin in the artery was 20 to 33 times higher than in the myocardium. For paclitaxel the factors were 110 to 243. Stent implantation prior to or following local delivery did not result in a different delivery efficiency. The results demonstrate that the characteristics of the delivered drug contribute largely to the delivery efficiency. Using identical injection parameters, drug concentrations in the arterial wall were significantly higher for the lipophilic paclitaxel as compared to the hydrophilic reviparin. Stenting of the artery did not influence delivery efficiency.
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Affiliation(s)
- A Baumbach
- Department of Medicine, University of Tübingen, Germany.
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Wilensky RL, Mehdi K, Sowinski KM, Baek SH, March KL. Increased Intramural Retention After Local Delivery of Molecules with Increased Binding Properties: Implications for Regional Delivery of Pharmacologic Agents. J Cardiovasc Pharmacol Ther 1999; 4:103-112. [PMID: 10684529 DOI: 10.1177/107424849900400205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Catheter-based local vascular delivery results in concentrated qualtities of pharmaceutical agents or genes into focal areas of the arterial wall. However, intramural retention is short and has reduced the potential efficacy of this approach. It was postulated that agents that possess increased intramural binding would show increased intramural retention. Platelet-derived growth factor (PDGF) and basic fibroblast growth factor (bFGF) were models of agents with increased cellular and extracellular matrix binding properties. METHODS AND RESULTS: The delivery efficiency and intramural retention of 2 mL of saline containing I(125) labeled PDGF (n = 35 arteries) and bFGF (n = 24) were compared with albumin (n = 21) after local delivery into porcine coronary arteries. Animals were sacrificed at three or more prespecified timepoints: immediately after delivery, 1 day, or 3 days after delivery and if necessary at 5 or 7 days to document prolonged retention. Autoradiograms of the arterial sections were evaluated for the extent of delivery. Delivery efficiency, defined as the amount leaving the catheter and retrieved from the arterial wall, was 0.60% +/- 0.42% for albumin, 1.98% +/- 0.88% for PDGF (P =.001), and 0.31% +/- 0.11% for bFGF. The calculated intramural half-life of albumin was 7.4 hours, 56.2 hours for PDGF, and 14.9 hours for bFGF (P =.0001 for PDGF). Infusate covering >50% of the medial area was observed in 85% of arteries immediately after delivery. Although myocardial delivery was similar for albumin, PDGF, and bFGF, myocardial retention was significantlylonger for bFGF (P <.001). CONCLUSIONS: Molecules that exhibit preferential intramural binding show a longer intramural residence duration than solutes without such binding properties. In addition, delivery and subsequent prolonged retention in the myocardium can be obtained by local delivery via the arterial lumen of solutions with preferential binding properties.
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Affiliation(s)
- RL Wilensky
- Cardiovascular Division, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Devices used in interventional radiology have significantly developed in the past few years. In order to understand the trends of this development, we analyzed how new interventional devices are progressively incorporating materials having original physical properties, and how developers are today progressively turning towards biomaterials, with respect to the new regulatory environment, and the requirements of biocompatibility.
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Affiliation(s)
- A Laurent
- Centre de Recherche en Imagerie Interventionnelle (Cr2i), APHP-INRA, Jouy-en-Josas, France
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Song C, Labhasetwar V, Cui X, Underwood T, Levy RJ. Arterial uptake of biodegradable nanoparticles for intravascular local drug delivery: results with an acute dog model. J Control Release 1998; 54:201-11. [PMID: 9724907 DOI: 10.1016/s0168-3659(98)00016-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Biodegradable nanoparticles (NP) with a spherical diameter ranging from 70 to 160 nm were investigated for potential usefulness for the local intraluminal therapy of restenosis, the disease process responsible for arterial reobstruction following angioplasty. NPs containing a water-insoluble anti-proliferative agent U-86983 (U-86, Pharmacia and Upjohn, Kalamazoo, MI) were formulated from oil-water emulsions using biodegradable polymers such as poly(lactic acid-co-glycolic acid) (PLGA), and specific additives after particle formation, to enhance arterial retention using either heparin, didodecylmethylammonium bromide (DMAB), or fibrinogen, or combinations. Femoral and carotid arteries of male mongrel dogs were isolated in situ, and were then subjected to a balloon angioplasty. A NP suspension of a predetermined concentration was then infused into the artery for various durations. This was followed by a 30 min restoration of blood flow through the vessel. The arterial segments were excised and analyzed for drug levels. From the drug loading the NP and the drug levels in the artery, the quantity of nanoparticles retained was calculated and expressed as microgram per 10 mg dry arteries. In general, repeated short infusions of nanoparticle suspension (15 s x 4) were two-fold more effective in terms of higher arterial U-86 levels than a single prolonged infusion (60 s). A single 15 s infusion was not significantly different than a 60 s compared to non-modified NPs (39.2 +/- 2.5 and 49.1 +/- 2.4 vs. 21.5 +/- 0.6 micrograms/10 mg mean +/- s.e., respectively). A comparably enhanced NP uptake was noted with a combined heparin/DMAB modification. Increasing the concentration of NP in infusate from 5 to 30 mg ml-1 significantly increased arterial NP uptake level (from 22.5 +/- 3.5 to 83.7 +/- 1.4 micrograms/10 mg). Thus, the results support the view that modified nanoparticles along with optimized infusion conditions could enhance arterial wall drug concentrations of agents to treat restenosis.
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Affiliation(s)
- C Song
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, USA.
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Abstract
Intensive work over the past decade has been directed to the study of vascular gene transfer as an approach to the unresolved problem of restenosis. This effort has resulted in a significant foundation of knowledge relative to the activities of potentially therapeutic gene products as well as the capabilities and limitations of vector systems and mechanical delivery modalities available for effecting the vascular expression of these gene products. In several instances, significant progress has been made by experiments highlighting unexpected difficulties and the need for more comprehensive understanding. It is thus now possible to clearly define and address specific challenges that must be overcome in order to make feasible progress from the preclinical to the clinical arena. The key challenges at present appear to include the evolution of clinically practical delivery methods that meet the kinetic requirements of achieving efficient gene transduction and the availability of vectors that maximize efficiency while minimizing undesirable host responses. Emerging data suggest that approaches to solving each of these issues may have recently been developed. Basic research evaluating these new delivery mechanisms and molecular vectors is essential to establish their true potential for use in the clinical arena.
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Affiliation(s)
- S Baek
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis 46202, USA
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Kandarpa K, Nakatsuka S, Bravo SM, Harapanhalli RS, Barry JJ. Mural delivery of iloprost with use of hydrogel-coated balloon catheters suppresses local platelet aggregation. J Vasc Interv Radiol 1997; 8:997-1004. [PMID: 9399469 DOI: 10.1016/s1051-0443(97)70701-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To develop reproducible and quantifiable methods for mural delivery of iloprost, a potent agent against platelet aggregation, with use of hydrogel-coated angioplasty balloons, and to determine the in vivo effect of direct iloprost delivery on platelet aggregation at the angioplasty site. MATERIALS AND METHODS Drug loading of tritiated iloprost from an immersion solution onto hydrogel-coated balloons was evaluated as a function of balloon size (3 mm x 2 cm, 6 mm x 2 cm, 8 mm x 3 cm; n = 4 each), drug concentration (0.0715 mg/mL, 0.1072 mg/mL, 0.1430 mg/mL; n = 3 each), and duration of immersion (40 seconds, 60 seconds, 120 seconds; n = 3 each). In another set of experiments, optimal drying methods were tested to minimize drug loss within a protective delivery sheath (n = 3 each). Ex vivo angioplasty was performed on excised swine arteries to estimate how much of the drug present on the balloon could be delivered to the wall (n = 3 iliac segments). Finally, in vivo angioplasty was performed in three Yorkshire pigs (n = 6 iloprost-treated and 6 control arteries) and indium-111-labeled platelet aggregation was measured at these sites, which were harvested 1 hour after the procedure. RESULTS In the initial set of experiments, the authors found that the volume of drug loaded is determined by the wet-volume of the hydrogel coating, that the majority of volume loading occurs within the first 2 minutes, and that the volume uptake is independent of the drug concentration. The optimal drying method resulting in the least loss of iloprost within the sheath (only 4%) was prolonged drying (5 hours) under ambient conditions. Ex vivo angioplasty experiments showed that approximately 33% of the drug present on the balloon can be delivered to the wall. Finally, in vivo experiments showed that platelet aggregation is significantly suppressed at treated sites (by approximately 33% compared to control sites; P = .03) by minuscule mural doses of iloprost (roughly estimated at under 1 microg). CONCLUSION Quantifiable and reproducible methods for loading iloprost onto hydrogel-coated angioplasty balloons were developed. The best of these methods was able to deliver enough iloprost into the wall to significantly reduce local platelet aggregation.
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Affiliation(s)
- K Kandarpa
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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O'Connor WM, Davidson BL, Kaplitt MG, Abbey MV, During MJ, Leone P, Langer D, O'Connor MJ, Freese A. Adenovirus vector-mediated gene transfer into human epileptogenic brain slices: prospects for gene therapy in epilepsy. Exp Neurol 1997; 148:167-78. [PMID: 9398459 DOI: 10.1006/exnr.1997.6658] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
As a first step in the development of a gene therapy approach to epilepsy, we evaluated the ability of adenovirus vectors to direct the transfer into and expression of a marker gene in human brain slices obtained from patients undergoing surgery for medically intractable epilepsy. Following injection of adenovirus vectors containing the Escherichia coli lacZ gene into hippocampal and cortical brain slices, lacZ mRNA, beta-galactosidase protein, and enzymatic activity were detected, confirming successful gene transfer, transcription, and translation into a functional protein. Transfected cells were predominantly glial, with some neurons expressing beta-galactosidase as well. These results support the potential of adenovirus vectors to transfer genetic information into human epileptogenic brain, resulting in expression of the gene into a functional protein. These findings also have implications for the development of gene therapy approaches to certain seizure disorders. A number of potential therapeutic approaches are discussed, including the elevation of inhibitory neurotransmitter or neuropeptide levels, expression or modulation of postsynaptic receptors, and manipulation of signal transduction systems.
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Affiliation(s)
- W M O'Connor
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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Microparticles of poly(dl-lactic-co-glycolic acid)/poly(ethylene glycol) blends for controlled drug delivery. J Control Release 1997. [DOI: 10.1016/s0168-3659(97)00052-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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40
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Camenzind E, Bakker WH, Reijs A, van Geijlswijk IM, Boersma E, Kutryk MJ, Krenning EP, Roelandt JR, Serruys PW. Site-specific intracoronary heparin delivery in humans after balloon angioplasty. A radioisotopic assessment of regional pharmacokinetics. Circulation 1997; 96:154-65. [PMID: 9236430 DOI: 10.1161/01.cir.96.1.154] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Demonstration and quantification of site-specific intracoronary administration of compounds has been confined thus far to the experimental animal laboratory. The aim of this study was to describe a scintigraphic method to demonstrate site-specific intracoronary drug delivery in humans. The methods allow on-line visualization and off-line quantification of site-specifically infused gamma-emitting compounds. METHODS AND RESULTS In 12 patients after balloon angioplasty, 99mTc-labeled heparin was administered at the site of dilatation by use of a coil balloon. Both the infusion period and the washout period after the end of infusion were monitored with a gamma-camera. A curve of counts per pixel as a function of time was derived that showed an accumulation phase during infusion followed by washout phase after the end of infusion. Both phases were fitted by regression analysis and showed a linear accumulation pattern and a biexponential washout pattern. After correction for background counts, 99mTc decay, and body attenuation, peak heparin amount and regional bioavailability were calculated. Peak amount was defined as the initial point of the slow washout component of the biexponential curve (elimination component), and regional bioavailability was defined as the area under the curve of accumulation and washout phase. Half-life and retention time, define as seven half-lives, were obtained by use of the elimination component after correction for 99mTc decay. Mean peak delivered amount was 45 +/- 44 IU (236 +/- 228 micrograms), corresponding to an efficiency of delivery ranging from 1% to 8% of the totally infused dose. Total regionally bioavailable heparin reached 244 +/- 194 IU.h (1.28 +/- 1.01 mg.h). Retention time varied from 12 to 90 hours (mean, 50:33 +/- 22:50 hours:minutes). CONCLUSIONS Site-specific intracoronary heparin delivery after angioplasty by means of the coil balloon was demonstrated in humans, and regional pharmacokinetics was quantified by use of a radioisotopic technique.
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Affiliation(s)
- E Camenzind
- Thoraxcenter, University Hospital Dijkzigt, Rotterdam, Netherlands
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41
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Camenzind E, Bakker WH, Reijs A, van Geijlswijk IM, Foley D, Krenning EP, Roelandt JR, Serruys PW. Site-specific intravascular administration of drugs: history of a method applicable in humans. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1997; 41:342-7. [PMID: 9213034 DOI: 10.1002/(sici)1097-0304(199707)41:3<342::aid-ccd16>3.0.co;2-p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Demonstration and quantification of site-specific intracoronary administration of pharmacological compounds has been limited thus far to animal experimental models. Recently, a method applicable in humans has been developed. The aim of this study is to give an overview on the available methods to visualize and quantify intravascularly administered "labeled" drugs in animals and to describe the historical development of a method now applied in the clinical arena. The potential of this approach is briefly summarized.
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Affiliation(s)
- E Camenzind
- Thoraxcenter, University Hospital Dijkzigt, Rotterdam, The Netherlands
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Lincoff AM, Furst JG, Ellis SG, Tuch RJ, Topol EJ. Sustained local delivery of dexamethasone by a novel intravascular eluting stent to prevent restenosis in the porcine coronary injury model. J Am Coll Cardiol 1997; 29:808-16. [PMID: 9091528 DOI: 10.1016/s0735-1097(96)00584-0] [Citation(s) in RCA: 212] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study sought to assess the feasibility, safety and efficacy of sustained intracoronary delivery of dexamethasone by a novel polymer-coated eluting stent. BACKGROUND Development of techniques to provide sustained local drug delivery has focused on polymers as matrices for drug incorporation and elution. METHODS A tantalum wire stent was coated with dexamethasone (0.8 mg) suspended in a matrix of either low (approximately 80 kD) or high (approximately 321 kD) molecular weight poly-L-lactic acid (PLLA [0.4 mg]). Uncoated stents, stents coated with PLLA or stents coated with dexamethasone in PLLA were overexpanded by 30% to the normal vessel diameter in the coronary arteries of juvenile farm pigs. Animals were euthanized 28 days later, and neointimal thicknesses were measured. Additional pigs underwent placement of stents coated with high molecular weight PLLA-dexamethasone for assessment of arterial tissue and serum concentrations of dexamethasone at 1 h and 1, 2, 10 and 28 days after stent implantation. RESULTS In vitro dexamethasone release occurred over the first 6 days. Stents coated with low molecular weight PLLA produced an intense inflammatory neointimal response. Stents utilizing the high molecular weight PLLA were well tolerated within the coronary vessel during the 28-day experiment. However, dexamethasone did not decrease neointimal hyperplasia. Dexamethasone concentrations in the arterial tissue were approximately 300,000-fold higher than those in the serum 24 h after stent implantation, remaining approximately 3,000-fold higher at 28 days. CONCLUSIONS The eluting stent utilizing high molecular weight PLLA appeared to be a well tolerated and effective means of providing sustained, site-specific drug delivery to the porcine coronary artery wall for at least 28 days.
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Affiliation(s)
- A M Lincoff
- Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA
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44
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Humphrey WR, Erickson LA, Simmons CA, Northrup JL, Wishka DG, Morris J, Labhasetwar V, Song C, Levy RJ, Shebuski RJ. The effect of intramural delivery of polymeric nanoparticles loaded with the antiproliferative 2-aminochromone U-86983 on neointimal hyperplasia development in balloon-injured porcine coronary arteries. Adv Drug Deliv Rev 1997. [DOI: 10.1016/s0169-409x(96)00484-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Pharmacokinetics of Local Vector Delivery to Vascular Tissues: Implications for Efficiency and Localization of Transduction. ACTA ACUST UNITED AC 1997. [DOI: 10.1007/978-1-4615-6277-1_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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46
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Golomb G, Fishbein I, Banai S, Mishaly D, Moscovitz D, Gertz SD, Gazit A, Poradosu E, Levitzki A. Controlled delivery of a tyrphostin inhibits intimal hyperplasia in a rat carotid artery injury model. Atherosclerosis 1996; 125:171-82. [PMID: 8842349 DOI: 10.1016/0021-9150(96)05868-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We examined the inhibitory effect of AG-17, a potent inhibitor of protein tyrosine kinase activity on injury-induced vascular SMC proliferation by polymeric-based, periadventitial controlled release implant in the balloon catheter carotid injury model in rats. The AG-17 delivery system was formulated from ethylenevinyl acetate copolymer and the release kinetics as well as drug stability were determined. Polymeric matrices containing 2 or 10% AG-17 were implanted perivascularly in rats following balloon catheter injury. Western blot analysis of explanted arterial segments revealed enhanced tyrosine phosphorylation in injured arteries that was essentially reduced to normal levels in treated arteries. The mean neointima to media ratios were significantly reduced in both 2% (0.79 +/- 0.17, n = 9, P < 0.02) and 10% AG-17 (0.59 +/- 0.09, n = 12, P < 0.001) groups in comparison to the control group (1.38 +/- 0.18, n = 16). The mean areas of the media in the control and the 2% AG-17 group did not differ significantly but a significant reduction of the mean area of the media was observed in 10% AG-17 group. Embedding of the unstable tyrphostin compound, AG-17, in a hydrophobic matrix stabilizes the drug both in vitro and in vivo, and allows delivery-rate modulation as well as protracted site-specific therapy. Perivascular controlled release delivery of the tyrphostin AG-17 inhibits neointimal formation in the rat carotid injury model.
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Affiliation(s)
- G Golomb
- School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
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Huehns TY, Gonschior P, Höfling B. Adventitia as a target for intravascular local drug delivery. HEART (BRITISH CARDIAC SOCIETY) 1996; 75:537-8. [PMID: 8697150 PMCID: PMC484370 DOI: 10.1136/hrt.75.6.537] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Nasser TK, Wilensky RL, Mehdi K, March KL. Microparticle deposition in periarterial microvasculature and intramural dissections after porous balloon delivery into atherosclerotic vessels: quantitation and localization by confocal scanning laser microscopy. Am Heart J 1996; 131:892-8. [PMID: 8615307 DOI: 10.1016/s0002-8703(96)90170-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Local delivery of pharmacologic or genetic agents with a porous balloon catheter offers a potential therapeutic approach to reducing restenosis and atherosclerosis and minimizing undesirable systemic toxicity. However, the delivery efficiency and intramural retention of liquid agents is low. The local intramural delivery and prolonged retention of 5 microns microparticles (MP) has been described previously. The current study was designed to evaluate the distribution of locally delivered MPs and to determine the effects of MP size and infusion pressure on intramural delivery efficiency. A 1% suspension of fluorescent, latex MPs (1 or 4.5 microns in diameter) was infused at either 3 or 6 atm into atherosclerotic rabbit femoral arteries (n = 32) immediately after angioplasty. Four groups of arteries were evaluated: 1) 1 micron MPs infused at 3 atm; 2) 1 micron MPs at 6 atm; 3) 4.5 microns MPs at 3 atm; and 4) 4.5 microns MP at 6 atm. The location of MPs was evaluated by fluorescent and light microscopy and confocal laser scanning microscopy. The tissue was dissolved and the delivered MPs quantified. All groups manifested numerous MPs within the vasa vasorum and periadventitial microvasculature, with a substantially lesser number within the neointimal and medial layers. The intramural deposition of the MPs was associated with dissection within the intima or media caused by the antecedent angioplasty or local delivery, indicating that an intact vessel wall is an anatomic barrier to MP delivery. The median values of fractional intramural delivery, defined as the percentage of infused MPs retained within the arterial wall, were 0.059%, 0.071%, 0.047%, and 0.062% for the groups 1 through 4, respectively (p not significant [NS]). The values of intramural particle concentration, expressed as the total number of MPs per weight of arterial tissue, were 55, 65, 1.5, and 1.2 x 10(4) MPs/mg for groups 1 through 4, respectively (p < 0.001 for 1 micron vs 4.5 microns MPs). Although more 1 microM MPs were delivered than 4.5 microns MPs, the fractional intramural delivery was unaffected by particle size or infusion pressure. The local delivery of MPs at atherosclerotic sites after angioplasty is characterized by fractional intramural delivery values similar to values of nonparticulate agents, with few MPs deposited into intima or media in the absence of a dissection caused by the antecedent angioplasty or the delivery procedure itself.
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Affiliation(s)
- T K Nasser
- Krannert Institute of Cardiology, Department of Medicine, Indiana University, School of Medicine, Indianapolis, USA
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Gonschior P, Pahl C, Huehns TY, Gerheuser F, Erdemci A, Larisch K, Dellian M, Deil S, Goetz AE, Lehr HA. Comparison of local intravascular drug-delivery catheter systems. Am Heart J 1995; 130:1174-81. [PMID: 7484766 DOI: 10.1016/0002-8703(95)90139-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Systemic and local delivery of the photosensitive drug Photofrin polyporphyrin was investigated in normal porcine arteries (n = 192). A macroporous balloon and a novel needle injection catheter were used for local drug delivery and compared with systemic delivery. Fluorescence microscopy combined with digital image analysis was used to quantify the drug-related fluorescence. Systemic delivery showed a maximum in the intima at 4 hours. Application with the porous balloon revealed maximum indicator-related fluorescence intensity in the intima after 5 minutes; delivery with the needle injection catheter resulted in a several-fold enhanced maximum in adventitia after 30 minutes compared with the maximum achieved with either systemic injection or porous balloon application. After 21 days fluorescence was detectable in arteries treated with the new needle injection catheter. Local drug delivery is feasible with either system, but prolonged delivery was achieved only with the needle injection catheter.
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Affiliation(s)
- P Gonschior
- Medical Department I, Klinikum Grosshadern, Munich, Germany
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50
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Gradus-Pizlo I, Wilensky RL, March KL, Fineberg N, Michaels M, Sandusky GE, Hathaway DR. Local delivery of biodegradable microparticles containing colchicine or a colchicine analogue: effects on restenosis and implications for catheter-based drug delivery. J Am Coll Cardiol 1995; 26:1549-57. [PMID: 7594084 DOI: 10.1016/0735-1097(95)00345-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study sought to evaluate the delivery efficiency, intramural retention and antirestenotic efficacy of soluble colchicine or colchicine analogue delivered into the arterial wall after angioplasty as well as the efficacy of these medications after prolonged local release from biodegradable microparticles. BACKGROUND Local delivery of pharmacologic agents is a potential treatment for restenosis. However, the delivery efficiency of the technique and the choice of agent to modulate cellular proliferation are unknown. It was hypothesized that restenosis would be unaffected by colchicine or a hydrophobic colchicine analogue with short intramural retention, whereas it would be reduced after prolonged local release. METHODS Rabbit atherosclerotic femoral arteries underwent angioplasty followed by local delivery. Delivery efficiency and intramural retention of 3H-colchicine were evaluated. The effect of agents in soluble formulation or released from microparticles on angiographic and morphometric restenosis was evaluated at 2 weeks and compared with that in the control groups (angioplasty only and local infusion of carrier solution). RESULTS Delivery of efficiency was 0.01% and intramural retention < 24 h. Neither soluble colchicine formulation reduced restenosis. Microparticles releasing the colchicine analogue reduced restenosis compared with control and colchicine microparticles but not angioplasty alone (p = 0.002). Delivery outside the artery was observed, and the long-term release of both colchicine resulted in toxicity to the adjacent musculature. CONCLUSIONS Colchicine or the colchicine analogue did not reduce restenosis, although the long-term local release of the colchicine analogue reduced neointimal proliferation resulting from local delivery. Local delivery of cytotoxic agents with insufficient vascular specificity may be limited by toxicity to adjacent tissues resulting from a larger than expected delivery area and prolonged agent retention.
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Affiliation(s)
- I Gradus-Pizlo
- Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis 46202-4800, USA
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