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Qiao Z, Wang F, Han D, Zhuang Y, Jiang Q, Zhang Y, Liu M, An Q, Wang Z, Shen D. Ultrasound-guided periadventitial administration of rapamycin-fibrin glue attenuates neointimal hyperplasia in the rat carotid artery injury model. Eur J Pharm Sci 2024; 192:106610. [PMID: 37852309 DOI: 10.1016/j.ejps.2023.106610] [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: 04/04/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Arterial restenosis caused by intimal hyperplasia (IH) is a serious complication after vascular interventions. In the rat carotid balloon injury model, we injected phosphate buffer saline (PBS), rapamycin-phosphate buffer saline suspension (RPM-PBS), blank fibrin glue (FG) and rapamycin-fibrin glue (RPM-FG) around the injured carotid artery under ultrasound guidance and observed the inhibitory effect on IH. METHODS The properties of RPM-FG in vitro were verified by scanning electron microscopy (SEM) and determination of the drug release rate. FG metabolism in vivo was observed by fluorescence imaging. The rat carotid balloon injury models were randomly classified into 4 groups: PBS group (control group), RPM-PBS group, FG group, and RPM-FG group. Periadventitial administration was performed by ultrasound-guided percutaneous puncture on the first day after angioplasty. Carotid artery specimens were analyzed by immunostaining, Evans blue staining and hematoxylin-eosin staining. RESULTS The RPM particles showed clustered distributions in the FG block. The glue was maintained for a longer time in vivo (> 14 days) than in vitro (approximately 7 days). Two-component liquid FG administered by ultrasound-guided injection completely encapsulated the injured artery before coagulation. The RPM-FG inhibited IH after carotid angioplasty vs. control and other groups. The proliferation of vascular smooth muscle cells (VSMCs) was significantly inhibited during neointima formation, whereas endothelial cell (EC) repair was not affected. CONCLUSION Periadventitial delivery of RPM-FG contributed to inhibiting IH in the rat carotid artery injury model without compromising re-endothelialization. Additionally, FG provided a promising platform for the future development of a safe, effective, and minimally invasive perivascular drug delivery method to treat vascular disease.
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Affiliation(s)
- Zhentao Qiao
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, China
| | - Fuhang Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou 450052, China
| | - Dongjian Han
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou 450052, China
| | - Yuansong Zhuang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou 450052, China
| | - Qingjiao Jiang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou 450052, China
| | - Yi Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou 450052, China
| | - Miaomiao Liu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou 450052, China
| | - Quanxu An
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou 450052, China
| | - Zhiwei Wang
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, China
| | - Deliang Shen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou 450052, China.
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Lee J, Jang EH, Kim JH, Park S, Kang Y, Park S, Lee K, Kim JH, Youn YN, Ryu W. Highly flexible and porous silk fibroin microneedle wraps for perivascular drug delivery. J Control Release 2021; 340:125-135. [PMID: 34688718 DOI: 10.1016/j.jconrel.2021.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/29/2022]
Abstract
Various perivascular drug delivery techniques have been demonstrated for localized post-treatment of intimal hyperplasia: a vascular inflammatory response caused by endothelial damages. Although most perivascular devices have focused on controlling the delivery duration of anti-proliferation drug, the confined and unidirectional delivery of the drug to the target tissue has become increasingly important. In addition, careful attention should also be paid to the luminal stability and the adequate exchange of vascular protein or cell between the blood vessel and extravascular tissue to avoid any side effect from the long-term application of any perivascular device. Here, a highly flexible and porous silk fibroin microneedle wrap (Silk MN wrap) is proposed to directly inject antiproliferative drug to the anastomosis sites while ensuring sufficient vascular exchanges. Drug-embedded silk MNs were transfer-molded on a highly flexible and porous silk wrap. The enhanced cell compatibility, molecular permeability, and flexibility of silk MN wrap guaranteed the structural integrity of blood vessels. Silk wrap successfully supported the silk MNs and induced multiple MN penetration to the target tissue. Over 28 days, silk MN wrap significantly inhibited intimal hyperplasia with a 62.1% reduction in neointimal formation.
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Affiliation(s)
- JiYong Lee
- School of Mechanical Engineering, YONSEI University, Seoul 03722, South Korea
| | - Eui Hwa Jang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, YONSEI University College of Medicine, Seoul 03722, South Korea
| | - Jae Ho Kim
- School of Mechanical Engineering, YONSEI University, Seoul 03722, South Korea
| | - SeungHyun Park
- School of Mechanical Engineering, YONSEI University, Seoul 03722, South Korea
| | - Yosup Kang
- School of Mechanical Engineering, YONSEI University, Seoul 03722, South Korea
| | - Sanghyun Park
- School of Mechanical Engineering, YONSEI University, Seoul 03722, South Korea
| | - KangJu Lee
- Department of Healthcare and Biomedical Engineering, Chonnam National University, Yeosu 59626, South Korea; Terasaki Institute for Biomedical Innovation, Los Angeles, CA 90005, USA
| | - Jung-Hwan Kim
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, YONSEI University College of Medicine, Seoul 03722, South Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, YONSEI University College of Medicine, Seoul 03722, South Korea.
| | - WonHyoung Ryu
- School of Mechanical Engineering, YONSEI University, Seoul 03722, South Korea.
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3
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Tierney JW, Evans BC, Cheung-Flynn J, Wang B, Colazo JM, Polcz ME, Cook RS, Brophy CM, Duvall CL. Therapeutic MK2 inhibition blocks pathological vascular smooth muscle cell phenotype switch. JCI Insight 2021; 6:142339. [PMID: 34622803 PMCID: PMC8525639 DOI: 10.1172/jci.insight.142339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
Vascular procedures, such as stenting, angioplasty, and bypass grafting, often fail due to intimal hyperplasia (IH), wherein contractile vascular smooth muscle cells (VSMCs) dedifferentiate to synthetic VSMCs, which are highly proliferative, migratory, and fibrotic. Previous studies suggest MAPK-activated protein kinase 2 (MK2) inhibition may limit VSMC proliferation and IH, although the molecular mechanism underlying the observation remains unclear. We demonstrated here that MK2 inhibition blocked the molecular program of contractile to synthetic dedifferentiation and mitigated IH development. Molecular markers of the VSMC contractile phenotype were sustained over time in culture in rat primary VSMCs treated with potent, long-lasting MK2 inhibitory peptide nanopolyplexes (MK2i-NPs), a result supported in human saphenous vein specimens cultured ex vivo. RNA-Seq of MK2i-NP-treated primary human VSMCs revealed programmatic switching toward a contractile VSMC gene expression profile, increasing expression of antiinflammatory and contractile-associated genes while lowering expression of proinflammatory, promigratory, and synthetic phenotype-associated genes. Finally, these results were confirmed using an in vivo rabbit vein graft model where brief, intraoperative treatment with MK2i-NPs decreased IH and synthetic phenotype markers while preserving contractile proteins. These results support further development of MK2i-NPs as a therapy for blocking VSMC phenotype switch and IH associated with cardiovascular procedures.
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Affiliation(s)
- J William Tierney
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Brian C Evans
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Joyce Cheung-Flynn
- Division of Vascular Surgery, Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bo Wang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Juan M Colazo
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.,Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Monica E Polcz
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.,Department of General Surgery and
| | - Rebecca S Cook
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Colleen M Brophy
- Division of Vascular Surgery, Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Craig L Duvall
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
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Moreno-Estar S, Serrano S, Arévalo-Martínez M, Cidad P, López-López JR, Santos M, Pérez-Garcia MT, Arias FJ. Elastin-like recombinamer-based devices releasing Kv1.3 blockers for the prevention of intimal hyperplasia: An in vitro and in vivo study. Acta Biomater 2020; 115:264-274. [PMID: 32771595 DOI: 10.1016/j.actbio.2020.07.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/25/2020] [Accepted: 07/30/2020] [Indexed: 12/16/2022]
Abstract
Coronary artery disease (CAD) is the most common cardiovascular disorder. Vascular surgery strategies for coronary revascularization (either percutaneous or open) show a high rate of failure because of restenosis of the vessel, due to phenotypic switch of vascular smooth muscle cells (VSMCs) leading to proliferation and migration. We have previously reported that the inhibition of Kv1.3 channel function with selective blockers represents an effective strategy for the prevention of restenosis in human vessels used for coronary angioplasty procedures. However, delivery systems for controlled release of these drugs have not been investigated. Here we tested the efficacy of several formulations of elastin like recombinamers (ELRs) hydrogels to deliver the Kv1.3 blocker PAP-1 in various restenosis models. The dose and time course of PAP-1 release from ELRs click hydrogels was able to inhibit human VSMC proliferation in vitro as well as remodeling of human vessels in organ culture and restenosis in in vivo models. We conclude that this combination of active compound and advanced delivery method could improve the outcomes of vascular surgery in patients. STATEMENT OF SIGNIFICANCE: Vascular surgery strategies for coronary revascularization show a high rate of failure, because of occlusion (restenosis) of the vessel, due to vascular smooth muscle cells proliferation and migration. We have previously reported that blockers of Kv1.3 channels represent an effective anti-restenosis therapy, but delivery systems for their controlled release have not being explored. Here we tested the efficacy of several formulations of elastin like recombinamers (ELRs) hydrogels to deliver the Kv1.3 blocker PAP-1 in various restenosis models, both in vivo and in vitro, and also in human vessels. We demonstrated that combination of active compound and advanced delivery method could improve the outcomes of vascular surgery in patients.
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Yang Q, Lei D, Huang S, Yang Y, Jiang C, Shi H, Chen W, Zhao Q, You Z, Ye X. A novel biodegradable external stent regulates vein graft remodeling via the Hippo-YAP and mTOR signaling pathways. Biomaterials 2020; 258:120254. [PMID: 32805499 DOI: 10.1016/j.biomaterials.2020.120254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 01/10/2023]
Abstract
Coronary artery bypass graft (CABG) has been confirmed to effectively improve the prognosis of coronary artery disease, which is a major public health concern worldwide. As the most frequently used conduits in CABG, saphenous vein grafts have the disadvantage of being susceptible to restenosis due to intimal hyperplasia. To meet the urgent clinical demand, adopting external stents (eStents) and illuminating the potential mechanisms underlying their function are important for preventing vein graft failure. Here, using 4-axis printing technology, we fabricated a novel biodegradable and flexible braided eStent, which exerts excellent inhibitory effect on intimal hyperplasia. The stented grafts downregulate Yes-associated protein (YAP), indicating that the eStent regulates vein graft remodeling via the Hippo-YAP signaling pathway. Further, as a drug-delivery vehicle, a rapamycin (RM)-coated eStent was designed to amplify the inhibitory effect of eStent on intimal hyperplasia through the synergistic effects of the Hippo and mammalian target of rapamycin (mTOR) signaling pathways. Overall, this study uncovers the underlying mechanisms of eStent function and identifies a new therapeutic target for the prevention of vein graft restenosis.
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Affiliation(s)
- Qi Yang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Dong Lei
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Belt and Road Joint Laboratory of Advanced Fiber and Low-dimension Materials (Donghua University), College of Materials Science and Engineering, Donghua University, Shanghai, 201620, China
| | - Shixing Huang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Yang Yang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Chenyu Jiang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Hongpeng Shi
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Wenyi Chen
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Belt and Road Joint Laboratory of Advanced Fiber and Low-dimension Materials (Donghua University), College of Materials Science and Engineering, Donghua University, Shanghai, 201620, China
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| | - Zhengwei You
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Belt and Road Joint Laboratory of Advanced Fiber and Low-dimension Materials (Donghua University), College of Materials Science and Engineering, Donghua University, Shanghai, 201620, China.
| | - Xiaofeng Ye
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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Ang HY, Xiong GM, Chaw SY, Phua JL, Ng JCK, Wong PEH, Venkatraman S, Chong TT, Huang Y. Adventitial injection delivery of nano-encapsulated sirolimus (Nanolimus) to injury-induced porcine femoral vessels to reduce luminal restenosis. J Control Release 2019; 319:15-24. [PMID: 31863795 DOI: 10.1016/j.jconrel.2019.12.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
Endovascular therapy in peripheral intervention has grown exponentially in the past decade, but the issue of high restenosis rates in lower extremity arteries still persist. While drug-coated balloons (DCB) have been the device of choice, recent controversary regarding the long-term safety of paclitaxel have raised concern over current DCBs. In our study, we proposed that the direct injection of a sirolimus nanoliposomal formulation (Nanolimus) using a infusion catheter can attenuate inflammation response in injured vessels. In vitro characterization showed retention of the nanoliposomes size and detectable drug amount up to 336 days in storage. For in vivo study, four female, mixed breed swines were subjected to balloon injury of the femoral arteries before treatment with either injection of saline (n = 4) or Nanolimus (n = 12) using the Bullfrog catheter. Pharmacokinetic analysis demonstrated sustained sirolimus release in the arteries and undetectable systemic drug level at 28 days. Arteries treated with Nanolimus showed significant reduction in neointima area (0.2 ± 0.3 mm2 vs 2.0 ± 1.2 mm2, p < 0.01) and luminal stenosis (14.2 ± 7.2% vs. 67.7 ± 24.8%, p < 0.01) compared to controls. In summary, adventitial delivery of sirolimus using an infusion catheter is a feasible and safe method to reduce vascular restenosis.
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Affiliation(s)
- Hui Ying Ang
- National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, 117583, Singapore
| | - Gordon Minru Xiong
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore
| | - Su Yin Chaw
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore
| | - Jie Liang Phua
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore
| | - Jaryl Chen Koon Ng
- National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, 117583, Singapore
| | - Philip En Hou Wong
- National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Subbu Venkatraman
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore
| | - Tze Tec Chong
- Duke-NUS Medical School, 8 College Road, 169857, Singapore; Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Yingying Huang
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore.
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Daban G, Bayram C, Bozdoğan B, Denkbaş EB. Porous polyurethane film fabricated via the breath figure approach for sustained drug release. J Appl Polym Sci 2019. [DOI: 10.1002/app.47658] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Gizem Daban
- Bioengineering Division, Graduate School of Science and EngineeringHacettepe University, 06800 Ankara Turkey
| | - Cem Bayram
- Advanced Technologies Application and Research CenterHacettepe University, 06800 Ankara Turkey
| | - Betül Bozdoğan
- Chemistry Department, Faculty of Science and LettersAksaray University, 68100 Aksaray Turkey
| | - Emir Baki Denkbaş
- Bioengineering Division, Graduate School of Science and EngineeringHacettepe University, 06800 Ankara Turkey
- Biomedical Engineering Department, Faculty of EngineeringBaşkent University, 06530 Bağlıca, Ankara Turkey
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Mylonaki I, Trosi O, Allémann E, Durand M, Jordan O, Delie F. Design and characterization of a perivascular PLGA coated PET mesh sustaining the release of atorvastatin for the prevention of intimal hyperplasia. Int J Pharm 2018; 537:40-47. [DOI: 10.1016/j.ijpharm.2017.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/28/2017] [Accepted: 12/10/2017] [Indexed: 12/29/2022]
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Lee J, Kim DH, Lee KJ, Seo IH, Park SH, Jang EH, Park Y, Youn YN, Ryu W. Transfer-molded wrappable microneedle meshes for perivascular drug delivery. J Control Release 2017; 268:237-246. [PMID: 29030224 DOI: 10.1016/j.jconrel.2017.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/11/2017] [Accepted: 10/06/2017] [Indexed: 12/27/2022]
Abstract
After surgical procedures such as coronary/peripheral bypass grafting or endarterectomy for the treatment of organ ischemia derived from atherosclerosis, intimal hyperplasia (IH) which leads to restenosis or occlusion at the site of graft anastomosis frequently occurs. In order to inhibit IH caused by abnormal growth of smooth muscle cells (SMCs) in tunica media, various perivascular drug delivery devices are reported for delivery of anti-proliferation drugs into vascular tissue. However, there still remain conflicting requirements such as local and unidirectional delivery vs device porosity, and conformal tight device installation vs pulsatile expansion and constriction of blood vessels. In this study, a biodegradable microneedle (MN) array is developed on a flexible woven surgical mesh using a transfer molding method. Mechanical properties of 'wrappable' MN meshes are investigated and compared to the properties of blood vessels. Ex vivo and in vivo animal studies demonstrate enhanced drug delivery efficiency, efficacy for IH reduction, and safety of MN mesh. In particular, MN mesh showed significantly reduced neointiamal formation (11.1%) compared to other competitive groups (23.7 and 22.2%) after 4-week in vivo animal study. Additionally, wrappable MN meshes effectively suppressed side effects such as IH due to mechanical constriction, loss of toxic drug to the surroundings, and cell death that were frequently observed with other previous perivascular drug delivery devices.
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Affiliation(s)
- JiYong Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Dae-Hyun Kim
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Kang Ju Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Il Ho Seo
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Seung Hyun Park
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Eui Hwa Jang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Youngjoo Park
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - WonHyoung Ryu
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
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Chen G, Shi X, Wang B, Xie R, Guo LW, Gong S, Kent KC. Unimolecular Micelle-Based Hybrid System for Perivascular Drug Delivery Produces Long-Term Efficacy for Neointima Attenuation in Rats. Biomacromolecules 2017; 18:2205-2213. [PMID: 28613846 DOI: 10.1021/acs.biomac.7b00617] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
At present, there are no clinical options for preventing neointima-caused (re)stenosis after open surgery such as bypass surgery for treating flow-limiting vascular disease. Perivascular drug delivery is a promising strategy, but in translational research, it remains a major challenge to achieve long-term (e.g., > 3 months) anti(re)stenotic efficacy. In this study, we engineered a unique drug delivery system consisting of durable unimolecular micelles, formed by single multiarm star amphiphilic block copolymers with only covalent bonds, and a thermosensitive hydrogel formed by a poly(lactide-co-glycolide)-poly(ethylene glycol)-poly(lactide-co-glycolide) triblock copolymer (abbreviated as triblock gel) that is stable for about 4 weeks in vitro. The drug-containing unimolecular micelles (UMs) suspended in Triblock gel were able to sustain rapamycin release for over 4 months. Remarkably, even 3 months after perivascular application of the rapamycin-loaded micelles in Triblock gel in the rat model, the intimal/medial area ratio (a restenosis measure) was still 80% inhibited compared to the control treated with empty micelle/gel (no drug). This could not be achieved by applying rapamycin in Triblock gel alone, which reduced the intimal/medial ratio only by 27%. In summary, we created a new UM/Triblock gel hybrid system for perivascular drug delivery, which produced a rare feat of 3-month restenosis inhibition in animal tests. This system exhibits a real potential for further translation into an anti(re)stenotic application with open surgery.
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Affiliation(s)
- Guojun Chen
- Department of Materials Science and Engineering, and Wisconsin Institute for Discovery and ‡Department of Biomedical Engineering and Department of Chemistry, University of Wisconsin-Madison , Madison, Wisconsin 53715, United States.,Department of Surgery, 5151 Wisconsin Institutes for Medical Research and ⊥McPherson Eye Research Institute, University of Wisconsin-Madison , Madison, Wisconsin 53705, United States.,Department of Surgery, Department of Physiology & Cell Biology, Davis Heart and Lung Research Institute and #Department of Surgery, College of Medicine, The Ohio State University , Columbus, Ohio 43210, United States
| | - Xudong Shi
- Department of Materials Science and Engineering, and Wisconsin Institute for Discovery and ‡Department of Biomedical Engineering and Department of Chemistry, University of Wisconsin-Madison , Madison, Wisconsin 53715, United States.,Department of Surgery, 5151 Wisconsin Institutes for Medical Research and ⊥McPherson Eye Research Institute, University of Wisconsin-Madison , Madison, Wisconsin 53705, United States.,Department of Surgery, Department of Physiology & Cell Biology, Davis Heart and Lung Research Institute and #Department of Surgery, College of Medicine, The Ohio State University , Columbus, Ohio 43210, United States
| | - Bowen Wang
- Department of Materials Science and Engineering, and Wisconsin Institute for Discovery and ‡Department of Biomedical Engineering and Department of Chemistry, University of Wisconsin-Madison , Madison, Wisconsin 53715, United States.,Department of Surgery, 5151 Wisconsin Institutes for Medical Research and ⊥McPherson Eye Research Institute, University of Wisconsin-Madison , Madison, Wisconsin 53705, United States.,Department of Surgery, Department of Physiology & Cell Biology, Davis Heart and Lung Research Institute and #Department of Surgery, College of Medicine, The Ohio State University , Columbus, Ohio 43210, United States
| | - Ruosen Xie
- Department of Materials Science and Engineering, and Wisconsin Institute for Discovery and ‡Department of Biomedical Engineering and Department of Chemistry, University of Wisconsin-Madison , Madison, Wisconsin 53715, United States.,Department of Surgery, 5151 Wisconsin Institutes for Medical Research and ⊥McPherson Eye Research Institute, University of Wisconsin-Madison , Madison, Wisconsin 53705, United States.,Department of Surgery, Department of Physiology & Cell Biology, Davis Heart and Lung Research Institute and #Department of Surgery, College of Medicine, The Ohio State University , Columbus, Ohio 43210, United States
| | - Lian-Wang Guo
- Department of Materials Science and Engineering, and Wisconsin Institute for Discovery and ‡Department of Biomedical Engineering and Department of Chemistry, University of Wisconsin-Madison , Madison, Wisconsin 53715, United States.,Department of Surgery, 5151 Wisconsin Institutes for Medical Research and ⊥McPherson Eye Research Institute, University of Wisconsin-Madison , Madison, Wisconsin 53705, United States.,Department of Surgery, Department of Physiology & Cell Biology, Davis Heart and Lung Research Institute and #Department of Surgery, College of Medicine, The Ohio State University , Columbus, Ohio 43210, United States
| | - Shaoqin Gong
- Department of Materials Science and Engineering, and Wisconsin Institute for Discovery and ‡Department of Biomedical Engineering and Department of Chemistry, University of Wisconsin-Madison , Madison, Wisconsin 53715, United States.,Department of Surgery, 5151 Wisconsin Institutes for Medical Research and ⊥McPherson Eye Research Institute, University of Wisconsin-Madison , Madison, Wisconsin 53705, United States.,Department of Surgery, Department of Physiology & Cell Biology, Davis Heart and Lung Research Institute and #Department of Surgery, College of Medicine, The Ohio State University , Columbus, Ohio 43210, United States
| | - K Craig Kent
- Department of Materials Science and Engineering, and Wisconsin Institute for Discovery and ‡Department of Biomedical Engineering and Department of Chemistry, University of Wisconsin-Madison , Madison, Wisconsin 53715, United States.,Department of Surgery, 5151 Wisconsin Institutes for Medical Research and ⊥McPherson Eye Research Institute, University of Wisconsin-Madison , Madison, Wisconsin 53705, United States.,Department of Surgery, Department of Physiology & Cell Biology, Davis Heart and Lung Research Institute and #Department of Surgery, College of Medicine, The Ohio State University , Columbus, Ohio 43210, United States
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Mylonaki I, Allémann É, Saucy F, Haefliger JA, Delie F, Jordan O. Perivascular medical devices and drug delivery systems: Making the right choices. Biomaterials 2017; 128:56-68. [PMID: 28288349 DOI: 10.1016/j.biomaterials.2017.02.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/13/2017] [Accepted: 02/26/2017] [Indexed: 12/31/2022]
Abstract
Perivascular medical devices and perivascular drug delivery systems are conceived for local application around a blood vessel during open vascular surgery. These systems provide mechanical support and/or pharmacological activity for the prevention of intimal hyperplasia following vessel injury. Despite abundant reports in the literature and numerous clinical trials, no efficient perivascular treatment is available. In this review, the existing perivascular medical devices and perivascular drug delivery systems, such as polymeric gels, meshes, sheaths, wraps, matrices, and metal meshes, are jointly evaluated. The key criteria for the design of an ideal perivascular system are identified. Perivascular treatments should have mechanical specifications that ensure system localization, prolonged retention and adequate vascular constriction. From the data gathered, it appears that a drug is necessary to increase the efficacy of these systems. As such, the release kinetics of pharmacological agents should match the development of the pathology. A successful perivascular system must combine these optimized pharmacological and mechanical properties to be efficient.
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Affiliation(s)
- Ioanna Mylonaki
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, rue Michel Servet 1, CH-1211 Geneva 4, Switzerland
| | - Éric Allémann
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, rue Michel Servet 1, CH-1211 Geneva 4, Switzerland
| | - François Saucy
- Department of Vascular Surgery, Lausanne University Hospital, rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Jacques-Antoine Haefliger
- Department of Vascular Surgery, Lausanne University Hospital, rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Florence Delie
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, rue Michel Servet 1, CH-1211 Geneva 4, Switzerland
| | - Olivier Jordan
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, rue Michel Servet 1, CH-1211 Geneva 4, Switzerland.
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A Biodegradable Microneedle Cuff for Comparison of Drug Effects through Perivascular Delivery to Balloon-Injured Arteries. Polymers (Basel) 2017; 9:polym9020056. [PMID: 30970733 PMCID: PMC6432118 DOI: 10.3390/polym9020056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/25/2017] [Accepted: 02/03/2017] [Indexed: 12/25/2022] Open
Abstract
Restenosis at a vascular anastomosis site is a major cause of graft failure and is difficult to prevent by conventional treatment. Perivascular drug delivery has advantages as drugs can be diffused to tunica media and subintima while minimizing the direct effect on endothelium. This in vivo study investigated the comparative effectiveness of paclitaxel, sirolimus, and sunitinib using a perivascular biodegradable microneedle cuff. A total of 31 New Zealand white rabbits were used. Rhodamine was used to visualize drug distribution (n = 3). Sirolimus- (n = 7), sunitinib- (n = 7), and paclitaxel-loaded (n = 7) microneedle cuffs were placed at balloon-injured abdominal aortae and compared to drug-free cuffs (n = 7). Basic histological structures were not affected by microneedle devices, and vascular wall thickness of the device-only group was similar to that of normal artery. Quantitative analysis revealed significantly decreased neointima formation in all drug-treated groups (p < 0.001). However, the tunica media layer of the paclitaxel-treated group was significantly thinner than that of other groups and also showed the highest apoptotic ratio (p < 0.001). Proliferating cell nuclear antigen (PCNA)-positive cells were significantly reduced in all drug-treated groups. Sirolimus or sunitinib appeared to be more appropriate for microneedle devices capable of slow drug release because vascular wall thickness was minimally affected.
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Boire TC, Balikov DA, Lee Y, Guth CM, Cheung-Flynn J, Sung HJ. Biomaterial-Based Approaches to Address Vein Graft and Hemodialysis Access Failures. Macromol Rapid Commun 2016; 37:1860-1880. [PMID: 27673474 PMCID: PMC5156561 DOI: 10.1002/marc.201600412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/15/2016] [Indexed: 12/19/2022]
Abstract
Veins used as grafts in heart bypass or as access points in hemodialysis exhibit high failure rates, thereby causing significant morbidity and mortality for patients. Interventional or revisional surgeries required to correct these failures have been met with limited success and exorbitant costs, particularly for the US Centers for Medicare & Medicaid Services. Vein stenosis or occlusion leading to failure is primarily the result of neointimal hyperplasia. Systemic therapies have achieved little long-term success, indicating the need for more localized, sustained, biomaterial-based solutions. Numerous studies have demonstrated the ability of external stents to reduce neointimal hyperplasia. However, successful results from animal models have failed to translate to the clinic thus far, and no external stent is currently approved for use in the US to prevent vein graft or hemodialysis access failures. This review discusses current progress in the field, design considerations, and future perspectives for biomaterial-based external stents. More comparative studies iteratively modulating biomaterial and biomaterial-drug approaches are critical in addressing mechanistic knowledge gaps associated with external stent application to the arteriovenous environment. Addressing these gaps will ultimately lead to more viable solutions that prevent vein graft and hemodialysis access failures.
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Affiliation(s)
- Timothy C Boire
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Daniel A Balikov
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Yunki Lee
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Christy M Guth
- Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Joyce Cheung-Flynn
- Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Hak-Joon Sung
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
- Severance Biomedical Science Institute, College of Medicine, Yonsei University, Seoul, 120-752, Republic of Korea
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Abstract
Cells are covered by a surface layer of glycans that is referred to as the 'glycocalyx'. In this review, we focus on the role of the glycocalyx in vascular diseases (atherosclerosis, stroke, hypertension, kidney disease and sepsis) and cancer. The glycocalyx and its principal glycosaminoglycans [heparan sulphate (HS) and hyaluronic acid (HA)] and core proteins (syndecans and glypicans) are degraded in vascular diseases, leading to a breakdown of the vascular permeability barrier, enhanced access of leucocytes to the arterial intima that propagate inflammation and alteration of endothelial mechanotransduction mechanisms that protect against disease. By contrast, the glycocalyx on cancer cells is generally robust, promoting integrin clustering and growth factor signalling, and mechanotransduction of interstitial flow shear stress that is elevated in tumours to upregulate matrix metalloproteinase release which enhances cell motility and metastasis. HS and HA are consistently elevated on cancer cells and are associated with tumour growth and metastasis. Later, we will review the agents that might be used to enhance or protect the glycocalyx to combat vascular disease, as well as a different set of compounds that can degrade the cancer cell glycocalyx to suppress cell growth and metastasis. It is clear that what is beneficial for either vascular disease or cancer will not be so for the other. The overarching conclusions are that (i) the importance of the glycocalyx in human medicine is only beginning to be recognized, and (ii) more detailed studies of glycocalyx involvement in vascular diseases and cancer will lead to novel treatment modalities.
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Affiliation(s)
- J M Tarbell
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - L M Cancel
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
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15
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Mylonaki I, Strano F, Deglise S, Allémann E, Alonso F, Corpataux JM, Dubuis C, Haefliger JA, Jordan O, Saucy F, Delie F. Perivascular sustained release of atorvastatin from a hydrogel-microparticle delivery system decreases intimal hyperplasia. J Control Release 2016; 232:93-102. [DOI: 10.1016/j.jconrel.2016.04.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 12/26/2022]
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Periadventitial drug delivery for the prevention of intimal hyperplasia following open surgery. J Control Release 2016; 233:174-80. [PMID: 27179635 DOI: 10.1016/j.jconrel.2016.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/02/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intimal hyperplasia (IH) remains a major cause of poor patient outcomes after surgical revascularization to treat atherosclerosis. A multitude of drugs have been shown to prevent the development of IH. Moreover, endovascular drug delivery following angioplasty and stenting has been achieved with a marked diminution in the incidence of restenosis. Despite advances in endovascular drug delivery, there is currently no clinically available method of periadventitial drug delivery suitable for open vascular reconstructions. Herein we provide an overview of the recent literature regarding innovative polymer platforms for periadventitial drug delivery in preclinical models of IH as well as insights about barriers to clinical translation. METHODS A comprehensive PubMed search confined to the past 15years was performed for studies of periadventitial drug delivery. Additional searches were performed for relevant clinical trials, patents, meeting abstracts, and awards of NIH funding. RESULTS Most of the research involving direct periadventitial delivery without a drug carrier was published prior to 2000. Over the past 15years there have been a surge of reports utilizing periadventitial drug-releasing polymer platforms, most commonly bioresorbable hydrogels and wraps. These methods proved to be effective for the inhibition of IH in various animal models (e.g. balloon angioplasty, wire injury, and vein graft), but very few have advanced to clinical trials. There are a number of barriers that may account for this lack of translation. Promising new approaches including the use of nanoparticles will be described. CONCLUSIONS No periadventitial drug delivery system has reached clinical application. For periadventitial delivery, polymer hydrogels, wraps, and nanoparticles exhibit overlapping and complementary properties. The ideal periadventitial delivery platform would allow for sustained drug release yet exert minimal mechanical and inflammatory stresses to the vessel wall. A clinically applicable strategy for periadventitial drug delivery would benefit thousands of patients undergoing open vascular reconstruction each year.
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Preparation and experimental research into retrievable rapamycin- and heparin-coated vena cava filters: a pilot study. J Thromb Thrombolysis 2015; 41:422-32. [PMID: 26364298 DOI: 10.1007/s11239-015-1278-3] [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] [Indexed: 12/30/2022]
Abstract
The use of retrievable vena cava filters (RVCFs) was once commonplace, but filter retrieval was often very difficult. Most unsuccessful retrieval was due to intimal hyperplasia of the inferior vena cava and in-filter thrombosis. This pilot study aimed to design a drug-eluting RVCF. The hypothesis was that coated drugs could be released continuously to inhibit vena intimal hyperplasia and thrombosis, and thus improve the retrieval rates of RVCFs. Various concentrations of polycaprolactone (PCL)/chloroform solution were made from a mixture of Rapamycin and Heparin according to the quality of PCL. The drug was coated onto the surface of the filters by a process of dipping. In vitro tests were performed to check stability and in vitro drug release. Animals receiving filter implantation were divided into 4 groups, the experimental intervention group (EI), experimental laparotomy group (EL), control intervention group (CI), and control laparotomy group (CL). Filters were retrieved by laparotomy in the EL and CL groups, and by interventional operation in the EI and CI groups at 10, 20 and 30 days after implantation. Pathological endothelia biopsies were performed with wood grain-eosin (HE) staining and immunohistochemical examination, with the proliferating cell nuclear antigen (PCNA) index, and the results were compared between the experimental and control groups. The weight of thrombus within the filters was also measured by scale and compared. The coating concentration that succeeded in completely covering the surface was 0.2 g/ml. There was better coverage by SEM at this concentration, and the coated drugs had no obvious loss after filter release. The drug release curves showed that the amount of Heparin released was more than 50 % at day 1; Rapamycin released little in the first few days, beginning in earnest at 20 to 30 days. The filters were easy to retrieve at 10 days for both groups, while neither could be retrieved at 30 days. However, at 20 days the filter in the EI group could be retrieved with some difficulty, but the filter in the CI group couldn't be removed at all. The pathological examination and immunohistochemical PCNA examination results showed that the use of drug-eluting filters could effectively inhibit endothelial hyperplasia at 10 and 20 days, but was less effective at 30 days. There was no apparent difference in the total weight of blood clots between the experimental and control groups. We successfully conducted a pilot study into preparing Rapamycin- and Heparin-coated RVCFs. In vitro and in vivo tests further proved the possibility of improving the retrieval rates of RVCFs by effectively inhibiting vein endothelial proliferation, but the anticoagulation and antithrombosis effects of Heparin were unsatisfactory.
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Yu X, Takayama T, Goel SA, Shi X, Zhou Y, Kent KC, Murphy WL, Guo LW. A rapamycin-releasing perivascular polymeric sheath produces highly effective inhibition of intimal hyperplasia. J Control Release 2014; 191:47-53. [PMID: 24852098 DOI: 10.1016/j.jconrel.2014.05.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/30/2014] [Accepted: 05/08/2014] [Indexed: 01/02/2023]
Abstract
Intimal hyperplasia produces restenosis (re-narrowing) of the vessel lumen following vascular intervention. Drugs that inhibit intimal hyperplasia have been developed, however there is currently no clinical method of perivascular drug-delivery to prevent restenosis following open surgical procedures. Here we report a poly(ε-caprolactone) (PCL) sheath that is highly effective in preventing intimal hyperplasia through perivascular delivery of rapamycin. We first screened a series of bioresorbable polymers, i.e., poly(lactide-co-glycolide) (PLGA), poly(lactic acid) (PLLA), PCL, and their blends, to identify desired release kinetics and sheath physical properties. Both PLGA and PLLA sheaths produced minimal (<30%) rapamycin release within 50days in PBS buffer. In contrast, PCL sheaths exhibited more rapid and near-linear release kinetics, as well as durable integrity (>90days) as evidenced in both scanning electron microscopy and subcutaneous embedding experiments. Moreover, a PCL sheath deployed around balloon-injured rat carotid arteries was associated with a minimum rate of thrombosis compared to PLGA and PLLA. Morphometric analysis and immunohistochemistry revealed that rapamycin-loaded perivascular PCL sheaths produced pronounced (85%) inhibition of intimal hyperplasia (0.15±0.05 vs 1.01±0.16), without impairment of the luminal endothelium, the vessel's anti-thrombotic layer. Our data collectively show that a rapamycin-loaded PCL delivery system produces substantial mitigation of neointima, likely due to its favorable physical properties leading to a stable yet flexible perivascular sheath and steady and prolonged release kinetics. Thus, a PCL sheath may provide useful scaffolding for devising effective perivascular drug delivery particularly suited for preventing restenosis following open vascular surgery.
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Affiliation(s)
- Xiaohua Yu
- Department of Biomedical Engineering, University of Wisconsin, 5009 Wisconsin Institute of Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Toshio Takayama
- Department of Surgery, University of Wisconsin, 5151 Wisconsin Institute of Medical Research, 1111 Highland Ave, Madison, WI 53705, USA
| | - Shakti A Goel
- Department of Surgery, University of Wisconsin, 5151 Wisconsin Institute of Medical Research, 1111 Highland Ave, Madison, WI 53705, USA
| | - Xudong Shi
- Department of Surgery, University of Wisconsin, 5151 Wisconsin Institute of Medical Research, 1111 Highland Ave, Madison, WI 53705, USA
| | - Yifan Zhou
- Department of Surgery, University of Wisconsin, 5151 Wisconsin Institute of Medical Research, 1111 Highland Ave, Madison, WI 53705, USA
| | - K Craig Kent
- Department of Surgery, University of Wisconsin, 5151 Wisconsin Institute of Medical Research, 1111 Highland Ave, Madison, WI 53705, USA; Department of Surgery, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - William L Murphy
- Department of Biomedical Engineering, University of Wisconsin, 5009 Wisconsin Institute of Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA.
| | - Lian-Wang Guo
- Department of Surgery, University of Wisconsin, 5151 Wisconsin Institute of Medical Research, 1111 Highland Ave, Madison, WI 53705, USA.
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