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Abundes-Velasco A, Jiménez-Rodríguez GM, Arias-Sánchez E, Damas-De Los Santos F, Martínez-Ríos MA, Molina-Méndez FJ, Sánchez-Pérez E, Arai-Ito Marco M, Rodríguez-Barriga E, Sánchez-Jara M, Aceves-Díaz González S, Rodríguez-Parra DA, Aranda-Fraustro A, Romero-Ibarra JL, Peña-Duque MA. Histological and Mechanical Behavior of INC 01 and 02 Bare Metal Stents Against a Commercial Stent: A Preclinical Study in a Porcine Model. Arch Med Res 2020; 51:406-412. [PMID: 32376040 DOI: 10.1016/j.arcmed.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/01/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND PCI is an expensive procedure in our population and it implies a huge cost for the institutions and National Health Service. AIM OF THE STUDY The main objective was to evaluate the technical and biological success of two stents designed in Mexico. METHODS Ten York pigs, 4-6 months of age, underwent implantation of the bare metal INC-01 (10 stents) and INC-02 (6 stents) coronary stent in addition to a conventional commercial stent (10 stents). Technical success was evaluated immediately with angiography and Intravascular Ultrasound IVUS, continued by a mean follow-up of 4 month and a final angiographic, IVUS and histological evaluation. RESULTS Initial technical success, angiography and IVUS between the three stents were not significant. One stent presented restenosis in follow-up (commercial stent), but all other stents presented excellent clinical outcome, satisfactory angiographic and IVUS results. Inflammation, proliferation and endothelialization between the stents had no major differences in histological analysis in a mean of 4 months follow-up. CONCLUSIONS In this pig model, the INC 01 and INC 02 stents showed the same delivering technical success, angiographic and IVUS features, biological and histological response compared to commercial last generation stents.
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Affiliation(s)
- Arturo Abundes-Velasco
- Subdirección de Proyectos de Innovación y Desarrollo Tecnológico, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | | | - Eduardo Arias-Sánchez
- Departamento de Hemodinámica, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Félix Damas-De Los Santos
- Departamento de Hemodinámica, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | | | - Francisco Javier Molina-Méndez
- Departamento de Anestesiología Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Efraín Sánchez-Pérez
- Subdirección de Innovación y Desarrollo Tecnológico, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Minoru Arai-Ito Marco
- Subdirección de Innovación y Desarrollo Tecnológico, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Erika Rodríguez-Barriga
- Departamento de Hemodinámica, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Mauricio Sánchez-Jara
- Departamento de Hemodinámica, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Sebastián Aceves-Díaz González
- Subdirección de Innovación y Desarrollo Tecnológico, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - David Alexis Rodríguez-Parra
- Subdirección de Innovación y Desarrollo Tecnológico, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Alberto Aranda-Fraustro
- Departamento de Patología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - José Luis Romero-Ibarra
- Departamento de Hemodinámica, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Marco Antonio Peña-Duque
- Subdirección de Innovación y Desarrollo Tecnológico, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México.
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Sullivan SJL, Madamba D, Sivan S, Miyashiro K, Dreher ML, Trépanier C, Nagaraja S. The effects of surface processing on in-vivo corrosion of Nitinol stents in a porcine model. Acta Biomater 2017; 62:385-396. [PMID: 28842334 DOI: 10.1016/j.actbio.2017.08.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 11/28/2022]
Abstract
A major limitation with current assessments of corrosion in metallic medical devices is the lack of correlation between in-vitro and in-vivo corrosion performance. Therefore, the objective of this study was to elucidate the relationship between pitting corrosion measured by breakdown potentials (Eb) in ASTM F2129 testing and corrosion resistance in-vivo. Four groups of Nitinol stents were manufactured using different processing methods to create unique surface properties. The stents were implanted into iliac arteries of minipigs for six months and explanted for corrosion analysis. Scanning electron microscopy and energy dispersive X-ray spectrometry analyses indicated that stents with a thick complex thermal oxide (420nm) and high corrosion resistance in-vitro (Eb=975±94mV) were free from detectable corrosion in-vivo and exhibited no changes in Ni/Ti ratio when compared to non-implanted controls. This result was also found in mechanically polished stents with a thin native oxide (4nm; Eb=767±226mV). In contrast, stents with a moderately thick thermal oxide (130nm) and low corrosion resistance in-vitro (Eb=111±63mV) possessed corrosion with associated surface microcracks in-vivo. In addition, Ni/Ti ratios in corroded regions were significantly lower compared to non-corroded adjacent areas on explanted stents. When stents were minimally processed (i.e. retained native tube oxide from the drawing process), a thick thermal oxide was present (399nm) with low in-vitro corrosion resistance (Eb=68±29mV) resulting in extensive in-vivo pitting. These findings demonstrate that functional corrosion testing combined with a detailed understanding of the surface characteristics of a Nitinol medical device can provide insight into in-vivo corrosion resistance. STATEMENT OF SIGNIFICANCE Nitinol is a commonly used material in the medical device industry. However, correlations between surface processing of nitinol and in-vivo corrosion has yet to be established. Elucidating the link between in-vivo corrosion and pre-clinical characterization can aid in improved prediction of clinical safety and performance of nitinol devices. We addressed this knowledge gap by fabricating nitinol stents to possess distinct surface properties and evaluating their corrosion susceptibility both in-vitro and after six months of in-vivo exposure. Relationships between stent processing, surface characterization, corrosion bench testing, and outcomes from explanted devices are discussed. These findings highlight the importance of surface characterization in nitinol devices and provide in-vitro pitting corrosion levels that can induce in-vivo corrosion in nitinol stents.
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Affiliation(s)
- Stacey J L Sullivan
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993, USA
| | | | - Shiril Sivan
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993, USA
| | | | - Maureen L Dreher
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993, USA
| | | | - Srinidhi Nagaraja
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993, USA.
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3
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Cui Y, Zhao F, Liu J, Wang X, Du J, Shi D, Chen K. Zedoary Guaiane-Type Sesquiterpenes-Eluting Stents Accelerate Endothelial Healing Without Neointimal Hyperplasia in a Porcine Coronary Artery Model. J Cardiovasc Pharmacol Ther 2017; 22:476-484. [PMID: 28269995 DOI: 10.1177/1074248417696819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: The effects of zedoary guaiane-type sesquiterpenes (ZGS)-based eluting stent (ZES) in accelerating reendothelialization and inhibiting neointimal hyperplasia were examined in a porcine coronary artery model. Methods: The ZES was prepared by polymer-free 316L stainless metal stents. Sirolimus-eluting stents (SES) and bare metal stents (BMS) with identical platforms were used as controls. Stents with 15 mm in length and 2.0 to 3.5 mm in diameter were implanted in porcine coronary arteries. Scanning electron microscopy (SEM) and histopathology were performed to assess the reendothelialization and neointimal hyperplasia. The 3-(4, 5-dimethylthiazol-2yl)-2, 5-diphenyl-2H-tetrazoliumbromide assay and flow cytometry were used to assess the influence of ZGS on human umbilical vascular endothelial cells (HUVECs). Results: At 7 days, SEM showed that percentage of endothelial coverage area was 94.04% ± 5.01% for ZES, 47.59% ± 19.91% for SES ( P < .01 for ZES vs SES), and 59.58% ± 19.61% for BMS ( P < .05 for ZES vs BMS). At 28 days, the percentage of coverage area was 98.51% ± 1.86% for ZES, 86.18% ± 8.16% for SES ( P < .05 for ZES vs SES), and 94.26% ± 5.58% for BMS. Neointimal area and stenosis were significantly lower in ZES (1.07 ± 0.48 mm2, 27.66% ± 12.20%) compared to BMS (1.73 ± 0.69 mm2, 44.08% ± 15.03%, both P < .01, respectively), with no difference in SES (0.94 ± 0.12 mm2, 28.87% ± 6.00%, both P > .05, respectively). The ZGS also promoted HUVECs viability and improved HUVECs proliferation compared to sirolimus. Conclusion: The ZES accelerated reendothelialization and suppressed neointimal hyperplasia in a porcine coronary artery model, with beneficial effects on HUVECs.
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Affiliation(s)
- Yuanyuan Cui
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fuhai Zhao
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiangang Liu
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xin Wang
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianpeng Du
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dazhuo Shi
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Keji Chen
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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Hussner J, Sünwoldt J, Seibert I, Gliesche DG, Zu Schwabedissen HEM. Pimecrolimus increases the expression of interferon-inducible genes that modulate human coronary artery cells proliferation. Eur J Pharmacol 2016; 784:137-46. [PMID: 27212382 DOI: 10.1016/j.ejphar.2016.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/21/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
The pharmacodynamics of the loaded compounds defines clinical failure or success of a drug-eluting device. Various limus derivatives have entered clinics due to the observed positive outcome after stent implantation, which is explained by their antiproliferative activity resulting from inhibition of the cytosolic immunophilin FK506-binding protein 12. Although pimecrolimus also binds to this protein, pimecrolimus-eluting stents failed in clinics. However, despite its impact on T lymphocytes little is known about the pharmacodynamics of pimecrolimus in cultured human coronary artery cells. We were able to show that pimecrolimus exerts antiproliferative activity in human smooth muscle and endothelial cells. Furthermore in those cells pimecrolimus induced transcription of interferon-inducible genes which in part are known to modulate cell proliferation. Modulation of gene expression may be part of an interaction between calcineurin, the downstream target of the pimecrolimus/FK506-binding protein 12-complex, and the toll-like receptor 4. In accordance are our findings showing that silencing of toll-like receptor 4 by siRNA in A549 a lung carcinoma cell line reduced the activation of interferon-inducible genes upon pimecrolimus treatment in those cells. Based on our findings we hypothesize that calcineurin inhibition may induce the toll-like receptor 4 mediated activation of type I interferon signaling finally inducing the observed effect in endothelial and smooth muscle cells. The crosstalk of interferon and toll-like receptor signaling may be a molecular mechanism that contributed to the failure of pimecrolimus-eluting stents in humans.
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Affiliation(s)
- Janine Hussner
- Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Juliane Sünwoldt
- Institute of Pharmacology, Center of Drug Absorption and Transport, University Medicine, Ernst Moritz Arndt University Greifswald, Felix-Hausdorff-Strasse 3, 17489 Greifswald, Germany
| | - Isabell Seibert
- Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Daniel G Gliesche
- Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
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König S, Browne S, Doleschal B, Schernthaner M, Poteser M, Mächler H, Wittchow E, Braune M, Muik M, Romanin C, Groschner K. Inhibition of Orai1-mediated Ca(2+) entry is a key mechanism of the antiproliferative action of sirolimus in human arterial smooth muscle. Am J Physiol Heart Circ Physiol 2013; 305:H1646-57. [PMID: 24056904 DOI: 10.1152/ajpheart.00365.2013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sirolimus (rapamycin) is used in drug-eluting stent strategies and proved clearly superior in this application compared with other immunomodulators such as pimecrolimus. The molecular basis of this action of sirolimus in the vascular system is still incompletely understood. Measurements of cell proliferation in human coronary artery smooth muscle cells (hCASM) demonstrated a higher antiproliferative activity of sirolimus compared with pimecrolimus. Although sirolimus lacks inhibitory effects on calcineurin, nuclear factor of activated T-cell activation in hCASM was suppressed to a similar extent by both drugs at 10 μM. Sirolimus, but not pimecrolimus, inhibited agonist-induced and store-operated Ca(2+) entry as well as cAMP response element binding protein (CREB) phosphorylation in human arterial smooth muscle, suggesting the existence of an as-yet unrecognized inhibitory effect of sirolimus on Ca(2+) signaling and Ca(2+)-dependent gene transcription. Electrophysiological experiments revealed that only sirolimus but not pimecrolimus significantly blocked the classical stromal interaction molecule/Orai-mediated, store-operated Ca(2+) current reconstituted in human embryonic kidney cells (HEK293). A link between Orai function and proliferation was confirmed by dominant-negative knockout of Orai in hCASM. Analysis of the effects of sirolimus on cell proliferation and CREB activation in an in vitro model of arterial intervention using human aorta corroborated the ability of sirolimus to suppress stent implantation-induced CREB activation in human arteries. We suggest inhibition of store-operated Ca(2+) entry based on Orai channels and the resulting suppression of Ca(2+) transcription coupling as a key mechanism underlying the antiproliferative activity of sirolimus in human arteries. This mechanism of action is specific for sirolimus and not a general feature of drugs interacting with FK506-binding proteins.
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Affiliation(s)
- Sarah König
- Institute of Biophysics, Medical University of Graz, Graz, Austria
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Schwartz RS, Edelman E, Virmani R, Carter A, Granada JF, Kaluza GL, Chronos NAF, Robinson KA, Waksman R, Weinberger J, Wilson GJ, Wilensky RL. Drug-eluting stents in preclinical studies: updated consensus recommendations for preclinical evaluation. Circ Cardiovasc Interv 2010; 1:143-53. [PMID: 20031669 DOI: 10.1161/circinterventions.108.789974] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Coronary drug-eluting stents are commonplace in clinical practice with acceptable safety and efficacy. Preclinical evaluation of novel drug-eluting stent technologies has great importance for understanding safety and possibly efficacy of these technologies, and well-defined preclinical testing methods clearly benefit multiple communities within the developmental, testing, and clinical evaluation chain. An earlier consensus publication enjoyed widespread adoption but is in need of updating. This publication is an update, presenting an integrated view for testing drug-eluting technologies in preclinical models, including novel devices such as bioabsorbable coatings, totally bioabsorbable stents, bifurcation stents, and stent-free balloon-based drug delivery. This consensus document was produced by preclinical and translational scientists and investigators engaged in interventional technology community. The United States Food and Drug Administration (USFDA) recently issued a Draft Guidance for Industry Document for Drug-Eluting Stents. This expert consensus document is consistent with the Food and Drug Administration guidance. The dynamic nature of this field mandates future modifications and additions that will be added over time.
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Affiliation(s)
- Robert S Schwartz
- Minneapolis Heart Institute and Foundation, 920 E. 28th Street, Suite 600, Minneapolis, MN 55407.
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Ormiston JA, Webster MW, Schwartz RS, Gladding P, Stewart JT, Kay IP, Ruygrok PN, Hatrick R. Feasibility, Safety, and Efficacy of a Novel Polymeric Pimecrolimus-Eluting Stent. JACC Cardiovasc Interv 2009; 2:1017-24. [DOI: 10.1016/j.jcin.2009.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 07/13/2009] [Accepted: 08/20/2009] [Indexed: 10/20/2022]
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Verheye S, Sarno G, Müller R, Birkemeyer R, Vrints C, Jung W, Agostoni P, van Langenhove G, Haine S, Willems T, Haude M, Grube E, Wijns W. The ProLimus trial: a prospective, non-randomised, multicentre trial to evaluate the safety and clinical performance of the pimecrolimus eluting stent system (ProGenic). EUROINTERVENTION 2009; 5:233-8. [DOI: 10.4244/eijv5i2a36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Verheye S, Agostoni P, Dawkins KD, Dens J, Rutsch W, Carrie D, Schofer J, Lotan C, Dubois CL, Cohen SA, Fitzgerald PJ, Lansky AJ. The GENESIS (Randomized, Multicenter Study of the Pimecrolimus-Eluting and Pimecrolimus/Paclitaxel-Eluting Coronary Stent System in Patients with De Novo Lesions of the Native Coronary Arteries) Trial. JACC Cardiovasc Interv 2009; 2:205-14. [DOI: 10.1016/j.jcin.2008.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 12/21/2008] [Indexed: 10/21/2022]
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