Drug-eluting stents: factors governing local pharmacokinetics

Understudied factors in drug-coated balloon design and evaluation: A biophysical perspective

Drug-coated balloon (DCB) percutaneous interventional therapy allows for durable reopening of the narrowed lumen via physical tissue expansion and local anti-restenosis drug delivery, providing an alternative to traditional uncoated balloons or a permanent indwelling implant such as a conventional metallic drug-eluting stent. While DCB-based treatment of peripheral arterial disease (PAD) has been incorporated into clinical guidelines, DCB use has been recently curtailed due to reports that showed evidence of increased mortality risk in patients treated with paclitaxel (PTX)-coated balloons. Given the United States Food and Drug Administration's 2019 consequent warning regarding PTX-eluting DCBs and the subsequent marked reduction in clinical DCB use, there is now a critical need to better understand the compositional and mechanical factors underlying DCB efficacy and safety. Most work to date on DCB refinement has focused on designing both the enabling balloon catheter and alternate coatings composed of various drugs and excipients, followed by device evaluation in preclinical and clinical studies. We contend that improvement in DCB performance will require a better understanding of the biophysical factors operative during and following balloon deployment, and moreover that the elaboration and demonstrated control of these factors are needed to address current concerns with DCB use. This article provides a perspective on the biophysical interactions that govern DCB performance and offers new design strategies for the development of next-generation DCB devices.

Microneedle-mediated therapy for cardiovascular diseases

Cardiovascular diseases remain a leading cause of global disease burden. To date, the limited drug delivery efficacy confines the therapeutic effect in most conventional approaches, such as intramyocardial injections and vascular devices, due to short-term drug release and low retention within the disease sites. As a typical transdermal medical device with a minimally invasive manner and controlled/sustained drug release pattern, microneedles have gained momentum in the field of cardiovascular therapy, from which several cardiovascular diseases have been benefited to the ultimate therapeutic effects. In this concise review, strategies based on the microneedles for the treatments of cardiovascular diseases are introduced, mainly focus on hypertension, atherosclerosis, thrombus, and myocardial diseases. The limitations at the present stage and perspectives of the next-generation microneedles for cardiovascular therapy are also discussed.

EFFECTS OF COATING PROPERTIES ON CONTROLLED DELIVERY FROM AN EMBEDDED DRUG-ELUTING STENT: A SIMULATION STUDY

The present investigation deals with the effects of biodegradable, biodurable and polymer-free coating of a stent on the release mechanism of the drug in a porous medium. The Brinkman equations for the interstitial fluid, the unsteady convection-diffusion-reaction equation for the transport of free drug in the tissue and the unsteady reaction equations for the bound as well as the internalized drug have been considered. In the coating, the transport of drug has been modeled as a diffusion process. Effects of different percentages of the embedment, convection and various coating properties of the stent on the transport of free drug, its retention and the internalization of the bound drug have been studied. Immersed Boundary Method (IBM) in the staggered grid formulation (IBM-MAC) has been used to tackle numerically the system of nonlinear governing equations. Simulated results predict the fastest release of drug from a biodegradable coating, but the averaged concentrations of all drug forms do reach a quasi-steady state in case of a biodurable coating irrespective of the degrees of embedment. Moreover, for all embedment levels of the stent, a biodegradable coating is superior to that of biodurable and polymer-free coating in the presence/absence of convection for larger times, but this superiority is lost for smaller times. Unlike biodurable coating, it is also predicted that the more the embedment level does not necessarily imply the more the effectiveness of delivery for biodegradable and polymer-free coatings of a stent.

Mechano-chemo-biological Computational Models for Arteries in Health, Disease and Healing: From Tissue Remodelling to Drug-eluting Devices

This review aims to highlight urgent priorities for the computational biomechanics community in the framework of mechano-chemo-biological models. Recent approaches, promising directions and open challenges on the computational modelling of arterial tissues in health and disease are introduced and investigated, together with in silico approaches for the analysis of drug-eluting stents that promote pharmacological-induced healing. The paper addresses a number of chemo-biological phenomena that are generally neglected in biomechanical engineering models but are most likely instrumental for the onset and the progression of arterial diseases. An interdisciplinary effort is thus encouraged for providing the tools for an effective in silico insight into medical problems. An integrated mechano-chemo-biological perspective is believed to be a fundamental missing piece for crossing the bridge between computational engineering and life sciences, and for bringing computational biomechanics into medical research and clinical practice.

Computational model of stent-based delivery from a half-embedded two-layered coating

An attempt is made in the present investigation to develop a computational model for the purpose of studying the effect of interstitial flow in the porous media on the distribution of drug eluted from a half-embedded drug-eluting stent and its retention in the presence of two-layered coating of the stent. The transport of free drug inside the coatings is considered as an unsteady diffusion process while that in the tissue as an unsteady convection-diffusion-reaction process. The bound drug is governed by an unsteady reaction process only. Immersed boundary method (IBM) in the staggered grid formulation, popularly known as marker and cell (MAC) method, has been leveraged to tackle numerically the governing equations. This model highlights the benefits of consideration of two-layered coating and does predict underlying mechanism for better efficacy by tweaking the kinetics parameters. Comparisons are also made with the results available for stent-based delivery.

* A Paradigm for the Evaluation of Tissue-Engineering Biomaterials and Templates

Procedures for the evaluation of tissue-engineering processes, including those used for the testing of the relevant biomaterials, have not been developed in a logical manner. This perspectives paper discusses the limitations of testing regimes and recommends a very different approach. The main emphasis is on the existing methods for assessing the biological safety of these biomaterials, which, it is suggested, are irrelevant for evaluating materials that are intended to facilitate the generation of new tissue. An algorithm is proposed that sets out the pathway from materials design and characterization through to the production of a file that sets out full biocompatibility, functionality, and tissue incorporation data that are suitable for regulatory consideration for first-in-man experiences. Central to this algorithm is the choice of animal models and the real-time monitoring of the implanted construct performance.

Beyond conventional antibiotics - New directions for combination products to combat biofilm

Medical device related infections are a significant and growing source of morbidity and mortality. Biofilm formation is a common feature of medical device infections that is not effectively prevented or treated by systemic antibiotics. Antimicrobial medical device combination products provide a pathway for local delivery of antimicrobial therapeutics with the ability to achieve high local concentrations while minimizing systemic side effects. In this review, we present considerations for the design of local antimicrobial delivery systems, which can be facilitated by modeling local pharmacokinetics in the context of the target device application. In addition to the need for local delivery, a critical barrier to progress in the field is the need to incorporate agents effective against biofilm. This article aims to review key properties of antimicrobial peptides that make them well suited to meet the demands of the next generation of antimicrobial medical devices, including broad spectrum activity, rapid and biocidal mechanisms of action, and efficacy against biofilm.

Fabrication and Mechanical Characterization of Hydrogel Infused Network Silk Scaffolds

Development and characterization of porous scaffolds for tissue engineering and regenerative medicine is of great importance. In recent times, silk scaffolds were developed and successfully tested in tissue engineering and drug release applications. We developed a novel composite scaffold by mechanical infusion of silk hydrogel matrix into a highly porous network silk scaffold. The mechanical behaviour of these scaffolds was thoroughly examined for their possible use in load bearing applications. Firstly, unconfined compression experiments show that the denser composite scaffolds displayed significant enhancement in the elastic modulus as compared to either of the components. This effect was examined and further explained with the help of foam mechanics principles. Secondly, results from confined compression experiments that resemble loading of cartilage in confinement, showed nonlinear material responses for all scaffolds. Finally, the confined creep experiments were performed to calculate the hydraulic permeability of the scaffolds using soil mechanics principles. Our results show that composite scaffolds with some modifications can be a potential candidate for use of cartilage like applications. We hope such approaches help in developing novel scaffolds for tissue engineering by providing an understanding of the mechanics and can further be used to develop graded scaffolds by targeted infusion in specific regions.

Diphenylalanine peptide nanotubes self-assembled on functionalized metal surfaces for potential application in drug-eluting stent

This study focuses on the potential of diphenylalanine self-assembled peptide nanotubes (FF Nts) for delivery of flufenamic acid (FA) from metal implants. Self-assembly of FF Nts was studied in solution and on surfaces of glass, silicone and gold substrates. FA was loaded inside the shell of FF Nts and subsequently FF/FA Nts were attached to gold surfaces. The substrate were characterized by Field Emission Scanning Electron Microscopy (FESEM), fluorescence microscopy, confocal microscopy, and UV-vis spectroscopy. Release of FA from FF Nts were investigated by immersing coated metal substrates in phosphate-buffered saline for 12 days. Self-assembly of FF in water and solvent resulted in formation of nanotubes, which efficiently loaded 98% of FA with concentration of 20 µg/mL. FESEM images confirmed successful attachment of FF/FA Nts to functionalized gold substrates. In vitro release studies indicated using FF Nts has prolonged the release rate of FA for several days. Biocompatibility studied confirmed more than 50% of the cells were alive in concentration of 250-1000 µg/mL of FF Nts thus suggesting the potential of peptide based self-assemble nanostructures as an alternate system for polymer coating in drugs eluting stents. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2280-2290, 2016.

Numerical simulation on the effects of drug-eluting stents with different bending angles on hemodynamics and drug distribution

Implantation of drug-eluting stents in curved blood vessels may cause changes in hemodynamics and drug distribution, and even provoke in-stent restenosis. Due to the complexity of building three-dimensional (3-D) curved stent model, few studies have gone through such numerical simulations. In this study, three virtual stent models with different bending angles (0°, 30° and 90°) were developed to numerically investigate the distribution of wall shear stress (WSS) and drug concentration. The results showed that (1) the low-WSS regions in the inner bend of the stent models increased with the bending angles; (2) the drug concentration differed between the inner and outer bends of the stents but irrespective to the changes of bending angle; (3) the pattern of drug concentration for the curved stents found similar to that of the straight stents, and the phenomenon, 'proximal part low and distal part high' in the drug concentration showed in both the straight and curved stents. The increase in bending angles from 30° to 90° had little effect on the WSS and drug concentration; however, the largest effect of the curved stents was the remarkable difference of drug concentration between the inner and outer bends of the stents-about 20 %. Hence, it is feasible that quick analysis focused on the straight stents instead of the curved stents.

Modelling the Impact of Atherosclerosis on Drug Release and Distribution from Coronary Stents

Although drug-eluting stents (DES) are now widely used for the treatment of coronary heart disease, there remains considerable scope for the development of enhanced designs which address some of the limitations of existing devices. The drug release profile is a key element governing the overall performance of DES. The use of in vitro, in vivo, ex vivo, in silico and mathematical models has enhanced understanding of the factors which govern drug uptake and distribution from DES. Such work has identified the physical phenomena determining the transport of drug from the stent and through tissue, and has highlighted the importance of stent coatings and drug physical properties to this process. However, there is limited information regarding the precise role that the atherosclerotic lesion has in determining the uptake and distribution of drug. In this review, we start by discussing the various models that have been used in this research area, highlighting the different types of information they can provide. We then go on to describe more recent methods that incorporate the impact of atherosclerotic lesions.

Comparison of Resolute zotarolimus-eluting stents versus everolimus-eluting stents in patients with metabolic syndrome and acute myocardial infarction: propensity score-matched analysis

BACKGROUND

Despite common use of second-generation drug-eluting stents in treating patients with coronary artery disease, there is lack of data comparing these stents exclusively in patients with acute myocardial infarction (AMI), especially with metabolic syndrome (MetS), which is highly prevalent in AMI and potential to worsen clinical outcomes. The aim of this study was to compare clinical outcomes of everolimus-eluting stent (EES) and Resolute-zotarolimus-eluting stent (R-ZES) in AMI patients with MetS, in terms of stent-related and patient-related outcomes.

METHODS

A total of 3942 AMI patients in the KAMIR (Korea Acute Myocardial Infarction Registry) were grouped according to the presence of MetS and stent type: EES (N=1582) and R-ZES (N=255) in MetS (1837). Target lesion failure (TLF) and patient-oriented composite events (POCE) at 1 year were evaluated.

RESULTS

In MetS patients, TLF (3.7% vs. 2.7%, p=0.592) and POCE (7.9% vs. 6.7%, p=0.764) were similar between EES and R-ZES. Also in Non-MetS patients, TLF (3.9% vs. 3.1%, p=0.307) and POCE (6.4% vs. 7.3%, p=0.866) were similar between 2 groups. TLF was similar between MetS and Non-MetS patients (3.6% vs. 3.8%), while POCEs (7.7% vs. 6.6%) were higher in MetS. Propensity-score matching analysis showed similar results between stent groups in MetS and Non-MetS. In multivariate analysis, left ventricular ejection fraction and symptom-to-door time were independent predictors of TLF and POCE in MetS patients with AMI.

CONCLUSIONS

In MetS patients with AMI, EES and R-ZES showed excellent performance and safety. However, patient-oriented composite events were relatively high, suggesting more efforts to improve them.

Analytical modeling of drug dynamics induced by eluting stents in the coronary multi-layered curved domain

Pharmacokinetics induced by drug eluting stents (DES) in coronary walls is modeled by means of a one-dimensional multi-layered model, accounting for vessel curvature and non-homogeneous properties of the arterial tissues. The model includes diffusion mechanisms, advection effects related to plasma filtration through the walls, and bio-chemical drug reactions. A non-classical Sturm-Liouville problem with discontinuous coefficients is derived, whose closed-form analytical solution is obtained via an eigenfunction expansion. Soundness and consistency of the proposed approach are shown by numerical computations based on possible clinical treatments involving both hydrophilic and hydrophobic drugs. The influence of the main model parameters on drug delivery mechanisms is analyzed, highlighting the effects induced by vessel curvature and yielding comparative indications and useful insights into the concurring mechanisms governing the pharmacokinetics.

Controlling drug delivery from coronary stents: are we aiming for the right targets?

In this review article, the currently employed or explored delivery concepts for local intravascular drug delivery with drug-eluting stents (DES) are discussed with a special emphasis on clinical evidence regarding the desired release profiles. Traditional concepts to control drug release from DES include diffusion through polymers, polymer degradation and erosion as well as dissolution of particulate drug. Published clinical studies do not always reveal fine mechanistic details. The long duration of release favored for DES and the short duration of release favored for drug-eluting balloons require further investigation in experimental studies and clinical trials.

Healing arterial ulcers: Endothelial lining regeneration upon vascular denudation injury

Thrombosis and restenosis are the most prevalent late complications of coronary artery stenting. Current standards of clinical care focus on prevention of smooth muscle cell proliferation by the use of drug-eluting stents able to release anti-proliferative drugs. Unfortunately, these drugs also block endothelial cell proliferation and, in this manner, prevent recovery of endothelial cell coverage. Continued lack of endothelial repair leaves the root cause of thrombosis and restenosis unchanged, creating a vicious cycle where drug-mediated prevention of restenosis simultaneously implies promotion of thrombosis. In this issue of Vascular Pharmacology, Hussner and colleagues provide in vitro evidence and a mechanistic basis for the use of atorvastatin in stents as a way to bypass this roadblock. Here we review the pathological mechanisms and therapeutic approaches to restore flow in occluded arteries. We argue that rational design of drug eluting stents should focus on specific inhibition of smooth muscle cell proliferation with concurrent stimulation of endothelial regeneration. We comment on the current poor understanding of the cellular and molecular regulation of endothelial cell proliferation in the context of a functional artery, and on the pitfalls of extrapolating from the well-studied process of neovascularization by sprouting vessel formation.

Nonvascular drug-eluting stent coated with sodium caprate-incorporated polyurethane for the efficient penetration of paclitaxel into tumor tissue

To increase the therapeutic potency of nonvascular drug-eluting stents, sodium caprate was employed as a drug-penetration enhancer. A polytetrafluoroethylene-covered drug-eluting stent was coated with a mixture containing sodium caprate, paclitaxel, and polyurethane via the rolling coating technique. The coated stent has a smooth membrane surface with a 40-µm membrane thickness. Paclitaxel was released from the coated stent for two months. In the multilayered cell sheet model, sodium caprate in the polyurethane membrane (PUSC10) showed the possibility of enhancing the paclitaxel tissue penetration. The amount of penetrated paclitaxel for the sodium caprate-containing polyurethane membrane (PUSC10) was two times higher than that of sodium caprate-free polyurethane membrane. Additionally, the potential of sodium caprate was confirmed by a tumor-bearing small animal model. PUSC10 incorporated with Nile red (as a model fluorescence dye for visualization of drug penetration; PUSC10–Nile red) or PUSC10 incorporated with paclitaxel (PUSC10–paclitaxel) membrane was implanted at tumor sites in Balb/c mice. In the case of PUSC10–Nile red, the tissue penetration depth of Nile red was significantly increased from 30 µm (without sodium caprate) to 1060 µm (with sodium caprate). After seven days, an almost four times higher therapeutic area of PUSC10–paclitaxel was observed compared to that of polyurethane–paclitaxel (without sodium caprate) by a terminal deoxynucleotidyl transferase dUTP nick end labeling assay. The results indicate that sodium caprate improves the penetration and therapeutic efficiencies of drugs in drug-eluting stents, and thus, it has potential for local stent therapy.

NUMERICAL STUDY ON THE EFFECTS OF THE NUMBER AND GEOMETRIES OF DRUG-ELUTING STENT LINKS ON THE DRUG CONCENTRATION

The paper investigated the effects of the link numbers and geometries of drug-eluting stents (DESs) on the hemodynamics and the distribution of drug concentration, and the final results could be used as a guide for the optimization of DES design. Four 3D virtual stents with different numbers and geometries of links were modeled and numerically studied with respect to the distribution of wall shear stress (WSS) and drug concentration. Results have showed (1) The geometries of links have big impact on the distribution of WSS regions and the uniform drug concentration distribution on the vascular wall, but little effect on the mean drug concentration on the vascular wall; the S-shaped link stents had less low-WSS regions and the reason is that the flow direction was considered in the design of this type of stents. (2) The drug concentration distribution on the vascular wall had remarkable difference from that in blood. (3) The 6S link stent had the least low-WSS regions and with high and uniformly distributed drug concentration, so this type of stent was concluded to be the best design in four stents. Overall, it is not reliable to use the drug concentration in blood to deduce the drug concentration on the vascular wall. In DES design, the configuration of links should be, as much as possible, in line with the blood flow direction, so it can decrease the low-WSS regions. Meanwhile, in order to get more uniformly distributed drug on the vascular wall, the distribution of drug on the stent surface should be taken into account. Additionally, because of the increment of contact area between the stents and vascular wall, the drug concentration on the vascular wall increased with the number of links.

Perivascular biodegradable microneedle cuff for reduction of neointima formation after vascular injury

Restenosis often occurs at the site of vascular grafting and may become fatal for patients. Restenosis at anastomosis sites is due to neointimal hyperplasia (NH) and difficult to treat with conventional treatments. Such abnormal growth of smooth muscle cells in tunica media of vascular tissue can be reduced by delivering anti-proliferation drugs such as paclitaxel (PTX) to the inner vascular layer. Drug eluting stents (DES) or drug eluting balloon (DEB) have been developed to treat such vascular diseases. However, they are less efficient in drug delivery due to the drug loss to blood stream and inadequate to be applied to re-stenotic area in the presence of stent or anastomosis sites. Recently, we have introduced microneedle cuff (MNC) as perivascular delivery devices to achieve high delivery efficiency to tunica media. In this study, we investigated in vivo microneedle insertion and efficacy in treating NH using a rabbit balloon injury model. Microneedle shape was optimized for reliable insertion into tunica media layer. Uniform distribution of PTX in tunica media delivered by MNC devices was also confirmed. Animal study demonstrated significant NH reduction by MNC treatments and much higher delivery efficiency than flat type devices.

Drug release analysis and optimization for drug-eluting stents

The drug release analysis and optimization for drug-eluting stents in the arterial wall are studied, which involves mechanics, fluid dynamics, and mass transfer processes and design optimization. The Finite Element Method (FEM) is used to analyze the process of drug release in the vessels for drug-eluting stents (DES). Kriging surrogate model is used to build an approximate function relationship between the drug distribution and the coating parameters, replacing the expensive FEM reanalysis of drug release for DES in the optimization process. The diffusion coefficients and the coating thickness are selected as design variables. An adaptive optimization approach based on kriging surrogate model is proposed to optimize the lifetime of the drug in artery wall. The adaptive process is implemented by an infilling sampling criterion named Expected Improvement (EI), which is used to balance local and global search and tends to find the global optimal design. The effect of coating diffusivity and thickness on the drug release process for a typical DES is analyzed by means of FEM. An implementation of the optimization method for the drug release is then discussed. The results demonstrate that the optimized design can efficiently improve the efficacy of drug deposition and penetration into the arterial walls.

Improving smooth muscle cell exposure to drugs from drug-eluting stents at early time points: a variable compression approach

The emergence of drug-eluting stents (DES) as a viable replacement for bare metal stenting has led to a significant decrease in the incidence of clinical restenosis. This is due to the transport of anti-restenotic drugs from within the polymer coating of a DES into the artery wall which arrests the cell cycle before restenosis can occur. The efficacy of DES is still under close scrutiny in the medical field as many issues regarding the effectiveness of DES drug transport in vivo still exist. One such issue, that has received less attention, is the limiting effect that stent strut compression has on the transport of drug species in the artery wall. Once the artery wall is compressed, the stents ability to transfer drug species into the arterial wall can be reduced. This leads to a reduction in the spatial therapeutic transfer of drug species to binding sites within the arterial wall. This paper investigates the concept of idealised variable compression as a means of demonstrating how such a stent design approach could improve the spatial delivery of drug species in the arterial wall. The study focused on assessing how the trends in concentration levels changed as a result of artery wall compression. Five idealised stent designs were created with a combination of thick struts that provide the necessary compression to restore luminal patency and thin uncompressive struts that improve the transport of drugs therein. By conducting numerical simulations of diffusive mass transport, this study found that the use of uncompressive struts results in a more uniform spatial distribution of drug species in the arterial wall.

A finite element study on variations in mass transport in stented porcine coronary arteries based on location in the coronary arterial tree

Drug-eluting stents have a significant clinical advantage in late-stage restenosis due to the antiproliferative drug release. Understanding how drug transport occurs between coronary arterial locations can better help guide localized drug treatment options. Finite element models with properties from specific porcine coronary artery sections (left anterior descending (LAD), right (RCA); proximal, middle, distal regions) were created for stent deployment and drug delivery simulations. Stress, strain, pore fluid velocity, and drug concentrations were exported at different time points of simulation (0-180 days). Tests indicated that the highest stresses occurred in LAD sections. Higher-than-resting homeostatic levels of stress and strain existed at upwards of 3.0 mm away from the stented region, whereas concentration of species only reached 2.7 mm away from the stented region. Region-specific concentration showed 2.2 times higher concentrations in RCA artery sections at times corresponding to vascular remodeling (peak in the middle segment) compared to all other segments. These results suggest that wall transport can occur differently based on coronary artery location. Awareness of peak growth stimulators and where drug accumulation occurs in the vasculature can better help guide local drug delivery therapies.

Location-dependent coronary artery diffusive and convective mass transport properties of a lipophilic drug surrogate measured using nonlinear microscopy

PURPOSE

Arterial wall mass transport properties dictate local distribution of biomolecules or locally delivered dugs. Knowing how these properties vary between coronary artery locations could provide insight into how therapy efficacy is altered between arterial locations.

METHODS

We introduced an indocarbocyanine drug surrogate to the lumens of left anterior descending and right coronary (LADC; RC) arteries from pigs with or without a pressure gradient. Interstitial fluorescent intensity was measured on live samples with multiphoton microscopy. We also measured binding to porcine coronary SMCs in monoculture.

RESULTS

Diffusive transport constants peaked in the middle sections of the LADC and RC arteries by 2.09 and 2.04 times, respectively, compared to the proximal and distal segments. There was no statistical difference between the average diffusivity value between LADC and RC arteries. The convection coefficients had an upward trend down each artery, with the RC being higher than the LADC by 3.89 times.

CONCLUSIONS

This study demonstrates that the convective and diffusive transport of lipophilic molecules changes between the LADC and the RC arteries as well as along their length. These results may have important implications in optimizing drug delivery for the treatment of coronary artery disease.

Curved biodegradable microneedles for vascular drug delivery

Curved biodegradable microneedles for application to the outer surface of blood vessels are produced to enhance drug delivery to vascular tissues suffering from hyperplasia or atherosclerosis. Spatially discrete thermal drawing and post-annealing processes are employed to fabricate microneedles on a curved surface. Insertion of microneedles into arteries in vivo and ex vivo is demonstrated, and their mechanical properties and drug-delivery function are studied.

Dual roles of hyaluronic acids in multilayer films capturing nanocarriers for drug-eluting coatings

We developed hyaluronic acid (HA)-based multilayer films capturing polymeric nanocarriers (NCs) for drug delivery. The electrostatic interactions between positively charged linear polyethylene imines (LPEI) and negatively charged HAs are the main driving forces to form multilayers based on the layer-by-layer (LbL) deposition. NCs were easily incorporated within the multilayer film due to intra- and/or inter-hydrogen bonding among HA chains. The amount of NCs captured by the HA chains was varied by the ratio between HAs and NCs as well as the length (i.e., molecular weight) and absolute number density of HAs in solution. Biocompatibility of the NC-capturing HA multilayer films was tested with the human dermal fibroblast (HDF) culture. In addition, the controlled release of paclitaxel (PTX) from the HA multilayer films successfully led to the apoptosis of human aortic smooth muscle cells (hSMC) in vitro, implying that the NC-capturing HA multilayer films would be quite useful as drug-eluting stent systems to prevent the restenosis after surgery.

Dual functional polyelectrolyte multilayer coatings for implants: permanent microbicidal base with controlled release of therapeutic agents

Here we present a new bifunctional layer-by-layer (LbL) construct made by combining a permanent microbicidal polyelectrolyte multilayered (PEM) base film with a hydrolytically degradable PEM top film that offers controlled and localized delivery of therapeutics. Two degradable film architectures are presented: (1) bolus release of an antibiotic (gentamicin) to eradicate initial infection at the implant site, or (2) sustained delivery of an anti-inflammatory drug (diclofenac) to cope with inflammation at the site of implantation due to tissue injury. Each degradable film was built on top of a permanent base film that imparts the implantable device surface with microbicidal functionality that prevents the formation of biofilms. Controlled-delivery of gentamicin was demonstrated over hours and that of diclofenac over days. Both drugs retained their efficacy upon release. The permanent microbicidal base film was biocompatible with A549 epithelial cancer cells and MC3T3-E1 osteoprogenitor cells, while also preventing bacteria attachment from turbid media for the entire duration of the two weeks studied. The microbicidal base film retains its functionality after the biodegradable films have completely degraded. The versatility of these PEM films and their ability to prevent biofilm formation make them attractive as coatings for implantable devices.

Factors that affect mass transport from drug eluting stents into the artery wall

Coronary artery disease can be treated by implanting a stent into the blocked region of an artery, thus enabling blood perfusion to distal vessels. Minimally invasive procedures of this nature often result in damage to the arterial tissue culminating in the re-blocking of the vessel. In an effort to alleviate this phenomenon, known as restenosis, drug eluting stents were developed. They are similar in composition to a bare metal stent but encompass a coating with therapeutic agents designed to reduce the overly aggressive healing response that contributes to restenosis. There are many variables that can influence the effectiveness of these therapeutic drugs being transported from the stent coating to and within the artery wall, many of which have been analysed and documented by researchers. However, the physical deformation of the artery substructure due to stent expansion, and its influence on a drugs ability to diffuse evenly within the artery wall have been lacking in published work to date. The paper highlights previous approaches adopted by researchers and proposes the addition of porous artery wall deformation to increase model accuracy.

Biological in situ dose painting for image-guided radiation therapy using drug-loaded implantable devices

PURPOSE

Implantable devices routinely used for increasing spatial accuracy in modern image-guided radiation treatments (IGRT), such as fiducials or brachytherapy spacers, encompass the potential for in situ release of biologically active drugs, providing an opportunity to enhance the therapeutic ratio. We model this new approach for two types of treatment.

METHODS AND MATERIALS

Radiopaque fiducials used in IGRT, or prostate brachytherapy spacers ("eluters"), were assumed to be loaded with radiosensitizer for in situ drug slow release. An analytic function describing the concentration of radiosensitizer versus distance from eluters, depending on diffusion-elimination properties of the drug in tissue, was developed. Tumor coverage by the drug was modeled for tumors typical of lung stereotactic body radiation therapy treatments for various eluter dimensions and drug properties. Six prostate (125)I brachytherapy cases were analyzed by assuming implantation of drug-loaded spacers. Radiosensitizer-induced subvolume boost was simulated from which biologically effective doses for typical radiosensitizers were calculated in one example.

RESULTS

Drug distributions from three-dimensional arrangements of drug eluters versus eluter size and drug properties were tabulated. Four radiosensitizer-loaded fiducials provide adequate radiosensitization for approximately 4-cm-diameter lung tumors, thus potentially boosting biologically equivalent doses in centrally located stereotactic body treated lesions. Similarly, multiple drug-loaded spacers provide prostate brachytherapy with flexible shaping of "biologically equivalent doses" to fit requirements difficult to meet by using radiation alone, e.g., boosting a high-risk region juxtaposed to the urethra while respecting normal tissue tolerance of both the urethra and the rectum.

CONCLUSIONS

Drug loading of implantable devices routinely used in IGRT provides new opportunities for therapy modulation via biological in situ dose painting.

Measurement of drug and macromolecule diffusion across atherosclerotic rabbit aorta ex vivo by attenuated total reflection-Fourier transform infrared imaging

Diffusion of two model drugs-benzyl nicotinate and ibuprofen-and the plasma macromolecule albumin across atherosclerotic rabbit aorta was studied ex vivo by attenuated total reflection-Fourier transform infrared (ATR-FTIR) imaging. Solutions of these molecules were applied to the endothelial surface of histological sections of the aortic wall that were sandwiched between two impermeable surfaces. An array of spectra, each corresponding to a specific location in the section, was obtained at various times during solute diffusion into the wall and revealed the distribution of the solutes within the tissue. Benzyl nicotinate in Ringer's solution showed higher affinity for atherosclerotic plaque than for apparently healthy tissue. Transmural concentration profiles for albumin demonstrated its permeation across the section and were consistent with a relatively low distribution volume for the macromolecule in the middle of the wall. The ability of albumin to act as a drug carrier for ibuprofen, otherwise undetected within the tissue, was demonstrated by multivariate subtraction image analysis. In conclusion, ATR-FTIR imaging can be used to study transport processes in tissue samples with high spatial and temporal resolution and without the need to label the solutes under study.

Mathematical modelling of NABD release from endoluminal gel paved stent

Coronary restenosis consists of the partial/total re-occlusion of the artery lumen following percutaneous transluminal angioplasty (PTCA). In order to match this pathology, PTCA is followed by the implantation of rigid scaffolds (stent or coated stent) aimed to contrast the most important mechanical (coronary wall elastic recoil and late remodelling) and biological (smooth muscle cells iper-proliferation) factors leading to restenosis. In the light of the clinical problems recently arisen about the use of traditional coated stents, this paper proposes a theoretical study to comprehend the release kinetics of novel anti-proliferative drugs, i.e. nucleic acid based drugs (NABD), complexed with the proper delivery agent (DA). The release of NABD-DA is supposed to occur from a double gel layer adhering to coronary wall and embedding the stent. The proposed mathematical model assumes that diffusion, convection and cellular internalisation/metabolism are the leading mechanisms ruling drug spreading in the coronary wall. In addition, stent void fraction, positioning (totally embedded or totally out of the coronary wall) and continuous or discontinuous character of the gel layer are other three important model parameters. In order to generalise the results, stent geometry is idealised as a series of not connected, equally spaced, rings positioned in the stented zone. In correspondence of stent strut, drug transport cannot occur. The most important outcomes of this study are that, in the usual void fraction range (0.7-0.9), stent presence does not sensibly affect NABD-DA release kinetics. In addition, whereas stent positioning in the continuous gel configuration (totally embedded or totally out of coronary wall) is not very important, in the discontinuous case, it becomes relevant. Finally, this study evidences that a proper mixture of NABD complexed with different (in dimensions and kind) DA can ensure an almost constant NABD coronary concentration for several months, as requested by clinical observations.