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Zhou Z, Li M, Zhang Z, Song Z, Xu J, Zhang M, Gong M. Overview of Panax ginseng and its active ingredients protective mechanism on cardiovascular diseases. JOURNAL OF ETHNOPHARMACOLOGY 2024; 334:118506. [PMID: 38964625 DOI: 10.1016/j.jep.2024.118506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
ETHNIC PHARMACOLOGICAL RELEVANCE Panax ginseng is a traditional Chinese herbal medicine used to treat cardiovascular diseases (CVDs), and it is still widely used to improve the clinical symptoms of various CVDs. However, there is currently a lack of summary and analysis on the mechanism of Panax ginseng exerts its cardiovascular protective effects. This article provides a review of in vivo and in vitro pharmacological studies on Panax ginseng and its active ingredients in reducing CVDs damage. AIM OF THIS REVIEW This review summarized the latest literature on Panax ginseng and its active ingredients in CVDs research, aiming to have a comprehensive and in-depth understanding of the cardiovascular protection mechanism of Panax ginseng, and to provide new ideas for the treatment of CVDs, as well as to optimize the clinical application of Panax ginseng. METHODS Enrichment of pathways and biological terms using the traditional Chinese medicine molecular mechanism bioinformatics analysis tool (BATMAN-TCM). The literature search is based on electronic databases such as PubMed, ScienceDirect, Scopus, CNKI, with a search period of 2002-2023. The search terms include Panax ginseng, Panax ginseng ingredients, ginsenosides, ginseng polysaccharides, ginseng glycoproteins, ginseng volatile oil, CVDs, heart, and cardiac. RESULTS 132 articles were ultimately included in the review. The ingredients in Panax ginseng that manifested cardiovascular protective effects are mainly ginsenosides (especially ginsenoside Rb1). Ginsenosides protected against CVDs such as ischemic reperfusion injury, atherosclerosis and heart failure mainly through improving energy metabolism, inhibiting hyper-autophagy, antioxidant, anti-inflammatory and promoting secretion of exosomes. CONCLUSION Panax ginseng and its active ingredients have a particularly prominent effect on improving myocardial energy metabolism remodeling in protecting against CVDs. The AMPK and PPAR signaling pathways are the key targets through which Panax ginseng produces multiple mechanisms of cardiovascular protection. Extracellular vesicles and nanoparticles as carriers are potential delivery ways for optimizing the bioavailability of Panax ginseng and its active ingredients.
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Affiliation(s)
- Ziwei Zhou
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
| | - Meijing Li
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
| | - Zekuan Zhang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
| | - Zhimin Song
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
| | - Jingjing Xu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China; Beijing Key Laboratory of Traditional Chinese Medicine Collateral Disease Theory Research, Beijing, 100069, China
| | - Minyu Zhang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China; Beijing Key Laboratory of Traditional Chinese Medicine Collateral Disease Theory Research, Beijing, 100069, China.
| | - Muxin Gong
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China; Beijing Key Laboratory of Traditional Chinese Medicine Collateral Disease Theory Research, Beijing, 100069, China.
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Wang Q, Cao S, Zhang T, Lv F, Zhai M, Bai D, Zhao M, Cheng H, Wang X. Reactive oxide species and ultrasound dual-responsive bilayer microneedle array for in-situ sequential therapy of acute myocardial infarction. BIOMATERIALS ADVANCES 2024; 162:213917. [PMID: 38861802 DOI: 10.1016/j.bioadv.2024.213917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/13/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
Acute myocardial infarction (AMI) resulting from coronary artery occlusion stands as the predominant cause of cardiovascular disability and mortality worldwide. An all-encompassing treatment strategy targeting pathological processes of oxidative stress, inflammation, proliferation and fibrotic remodeling post-AMI is anticipated to enhance therapeutic outcomes. Herein, an up-down-structured bilayer microneedle (Ce-CLMs-BMN) with reactive oxygen species (ROS) and ultrasound (US) dual-responsiveness is proposed for AMI in-situ sequential therapy. The upper-layer microneedle is formulated by crosslinking ROS-sensitive linker with polyvinyl alcohol loaded with cerium dioxide nanoparticles (CeNPs) featuring versatile enzyme-mimetic activities. During AMI acute phase, prompted by ischemia-induced microenvironmental redox imbalance, this layer swiftly releases CeNPs, which aid in eliminating excessive ROS and catalyzing oxygen gas (O2) production through multiple enzymatic pathways, thereby alleviating oxidative stress-induced damage and modulating inflammation. In AMI chronic repair phase, micro-nano reactors (CLMs) situated in the lower-layer microneedle undergo cascade reactions with the assistance of US irradiation to generate nitric oxide (NO). As a bioactive molecule with pro-angiogenic and anti-fibrotic effects, NO expedites cardiac repair while attenuating adverse remodeling. Additionally, its antiplatelet-aggregating properties contribute to thromboprophylaxis. In-vitro and in-vivo results substantiate the efficacy of this integrated healing approach in AMI management, showcasing promising prospects for advancing infarcted heart repair.
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Affiliation(s)
- Qingqing Wang
- School of Pharmacy, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China
| | - Shuangyuan Cao
- The National Engineering Research Center for Bioengineering Drugs and the Technologies, Institute of Translational Medicine, Jiangxi Medical College, Nanchang University, Nanchang 330088, PR China
| | - Teng Zhang
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China
| | - Fanzhen Lv
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China
| | - Mingfei Zhai
- School of Chemistry and Chemical Engineering, Nanchang University, Nanchang 330088, PR China
| | - Danmeng Bai
- The National Engineering Research Center for Bioengineering Drugs and the Technologies, Institute of Translational Medicine, Jiangxi Medical College, Nanchang University, Nanchang 330088, PR China
| | - Mengzhen Zhao
- School of Chemistry and Chemical Engineering, Nanchang University, Nanchang 330088, PR China
| | - Haoxin Cheng
- School of Chemistry and Chemical Engineering, Nanchang University, Nanchang 330088, PR China
| | - Xiaolei Wang
- School of Pharmacy, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China; The National Engineering Research Center for Bioengineering Drugs and the Technologies, Institute of Translational Medicine, Jiangxi Medical College, Nanchang University, Nanchang 330088, PR China; School of Chemistry and Chemical Engineering, Nanchang University, Nanchang 330088, PR China.
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Xu Y, Chen Y, Tan JJ, Ooi JP, Guo Z. Intrapericardial Administration to Achieve Localized and Targeted Treatment for Cardiac Disease. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10553-3. [PMID: 39164600 DOI: 10.1007/s12265-024-10553-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 08/06/2024] [Indexed: 08/22/2024]
Abstract
Intrapericardial administration has been proposed as an alternative delivery route of pharmacological agents via the bilaminar sac of pericardium surrounding the heart. To date, intrapericardial administration has entailed the localized administration of a broad spectrum of therapeutic agents. These agents include stem cells, extracellular matrix, growth factor, drugs, bioactive materials, and genetic materials, to the heart and coronary arteries. The route not only overcomes the limitations associated with traditional systemic administration methods, but also presents multiple intrinsic advantages over the other approaches, allowing greater therapeutic actions. Intrapericardial administration exhibits versatility in addressing certain cardiac conditions and ongoing research in this field certainly holds promise for further innovations and advancements to improve cardiac treatment. Thus, this review discusses the anatomy and physiology of the pericardium, the intrapericardial administration access routes, the recent application of intrapericardial delivery in the context of cardiac repair as well as the challenges associated with the approach.
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Affiliation(s)
- Yaping Xu
- USM-ALPS Joint Laboratory for Heart Research, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia
- Henan Key Laboratory of Cardiac Reconstruction and Heart Transplantation, Zhengzhou the Seventh People's Hospital, Zhengzhou, 45300, Henan, P. R. China
| | - Yan Chen
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang Henan, 453003, P. R. China
| | - Jun Jie Tan
- USM-ALPS Joint Laboratory for Heart Research, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia
| | - Jer Ping Ooi
- USM-ALPS Joint Laboratory for Heart Research, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia.
| | - Zhikun Guo
- Henan Key Laboratory of Cardiac Reconstruction and Heart Transplantation, Zhengzhou the Seventh People's Hospital, Zhengzhou, 45300, Henan, P. R. China.
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Silva ED, Pereira-Sousa D, Ribeiro-Costa F, Cerqueira R, Enguita FJ, Gomes RN, Dias-Ferreira J, Pereira C, Castanheira A, Pinto-do-Ó P, Leite-Moreira AF, Nascimento DS. Pericardial Fluid Accumulates microRNAs That Regulate Heart Fibrosis after Myocardial Infarction. Int J Mol Sci 2024; 25:8329. [PMID: 39125899 PMCID: PMC11313565 DOI: 10.3390/ijms25158329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Pericardial fluid (PF) has been suggested as a reservoir of molecular targets that can be modulated for efficient repair after myocardial infarction (MI). Here, we set out to address the content of this biofluid after MI, namely in terms of microRNAs (miRs) that are important modulators of the cardiac pathological response. PF was collected during coronary artery bypass grafting (CABG) from two MI cohorts, patients with non-ST-segment elevation MI (NSTEMI) and patients with ST-segment elevation MI (STEMI), and a control group composed of patients with stable angina and without previous history of MI. The PF miR content was analyzed by small RNA sequencing, and its biological effect was assessed on human cardiac fibroblasts. PF accumulates fibrotic and inflammatory molecules in STEMI patients, namely causing the soluble suppression of tumorigenicity 2 (ST-2), which inversely correlates with the left ventricle ejection fraction. Although the PF of the three patient groups induce similar levels of fibroblast-to-myofibroblast activation in vitro, RNA sequencing revealed that PF from STEMI patients is particularly enriched not only in pro-fibrotic miRs but also anti-fibrotic miRs. Among those, miR-22-3p was herein found to inhibit TGF-β-induced human cardiac fibroblast activation in vitro. PF constitutes an attractive source for screening diagnostic/prognostic miRs and for unveiling novel therapeutic targets in cardiac fibrosis.
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Affiliation(s)
- Elsa D. Silva
- i3S—Institute for Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal; (E.D.S.); (F.R.-C.); (R.N.G.); (J.D.-F.); (C.P.); (A.C.); (P.P.-d.-Ó.)
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- INEB—Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal
| | - Daniel Pereira-Sousa
- i3S—Institute for Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal; (E.D.S.); (F.R.-C.); (R.N.G.); (J.D.-F.); (C.P.); (A.C.); (P.P.-d.-Ó.)
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Center for Translational Medicine (CTM), International Clinical Research Centre (ICRC), St. Anne’s Hospital, 60200 Brno, Czech Republic
- Department of Biomedical Sciences, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Francisco Ribeiro-Costa
- i3S—Institute for Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal; (E.D.S.); (F.R.-C.); (R.N.G.); (J.D.-F.); (C.P.); (A.C.); (P.P.-d.-Ó.)
- INEB—Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal
| | - Rui Cerqueira
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, 4150-180 Porto, Portugal; (R.C.)
| | - Francisco J. Enguita
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal;
| | - Rita N. Gomes
- i3S—Institute for Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal; (E.D.S.); (F.R.-C.); (R.N.G.); (J.D.-F.); (C.P.); (A.C.); (P.P.-d.-Ó.)
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- INEB—Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal
| | - João Dias-Ferreira
- i3S—Institute for Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal; (E.D.S.); (F.R.-C.); (R.N.G.); (J.D.-F.); (C.P.); (A.C.); (P.P.-d.-Ó.)
- INEB—Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal
| | - Cassilda Pereira
- i3S—Institute for Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal; (E.D.S.); (F.R.-C.); (R.N.G.); (J.D.-F.); (C.P.); (A.C.); (P.P.-d.-Ó.)
- INEB—Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal
- Center for Translational Health and Medical Biotechnology Research (TBIO)/Health Research Network (RISE-Health), ESS, Polytechnic of Porto, 4200-072 Porto, Portugal
- Chemical and Biomolecular Sciences, School of Health (ESS), Polytechnic of Porto, 4200-465 Porto, Portugal
| | - Ana Castanheira
- i3S—Institute for Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal; (E.D.S.); (F.R.-C.); (R.N.G.); (J.D.-F.); (C.P.); (A.C.); (P.P.-d.-Ó.)
- INEB—Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal
- INL—International Iberian Nanotechnology Laboratory, 4715-330 Braga, Portugal
| | - Perpétua Pinto-do-Ó
- i3S—Institute for Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal; (E.D.S.); (F.R.-C.); (R.N.G.); (J.D.-F.); (C.P.); (A.C.); (P.P.-d.-Ó.)
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- INEB—Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal
| | - Adelino F. Leite-Moreira
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, 4150-180 Porto, Portugal; (R.C.)
| | - Diana S. Nascimento
- i3S—Institute for Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal; (E.D.S.); (F.R.-C.); (R.N.G.); (J.D.-F.); (C.P.); (A.C.); (P.P.-d.-Ó.)
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- INEB—Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135 Porto, Portugal
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Alshihri AA, Khan SU, Alissa M, Alnoud MAH, Shams Ul Hassan S, Alghamdi SA, Mushtaq RY, Albariqi AH, Almhitheef AI, Anthony S, Sheirdil RA, Murshed A. Nano guardians of the heart: A comprehensive investigation into the impact of silver nanoparticles on cardiovascular physiology. Curr Probl Cardiol 2024; 49:102542. [PMID: 38527698 DOI: 10.1016/j.cpcardiol.2024.102542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
Globally, cardiovascular diseases (CVDs) constitute the leading cause of death at the moment. More effective treatments to combat CVDs are urgently required. Recent advances in nanotechnology have opened the door to new avenues for cardiovascular health treatment. Silver nanotechnology's inherent therapeutic powers and wide-ranging applications have made it the center of focus in recent years. This review aims to analyze the chemical, physical, and biological processes ofproducing AgNPs and determine their potential utility as theranostics. Despite significant advances, the precise mechanism by which AgNPs function in numerous biological systems remains a mystery. We hope that at the end of this review, you will better understand how AgNPs affect the cardiovascular system from the research done thus far. This endeavor thoroughly investigates the possible toxicological effects and risks associated with exposure to AgNPs. The findings shed light on novel applications of these versatile nanomaterials and point the way toward future research directions. Due to a shortage of relevant research, we will limit our attention to AgNPs as they pertain to CVDs. Future research can use this opportunity to investigate the many medical uses of AgNPs. Given their global prevalence, we fully endorse academics' efforts to prioritize nanotechnological techniques in pursuing risk factor targeting for cardiovascular diseases. The critical need for innovative solutions to this widespread health problem is underscored by the fact that this technique may help with the early diagnosis and treatment of CVDs.
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Affiliation(s)
- Abdulaziz A Alshihri
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Shahid Ullah Khan
- Department of Biochemistry, Women Medical and Dental College, Khyber Medical University, Abbottabad, 22080, Khyber Pakhtunkhwa, Pakistan
| | - Mohammed Alissa
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Mohammed A H Alnoud
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112; USA
| | - Syed Shams Ul Hassan
- Department of Natural product chemistry, School of Pharmacy, Shanghai Jiao Tong Unviversity, Shanghai, China
| | - Suad A Alghamdi
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Rayan Y Mushtaq
- Department of Pharmaceutics, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Ahmed H Albariqi
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
| | | | - Stefan Anthony
- Liaoning Provincial Key Laboratory of Cerebral Diseases, Department of Physiology, Dalian Medical University Liaoning Provence China.
| | | | - Abduh Murshed
- Department of Intensive Care Unit, Affiliated Hospital of Guangdong Medical University, 524000, Zhanjiang, China
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6
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Shazly T, Smith A, Uline MJ, Spinale FG. Therapeutic payload delivery to the myocardium: Evolving strategies and obstacles. JTCVS OPEN 2022; 10:185-194. [PMID: 36004211 PMCID: PMC9390211 DOI: 10.1016/j.xjon.2022.04.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Key Words
- BMC, bone marrow cell
- HF, heart failure
- ID, intracoronary delivery
- IMD, intramyocardial delivery
- IPD, intrapericardial delivery
- LV, left ventricle
- MI, myocardial infarct
- MSC, mesenchymal stem cell
- TED, transendocardial delivery
- bFGF, basic fibroblast growth factor
- biomaterial
- cardiac
- injection
- local delivery
- myocardium
- payload
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Affiliation(s)
- Tarek Shazly
- College of Engineering and Computing, School of Medicine, University of South Carolina, Columbia, SC
| | - Arianna Smith
- College of Arts and Sciences, Florida Gulf Coast University, Fort Myers, Fla
| | - Mark J. Uline
- College of Engineering and Computing, School of Medicine, University of South Carolina, Columbia, SC
| | - Francis G. Spinale
- College of Engineering and Computing, School of Medicine, University of South Carolina, Columbia, SC
- Cardiovascular Translational Research Center, School of Medicine, University of South Carolina, Columbia, SC
- Columbia VA Health Care System, Columbia, SC
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Grattoni A, Cooke JP. Emerging nanotechnologies in cardiovascular medicine. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2021; 39:102472. [PMID: 34715052 DOI: 10.1016/j.nano.2021.102472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/15/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Alessandro Grattoni
- Department of Nanomedicine, Houston Methodist Research Institute; Department of Surgery, Houston Methodist Hospital; Department of Radiation Oncology, Houston Methodist Hospital.
| | - John P Cooke
- Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute; Center for RNA Therapeutics, Houston Methodist Hospital, Houston, TX, USA
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Wang X, Liu Z, Sandoval-Salaiza DA, Afewerki S, Jimenez-Rodriguez MG, Sanchez-Melgar L, Güemes-Aguilar G, Gonzalez-Sanchez DG, Noble O, Lerma C, Parra-Saldivar R, Lemos DR, Llamas-Esperon GA, Shi J, Li L, Lobo AO, Fuentes-Baldemar AA, Bonventre JV, Dong N, Ruiz-Esparza GU. Nanostructured Non-Newtonian Drug Delivery Barrier Prevents Postoperative Intrapericardial Adhesions. ACS APPLIED MATERIALS & INTERFACES 2021; 13:29231-29246. [PMID: 34137251 DOI: 10.1021/acsami.0c20084] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
With the increasing volume of cardiovascular surgeries and the rising adoption rate of new methodologies that serve as a bridge to cardiac transplantation and that require multiple surgical interventions, the formation of postoperative intrapericardial adhesions has become a challenging problem that limits future surgical procedures, causes serious complications, and increases medical costs. To prevent this pathology, we developed a nanotechnology-based self-healing drug delivery hydrogel barrier composed of silicate nanodisks and polyethylene glycol with the ability to coat the epicardial surface of the heart without friction and locally deliver dexamethasone, an anti-inflammatory drug. After the fabrication of the hydrogel, mechanical characterization and responses to shear, strain, and recovery were analyzed, confirming its shear-thinning and self-healing properties. This behavior allowed its facile injection (5.75 ± 0.15 to 22.01 ± 0.95 N) and subsequent mechanical recovery. The encapsulation of dexamethasone within the hydrogel system was confirmed by 1H NMR, and controlled release for 5 days was observed. In vitro, limited cellular adhesion to the hydrogel surface was achieved, and its anti-inflammatory properties were confirmed, as downregulation of ICAM-1 and VCAM-1 was observed in TNF-α activated endothelial cells. In vivo, 1 week after administration of the hydrogel to a rabbit model of intrapericardial injury, superior efficacy was observed when compared to a commercial adhesion barrier, as histological and immunohistochemical examination revealed reduced adhesion formation and minimal immune infiltration of CD3+ lymphocytes and CD68+ macrophages, as well as NF-κβ downregulation. We presented a novel nanostructured drug delivery hydrogel system with unique mechanical and biological properties that act synergistically to prevent cellular infiltration while providing local immunomodulation to protect the intrapericardial space after a surgical intervention.
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Affiliation(s)
- Xichi Wang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zongtao Liu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Diego A Sandoval-Salaiza
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Engineering and Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Samson Afewerki
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Mildred G Jimenez-Rodriguez
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Engineering and Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Lorena Sanchez-Melgar
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Engineering and Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Gabriela Güemes-Aguilar
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Medicine and Health Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - David G Gonzalez-Sanchez
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Medicine and Health Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Oscar Noble
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Medicine and Health Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Cecilia Lerma
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Engineering and Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Roberto Parra-Saldivar
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- School of Engineering and Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Dario R Lemos
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Guillermo A Llamas-Esperon
- Department of Interventional Cardiology, Hospital Cardiológica, Aguascalientes, Aguascalientes 20230, Mexico
| | - Jiawei Shi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Li Li
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Anderson O Lobo
- LIMAV-Interdisciplinary Laboratory for Advanced Materials, BioMatLab group, Material Science and Engineering Graduate Program, UFPI- Federal University of Piauí, Teresina, Piauí 64049-550, Brazil
| | - Andres A Fuentes-Baldemar
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Joseph V Bonventre
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Guillermo U Ruiz-Esparza
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
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9
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Borrelli MA, Turnquist HR, Little SR. Biologics and their delivery systems: Trends in myocardial infarction. Adv Drug Deliv Rev 2021; 173:181-215. [PMID: 33775706 PMCID: PMC8178247 DOI: 10.1016/j.addr.2021.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/14/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is the leading cause of death around the world, in which myocardial infarction (MI) is a precipitating event. However, current therapies do not adequately address the multiple dysregulated systems following MI. Consequently, recent studies have developed novel biologic delivery systems to more effectively address these maladies. This review utilizes a scientometric summary of the recent literature to identify trends among biologic delivery systems designed to treat MI. Emphasis is placed on sustained or targeted release of biologics (e.g. growth factors, nucleic acids, stem cells, chemokines) from common delivery systems (e.g. microparticles, nanocarriers, injectable hydrogels, implantable patches). We also evaluate biologic delivery system trends in the entire regenerative medicine field to identify emerging approaches that may translate to the treatment of MI. Future developments include immune system targeting through soluble factor or chemokine delivery, and the development of advanced delivery systems that facilitate the synergistic delivery of biologics.
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Affiliation(s)
- Matthew A Borrelli
- Department of Chemical Engineering, University of Pittsburgh, 940 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Heth R Turnquist
- Starzl Transplantation Institute, 200 Darragh St, Pittsburgh, PA 15213, USA; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Immunology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Steven R Little
- Department of Chemical Engineering, University of Pittsburgh, 940 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA 15213, USA; Department of Clinical and Translational Science, University of Pittsburgh, Forbes Tower, Suite 7057, Pittsburgh, PA 15213, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219, USA; Department of Immunology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Department of Pharmaceutical Science, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA 15213, USA; Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA 15213, USA.
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10
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Narasimhan B, Turagam MK, Garg J, Della Rocca DG, Gopinathannair R, Biase LD, Romero J, Mohanty S, Natale A, Lakkireddy D. Role of immunosuppressive therapy in the management refractory postprocedural pericarditis. J Cardiovasc Electrophysiol 2021; 32:2165-2170. [PMID: 33942420 DOI: 10.1111/jce.15069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/26/2021] [Accepted: 04/17/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of a novel immunosuppressive regimen-combination Methotrexate/Prednisone (cMtx/P)-in the management of severe refractory rPPP. METHODS In this multicenter, nonrandomized, retrospective, observational study, 408 consecutive patients diagnosed with persistent rPPP between 2017 and 19 were included. Patients with refractory symptoms despite 3 months of conventional therapy were initiated on a 4-week regimen of oral steroids. Persistence of symptoms at this point, that is, rPPP (n = 25; catheter based = 18, open surgical = 7) prompted therapy with Methotrexate (7.5-15 mg weekly) with folate supplementation along with low dose prednisone (5 mg PO) for a further 3 months. Patients were followed for a total of 11.3 ± 1.8 months. RESULTS Treatment refractory rPPP occurred in 6.1% of the study population prompting immunosuppressive therapy with cMtx/P. All patients demonstrated complete symptom resolution following 3 months of treatment with an 85% decline in clinically significant pericardial effusions. One patient developed recurrent pericarditis during the 11-month follow-up. Therapy was well tolerated with no significant drug related adverse effects. CONCLUSION cMtx/P therapy is a safe and effective adjunct in the management of rPPP refractory to standard therapy.
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Affiliation(s)
- Bharat Narasimhan
- St. Luke's-Roosevelt -Mount Sinai, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jalaj Garg
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | | | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
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11
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Terracciano R, Demarchi D, Ruo Roch M, Aiassa S, Pagana G. Nanomaterials to Fight Cancer: An Overview on Their Multifunctional Exploitability. JOURNAL OF NANOSCIENCE AND NANOTECHNOLOGY 2021; 21:2760-2777. [PMID: 33653442 DOI: 10.1166/jnn.2021.19061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In recent years the worldwide research community has highlighted innumerable benefits of nanomaterials in cancer detection and therapy. Nevertheless, the development of cancer nanomedicines and other bionanotechnology requires a huge amount of considerations about the interactions of nanomaterials and biological systems, since long-term effects are not yet fully known. Open issues remain the determination of the nanoparticles distributions patterns and the internalization rate into the tumor while avoiding their accumulation in internal organs or other healthy tissues. The purpose of this work is to provide a standard overview of the most recent advances in nanomaterials to fight cancer and to collect trends and future directions to follow according to some critical aspects still present in this field. Complementary to the very recent review of Wolfram and Ferrari which discusses and classifies successful clinically-approved cancer nanodrugs as well as promising candidates in the pipeline, this work embraces part of their proposed classification system based on the exploitation of multifunctionality and extends the review to peer-reviewed journal articles published in the last 3 years identified through international databases.
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Affiliation(s)
- Rossana Terracciano
- Department of Electronics and Telecommunications (DET), Politecnico di Torino, 10129, Italy
| | - Danilo Demarchi
- Department of Electronics and Telecommunications (DET), Politecnico di Torino, 10129, Italy
| | - Massimo Ruo Roch
- Department of Electronics and Telecommunications (DET), Politecnico di Torino, 10129, Italy
| | - Simone Aiassa
- Department of Electronics and Telecommunications (DET), Politecnico di Torino, 10129, Italy
| | - Guido Pagana
- Department of Electronics and Telecommunications (DET), Politecnico di Torino, 10129, Italy
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12
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Nanotechnology applications for cardiovascular disease treatment: Current and future perspectives. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2021; 34:102387. [PMID: 33753283 DOI: 10.1016/j.nano.2021.102387] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/24/2021] [Accepted: 03/03/2021] [Indexed: 11/22/2022]
Abstract
A large majority of cardiovascular nanomedicine research has focused on fabricating designer nanoparticles for improved targeting as a means to overcome biological barriers. For cardiac related disorders, such as atherosclerosis, hypertension, and myocardial infarction, designer micro or nanoparticles are often administered into the vasculature or targeted vessel with the hope to circumvent problems associated with conventional drug delivery, including negative systemic side effects. Additionally, novel nano-drug carriers that enter circulation can be selectively uptaken by immune cells with the intended purpose that they modulate inflammatory processes and migrate locally to plaque for therapeutic payload delivery. Indeed, innovative design in nanoparticle composition, formulation, and functionalization has advanced the field as a means to achieve therapeutic efficacy for a variety of cardiac disease indications. This perspective aims to discuss these advances and provide new interpretations of how nanotechnology can be best applied to aid in cardiovascular disease treatment. In an effort to spark discussions on where the field of research should go, we share our outlook in new areas of nanotechnological inclusion and integration, such as in vascular, implantable, or wearable device technologies as well as nanocomposites and nanocoatings. Further, as cardiovascular diseases (CVD) increasingly claim a number of lives globally, we propose more attention should be placed by researchers on nanotechnological approaches for risk factor treatment to aid in early prevention and treatment of CVD.
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13
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Hendrickson T, Mancino C, Whitney L, Tsao C, Rahimi M, Taraballi F. Mimicking cardiac tissue complexity through physical cues: A review on cardiac tissue engineering approaches. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2021; 33:102367. [PMID: 33549819 DOI: 10.1016/j.nano.2021.102367] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/06/2021] [Accepted: 01/15/2021] [Indexed: 02/08/2023]
Abstract
Cardiovascular diseases are the number one killer in the world.1,2 Currently, there are no clinical treatments to regenerate damaged cardiac tissue, leaving patients to develop further life-threatening cardiac complications. Cardiac tissue has multiple functional demands including vascularization, contraction, and conduction that require many synergic components to properly work. Most of these functions are a direct result of the cardiac tissue structure and composition, and, for this reason, tissue engineering strongly proposed to develop substitute engineered heart tissues (EHTs). EHTs usually have combined pluripotent stem cells and supporting scaffolds with the final aim to repair or replace the damaged native tissue. However, as simple as this idea is, indeed, it resulted, after many attempts in the field, to be very challenging. Without design complexity, EHTs remain unable to mature fully and integrate into surrounding heart tissue resulting in minimal in vivo effects.3 Lately, there has been a growing body of evidence that a complex, multifunctional approach through implementing scaffold designs, cellularization, and molecular release appears to be essential in the development of a functional cardiac EHTs.4-6 This review covers the advancements in EHTs developments focusing on how to integrate contraction, conduction, and vascularization mimics and how combinations have resulted in improved designs thus warranting further investigation to develop a clinically applicable treatment.
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Affiliation(s)
- Troy Hendrickson
- Center for Musculoskeletal Regeneration, Houston Methodist Research Institute, Houston Methodist, Houston, TX, USA; Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA; Texas A&M MD/PhD Program, Texas A&M Health Science Center, College Station, TX, USA
| | - Chiara Mancino
- Center for Musculoskeletal Regeneration, Houston Methodist Research Institute, Houston Methodist, Houston, TX, USA; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, (MI), Italy
| | - Lauren Whitney
- Texas A&M Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Chris Tsao
- Center for Musculoskeletal Regeneration, Houston Methodist Research Institute, Houston Methodist, Houston, TX, USA
| | - Maham Rahimi
- Department of Cardiovascular Surgery, Houston Methodist, Houston, TX, USA
| | - Francesca Taraballi
- Center for Musculoskeletal Regeneration, Houston Methodist Research Institute, Houston Methodist, Houston, TX, USA; Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA.
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14
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Recent advances in the implant-based drug delivery in otorhinolaryngology. Acta Biomater 2020; 108:46-55. [PMID: 32289495 DOI: 10.1016/j.actbio.2020.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/13/2022]
Abstract
The surgical implant is an interdisciplinary therapeutic modality that offers unique advantages in the daily practice of otorhinolaryngology. Some well-known examples include cochlear implants, bone-anchored hearing aids, sinus stents, and tracheostomy tubes. Neuroprotective, osteogenic, anti-inflammatory, and antimicrobial effects are among their established or pursued functions. Implant-based drug delivery affords an efficient and potent approach to enhancing these therapeutic functions. Recent innovations have infiltrated all four elements of a drug-eluting implant. The purpose of this pre-clinical, biotechnology-oriented review is to discuss these developments in terms of the implant biomaterial, loaded medication, delivery pattern, and system fabrication. Cell-mediated neurotrophin release, fabrication of a hydroxyapatite-supported system, biodegradable polymer-based implants, and multiclass and multidrug delivery are some representative advancements. The ultimate goal here is to bridge the gap between biotechnology advances and clinical needs. The review is concluded with a perspective regarding the future opportunities and challenges in this popular and rapidly developing subject of research. STATEMENT OF SIGNIFICANCE: Surgical implants and local drug delivery are representative modern modalities of surgical treatment and medical treatment, respectively. Their synergy offers unique therapeutic advantages, such as minimal systemic side effects, proximity-related high efficiency, and potential absorbability. The applications of implant-based drug delivery have infiltrated otorhinolaryngology and head & neck surgery, which is well known for its related tissue diversity and surgical complexity. Examples discussed here include cochlear implants, bone-anchored hearing aids, sinus stents, and airway tubes. This timely review focuses primarily on the four fundamental components of an implant-based drug delivery system, namely implant biomaterial, loaded medication, delivery pattern, and system fabrication. A particular emphasis is placed upon the in vitro cellular and in vivo animal studies that demonstrate pre-clinical potentials.
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