1
|
Shazly T, Torres WM, Secemsky EA, Chitalia VC, Jaffer FA, Kolachalama VB. Understudied factors in drug-coated balloon design and evaluation: A biophysical perspective. Bioeng Transl Med 2023; 8:e10370. [PMID: 36684110 PMCID: PMC9842065 DOI: 10.1002/btm2.10370] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/28/2022] [Accepted: 06/12/2022] [Indexed: 01/25/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Tarek Shazly
- College of Engineering & Computing University of South Carolina Columbia South Carolina USA
| | - William M Torres
- College of Engineering & Computing University of South Carolina Columbia South Carolina USA
- Exponent Inc. Philadelphia Pennsylvania USA
| | - Eric A Secemsky
- Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Vipul C Chitalia
- Department of Medicine, Boston University School of Medicine Boston Veterans Affairs Healthcare System Boston Massachusetts USA
| | - Farouc A Jaffer
- Cardiovascular Research Center and Cardiology Division Massachusetts General Hospital Boston Massachusetts USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine; Department of Computer Science and Faculty of Computing & Data Sciences Boston University Boston Massachusetts USA
| |
Collapse
|
2
|
Zhou R, Yu J, Gu Z, Zhang Y. Microneedle-mediated therapy for cardiovascular diseases. Drug Deliv Transl Res 2021; 12:472-483. [PMID: 34637115 DOI: 10.1007/s13346-021-01073-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Ruyi Zhou
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Jicheng Yu
- Zenomics Inc., Los Angeles, CA, 90095, USA
| | - Zhen Gu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China. .,Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, 310016, China. .,Zhejiang Laboratory of Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, 311121, China. .,MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China.
| | - Yuqi Zhang
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China. .,Department of Burns and Wound Center, College of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, 310009, China.
| |
Collapse
|
3
|
SARIFUDDIN, ALSEMIRY REIMAD, MANDAL PRASHANTAKUMAR. EFFECTS OF COATING PROPERTIES ON CONTROLLED DELIVERY FROM AN EMBEDDED DRUG-ELUTING STENT: A SIMULATION STUDY. J BIOL SYST 2021. [DOI: 10.1142/s0218339021500145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- SARIFUDDIN
- Department of Mathematics, Berhampore College, P.O.-Berhampore, Dist.-Murshidabad, WB 742101, India
| | - REIMA D. ALSEMIRY
- Department of Mathematics, Faculty of Science, Taibah University, P.O. Box 89, Yanbu 41911, Saudi Arabia
- Department of Mathematical Sciences, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
| | | |
Collapse
|
4
|
Marino M, Vairo G, Wriggers P. Mechano-chemo-biological Computational Models for Arteries in Health, Disease and Healing: From Tissue Remodelling to Drug-eluting Devices. Curr Pharm Des 2021; 27:1904-1917. [PMID: 32723253 DOI: 10.2174/1381612826666200728145752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/14/2020] [Indexed: 11/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Michele Marino
- Institute of Continuum Mechanics, Leibniz Universität Hannover, An der Universität 1, 30823 Garbsen, Germany
| | - Giuseppe Vairo
- Department of Civil Engineering and Computer Science, University of Rome "Tor Vergata" via del Politecnico 1, 00133 Rome, Italy
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz Universität Hannover, An der Universität 1, 30823 Garbsen, Germany
| |
Collapse
|
5
|
Sarifuddin, Roy S, Mandal PK. Computational model of stent-based delivery from a half-embedded two-layered coating. Comput Methods Biomech Biomed Engin 2020; 23:815-831. [PMID: 32588648 DOI: 10.1080/10255842.2020.1767775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
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.
Collapse
Affiliation(s)
- Sarifuddin
- Department of Mathematics, Berhampore College, Berhampore, West Bengal, India
| | - Somnath Roy
- Department of Mechanical Engineering, Indian Institute of Technology, Kharagpur, West Bengal, India
| | | |
Collapse
|
6
|
Conservative Exposure Predictions for Rapid Risk Assessment of Phase-Separated Additives in Medical Device Polymers. Ann Biomed Eng 2017; 46:14-24. [DOI: 10.1007/s10439-017-1931-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 09/19/2017] [Indexed: 11/27/2022]
|
7
|
Williams DF. * A Paradigm for the Evaluation of Tissue-Engineering Biomaterials and Templates. Tissue Eng Part C Methods 2017; 23:926-937. [PMID: 28762883 DOI: 10.1089/ten.tec.2017.0181] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- David F Williams
- Wake Forest Institute of Regenerative Medicine , Winston Salem, North Carolina
| |
Collapse
|
8
|
Bayramov DF, Neff JA. Beyond conventional antibiotics - New directions for combination products to combat biofilm. Adv Drug Deliv Rev 2017; 112:48-60. [PMID: 27496704 DOI: 10.1016/j.addr.2016.07.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/10/2016] [Accepted: 07/26/2016] [Indexed: 12/17/2022]
Abstract
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.
Collapse
|
9
|
|
10
|
Kundanati L, Singh SK, Mandal BB, Murthy TG, Gundiah N, Pugno NM. Fabrication and Mechanical Characterization of Hydrogel Infused Network Silk Scaffolds. Int J Mol Sci 2016; 17:ijms17101631. [PMID: 27681725 PMCID: PMC5085664 DOI: 10.3390/ijms17101631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/30/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Lakshminath Kundanati
- Laboratory of Bio-Inspired & Graphene Nanomechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano 77, 38123 Trento, Italy.
| | - Saket K Singh
- Biomaterial and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology, Guwahati 781039, Assam, India.
| | - Biman B Mandal
- Biomaterial and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology, Guwahati 781039, Assam, India.
| | - Tejas G Murthy
- Departments of Civil Engineering, Indian Institute of Science, Bangalore 560012, Karnataka, India.
| | - Namrata Gundiah
- Departments of Mechanical Engineering, Indian Institute of Science, Bangalore 560012, Karnataka, India.
| | - Nicola M Pugno
- Laboratory of Bio-Inspired & Graphene Nanomechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano 77, 38123 Trento, Italy.
- Center for Materials and Microsystems, Fondazione Bruno Kessler, Via Sommarive 18, Povo, I-38123 Trento, Italy.
- School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK.
| |
Collapse
|
11
|
Gao L, Sun Q, Wang Y, Zhu W, Li X, Luo Q, Li X, Shen Z. Injectable poly(ethylene glycol) hydrogels for sustained doxorubicin release. POLYM ADVAN TECHNOL 2016. [DOI: 10.1002/pat.3852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Lilong Gao
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering; Zhejiang University; Hangzhou 310027 China
| | - Qiang Sun
- Affiliated Stomatology Hospital, School of Medicine; Zhejiang University; Hangzhou 310006 China
| | - Ying Wang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering; Zhejiang University; Hangzhou 310027 China
- Affiliated Stomatology Hospital, School of Medicine; Zhejiang University; Hangzhou 310006 China
| | - Weipu Zhu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering; Zhejiang University; Hangzhou 310027 China
- Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province; Hangzhou 310027 China
| | - Xiaojun Li
- Affiliated Stomatology Hospital, School of Medicine; Zhejiang University; Hangzhou 310006 China
| | - Qiaojie Luo
- The First Affiliated Hospital, College of Medicine; Zhejiang University; Hangzhou 310003 China
| | - Xiaodong Li
- Affiliated Stomatology Hospital, School of Medicine; Zhejiang University; Hangzhou 310006 China
| | - Zhiquan Shen
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering; Zhejiang University; Hangzhou 310027 China
| |
Collapse
|
12
|
Zohrabi T, Habibi N, Zarrabi A, Fanaei M, Lee LY. Diphenylalanine peptide nanotubes self-assembled on functionalized metal surfaces for potential application in drug-eluting stent. J Biomed Mater Res A 2016; 104:2280-90. [PMID: 27119433 DOI: 10.1002/jbm.a.35764] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/10/2016] [Accepted: 04/25/2016] [Indexed: 11/07/2022]
Abstract
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.
Collapse
Affiliation(s)
- Tayebeh Zohrabi
- Department of Biotechnology, Faculty of Advanced Sciences and Technologies, University of Isfahan, Iran
| | - Neda Habibi
- Nanotechnology and Advanced Material Institute, Isfahan University of Technology, Iran
| | - Ali Zarrabi
- Department of Biotechnology, Faculty of Advanced Sciences and Technologies, University of Isfahan, Iran
| | - Maryam Fanaei
- Department of Biology, Faculty of Science, University of Isfahan, Iran
| | - Lai Yeng Lee
- School of Chemical Engineering and Advanced Materials, Newcastle University, United Kingdom
| |
Collapse
|
13
|
Chen Y, Xiong Y, Jiang W, Wong MS, Yan F, Wang Q, Fan Y. Numerical simulation on the effects of drug-eluting stents with different bending angles on hemodynamics and drug distribution. Med Biol Eng Comput 2016; 54:1859-1870. [PMID: 27048391 DOI: 10.1007/s11517-016-1488-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 03/09/2016] [Indexed: 11/26/2022]
Abstract
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.
Collapse
Affiliation(s)
- Yu Chen
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu, 610065, China
| | - Yan Xiong
- School of Manufacturing Science and Engineering, Sichuan University, Chengdu, 610065, China
| | - Wentao Jiang
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu, 610065, China.
| | - Man Sang Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, 999077, China
| | - Fei Yan
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu, 610065, China
| | - Qingyuan Wang
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu, 610065, China
| | - Yubo Fan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| |
Collapse
|
14
|
McKittrick CM, Kennedy S, Oldroyd KG, McGinty S, McCormick C. Modelling the Impact of Atherosclerosis on Drug Release and Distribution from Coronary Stents. Ann Biomed Eng 2016; 44:477-87. [PMID: 26384667 PMCID: PMC4764635 DOI: 10.1007/s10439-015-1456-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- C M McKittrick
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - S Kennedy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - K G Oldroyd
- West of Scotland Region Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK
| | - S McGinty
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - C McCormick
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
| |
Collapse
|
15
|
Affiliation(s)
- Mark W. Tibbitt
- Koch
Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
- Department
of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
| | - James E. Dahlman
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
- Wallace
H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Robert Langer
- Koch
Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
- Department
of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
- Harvard-MIT
Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| |
Collapse
|
16
|
Jenjob R, Taranamai P, Na K, Yang SG. Recent trend in applications of polymer materials to stents. GASTROINTESTINAL INTERVENTION 2015. [DOI: 10.18528/gii150022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
17
|
Ji MS, Jeong MH, Ahn YK, Kim SH, Kim YJ, Chae SC, Hong TJ, Seong IW, Chae JK, Kim CJ, Cho MC, Rha SW, Bae JH, Seung KB, Park SJ, Hur SH. Comparison of Resolute zotarolimus-eluting stents versus everolimus-eluting stents in patients with metabolic syndrome and acute myocardial infarction: propensity score-matched analysis. Int J Cardiol 2015; 199:53-62. [PMID: 26186631 DOI: 10.1016/j.ijcard.2015.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 06/21/2015] [Accepted: 07/02/2015] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Mi Seon Ji
- Chonnam National University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea.
| | - Young Keun Ahn
- Chonnam National University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Sang Hyung Kim
- Chonnam National University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Young Jo Kim
- YeungnamUniversityHospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Shung Chull Chae
- Kyungpook National University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Taek Jong Hong
- Pusan National University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - In Whan Seong
- Chungnam National University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Jei Keon Chae
- Chonbuk National University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Chong Jin Kim
- Kyung Hee University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Myeong Chan Cho
- Chungbuk National University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Seung-Woon Rha
- Korea University Guro Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Jang Ho Bae
- Konyang University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Ki Bae Seung
- Catholic University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Seung Jung Park
- Asan Medical Center, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | - Seung Ho Hur
- Keimyung University Hospital, Korea Acute Myocardial infarction Registry (KAMIR) Study Group of Korean Circulation Society, Republic of Korea
| | | |
Collapse
|
18
|
d'Errico M, Sammarco P, Vairo G. Analytical modeling of drug dynamics induced by eluting stents in the coronary multi-layered curved domain. Math Biosci 2015; 267:79-96. [PMID: 26162517 DOI: 10.1016/j.mbs.2015.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Michele d'Errico
- Department of Civil Engineering and Computer Science Engineering (DICII), Università degli Studi di Roma "Tor Vergata", via del Politecnico 1, Rome 00133, Italy.
| | - Paolo Sammarco
- Department of Civil Engineering and Computer Science Engineering (DICII), Università degli Studi di Roma "Tor Vergata", via del Politecnico 1, Rome 00133, Italy.
| | - Giuseppe Vairo
- Department of Civil Engineering and Computer Science Engineering (DICII), Università degli Studi di Roma "Tor Vergata", via del Politecnico 1, Rome 00133, Italy.
| |
Collapse
|
19
|
Controlling drug delivery from coronary stents: are we aiming for the right targets? Ther Deliv 2015; 6:705-20. [PMID: 26149786 DOI: 10.4155/tde.15.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
|
20
|
McDonald AI, Iruela-Arispe ML. Healing arterial ulcers: Endothelial lining regeneration upon vascular denudation injury. Vascul Pharmacol 2015; 72:9-15. [PMID: 26093336 DOI: 10.1016/j.vph.2015.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 06/16/2015] [Indexed: 12/20/2022]
Abstract
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.
Collapse
Affiliation(s)
- Austin I McDonald
- Molecular Biology Institute, University of California, Los Angeles, CA 90095, USA
| | - M Luisa Iruela-Arispe
- Molecular Biology Institute, University of California, Los Angeles, CA 90095, USA; Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, CA 90095, USA..
| |
Collapse
|
21
|
A decade of modelling drug release from arterial stents. Math Biosci 2014; 257:80-90. [DOI: 10.1016/j.mbs.2014.06.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/16/2014] [Accepted: 06/26/2014] [Indexed: 11/20/2022]
|
22
|
Jeong D, Lee DH, Lee DK, Na K. Nonvascular drug-eluting stent coated with sodium caprate-incorporated polyurethane for the efficient penetration of paclitaxel into tumor tissue. J Biomater Appl 2014; 29:1133-44. [DOI: 10.1177/0885328214552712] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Dooyong Jeong
- Department of Biotechnology, The Catholic University of Korea, Bucheon-si, Gyeonggi-do, Korea
| | - Don Haeng Lee
- Utah-Inha DDS and Advanced Therapeutics Research Center, College of Medicine, Inha University, Nam-Ku, Incheon, Korea
| | - Dong Ki Lee
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kun Na
- Department of Biotechnology, The Catholic University of Korea, Bucheon-si, Gyeonggi-do, Korea
| |
Collapse
|
23
|
CHEN YU, XIONG YAN, JIANG WENTAO, CHEN JIAN, GUO MENG, WANG QINGYUAN, FAN YUBO. NUMERICAL STUDY ON THE EFFECTS OF THE NUMBER AND GEOMETRIES OF DRUG-ELUTING STENT LINKS ON THE DRUG CONCENTRATION. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414500778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- YU CHEN
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu 610065, P. R. China
| | - YAN XIONG
- School of Manufacturing Science and Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - WENTAO JIANG
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu 610065, P. R. China
| | - JIAN CHEN
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney 2052, Australia
| | - MENG GUO
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, XueYuan Road No. 37, HaiDian District, Beijing 100191, P. R. China
| | - QINGYUAN WANG
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu 610065, P. R. China
| | - YUBO FAN
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, XueYuan Road No. 37, HaiDian District, Beijing 100191, P. R. China
| |
Collapse
|
24
|
Lee KJ, Park SH, Lee JY, Joo HC, Jang EH, Youn YN, Ryu W. Perivascular biodegradable microneedle cuff for reduction of neointima formation after vascular injury. J Control Release 2014; 192:174-81. [PMID: 25025286 DOI: 10.1016/j.jconrel.2014.07.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/30/2014] [Accepted: 07/06/2014] [Indexed: 11/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Kang Ju Lee
- School of Mechanical Engineering, Yonsei University, Seoul 120-749, Republic of Korea
| | - Seung Hyun Park
- School of Mechanical Engineering, Yonsei University, Seoul 120-749, Republic of Korea
| | - Ji Yong Lee
- School of Mechanical Engineering, Yonsei University, Seoul 120-749, Republic of Korea
| | - Hyun Chel Joo
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Eui Hwa Jang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea.
| | - WonHyoung Ryu
- School of Mechanical Engineering, Yonsei University, Seoul 120-749, Republic of Korea.
| |
Collapse
|
25
|
Drug release analysis and optimization for drug-eluting stents. ScientificWorldJournal 2014; 2013:827839. [PMID: 24470792 PMCID: PMC3891432 DOI: 10.1155/2013/827839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/01/2013] [Indexed: 11/29/2022] Open
Abstract
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.
Collapse
|
26
|
Denny WJ, Walsh MT. Numerical modelling of mass transport in an arterial wall with anisotropic transport properties. J Biomech 2014; 47:168-77. [DOI: 10.1016/j.jbiomech.2013.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 08/28/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
|
27
|
O'Connell BM, Cunnane EM, Denny WJ, Carroll GT, Walsh MT. Improving smooth muscle cell exposure to drugs from drug-eluting stents at early time points: a variable compression approach. Biomech Model Mechanobiol 2013; 13:771-81. [PMID: 24101254 DOI: 10.1007/s10237-013-0533-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 09/22/2013] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Barry M O'Connell
- Centre for Applied Biomedical Engineering (CABER), Department of Mechanical, Aeronautical and Biomedical Engineering and The Materials and Surface Science Institute, University of Limerick, Limerick, Ireland
| | | | | | | | | |
Collapse
|
28
|
Keyes JT, Simon BR, Vande Geest JP. A finite element study on variations in mass transport in stented porcine coronary arteries based on location in the coronary arterial tree. J Biomech Eng 2013; 135:61008-11. [PMID: 23699720 DOI: 10.1115/1.4024137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 04/04/2013] [Indexed: 11/08/2022]
Abstract
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.
Collapse
Affiliation(s)
- Joseph T Keyes
- Graduate Interdisciplinary Program in Biomedical Engineering, The University of Arizona,Tucson, AZ 85721, USA.
| | | | | |
Collapse
|
29
|
Stark JR, Gorman JM, Sparrow EM, Abraham JP, Kohler RE. Controlling the rate of penetration of a therapeutic drug into the wall of an artery by means of a pressurized balloon. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.65067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
30
|
Ichikawa M, Kijima Y. Optical Coherence Tomographic and Angioscopic Assessments of Arterial Healing in Coronary Artery Perforation After Implantation of Zotarolimus-Eluting Stent. Int Heart J 2013; 54:332-3. [DOI: 10.1536/ihj.54.332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Minoru Ichikawa
- Department of Cardiology, Higashi-osaka City General Hospital
| | | |
Collapse
|
31
|
Location-dependent coronary artery diffusive and convective mass transport properties of a lipophilic drug surrogate measured using nonlinear microscopy. Pharm Res 2012; 30:1147-60. [PMID: 23224981 DOI: 10.1007/s11095-012-0950-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
Abstract
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.
Collapse
|
32
|
Choi CK, Kim JB, Jang EH, Youn YN, Ryu WH. Curved biodegradable microneedles for vascular drug delivery. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2012; 8:2483-8. [PMID: 22628194 DOI: 10.1002/smll.201200441] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Indexed: 05/15/2023]
Abstract
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.
Collapse
Affiliation(s)
- Chang Kuk Choi
- School of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, Republic of Korea
| | | | | | | | | |
Collapse
|
33
|
Khan W, Farah S, Domb AJ. Drug eluting stents: Developments and current status. J Control Release 2012; 161:703-12. [PMID: 22366546 DOI: 10.1016/j.jconrel.2012.02.010] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 02/07/2012] [Accepted: 02/11/2012] [Indexed: 11/27/2022]
|
34
|
Rossi F, Casalini T, Raffa E, Masi M, Perale G. Bioresorbable Polymer Coated Drug Eluting Stent: A Model Study. Mol Pharm 2012; 9:1898-910. [DOI: 10.1021/mp200573f] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Filippo Rossi
- Department
of Chemistry, Materials and Chemical Engineering
“Giulio Natta”, Politecnico di Milano, Via Mancinelli 7, 20131 Milano, Italy
| | - Tommaso Casalini
- Department
of Chemistry, Materials and Chemical Engineering
“Giulio Natta”, Politecnico di Milano, Via Mancinelli 7, 20131 Milano, Italy
| | - Edoardo Raffa
- Department
of Chemistry, Materials and Chemical Engineering
“Giulio Natta”, Politecnico di Milano, Via Mancinelli 7, 20131 Milano, Italy
| | - Maurizio Masi
- Department
of Chemistry, Materials and Chemical Engineering
“Giulio Natta”, Politecnico di Milano, Via Mancinelli 7, 20131 Milano, Italy
| | - Giuseppe Perale
- Department
of Chemistry, Materials and Chemical Engineering
“Giulio Natta”, Politecnico di Milano, Via Mancinelli 7, 20131 Milano, Italy
| |
Collapse
|
35
|
Park S, Bhang SH, La WG, Seo J, Kim BS, Char K. Dual roles of hyaluronic acids in multilayer films capturing nanocarriers for drug-eluting coatings. Biomaterials 2012; 33:5468-77. [PMID: 22541539 DOI: 10.1016/j.biomaterials.2012.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/01/2012] [Indexed: 01/23/2023]
Abstract
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.
Collapse
Affiliation(s)
- Saibom Park
- The National Creative Research Initiative Center for Intelligent Hybrids, The WCU Program of Chemical Convergence of Energy & Environment, Seoul National University, Seoul 151-744, South Korea
| | | | | | | | | | | |
Collapse
|
36
|
Mathematical modeling of simultaneous drug release and in vivo absorption. Int J Pharm 2011; 418:130-41. [DOI: 10.1016/j.ijpharm.2010.12.044] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/22/2010] [Accepted: 12/27/2010] [Indexed: 01/17/2023]
|
37
|
Setting acceptance criteria for validation of analytical methods of drug eluting stents: Minimum requirements for analytical variability. Eur J Pharm Sci 2011; 42:230-7. [DOI: 10.1016/j.ejps.2010.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 11/05/2010] [Accepted: 11/24/2010] [Indexed: 11/20/2022]
|
38
|
Wong SY, Moskowitz JS, Veselinovic J, Rosario RA, Timachova K, Blaisse MR, Smith RC, Klibanov AM, Hammond PT. Dual functional polyelectrolyte multilayer coatings for implants: permanent microbicidal base with controlled release of therapeutic agents. J Am Chem Soc 2010; 132:17840-8. [PMID: 21105659 PMCID: PMC3218101 DOI: 10.1021/ja106288c] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Sze Yinn Wong
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Joshua S. Moskowitz
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Jovana Veselinovic
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Ryan A. Rosario
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Ksenia Timachova
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Michael R. Blaisse
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Renée C. Smith
- Harvard-MIT Division of Health Sciences and Technology (HST), Cambridge MA 02139, USA
| | - Alexander M. Klibanov
- Departments of Chemistry and Biological Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Paula T. Hammond
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| |
Collapse
|
39
|
Raval A, Parikh J, Engineer C. Mechanism of controlled release kinetics from medical devices. BRAZILIAN JOURNAL OF CHEMICAL ENGINEERING 2010. [DOI: 10.1590/s0104-66322010000200001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- A. Raval
- Sardar Vallabhbhai National Institute of Technology, India
| | - J. Parikh
- Sardar Vallabhbhai National Institute of Technology, India
| | - C. Engineer
- Sahajanand Medical Technologies Pvt. Ltd., India
| |
Collapse
|
40
|
Drug release from coronary eluting stents: A multidomain approach. J Biomech 2010; 43:1580-9. [DOI: 10.1016/j.jbiomech.2010.01.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 11/17/2009] [Accepted: 01/03/2010] [Indexed: 11/23/2022]
|
41
|
O'Connell BM, McGloughlin TM, Walsh MT. Factors that affect mass transport from drug eluting stents into the artery wall. Biomed Eng Online 2010; 9:15. [PMID: 20214774 PMCID: PMC2854105 DOI: 10.1186/1475-925x-9-15] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 03/09/2010] [Indexed: 01/12/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Barry M O'Connell
- Centre for Applied Biomedical Engineering Research, Department of Mechanical and Aeronautical Engineering and the Materials and Surface Science Institute, University of Limerick, Limerick, Ireland
| | | | | |
Collapse
|
42
|
Sirianni RW, Jang EH, Miller KM, Saltzman WM. Parameter estimation methodology in a model of hydrophobic drug release from a polymer coating. J Control Release 2010; 142:474-82. [DOI: 10.1016/j.jconrel.2009.11.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 11/22/2009] [Indexed: 10/20/2022]
|
43
|
Cilurzo F, Minghetti P, Selmin F, Cupone I, Gennari C, Rossoni G, Montanari L. A new ex vivo method for assessing local pharmacokinetic after tacrolimus eluting stent deployment in rat aorta. J Drug Deliv Sci Technol 2010. [DOI: 10.1016/s1773-2247(10)50033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
44
|
Biological in situ dose painting for image-guided radiation therapy using drug-loaded implantable devices. Int J Radiat Oncol Biol Phys 2009; 76:615-23. [PMID: 19879699 DOI: 10.1016/j.ijrobp.2009.06.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 04/26/2009] [Accepted: 06/04/2009] [Indexed: 11/22/2022]
Abstract
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.
Collapse
|
45
|
Palombo F, Danoux CB, Weinberg PD, Kazarian SG. Measurement of drug and macromolecule diffusion across atherosclerotic rabbit aorta ex vivo by attenuated total reflection-Fourier transform infrared imaging. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:044008. [PMID: 19725720 DOI: 10.1117/1.3174395] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
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.
Collapse
Affiliation(s)
- Francesca Palombo
- Imperial College London, Department of Chemical Engineering and Chemical Technology, South Kensington Campus, London, SW7 2AZ, United Kingdom
| | | | | | | |
Collapse
|
46
|
Ferdous J, Chong CK. Effect of Atherosclerotic Plaque on Drug Delivery from Drug-eluting Stent. IFMBE PROCEEDINGS 2009. [DOI: 10.1007/978-3-540-92841-6_376] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|
47
|
Parylene-Encapsulated Copolymeric Membranes as Localized and Sustained Drug Delivery Platforms. Ann Biomed Eng 2009; 37:2003-17. [DOI: 10.1007/s10439-009-9662-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 02/25/2009] [Indexed: 01/17/2023]
|
48
|
Lewis G. Materials, fluid dynamics, and solid mechanics aspects of coronary artery stents: A state‐of‐the‐art review. J Biomed Mater Res B Appl Biomater 2008; 86:569-90. [DOI: 10.1002/jbm.b.31028] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
49
|
Davia L, Grassi G, Pontrelli G, Lapasin R, Perin D, Grassi M. Mathematical modelling of NABD release from endoluminal gel paved stent. Comput Biol Chem 2008; 33:33-40. [PMID: 18799356 DOI: 10.1016/j.compbiolchem.2008.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
Abstract
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.
Collapse
Affiliation(s)
- L Davia
- Department of Chemical, Environmental and Raw Materials Engineering, DICAMP, University of Trieste, Trieste, Italy
| | | | | | | | | | | |
Collapse
|
50
|
Sirolimus-Induced Vascular Dysfunction. J Am Coll Cardiol 2008; 51:2130-8. [DOI: 10.1016/j.jacc.2008.01.058] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 12/31/2007] [Accepted: 01/21/2008] [Indexed: 01/08/2023]
|