1
|
Islam P, Schaly S, Abosalha AK, Boyajian J, Thareja R, Ahmad W, Shum-Tim D, Prakash S. Nanotechnology in development of next generation of stent and related medical devices: Current and future aspects. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2024; 16:e1941. [PMID: 38528392 DOI: 10.1002/wnan.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
Coronary stents have saved millions of lives in the last three decades by treating atherosclerosis especially, by preventing plaque protrusion and subsequent aneurysms. They attenuate the vascular SMC proliferation and promote reconstruction of the endothelial bed to ensure superior revascularization. With the evolution of modern stent types, nanotechnology has become an integral part of stent technology. Nanocoating and nanosurface fabrication on metallic and polymeric stents have improved their drug loading capacity as well as other mechanical, physico-chemical, and biological properties. Nanofeatures can mimic the natural nanofeatures of vascular tissue and control drug-delivery. This review will highlight the role of nanotechnology in addressing the challenges of coronary stents and the recent advancements in the field of related medical devices. Different generations of stents carrying nanoparticle-based formulations like liposomes, lipid-polymer hybrid NPs, polymeric micelles, and dendrimers are discussed highlighting their roles in local drug delivery and anti-restenotic properties. Drug nanoparticles like Paclitaxel embedded in metal stents are discussed as a feature of first-generation drug-eluting stents. Customized precision stents ensure safe delivery of nanoparticle-mediated genes or concerted transfer of gene, drug, and/or bioactive molecules like antibodies, gene mimics via nanofabricated stents. Nanotechnology can aid such therapies for drug delivery successfully due to its easy scale-up possibilities. However, limitations of this technology such as their potential cytotoxic effects associated with nanoparticle delivery that can trigger hypersensitivity reactions have also been discussed in this review. This article is categorized under: Implantable Materials and Surgical Technologies > Nanotechnology in Tissue Repair and Replacement Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease Therapeutic Approaches and Drug Discovery > Emerging Technologies.
Collapse
Affiliation(s)
- Paromita Islam
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Sabrina Schaly
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Ahmed Kh Abosalha
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Pharmaceutical Technology Department, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Jacqueline Boyajian
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Rahul Thareja
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Waqar Ahmad
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Dominique Shum-Tim
- Division of Cardiac Surgery, Royal Victoria Hospital, McGill University Health Centre, McGill University, Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Satya Prakash
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
2
|
Chowdhury MM, Piao Z, Albaghdadi MS, Coughlin PA, Rudd JHF, Tearney GJ, Jaffer FA. Intravascular Fluorescence Molecular Imaging of Atherosclerosis. Methods Mol Biol 2022; 2419:853-872. [PMID: 35238006 PMCID: PMC9052094 DOI: 10.1007/978-1-0716-1924-7_52] [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] [Indexed: 01/03/2023]
Abstract
Optical molecular imaging using near-infrared fluorescence (NIRF) light is an emerging high-resolution imaging approach to image a wide range of molecular and cellular species in vivo. Imaging using NIR wavelengths (650-900 nm) enables deeper photon penetration into tissue and reduced tissue autofluorescence, resulting in higher sensitivity to detect exogenously administered NIR fluorophores (injectable molecular imaging agents). Greater imaging depth of several centimeters is further achievable in the NIR window as blood absorption is as an order of magnitude lower than in the visible range. Furthermore, as optical imaging is routinely performed in the cardiac catheterization laboratory (e.g., optical coherence tomography), intravascular NIRF offers a promising translational approach for clinical coronary and peripheral arterial imaging. To this point, the first human intravascular NIRF imaging study recently demonstrated the ability to detect NIR autofluorescence in patients with coronary atherosclerosis. This study provides a foundation for targeted intravascular NIRF molecular imaging studies in coronary patients. In this chapter, we detail system engineering, imaging agents and translational applications of intravascular NIRF molecular imaging.
Collapse
Affiliation(s)
- Mohammed M Chowdhury
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Vascular Surgery, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Zhonglie Piao
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Mazen S Albaghdadi
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick A Coughlin
- Division of Vascular Surgery, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Farouc A Jaffer
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
3
|
Dowlati E, Pasko KBD, Liu J, Miller CA, Felbaum DR, Sur S, Chang JJ, Liu AH, Armonda RA, Mai JC. Treatment of In-Stent Stenosis Following Flow Diversion of Intracranial Aneurysms with Cilostazol and Clopidogrel. Neurointervention 2021; 16:285-292. [PMID: 34503310 PMCID: PMC8561031 DOI: 10.5469/neuroint.2021.00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022] Open
Abstract
In-stent stenosis is a feared complication of flow diversion treatment for cerebral aneurysms. We present 2 cases of patients treated with pipeline flow diversion for unruptured cerebral aneurysms. Initial perioperative dual antiplatelet therapy (DAPT) consisted of standard aspirin plus clopidogrel. At 6-month follow-up cerebral angiography, the patients were noted to have developed significant in-stent stenosis (63% and 53%). The patients were treated with cilostazol and clopidogrel for at least 6 months. Subsequent angiography at 1-year post-treatment showed significant improvement of the in-stent stenosis from 63% to 34% and 53% to 21%. The role of cilostazol as treatment of intracranial in-stent stenosis has not been previously described. Cilostazol’s vasodilatory effect and suppression of vascular smooth muscle proliferation provides ideal benefits in this setting. Cilostazol plus clopidogrel may be a safe and effective alternative to standard DAPT for treatment of in-stent stenosis following flow diversion and warrants further consideration and investigation.
Collapse
Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Jiaqi Liu
- Georgetown University School of Medicine, Washington, DC, USA
| | - Charles A Miller
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Samir Sur
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ai-Hsi Liu
- Department of Radiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
4
|
Iop L. Toward the Effective Bioengineering of a Pathological Tissue for Cardiovascular Disease Modeling: Old Strategies and New Frontiers for Prevention, Diagnosis, and Therapy. Front Cardiovasc Med 2021; 7:591583. [PMID: 33748193 PMCID: PMC7969521 DOI: 10.3389/fcvm.2020.591583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular diseases (CVDs) still represent the primary cause of mortality worldwide. Preclinical modeling by recapitulating human pathophysiology is fundamental to advance the comprehension of these diseases and propose effective strategies for their prevention, diagnosis, and treatment. In silico, in vivo, and in vitro models have been applied to dissect many cardiovascular pathologies. Computational and bioinformatic simulations allow developing algorithmic disease models considering all known variables and severity degrees of disease. In vivo studies based on small or large animals have a long tradition and largely contribute to the current treatment and management of CVDs. In vitro investigation with two-dimensional cell culture demonstrates its suitability to analyze the behavior of single, diseased cellular types. The introduction of induced pluripotent stem cell technology and the application of bioengineering principles raised the bar toward in vitro three-dimensional modeling by enabling the development of pathological tissue equivalents. This review article intends to describe the advantages and disadvantages of past and present modeling approaches applied to provide insights on some of the most relevant congenital and acquired CVDs, such as rhythm disturbances, bicuspid aortic valve, cardiac infections and autoimmunity, cardiovascular fibrosis, atherosclerosis, and calcific aortic valve stenosis.
Collapse
Affiliation(s)
- Laura Iop
- Department of Cardiac Thoracic Vascular Sciences, and Public Health, University of Padua Medical School, Padua, Italy
| |
Collapse
|
5
|
Wu Q, Shao Q, Li L, Liang X, Chang K, Li T, He Y. Prophylactic administration of tirofiban for preventing thromboembolic events in flow diversion treatment of intracranial aneurysms. J Neurointerv Surg 2020; 13:835-840. [PMID: 33199539 DOI: 10.1136/neurintsurg-2020-016878] [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: 09/15/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Flow diverter (FD) is widely used in the treatment of intracranial aneurysms. However, thromboembolic events (TEs) continue to be the major complications during the periprocedural phase. To evaluate the safety and efficacy of the prophylactic use of tirofiban, combined with the conventional dual antiplatelet therapy (DAT), as a new antiplatelet protocol in patients with intracranial aneurysms treated with FDs. METHODS At least 3-5 days before the procedure, daily DAT were administrated to the patients. Tirofiban was administered as an intravenous bolus (5 µg/kg) over a 3 min period during or immediately after FD deployment, followed by a 0.05 µg/kg/min maintenance infusion for 24-48 hours. Periprocedural TEs and hemorrhagic events (HEs) were recorded. RESULTS A total of 331 patients were included, including 229 (69.2%) who received tirofiban administration (tirofiban group) and 102 (30.8%) who received only DAT (non-tirofiban group). Periprocedural TEs occurred in 12 (3.6%) patients, including eight (7.8%) in the non-tirofiban group and four (1.7%) in the tirofiban group. In multivariate analysis, patients receiving tirofiban administration had significantly lower TEs as compared with those who received only DAT (P=0.004). Balloon angioplasty and longer procedure time (>137 min) were also risk factors for TEs. Also, no increase was observed in the rate of HEs related to tirofiban administration. CONCLUSIONS The current study suggested that prophylactic administration of tirofiban combined with conventional oral DAT seems safe and efficient for preventing TEs during FD treatment of unruptured intracranial aneurysms. Balloon angioplasty and prolonged procedure are associated with a high risk of TEs.
Collapse
Affiliation(s)
- Qiaowei Wu
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou, China
| | - Qiuji Shao
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou, China
| | - Li Li
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou, China
| | - Xiaodong Liang
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou, China
| | - Kaitao Chang
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou, China
| | - Yingkun He
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou, China
| |
Collapse
|
6
|
Simard T, Motazedian P, Majeed K, Sarathy K, Jung RG, Feder J, Ramirez FD, Di Santo P, Marbach J, Dhaliwal S, Short S, Labinaz A, Schultz C, Russo JJ, So D, Chong AY, Le May M, Hibbert B. Contrast-free optical coherence tomography:Systematic evaluation of non-contrast media for intravascular assessment. PLoS One 2020; 15:e0237588. [PMID: 32817672 PMCID: PMC7446899 DOI: 10.1371/journal.pone.0237588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background Coronary revascularization using imaging guidance is rapidly becoming the standard of care. Intravascular optical coherence tomography uses near-infrared light to obtain high resolution intravascular images. Standard optical coherence tomography imaging technique employs iodinated contrast dye to achieve the required blood clearance during acquisition. We sought to systematically evaluate the technical performance of saline as an alternative to iodinated contrast for intravascular optical coherence tomography assessment. Methods and results We performed bench top optical coherence tomography analysis on nylon tubing with sequential contrast/saline dilutions to empirically derive adjustment coefficients. We then applied these coefficients in vivo in an established rabbit abdominal stenting model with both saline and contrast optical coherence tomography imaging. In this model, we assessed the impact of saline on both quantitative and qualitative vessel assessment. Nylon tubing assessment demonstrated a linear relationship between saline and contrast for both area and diameter. We then derived adjustment coefficients, allowing for accurate calculation of area and diameter when converting saline into both contrast and reference dimensions. In vivo studies confirmed reduced area with saline versus contrast [7.43 (5.67–8.36) mm2 versus 8.2 (6.34–9.39) mm2, p = 0.001] and diameter [3.08 mm versus 3.23 mm, p = 0.001]. Following correction, a strong relationship was achieved in vivo between saline and contrast in both area and diameter without compromising image quality, artefact, or strut assessment. Conclusion Saline generates reduced dimensions compared to contrast during intravascular optical coherence tomography imaging. The relationship across physiologic coronary diameters is linear and can be corrected with high fidelity. Saline does not adversely impact image quality, artefact, or strut assessment.
Collapse
Affiliation(s)
- Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Kiran Sarathy
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard G. Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Feder
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F. Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
- L’Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey Marbach
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shan Dhaliwal
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Spencer Short
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Alisha Labinaz
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Carl Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Juan J. Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Derek So
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aun-Yeong Chong
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michel Le May
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
| |
Collapse
|
7
|
Kuznetsov KA, Murashov IS, Chernonosova VS, Chelobanov BP, Stepanova AO, Sergeevichev DS, Karpenko AA, Laktionov PP. Vascular Stents Coated with Electrospun Drug-Eluting Material: Functioning in Rabbit Iliac Artery. Polymers (Basel) 2020; 12:polym12081741. [PMID: 32759856 PMCID: PMC7465440 DOI: 10.3390/polym12081741] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 12/27/2022] Open
Abstract
A stenting procedure aimed at blood flow restoration in stenosed arteries significantly improves the efficiency of vascular surgery. However, the current challenge is to prevent neointimal growth, which reduces the vessel lumen, in the stented segments in the long run. We tested in vivo drug-eluting coating applied by electrospinning to metal vascular stents to inhibit the overgrowth of neointimal cells via both the drug release and mechanical support of the vascular wall. The blend of polycaprolactone with human serum albumin and paclitaxel was used for stent coating by electrospinning. The drug-eluting stents (DESs) were placed using a balloon catheter to the rabbit common iliac artery for 1, 3, and 6 months. The blood flow rate was ultrasonically determined in vivo. After explantation, the stented arterial segment was visually and histologically examined. Any undesirable biological responses (rejection or hemodynamically significant stenosis) were unobservable in the experimental groups. DESs were less traumatic and induced weaker neointimal growth; over six months, the blood flow increased by 37% versus bare-metal stents, where it increased by at least double the rate. Thus, electrospun-coated DESs demonstrate considerable advantages over the bare-metal variants.
Collapse
Affiliation(s)
- Konstantin A. Kuznetsov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, 630090 Novosibirsk, Russia; (V.S.C.); (B.P.C.); (A.O.S.); (P.P.L.)
- City Clinical Hospital no. 1, 630047 Novosibirsk, Russia
- Correspondence: ; Tel.: +7-(383)-363-51-44
| | - Ivan S. Murashov
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 630055 Novosibirsk, Russia; (I.S.M.); (D.S.S.); (A.A.K.)
| | - Vera S. Chernonosova
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, 630090 Novosibirsk, Russia; (V.S.C.); (B.P.C.); (A.O.S.); (P.P.L.)
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 630055 Novosibirsk, Russia; (I.S.M.); (D.S.S.); (A.A.K.)
| | - Boris P. Chelobanov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, 630090 Novosibirsk, Russia; (V.S.C.); (B.P.C.); (A.O.S.); (P.P.L.)
| | - Alena O. Stepanova
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, 630090 Novosibirsk, Russia; (V.S.C.); (B.P.C.); (A.O.S.); (P.P.L.)
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 630055 Novosibirsk, Russia; (I.S.M.); (D.S.S.); (A.A.K.)
| | - David S. Sergeevichev
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 630055 Novosibirsk, Russia; (I.S.M.); (D.S.S.); (A.A.K.)
| | - Andrey A. Karpenko
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 630055 Novosibirsk, Russia; (I.S.M.); (D.S.S.); (A.A.K.)
| | - Pavel P. Laktionov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, 630090 Novosibirsk, Russia; (V.S.C.); (B.P.C.); (A.O.S.); (P.P.L.)
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 630055 Novosibirsk, Russia; (I.S.M.); (D.S.S.); (A.A.K.)
| |
Collapse
|
8
|
Flexible endoscopic micro-optical coherence tomography for three-dimensional imaging of the arterial microstructure. Sci Rep 2020; 10:9248. [PMID: 32514084 PMCID: PMC7280224 DOI: 10.1038/s41598-020-65742-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/06/2020] [Indexed: 12/18/2022] Open
Abstract
Micro-optical coherence tomography (µOCT) is a novel imaging approach enabling visualization of the microstructures of biological tissues at a cellular or sub-cellular level. However, it has been challenging to develop a miniaturized flexible endoscopic µOCT probe allowing helical luminal scanning. In this study, we built a flexible endoscopic µOCT probe with an outer diameter of 1.2 mm, which acquires three-dimensional images of the arterial microstructures via helical scanning with an axial and lateral resolutions of 1.83 µm and 3.38 µm in air, respectively. Furthermore, the depth of focus of the µOCT imaging probe was extended two-fold using a binary phase spatial filter. We demonstrated that the present endoscopic µOCT could image cellular level features of a rabbit artery with high-risk atheroma and a bioresorbable scaffold-implanted swine coronary artery. This highly-translatable endoscopic µOCT will be a useful tool for investigating coronary artery disease and stent biology.
Collapse
|
9
|
Goel E, Erwin M, Cawthon CV, Schaff C, Fedor N, Rayl T, Wilson O, Christians U, Register TC, Geary RL, Saul J, Yazdani SK. Pre-Clinical Investigation of Keratose as an Excipient of Drug Coated Balloons. Molecules 2020; 25:molecules25071596. [PMID: 32244375 PMCID: PMC7180741 DOI: 10.3390/molecules25071596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Drug-coated balloons (DCBs), which deliver anti-proliferative drugs with the aid of excipients, have emerged as a new endovascular therapy for the treatment of peripheral arterial disease. In this study, we evaluated the use of keratose (KOS) as a novel DCB-coating excipient to deliver and retain paclitaxel. METHODS A custom coating method was developed to deposit KOS and paclitaxel on uncoated angioplasty balloons. The retention of the KOS-paclitaxel coating, in comparison to a commercially available DCB, was evaluated using a novel vascular-motion simulating ex vivo flow model at 1 h and 3 days. Additionally, the locoregional biological response of the KOS-paclitaxel coating was evaluated in a rabbit ilio-femoral injury model at 14 days. RESULTS The KOS coating exhibited greater retention of the paclitaxel at 3 days under pulsatile conditions with vascular motion as compared to the commercially available DCB (14.89 ± 4.12 ng/mg vs. 0.60 ± 0.26 ng/mg, p = 0.018). Histological analysis of the KOS-paclitaxel-treated arteries demonstrated a significant reduction in neointimal thickness as compared to the uncoated balloons, KOS-only balloon and paclitaxel-only balloon. CONCLUSIONS The ability to enhance drug delivery and retention in targeted arterial segments can ultimately improve clinical peripheral endovascular outcomes.
Collapse
Affiliation(s)
- Emily Goel
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA; (E.G.); (M.E.); (C.V.C.); (C.S.); (N.F.); (T.R.); (O.W.)
| | - Megan Erwin
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA; (E.G.); (M.E.); (C.V.C.); (C.S.); (N.F.); (T.R.); (O.W.)
| | - Claire V. Cawthon
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA; (E.G.); (M.E.); (C.V.C.); (C.S.); (N.F.); (T.R.); (O.W.)
| | - Carson Schaff
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA; (E.G.); (M.E.); (C.V.C.); (C.S.); (N.F.); (T.R.); (O.W.)
| | - Nathaniel Fedor
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA; (E.G.); (M.E.); (C.V.C.); (C.S.); (N.F.); (T.R.); (O.W.)
| | - Trevor Rayl
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA; (E.G.); (M.E.); (C.V.C.); (C.S.); (N.F.); (T.R.); (O.W.)
| | - Onree Wilson
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA; (E.G.); (M.E.); (C.V.C.); (C.S.); (N.F.); (T.R.); (O.W.)
| | - Uwe Christians
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado; Aurora, CO 80045, USA;
| | - Thomas C. Register
- Department of Vascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Randolph L. Geary
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Justin Saul
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH 45056, USA;
| | - Saami K. Yazdani
- Department of Engineering, Wake Forest University, Winston-Salem, NC 27101, USA
- Correspondence: ; Tel.: +1-336-702-1968
| |
Collapse
|
10
|
Cornelissen A, Simsekyilmaz S, Liehn E, Rusu M, Schaaps N, Afify M, Florescu R, Almalla M, Borinski M, Vogt F. Apolipoprotein E deficient rats generated via zinc-finger nucleases exhibit pronounced in-stent restenosis. Sci Rep 2019; 9:18153. [PMID: 31796798 PMCID: PMC6890749 DOI: 10.1038/s41598-019-54541-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/22/2019] [Indexed: 12/17/2022] Open
Abstract
The long-term success of coronary stent implantation is limited by in-stent restenosis (ISR). In spite of a broad variety of animal models available, an ideal high-throughput model of ISR has been lacking. Apolipoprotein E (apoE) deficient rats enable the evaluation of human-sized coronary stents while at the same time providing an atherogenic phenotype. Whereas apoE deficient rats have been proposed as animal model of atherosclerosis, to date it is unknown whether they also develop pronounced ISR. We sought to assess ISR after abdominal aorta stent implantation in apoE deficient rats. A total of 42 rats (16 wildtype, 13 homozygous apoE−/− and 13 heterozygous apoE+/− rats) underwent abdominal aorta stent implantation. After 28 days blood samples were analyzed to characterize lipid profiles. ISR was assessed by histomorphometric means. Homozygous apoE−/− rats exhibited significantly higher total cholesterol and low-density cholesterol levels than wildtype apoE+/+ and heterozygous apoE+/− rats. ISR was significantly pronounced in homozygous apoE−/− rats as compared to wildtype apoE+/+ (p = <0.0001) and heterozygous apoE+/− rats (p = 0.0102) on western diet. Abdominal aorta stenting of apoE−/− rats is a reliable model to investigate ISR after stent implantation and thus can be used for the evaluation of novel stent concepts. Apolipoprotein E (apoE) deficient rats have been proposed as animal model of atherosclerosis. We investigated the development of restenosis 28 days after stent implantation into the abdominal aorta of wildtype apoE+/+, homozygous apoE−/− and heterozygous apoE+/− rats, respectively. Homozygous apoE−/− rats exhibited significantly higher LDL and significantly lower HDL cholesterol levels compared to wildtype apoE+/+ and heterozygous apoE+/− rats. Restenosis after stent implantation was significantly pronounced in western-diet-fed homozygous apoE−/− rats, accompanied by a significantly increased neointimal thickness. Thus, apoE knockout rats exhibit elevated restenosis and might provide a novel tool for testing of innovative stent concepts.
Collapse
Affiliation(s)
- Anne Cornelissen
- University Hospital RWTH Aachen, Division of Cardiology, Pneumology, Angiology and Critical Care, Aachen, Germany.
| | - Sakine Simsekyilmaz
- University Hospital RWTH Aachen, Division of Cardiology, Pneumology, Angiology and Critical Care, Aachen, Germany
| | - Elisa Liehn
- University Hospital RWTH Aachen, Division of Cardiology, Pneumology, Angiology and Critical Care, Aachen, Germany
| | - Mihaela Rusu
- University Hospital RWTH Aachen, Division of Cardiology, Pneumology, Angiology and Critical Care, Aachen, Germany
| | - Nicole Schaaps
- University Hospital RWTH Aachen, Division of Cardiology, Pneumology, Angiology and Critical Care, Aachen, Germany
| | - Mamdouh Afify
- University Hospital RWTH Aachen, Division of Cardiology, Pneumology, Angiology and Critical Care, Aachen, Germany
| | - Roberta Florescu
- University Hospital RWTH Aachen, Division of Cardiology, Pneumology, Angiology and Critical Care, Aachen, Germany
| | - Mohammad Almalla
- University Hospital RWTH Aachen, Division of Cardiology, Pneumology, Angiology and Critical Care, Aachen, Germany
| | - Mauricio Borinski
- University Hospital RWTH Aachen, Division of Cardiology, Pneumology, Angiology and Critical Care, Aachen, Germany
| | - Felix Vogt
- University Hospital RWTH Aachen, Division of Cardiology, Pneumology, Angiology and Critical Care, Aachen, Germany
| |
Collapse
|
11
|
Bienek S, Kusmierczuk M, Mittag A, Bettink S, Scheller B. Novel, vessel anatomy adjusting drug-coated balloon-Preclinical evaluation in peripheral porcine arteries. Catheter Cardiovasc Interv 2019; 95:319-328. [PMID: 31696642 DOI: 10.1002/ccd.28592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/06/2019] [Accepted: 10/26/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The diameter of balloons or stents is selected according to the estimated reference vessel diameter and do not adapt to the vessel anatomy. The aim of the present preclinical studies was to investigate a novel, vessel anatomy adjusting hypercompliant drug-coated balloon catheter (HCDCB). METHODS Hypercompliant balloon membranes were coated in a constricted state with high drug density. Drug adherence was investigated in vitro, transfer to the porcine peripheral arteries and longitudinal distribution in vivo. In young domestic swine, neointimal proliferation was induced by vessel overstretch and continuous irritation by permanent stents. Uncoated hypercompliant balloons (HCB), and standard uncoated balloons and drug-coated balloons (DCB) served as controls. Efficacy was assessed by angiography, optical coherence tomography (OCT), and histomorphometry. RESULTS HCDCB lost 18.0 ± 3.9% of dose during in vitro simulated delivery to the lesion. Drug transfer to the vessel wall was 13.9 ± 6.4% and drug concentration was 1,044 ± 529 ng/mg tissue. Four weeks after treatment, the histomorphometric neointimal area was smaller with HCDCB versus uncoated HCB (2.39 ± 0.55 mm2 vs. 3.26 ± 0.72 mm2 , p = .038) and area stenosis (OCT) was less (11.6 ± 6.9% vs. 24.7 ± 9.7%, p = .022). No premature death occurred and no in-life clinical symptoms or treatment-associated thrombi were observed. CONCLUSIONS HCDCB were found to inhibit excessive neointimal proliferation. Balloon adaption to different vessel diameters and shapes may provide drug-delivery in irregular lumen and facilitate balloon selection.
Collapse
Affiliation(s)
| | | | - Antje Mittag
- Institute of Medical Technology and Research GmbH, Rottmersleben, Germany
| | - Stephanie Bettink
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg, Saarland, Germany
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg, Saarland, Germany
| |
Collapse
|
12
|
Perkins LEL, Rippy MK. Balloons and Stents and Scaffolds: Preclinical Evaluation of Interventional Devices for Occlusive Arterial Disease. Toxicol Pathol 2018; 47:297-310. [DOI: 10.1177/0192623318815604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Atherosclerosis places a significant burden on humankind; it is the leading cause of mortality globally, and for those living with atherosclerosis, it can significantly impact quality of life. Fortunately, treatment advances have effectively reduced the morbidity and mortality related to atherosclerosis, with one such modality being percutaneous intervention (PCI) to open occluded arteries. Over the 40-year history of PCI, preclinical models have played a critical role in demonstrating proof of concept, characterizing the in vivo behavior (pharmacokinetics, degradation) and providing a reasonable assurance of biologic safety of interventional devices before entering into clinical trials. Further, preclinical models may provide insight into the potential efficacy of these devices with the appropriate study design and end points. While several species have been used in the evaluation of interventional devices, the porcine model has been the principal model used in the evaluation of safety of devices for both coronary and endovascular treatments. This article reviews the fundamentals of permanent stents, transient scaffolds, and drug-coated balloons and the models, objectives, and methods used in their preclinical evaluation.
Collapse
|
13
|
Mühl-Benninghaus R, Haußmann A, Simgen A, Tomori T, Reith W, Yilmaz U. Transient in-stent stenosis: a common finding after flow diverter implantation. J Neurointerv Surg 2018; 11:196-199. [DOI: 10.1136/neurintsurg-2018-013975] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/23/2022]
Abstract
Background and purposeIn recent years, implantation of flow diverters has emerged as an option for the endovascular treatment of intracranial aneurysms. One complication of treatment with flow diverters is the occurrence of in-stent stenosis, which has been reported to be partially reversible. The purpose of our study was to assess the incidence and dynamics of in-stent stenosis on angiographic short term and long term follow-up after treatment with flow diverters.MethodsA retrospective review of our prospectively maintained database identified all patients with intracranial internal carotid artery (ICA) aneurysms treated by flow diverters at our institution between 2014 and 2017. Clinical charts, procedural data, and angiographic results were reviewed.Results18 patients were included. The mean short term follow-up was 92±19 days and mean long term follow-up was 449±120 days after treatment. No neurologic complications were observed. There was no procedure related mortality. Long term angiographic results showed complete occlusion in 83.3%, neck remnants in 11.1%, and incomplete occlusion in 5.5% of cases. In-stent stenosis was observed in all cases. Mean stenosis improved significantly from 30% on short term follow-up to 12% on long-term follow-up (P<0.0001).ConclusionIn-stent stenosis is a common finding on short term follow-up after the treatment with flow diverters but improves over time.
Collapse
|
14
|
Atigh MK, Turner E, Christians U, Yazdani SK. The use of an occlusion perfusion catheter to deliver paclitaxel to the arterial wall. Cardiovasc Ther 2018; 35. [PMID: 28445625 DOI: 10.1111/1755-5922.12269] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/24/2017] [Accepted: 04/22/2017] [Indexed: 12/17/2022] Open
Abstract
AIM Nonstent drug delivery platforms have recently emerged as an alternative treatment of peripheral arterial disease. Perfusion catheters have the potential to directly deliver antiproliferative agents to the medial arterial layer to prevent restenosis. The purpose of this study was to therefore determine the effectiveness of a perfusion catheter to deliver paclitaxel, a proven antiproliferative agent, to combat restenosis. METHODS A benchtop model was utilized to determine the varying parameters of a novel occlusion perfusion catheter to maximize paclitaxel delivery using pharmacokinetic evaluation and fluorescent microscopy. Parameters tested included concentration of paclitaxel, delivery pressure, duration of delivery, and the use of an excipient. In addition, bilateral rabbit iliac arteries were treated with the perfusion catheter and pharmacokinetic evaluation performed at 1 hour, 1 day and 3 days. RESULTS Benchtop testing demonstrated uniform and circumferential penetration of paclitaxel within the treated arteries. The results of the ex vivo test identified two groups with and without an excipient with similar loading conditions (with excipient: 15.4±8.6 ng/mg vs without excipient: 8.9±6.9 ng/mg, P=.77). The in vivo pharmacokinetic analysis of these two groups demonstrated the use of contrast agent increased arterial paclitaxel levels and maintained initial paclitaxel dosing up to 3 days (With excipient: 1 hour: 107±62 ng vs 3 days: 40±23 ng, P=.824; No excipient: 1 hour: 247±120 ng vs 3 days: 2.92±2.9 ng, P=.009). CONCLUSIONS These results demonstrate the feasibility to deliver paclitaxel directly to the medial layer of an artery via a perfusion catheter.
Collapse
Affiliation(s)
- Marzieh K Atigh
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
| | - Emily Turner
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
| | - Uwe Christians
- iC42 Clinical Research and Development, University of Colorado, Aurora, CO, USA
| | - Saami K Yazdani
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
| |
Collapse
|
15
|
He Y, Mei L, Jin Y, Li XP, Jin C. Overexpression of Hepatocyte Growth Factor mRNA Induced by Gene Transfer Attenuates Neointimal Hyperplasia After Balloon Injury. Hum Gene Ther 2018; 29:816-827. [PMID: 29382231 DOI: 10.1089/hum.2017.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Hepatic growth factor (HGF) has been widely used in studies on arterial remodeling after injury, and results turn out to be inconsistent. The changes of endogenous HGF expression after injury also remain controversial. This study clarified the role of exogenous human HGF (hHGF) gene transfer in neointimal hyperplasia and investigated the associated alterations of endogenous HGF and c-Met expressions under endothelial denudation with or without hHGF gene transfer using a balloon-injured rabbit aorta model. Sixty-one rabbits were randomly divided into normal controls, endothelial injury, endothelial injury with hHGF, or the control vector gene transfer groups. On weeks 1, 2, 4, and 8 after injury, neointimal hyperplasia and endothelialization were evaluated by the ratio of neointimal area to medial area (N/M ratio), CD31-positive staining, α-smooth muscle actin, and endothelial nitric oxide synthase expressions using histological analysis, immunohistochemistry staining, or real-time quantitative reverse transcriptase polymerase chain reaction. Endogenous rabbit HGF (rHGF) and c-Met expressions were detected with immunohistochemistry staining and quantitative reverse transcriptase polymerase chain reaction. It was found that expressions of endogeneous rHGF and c-Met in endothelial injury upregulated with peak levels on week 2 or week 4 after injury (p < 0.01). On week 1 after hHGF transfer, neointimal hyperplasia was significantly inhibited (p < 0.001), with decreased α-smooth muscle actin expression (p < 0.05) and improved endothelial cells regeneration and function (p < 0.01). More remarkable overexpression of endogenous rHGF and c-Met mRNAs were detected, and lowered positive staining of rHGF and c-Met was shown in the neointima (p < 0.05). These results demonstrated hHGF gene transfer induced further overexpression of endogenous rHGF and c-Met mRNAs but lowered immunoreactivities of rHGF and c-Met in the neointima, thus leading to significant attenuation of neointimal hyperplasia.
Collapse
Affiliation(s)
- Yu He
- 1 Department of Ultrasound, China-Japan Union Hospital of Jilin University , Changchun, China
| | - Li Mei
- 2 Department of Ultrasound, the First Hospital of Jilin University , Changchun, China
| | - Ying Jin
- 3 Department of Surgery, the First Hospital of Jilin University , Changchun, China
| | - Xiao-Ping Li
- 1 Department of Ultrasound, China-Japan Union Hospital of Jilin University , Changchun, China
| | - Chunxiang Jin
- 1 Department of Ultrasound, China-Japan Union Hospital of Jilin University , Changchun, China
| |
Collapse
|
16
|
Suna G, Wojakowski W, Lynch M, Barallobre-Barreiro J, Yin X, Mayr U, Baig F, Lu R, Fava M, Hayward R, Molenaar C, White SJ, Roleder T, Milewski KP, Gasior P, Buszman PP, Buszman P, Jahangiri M, Shanahan CM, Hill J, Mayr M. Extracellular Matrix Proteomics Reveals Interplay of Aggrecan and Aggrecanases in Vascular Remodeling of Stented Coronary Arteries. Circulation 2017; 137:166-183. [PMID: 29030347 PMCID: PMC5757669 DOI: 10.1161/circulationaha.116.023381] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 09/22/2017] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Extracellular matrix (ECM) remodeling contributes to in-stent restenosis and thrombosis. Despite its important clinical implications, little is known about ECM changes post–stent implantation. Methods: Bare-metal and drug-eluting stents were implanted in pig coronary arteries with an overstretch under optical coherence tomography guidance. Stented segments were harvested 1, 3, 7, 14, and 28 days post-stenting for proteomics analysis of the media and neointima. Results: A total of 151 ECM and ECM-associated proteins were identified by mass spectrometry. After stent implantation, proteins involved in regulating calcification were upregulated in the neointima of drug-eluting stents. The earliest changes in the media were proteins involved in inflammation and thrombosis, followed by changes in regulatory ECM proteins. By day 28, basement membrane proteins were reduced in drug-eluting stents in comparison with bare-metal stents. In contrast, the large aggregating proteoglycan aggrecan was increased. Aggrecanases of the ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs) family contribute to the catabolism of vascular proteoglycans. An increase in ADAMTS-specific aggrecan fragments was accompanied by a notable shift from ADAMTS1 and ADAMTS5 to ADAMTS4 gene expression after stent implantation. Immunostaining in human stented coronary arteries confirmed the presence of aggrecan and aggrecan fragments, in particular, at the contacts of the stent struts with the artery. Further investigation of aggrecan presence in the human vasculature revealed that aggrecan and aggrecan cleavage were more abundant in human arteries than in human veins. In addition, aggrecan synthesis was induced on grafting a vein into the arterial circulation, suggesting an important role for aggrecan in vascular plasticity. Finally, lack of ADAMTS-5 activity in mice resulted in an accumulation of aggrecan and a dilation of the thoracic aorta, confirming that aggrecanase activity regulates aggrecan abundance in the arterial wall and contributes to vascular remodeling. Conclusions: Significant differences were identified by proteomics in the ECM of coronary arteries after bare-metal and drug-eluting stent implantation, most notably an upregulation of aggrecan, a major ECM component of cartilaginous tissues that confers resistance to compression. The accumulation of aggrecan coincided with a shift in ADAMTS gene expression. This study provides the first evidence implicating aggrecan and aggrecanases in the vascular injury response after stenting.
Collapse
Affiliation(s)
- Gonca Suna
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Wojciech Wojakowski
- 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland (W.W., T.R., P.G.)
| | - Marc Lynch
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Javier Barallobre-Barreiro
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Xiaoke Yin
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Ursula Mayr
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Ferheen Baig
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Ruifang Lu
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Marika Fava
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Robert Hayward
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Chris Molenaar
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Stephen J White
- Healthcare Science Research Centre, Manchester Metropolitan University, United Kingdom (S.J.W.)
| | - Tomasz Roleder
- 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland (W.W., T.R., P.G.)
| | - Krzysztof P Milewski
- Centre for Cardiovascular Research and Development, American Heart of Poland, Katowice (K.P.M., P.P.B., P.B.)
| | - Pawel Gasior
- 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland (W.W., T.R., P.G.)
| | - Piotr P Buszman
- Centre for Cardiovascular Research and Development, American Heart of Poland, Katowice (K.P.M., P.P.B., P.B.)
| | - Pawel Buszman
- Centre for Cardiovascular Research and Development, American Heart of Poland, Katowice (K.P.M., P.P.B., P.B.)
| | - Marjan Jahangiri
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, United Kingdom (M.J.)
| | - Catherine M Shanahan
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| | - Jonathan Hill
- King's College Hospital and King's Health Partners Academic Health Sciences, London, United Kingdom (J.H.)
| | - Manuel Mayr
- King's British Heart Foundation Centre, King's College London, United Kingdom (G.S., M.L., J.B.-B., X.Y., U.M., F.B., R.L., M.F., R.H., C.M., C.M.S., M.M.)
| |
Collapse
|
17
|
Mei L, He Y, Wang H, Jin Y, Wang S, Jin C. Human hepatocyte growth factor inhibits early neointima formation in rabbit abdominal aortae following ultrasound-guided balloon injury. Mol Med Rep 2017; 16:5203-5210. [PMID: 28849185 PMCID: PMC5647058 DOI: 10.3892/mmr.2017.7229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 06/08/2017] [Indexed: 12/20/2022] Open
Abstract
The present study investigated the effects of in vivo gene transfer of human hepatocyte growth factor (hHGF) on neointima formation in rabbit abdominal aortae following ultrasound‑guided balloon injury. New Zealand white rabbits were randomly divided into four groups: endothelium injury alone (EI), endothelium injury with control vector transfection (EI‑V), endothelium injury with hHGF transfection (EI‑HGF), and hHGF transfection alone without endothelium injury (HGF). Endothelial injury was established by scraping the abdominal aortic wall using a balloon catheter under the guidance of a transabdominal ultrasound. hHGF gene transfer was performed 7 days following injury. hHGF mRNA and protein expression levels were determined at 3, 7, 14 and 21 days following transfection. Neointima formation was assessed by histopathological analysis at 14 and 28 days following injury. hHGF mRNA and protein expression levels were detected in the target abdominal aortae in EI‑HGF and HGF groups with the greatest levels observed 3 days following transfection, and their levels dropped below detection limits at 21 days following transfection. hHGF was not detectable in the EI and EI‑V groups throughout the experiment. The neointimal area and the neointima to media ratio in the EI‑HGF group were significantly decreased compared with those in the EI or EI‑V group at 14 days following injury. However, no differences were observed at 28 days following injury. The present study demonstrated that in vivo hHGF gene transfer inhibits the early formation of neointima in balloon‑injured rabbit abdominal aortae.
Collapse
Affiliation(s)
- Li Mei
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yu He
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Ying Jin
- Department of Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shuai Wang
- Department of Pathology, Cancer Hospital of Jilin, Changchun, Jilin 130012, P.R. China
| | - Chunxiang Jin
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
- Correspondence to: Professor Chunxiang Jin, Department of Ultrasound, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, Jilin 130033, P.R. China, E-mail:
| |
Collapse
|
18
|
Huang Y, Wong YS, Ng HCA, Boey FYC, Venkatraman S. Translation in cardiovascular stents and occluders: From biostable to fully degradable. Bioeng Transl Med 2017; 2:156-169. [PMID: 29313029 PMCID: PMC5675095 DOI: 10.1002/btm2.10066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/16/2017] [Accepted: 06/18/2017] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular disease is a major cause of morbidity and mortality, especially in developed countries. Most academic research efforts in cardiovascular disease management focus on pharmacological interventions, or are concerned with discovering new disease markers for diagnosis and monitoring. Nonpharmacological interventions with therapeutic devices, conversely, are driven largely by novel materials and device design. Examples of such devices include coronary stents, heart valves, ventricular assist devices, and occluders for septal defects. Until recently, development of such devices remained largely with medical device companies. We trace the materials evolution story in two of these devices (stents and occluders), while also highlighting academic contributions, including our own, to the evolution story. Specifically, it addresses not only our successes, but also the challenges facing the translatability of concepts generated via academic research.
Collapse
Affiliation(s)
- Yingying Huang
- School of Materials Science and Engineering Nanyang Technological University Singapore 639798 Singapore
| | - Yee Shan Wong
- School of Materials Science and Engineering Nanyang Technological University Singapore 639798 Singapore
| | - Herr Cheun Anthony Ng
- School of Materials Science and Engineering Nanyang Technological University Singapore 639798 Singapore
| | - Freddy Y C Boey
- School of Materials Science and Engineering Nanyang Technological University Singapore 639798 Singapore
| | - Subbu Venkatraman
- School of Materials Science and Engineering Nanyang Technological University Singapore 639798 Singapore
| |
Collapse
|
19
|
Shine R, Neghabat Shirazi R, Ronan W, Sweeney CA, Kelly N, Rochev YA, McHugh PE. Modeling of Biodegradable Polyesters With Applications to Coronary Stents. J Med Device 2017. [DOI: 10.1115/1.4035723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The interest in biodegradable polymers for clinical and biomedical engineering applications has seen a dramatic increase in the last 10 years. Recent innovations include bioresorbable polymeric stents (BPS), which are temporary vascular scaffolds designed to restore patency and provide short-term support to a blocked blood vessel, before becoming naturally resorbed over time. BPS offer possibilities to overcome the long-term complications often observed with the permanent metallic stents, well established in the treatment of coronary and peripheral artery disease. From the perspective of designing next generation BPS, the bulk degradation behavior of the polymer material adds considerable complications. Computational modeling offers an efficient framework to predict and provide understanding into the behavior of medical devices and implants. Current computational modeling techniques for the degradation of BPS are either phenomenologically or physically based. In this work, a physically based polymer degradation model is implemented into a number of different computational frameworks to investigate the degradation of a number of polymeric structures. A thermal analogy is presented to implement the degradation model into the commercially available finite-element code, abaqus/standard. This approach is then applied to the degradation of BPS, and the effects of material, boundary condition, and design on the degradation rates of the stents are examined. The results indicate that there is a notable difference in the molecular weight trends predicted for the different materials and boundary condition assumptions investigated, with autocatalysis emerging as a dominant mechanism controlling the degradation behavior. Insights into the scaffolding ability of the various BPS examined are then obtained using a suggested general relationship between Young's modulus and molecular weight.
Collapse
Affiliation(s)
- Rosa Shine
- Biomechanics Research Centre (BMEC), Biomedical Engineering, National University of Ireland Galway, University Road, Galway H91 HX31, Ireland e-mail:
| | - Reyhaneh Neghabat Shirazi
- Biomechanics Research Centre (BMEC), Biomedical Engineering, National University of Ireland Galway, University Road, Galway H91 HX31, Ireland e-mail:
| | - William Ronan
- Biomechanics Research Centre (BMEC), Biomedical Engineering, National University of Ireland Galway, University Road, Galway H91 HX31, Ireland e-mail:
| | - Caoimhe A. Sweeney
- Biomechanics Research Centre (BMEC), Biomedical Engineering, National University of Ireland Galway, University Road, Galway H91 HX31, Ireland e-mail:
| | - Nicola Kelly
- Biomechanics Research Centre (BMEC), Biomedical Engineering, National University of Ireland Galway, University Road, Galway H91 HX31, Ireland e-mail:
| | - Yury A. Rochev
- National Centre for Biomedical Engineering Science (NCBES), National University of Ireland Galway, University Road, Galway H91 HX31, Ireland e-mail:
| | - Peter E. McHugh
- Professor Biomechanics Research Centre (BMEC), Biomedical Engineering, National University of Ireland Galway, University Road, Galway H91 HX31, Ireland e-mail:
| |
Collapse
|
20
|
Tenekecioglu E, Sotomi Y, Torii R, Bourantas C, Miyazaki Y, Collet C, Crake T, Su S, Onuma Y, Serruys PW. Strut protrusion and shape impact on endothelial shear stress: insights from pre-clinical study comparing Mirage and Absorb bioresorbable scaffolds. Int J Cardiovasc Imaging 2017; 33:1313-1322. [PMID: 28365819 PMCID: PMC5539274 DOI: 10.1007/s10554-017-1124-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/21/2017] [Indexed: 12/16/2022]
Abstract
Protrusion of scaffold struts is related with local coronary flow dynamics that can promote scaffold restenosis and thrombosis. That fact has prompted us to investigate in vivo the protrusion status of different types of scaffolds and their relationship with endothelial shear stress (ESS) distributions. Six Absorb everolimus-eluting Bioresorbable Vascular Scaffolds (Absorb, Abbott Vascular) and 11 Mirage sirolimus-eluting Bioresorbable Microfiber Scaffolds (Mirage, Manli Cardiology) were implanted in coronaries of eight mini pigs. Optical coherence tomography (OCT) was performed post-scaffold implantation and obtained images were fused with angiographic data to reconstruct the three dimensional coronary anatomy. Blood flow simulation was performed and ESS distribution was estimated for each scaffold. Protrusion distance was estimated using a dedicated software. Correlation between OCT-derived protrusion and ESS distribution was assessed for both scaffold groups. A significant difference was observed in the protrusion distances (156 ± 137 µm for Absorb, 139 ± 153 µm for Mirage; p = 0.035), whereas difference remained after adjusting the protrusion distances according to the luminal areas. Strut protrusion of Absorb is inversely correlated with ESS (r = −0.369, p < 0.0001), whereas in Mirage protrusion was positively correlated with EES (r = 0.192, p < 0.0001). Protrusion distance was higher in Absorb than in Mirage. The protrusion of the thick quadratic struts of Absorb has a tendency to lower shear stress in the close vicinity of struts. However, circular shape of the less thick struts of Mirage didn’t show this trend in creating zone of recirculation around the struts. Strut geometry has different effect on the relationship between protrusion and shear stress in Absorb and Mirage scaffolds.
Collapse
Affiliation(s)
- Erhan Tenekecioglu
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Yohei Sotomi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Christos Bourantas
- Department of Cardiology, University College of London Hospitals, London, UK
| | - Yosuke Miyazaki
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom Crake
- Department of Cardiology, University College of London Hospitals, London, UK
| | | | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Patrick W Serruys
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands. .,Imperial College, London, UK. .,Emeritus Professor of Medicine Erasmus University, Westblaak 98, 3012KM, Rotterdam, The Netherlands.
| |
Collapse
|
21
|
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.
Collapse
|
22
|
Akhtar M, Liu W. Use of intravascular ultrasound vs. optical coherence tomography for mechanism and patterns of in-stent restenosis among bare metal stents and drug eluting stents. J Thorac Dis 2016; 8:E104-8. [PMID: 26904234 DOI: 10.3978/j.issn.2072-1439.2016.01.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This article is a perspective responses to the "Mechanisms and Patterns of Intravascular Ultrasound In-Stent Restenosis Among Bare Metal Stents and First- and Second-Generation Drug-Eluting Stents" by Goto et al., The above mentioned article outlines the use of intravascular ultrasound (IVUS) in visualizing the patterns and mechanisms of in-stent restenosis (ISR) post percutaneous coronary intervention (PCI). Although IVUS is an appropriate method of choice for this scenario, IVUS has certain limitations which can be overcome by using optical coherent tomography (OCT). OCT is not only able to overcome IVUS's limitations but is also able to provide additional information to enhance the understanding of in-stent restenotic lesions. This article also outlines the future directions for OCT both in clinical and investigation settings.
Collapse
Affiliation(s)
- Muzina Akhtar
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Wei Liu
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| |
Collapse
|
23
|
Sotomi Y, Tateishi H, Suwannasom P, Dijkstra J, Eggermont J, Liu S, Tenekecioglu E, Zheng Y, Abdelghani M, Cavalcante R, de Winter RJ, Wykrzykowska JJ, Onuma Y, Serruys PW, Kimura T. Quantitative assessment of the stent/scaffold strut embedment analysis by optical coherence tomography. Int J Cardiovasc Imaging 2016; 32:871-83. [PMID: 26898315 PMCID: PMC4879175 DOI: 10.1007/s10554-016-0856-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/08/2016] [Indexed: 11/25/2022]
Abstract
The degree of stent/scaffold embedment could be a surrogate parameter of the vessel wall-stent/scaffold interaction and could have biological implications in the vascular response. We have developed a new specific software for the quantitative evaluation of embedment of struts by optical coherence tomography (OCT). In the present study, we described the algorithm of the embedment analysis and its reproducibility. The degree of embedment was evaluated as the ratio of the embedded part versus the whole strut height and subdivided into quartiles. The agreement and the inter- and intra-observer reproducibility were evaluated using the kappa and the interclass correlation coefficient (ICC). A total of 4 pullbacks of OCT images in 4 randomly selected coronary lesions with 3.0 × 18 mm devices [2 lesions with Absorb BVS and 2 lesions with XIENCE (both from Abbott Vascular, Santa Clara, CA, USA)] from Absorb Japan trial were evaluated by two investigators with QCU-CMS software version 4.69 (Leiden University Medical Center, Leiden, The Netherlands). Finally, 1481 polymeric struts in 174 cross-sections and 1415 metallic struts in 161 cross-sections were analyzed. Inter- and intra-observer reproducibility of quantitative measurements of embedment ratio and categorical assessment of embedment in Absorb BVS and XIENCE had excellent agreement with ICC ranging from 0.958 to 0.999 and kappa ranging from 0.850 to 0.980. The newly developed embedment software showed excellent reproducibility. Computer-assisted embedment analysis could be a feasible tool to assess the strut penetration into the vessel wall that could be a surrogate of acute injury caused by implantation of devices.
Collapse
Affiliation(s)
- Yohei Sotomi
- />Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hiroki Tateishi
- />ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Pannipa Suwannasom
- />Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- />ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands
- />Northern Region Heart Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jouke Dijkstra
- />Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Eggermont
- />Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Shengnan Liu
- />Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Yaping Zheng
- />ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mohammad Abdelghani
- />Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Yoshinobu Onuma
- />ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Patrick W. Serruys
- />International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Takeshi Kimura
- />Department of Cardiovascular Medicine, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
24
|
In vivo Evaluation of Cenderitide-Eluting Stent (CES) II. Ann Biomed Eng 2015; 44:432-41. [PMID: 26178873 DOI: 10.1007/s10439-015-1389-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
Abstract
The use of drug-eluting coronary stents has led to significant reduction in in-stent restenosis (ISR), but led to delayed endothelialization, necessitating the prolonged use of expensive anti-thrombotic drugs with their side-effects. Cenderitide (CD-NP) is a novel anti-proliferative chimeric peptide of semi-endothelial origin. Our previous work in vitro has demonstrated; that the smooth muscle cells were inhibited significantly more than endothelial cells which is the desirable feature of an anti-restenosis drug. This work reports the effects of implantation of a centeritide-eluting stent (CES) on ISR and endothelialization in an in vivo model. CESs were produced by coating bare metallic stents with CD-NP entrapped in biodegradable poly(ε-caprolactone) using an ultrasonic spray coater. A total of 32 stents were successfully implanted into 16 pigs, and all animal survived for 28 days. The plasma levels of CD-NP were significantly higher in the CES group than in the control group (bare metal stents and polymer-coated stent) at post-stenting, indicating the successful release of CD-NP from the stent in vivo. Furthermore, SEM analysis results showed the greater endothelial coverage of the stent struts, as well as between the struts in CES group. Moreover, histological results showed mild inflammation, and low fibrin score at 28 days. However, plasma cGMP (second messenger, cyclic 3',5' guanosine monophosphate) does not show a significant difference, and the CES is also unable to show significant difference in terms on neointimal area and stenosis, in comparison to BMS at 28 days.
Collapse
|
25
|
Lee WS, Park M, Kim MH, Park CG, Huh BK, Seok HK, Choy YB. Nanoparticle coating on the silane-modified surface of magnesium for local drug delivery and controlled corrosion. J Biomater Appl 2015; 30:651-61. [DOI: 10.1177/0885328215582110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we proposed a potential method for the preparation of a magnesium-based medical device for local drug delivery and controlled corrosion. A magnesium surface was modified with 3-aminopropyltrimethoxy silane, and the resulting surface was then coated with drug-loaded nanoparticles made of poly (lactic-co-glycolic acid) via electrophoretic deposition. The drug-loaded nanoparticles (i.e., Tr_NP) exhibited a size of 250 ± 67 nm and a negative zeta potential of −20.9 ± 2.75 mV. The drug was released from the nanoparticles in a sustained manner for 21 days, and this did not change after their coating on the silane-modified magnesium. The silane-modified surface suppressed magnesium corrosion. When immersed in phosphate buffered saline at pH 7.4, the average rate of hydrogen gas generation was 0.41–0.45 ml/cm2/day, compared to 0.58–0.6 ml/cm2/day from a bare magnesium surface. This corrosion profile was not significantly changed after nanoparticle coating under the conditions employed in this work. The in vitro cell test revealed that the drug released from the coating was effective during the whole release period of 21 days, and both the silane-modified surface and carrier nanoparticles herein were not cytotoxic.
Collapse
Affiliation(s)
- Won Seok Lee
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, Republic of Korea
| | - Min Park
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, Republic of Korea
| | - Myung Hun Kim
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, Republic of Korea
| | - Chun Gwon Park
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Beom Kang Huh
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, Republic of Korea
| | - Hyun Kwang Seok
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science & Technology, Seoul, Republic of Korea
| | - Young Bin Choy
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, Republic of Korea
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
26
|
Ng XW, Huang Y, Liu KL, Lim SG, Chen HH, Burnett JC, Freddy Boey YC, Venkatraman SS. In vitro evaluation of cenderitide-eluting stent I -an antirestenosis and proendothelization approach. J Pharm Sci 2014; 103:3631-3640. [PMID: 25223419 DOI: 10.1002/jps.24165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/19/2014] [Accepted: 08/21/2014] [Indexed: 12/16/2022]
Abstract
Despite the success that drug-eluting stents (DESs) have achieved for minimizing in-stent restenosis (ISR), the antirestenotic agents used in DES have been implicated in delayed endothelial healing and impairment of endothelial functions. Cenderitide (CD-NP) is a novel antiproliferation chimeric peptide of semiendothelial origin; thus, this paper aims to demonstrate the selectivity aspect of this new peptide via in vitro evaluation on key players in ISR-smooth muscle cells (SMCs) and endothelial cells. The microbicinchoninic acid protein assay was used to investigate the CD-NP release from films and stents. Cenderitide-containing films blended with poly(ethylene glycol) and its copolymer exhibited higher release kinetics compared with neat poly(ε-caprolactone) (PCL) formulation. Cenderitide-eluting stents (CES) was produced by coating bare metallic stents with CD-NP entrapped PCL using an ultrasonic spray coater. The investigation of CD-NP on in vitro cells revealed that CD-NP inhibits human coronary smooth muscle cells (HCaSMCs) proliferation but exhibits no effects on human umbilical vein endothelial cells (HUVECs) proliferation. Moreover, CD-NP released up to 7 days displayed inhibitory effects on SMCs proliferation. The CES produced in this work shows that the released CD-NP inhibits HCaSMCs proliferation but did not hamper HUVECs proliferation in vitro, suggesting that it has potential to reduce ISR without retarding the endothelialization healing in vivo.
Collapse
Affiliation(s)
- Xu Wen Ng
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Yingying Huang
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Kerh Lin Liu
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Soon Ghim Lim
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Horng Haur Chen
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - John C Burnett
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Yin Chiang Freddy Boey
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Subbu S Venkatraman
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore.
| |
Collapse
|
27
|
Feinberg MW. Healing the injured vessel wall using microRNA-facilitated gene delivery. J Clin Invest 2014; 124:3694-7. [PMID: 25133421 DOI: 10.1172/jci77509] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Drug-eluting stents have emerged as potent weapons in the treatment of patients with symptomatic coronary artery disease by reducing restenosis rates; however, a significant clinical consequence of these stents is delayed reendothelialization, which may increase the risk of late stent thrombosis. In this issue of the JCI, Santulli and colleagues generated an adenovirus that expresses the cyclin-dependent kinase inhibitor p27(Kip1) (p27) and bears four tandem copies of target sequences for the endothelial cell-enriched microRNA (miRNA) miR-126-3p (Ad-p27-126TS) in an attempt to specifically reduce proliferation of vascular smooth muscle cells, but not endothelial cells. Indeed, delivery of Ad-p27-126TS to balloon-injured arteries in rats not only induced faster and more complete reendothelialization, but also effectively improved neointimal hyperplasia, hypercoagulability, and vasoreactivity. Collectively, these findings provide a cogent foundation for the potential therapeutic use of miRNA-facilitated gene delivery strategies to heal vessel wall injury.
Collapse
|
28
|
Holy EW, Jakob P, Eickner T, Camici GG, Beer JH, Akhmedov A, Sternberg K, Schmitz KP, Lüscher TF, Tanner FC. PI3K/p110α inhibition selectively interferes with arterial thrombosis and neointima formation, but not re-endothelialization: potential implications for drug-eluting stent design. Eur Heart J 2014; 35:808-20. [PMID: 24334406 DOI: 10.1093/eurheartj/eht496] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND Impaired re-endothelialization and stent thrombosis are a safety concern associated with drug-eluting stents (DES). PI3K/p110α controls cellular wound healing pathways, thereby representing an emerging drug target to modulate vascular homoeostasis after injury. METHODS AND RESULTS PI3K/p110α was inhibited by treatment with the small molecule inhibitor PIK75 or a specific siRNA. Arterial thrombosis, neointima formation, and re-endothelialization were studied in a murine carotid artery injury model. Proliferation and migration of human vascular smooth muscle cell (VSMC) and endothelial cell (EC) were assessed by cell number and Boyden chamber, respectively. Endothelial senescence was evaluated by the β-galactosidase assay, endothelial dysfunction by organ chambers for isometric tension. Arterial thrombus formation was delayed in mice treated with PIK75 when compared with controls. PIK75 impaired arterial expression and activity of tissue factor (TF) and plasminogen activator inhibitor-1 (PAI-1); in contrast, plasma clotting and platelet aggregation did not differ. In VSMC and EC, PIK75 inhibited expression and activity of TF and PAI-1. These effects occurred at the transcriptional level via the RhoA signalling cascade and the transcription factor NFkB. Furthermore, inhibition of PI3K/p110α with PIK75 or a specific siRNA selectively impaired proliferation and migration of VSMC while sparing EC completely. Treatment with PIK75 did not induce endothelial senescence nor inhibit endothelium-dependent relaxations. In line with this observation, treatment with PIK75 selectively inhibited neointima formation without affecting re-endothelialization following vascular injury. CONCLUSION Following vascular injury, PI3K/p110α inhibition selectively interferes with arterial thrombosis and neointima formation, but not re-endothelialization. Hence, PI3K/p110α represents an attractive new target in DES design.
Collapse
Affiliation(s)
- Erik W Holy
- Cardiology, Cardiovascular Center, University Hospital Zürich, Rämistrasse 100, Zurich 8091, Switzerland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Lee JM, Lee J, Jeong H, Choe WS, Seo WW, Lim WH, Kim YC, Hur J, Lee SE, Yang HM, Cho HJ, Kim HS. Development of a rabbit model for a preclinical comparison of coronary stent types in-vivo. Korean Circ J 2013; 43:713-22. [PMID: 24363745 PMCID: PMC3866309 DOI: 10.4070/kcj.2013.43.11.713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/02/2013] [Accepted: 09/03/2013] [Indexed: 01/30/2023] Open
Abstract
Along with the development of innovative stent designs, preclinical trials in animal models are essential. Many animal models have been used and appear to yield comparable results to clinical trials despite substantial criticisms about their validity. Among the animal models, porcine coronary artery models have been the standard models for the preclinical evaluation of endovascular devices. However, rapid growth rate, high body weight potential, and the propensity to develop granulomatous inflammatory reactions are major limitations of the porcine coronary artery model. Compared with porcine coronary artery models, the comparative rabbit iliac artery model has the advantages of being small and easy to handle and relatively inexpensive. Furthermore, the rabbit model has been known to reliably reflect human restenosis histopathologically and have major advantages such as pairwise comparison, which makes each animal serve as its own control subject, therefore, maximizing its statistical power for comparative testing. However, despite the widespread use of this model, a systematic description of the procedure and harvest protocols has never been published. This article describes the surgical procedure, stent implantation procedure, method for tissue harvesting, and how measurements are performed. Although the results of animal models may not perfectly extrapolate to humans, the comparative rabbit iliac artery model may be a useful tool for assessing and comparing the efficacy of new coronary stents with conventional stent systems. This thorough description of the techniques required for vascular access, stent implantation, tissue preparation, and measurement, should aid investigators wishing to begin using the comparative rabbit iliac artery model.
Collapse
Affiliation(s)
- Joo Myung Lee
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Jaewon Lee
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Heewon Jeong
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Won Seok Choe
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Won-Woo Seo
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Woo-Hyun Lim
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Young-Chan Kim
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Jin Hur
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Sang Eun Lee
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Han-Mo Yang
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jai Cho
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Soo Kim
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea. ; World Class University Program, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Korea
| |
Collapse
|
30
|
Douglas G, Van Kampen E, Hale AB, McNeill E, Patel J, Crabtree MJ, Ali Z, Hoerr RA, Alp NJ, Channon KM. Endothelial cell repopulation after stenting determines in-stent neointima formation: effects of bare-metal vs. drug-eluting stents and genetic endothelial cell modification. Eur Heart J 2012; 34:3378-88. [PMID: 23008511 PMCID: PMC3827553 DOI: 10.1093/eurheartj/ehs240] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Aims Understanding endothelial cell repopulation post-stenting and how this modulates in-stent restenosis is critical to improving arterial healing post-stenting. We used a novel murine stent model to investigate endothelial cell repopulation post-stenting, comparing the response of drug-eluting stents with a primary genetic modification to improve endothelial cell function. Methods and results Endothelial cell repopulation was assessed en face in stented arteries in ApoE−/− mice with endothelial-specific LacZ expression. Stent deployment resulted in near-complete denudation of endothelium, but was followed by endothelial cell repopulation, by cells originating from both bone marrow-derived endothelial progenitor cells and from the adjacent vasculature. Paclitaxel-eluting stents reduced neointima formation (0.423 ± 0.065 vs. 0.240 ± 0.040 mm2, P = 0.038), but decreased endothelial cell repopulation (238 ± 17 vs. 154 ± 22 nuclei/mm2, P = 0.018), despite complete strut coverage. To test the effects of selectively improving endothelial cell function, we used transgenic mice with endothelial-specific overexpression of GTP-cyclohydrolase 1 (GCH-Tg) as a model of enhanced endothelial cell function and increased NO production. GCH-Tg ApoE−/− mice had less neointima formation compared with ApoE−/− littermates (0.52 ± 0.08 vs. 0.26 ± 0.09 mm2, P = 0.039). In contrast to paclitaxel-eluting stents, reduced neointima formation in GCH-Tg mice was accompanied by increased endothelial cell coverage (156 ± 17 vs. 209 ± 23 nuclei/mm2, P = 0.043). Conclusion Drug-eluting stents reduce not only neointima formation but also endothelial cell repopulation, independent of strut coverage. In contrast, selective targeting of endothelial cell function is sufficient to improve endothelial cell repopulation and reduce neointima formation. Targeting endothelial cell function is a rational therapeutic strategy to improve vascular healing and decrease neointima formation after stenting.
Collapse
Affiliation(s)
- Gillian Douglas
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Rapamycin regulates the expression and activity of Krüppel-like transcription factor 2 in human umbilical vein endothelial cells. PLoS One 2012; 7:e43315. [PMID: 22937032 PMCID: PMC3427376 DOI: 10.1371/journal.pone.0043315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 07/19/2012] [Indexed: 02/02/2023] Open
Abstract
Background Although rapamycin has been reported to increase procoagulants and decrease anticoagulants in human umbilical vein endothelial cells (HUVECs), there is no significant difference in the incidence of stent thrombosis between patients with drug-eluting stents (DESs) and those with bare metal stents (BMSs). Krüppel-like transcription factor 2 (KLF2) has been identified as a key regulator of endothelial antithrombotic function. We hypothesized that rapamycin might induce the expression and activity of KLF2, thereby counteracting coronary endothelial dysfunction induced by DESs. Methods and Results Expression of KLF2, tissue factor (TF) and endothelial NO synthase (eNOS) were assessed in HUVECs treated with rapamycin at concentrations of 2, 20, 200 and 2000 ng/ml for 24 and 48 hours without or with thrombin. Rapamycin strongly induced the expression and activity of KLF2 in high dose groups (p<0.01). Compared with control group, the expression of TF was increased by rapamycin, which inhibited the expression of eNOS after treating for 24 hours (p<0.01). Furthermore, small-interfering RNA–mediated knockdown of KLF2 strongly magnified the ability of rapamycin to induce TF and reduce eNOS accumulation in HUVECs. Conclusions Rapamycin-dependent induction of KLF2 might partly counteract coronary endothelial dysfunction and thereby provided a novel molecular target to prevent stent thrombosis induced by DESs.
Collapse
|
32
|
Lemos PA, Takimura CK, Laurindo FRM, Gutierrez PS, Aiello VD. A histopathological comparison of different definitions for quantifying in-stent neointimal tissue: implications for the validity of intracoronary ultrasound and optical coherence tomography measurements. Cardiovasc Diagn Ther 2011; 1:3-10. [PMID: 24282681 DOI: 10.3978/j.issn.2223-3652.2011.10.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 10/27/2011] [Indexed: 11/14/2022]
Abstract
PURPOSE Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) define neointima as the tissue encompassed between the stent and the lumen boundaries. This approach differs from the gold-standard histopathology, where neointima is traditionally calculated as the tissue between the internal elastic lamina (IEL) and the lumen. We aimed to investigate whether the neointimal assessment using IVUS and OCT-like definitions would correlate with the traditional histopathological quantification of neointima. METHODS Histopathological analysis was obtained from a porcine model of 28-day coronary in-stent neointimal proliferation (n=13 bare stents). Traditional histopathology neointimal area (NIHPATH area) was calculated as the lumen area minus the IEL area, while the percent neointimal obstruction was defined as NIHPATH area divided by the IEL area. The IVUS/OCT-like neointima area (NIHIVUS/OCT area) was defined as the lumen area minus the stent area, while the percent neointimal obstruction was defined as NIHIVUS/OCT area divided by the stent area. RESULTS The neointimal area as well as the percent obstruction were significantly correlated between histopathology and IVUS/OCT-like definitions (R(2)=0.89 and 0.95 respectively; P<0.01 for both). The average absolute difference between the IVUS/OCT-like and the pathology-like measurements was close to zero, however with a relatively wide dispersion (difference for neointimal area: 0.41 mm(2) [95% CI 1.72 to (-)0.90 mm(2)]; difference for percent neointimal obstruction: 2.5% [95% CI 11.5% to (-)6.5%]). CONCLUSIONS The present findings support the use of stent area in replacement to IEL area, as in IVUS & OCT imaging protocols, for the calculation of neointimal parameters in experimental model of restenosis.
Collapse
Affiliation(s)
- Pedro A Lemos
- The Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
33
|
Ma Q, Zhou Y, Nie X, Yu M, Gao F, Wang Z, Ge H, Jia D, Yang S, Liu X, Han H, Hu B, Shen H, Xu X. Rapamycin affects tissue plasminogen activator and plasminogen activator inhibitor I expression: a potential prothrombotic mechanism of drug-eluting stents. Angiology 2011; 63:330-5. [PMID: 21900343 DOI: 10.1177/0003319711418219] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although drug-eluting stents (DESs) can decrease the risk of restenosis, this benefit is tempered by a possible increased risk of in-stent thrombosis. We assessed the effects of rapamycin on human umbilical vein endothelial cells (HUVECs) to identify the alterations in gene expression associated with thrombosis. Expression of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1) was assessed in HUVECs treated with rapamycin (final concentrations: 1, 10, 100, and 1000 ng/mL) for 24 and 48 hours. Incubation of HUVECs with rapamycin strongly reduced the expression of t-PA in a concentration-dependant manner (P < .05 to < .01). However, the expression of PAI-1 was induced by rapamycin (P < .05 to < .01). The increase in PAI-1 induction was up to 3.3-fold. In conclusion, rapamycin inhibited t-PA and induced PAI-1 expression in HUVECs. This effect may contribute to in-stent thrombosis associated with DESs.
Collapse
Affiliation(s)
- Qian Ma
- Department of Cardiology, Beijing Anzhen Hospital Affiliated to the Capital Medical University, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Grudtner MA, de Lara Elesbão JL, Gutierrez PS, Meyer FS, Pereira AH. Histological analysis of cobalt-chromium stents with and without Camouflage® polymer coating: experimental porcine carotid artery model. Vascular 2011; 19:89-96. [PMID: 21489934 DOI: 10.1258/vasc.2010.oa0268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study evaluated the arterial response to cobalt-chromium stents with and without polymer coating (Camouflage®, Hemoteq AG, Wuerselen, Germany) implanted in pigs. Cobalt-chromium balloon-expandable stents (4 × 16 mm) were implanted in the common carotid arteries of nine pigs. Histological analysis of endothelialization, inflammation and injury was performed one month later. All stents were successfully deployed, and all but one animal survived the 30 study days. All arteries were patent. Endothelialization was nearly complete in most sections of all carotid stents in both groups. There were mild inflammatory infiltrate and mild-to-moderate injury, which were associated with the stent shafts and not significantly different between groups. Our findings suggest that, in porcine carotid arteries, the histological response to balloon-expandable cobalt-chromium stents coated with polymer (Camouflage®, Hemoteq AG) is similar to the response to non-coated cobalt-chromium stents.
Collapse
|
35
|
Dohi T, Miyauchi K, Iesaki T, Tsuruta R, Tsuboi S, Ogita M, Kubota N, Kasai T, Yokoyama T, Daida H. Candesartan with pioglitazone protects against endothelial dysfunction and inflammatory responses in porcine coronary arteries implanted with sirolimus-eluting stents. Circ J 2011; 75:1098-106. [PMID: 21383515 DOI: 10.1253/circj.cj-10-0917] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sirolimus-eluting stents (SES) are widely used in coronary artery disease as revascularization therapy. Although endothelial dysfunction induced by implanted SES can become a major clinical concern, therapeutic strategies to overcome this disorder remain unclear. The aim of the present study was therefore to identify effective therapies in a clinically relevant animal model. METHODS AND RESULTS Twenty-one pigs were randomized to control, candesartan (CAN) and candesartan plus pioglitazone (CAN+PIO) groups. Drugs were administered orally for 7 days before SES implantation until the time of death. Forty-two SES were used in porcine coronary arteries. Early inflammatory cell adhesion in SES evaluated on scanning electron microscopy at 3 days was significantly suppressed in the CAN and CAN+PIO groups compared with controls. Bradykinin-induced endothelium-dependent relaxation at an adjacent segment distal to the SES evaluated using organ chambers was reduced compared with intact segments in control coronaries at 28 days. Endothelial dysfunction was reversed by CAN and even more obviously improved in the CAN+PIO group. CONCLUSIONS Candesartan protected against vascular inflammation and restored endothelial function after SES implantation. The combination of candesartan and pioglitazone was more effective than candesartan monotherapy and might confer vascular protection when administered before SES implantation.
Collapse
Affiliation(s)
- Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Braun A, Dofiles L, Rousselle S, Guerrero L, Gunther J, Yednock T, Stricker-Krongrad A, Messersmith E. Effects of an alpha-4 integrin inhibitor on restenosis in a new porcine model combining endothelial denudation and stent placement. PLoS One 2010; 5:e14314. [PMID: 21179441 PMCID: PMC3001476 DOI: 10.1371/journal.pone.0014314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 10/12/2010] [Indexed: 11/29/2022] Open
Abstract
Restenosis remains the main complication of balloon angioplasty and/or stent implantation. Preclinical testing of new pharmacologic agents preventing restenosis largely rely on porcine models, where restenosis is assessed after endothelial abrasion of the arterial wall or stent implantation. We combined endothelial cell denudation and implantation of stents to develop a new clinically relevant porcine model of restenosis, and used this model to determine the effects of an α4 integrin inhibitor, ELN 457946, on restenosis. Balloon-angioplasty endothelial cell denudation and subsequent implantation of bare metal stents in the left anterior descending coronary, iliac, and left common carotid arteries was performed in domestic pigs, treated with vehicle or ELN 457946, once weekly via subcutaneous injections, for four weeks. After 1 month, histopathology and morphometric analyses of the arteries showed complete healing and robust, consistent restenotic response in stented arteries. Treatment with ELN 457946 resulted in a reduction in the neointimal response, with decreases in area percent stenosis between 12% in coronary arteries and 30% in peripheral vessels. This is the first description of a successful pig model combining endothelial cell denudation and bare metal stent implantation. This new double injury model may prove particularly useful to assess pharmacological effects of drug candidates on restenosis, in coronary and/or peripheral arteries. Furthermore, the ELN 457946 α4 integrin inhibitor, administered subcutaneously, reduced inflammation and restenosis in stented coronary and peripheral arteries in pigs, therefore representing a promising systemic therapeutic approach in reducing restenosis in patients undergoing angioplasty and/or stent implantation.
Collapse
Affiliation(s)
- Anne Braun
- Charles River Laboratories, Preclinical Services Massachusetts, Shrewsbury, Massachusetts, United States of America.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
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: 171] [Impact Index Per Article: 12.2] [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.
Collapse
Affiliation(s)
- Robert S Schwartz
- Minneapolis Heart Institute and Foundation, 920 E. 28th Street, Suite 600, Minneapolis, MN 55407.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
O'Connell BM, McGloughlin TM, Walsh MT. Factors that affect mass transport from drug eluting stents into the artery wall. Biomed Eng Online 2010; 9:15. [PMID: 20214774 PMCID: PMC2854105 DOI: 10.1186/1475-925x-9-15] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 03/09/2010] [Indexed: 01/12/2023] Open
Abstract
Coronary artery disease can be treated by implanting a stent into the blocked region of an artery, thus enabling blood perfusion to distal vessels. Minimally invasive procedures of this nature often result in damage to the arterial tissue culminating in the re-blocking of the vessel. In an effort to alleviate this phenomenon, known as restenosis, drug eluting stents were developed. They are similar in composition to a bare metal stent but encompass a coating with therapeutic agents designed to reduce the overly aggressive healing response that contributes to restenosis. There are many variables that can influence the effectiveness of these therapeutic drugs being transported from the stent coating to and within the artery wall, many of which have been analysed and documented by researchers. However, the physical deformation of the artery substructure due to stent expansion, and its influence on a drugs ability to diffuse evenly within the artery wall have been lacking in published work to date. The paper highlights previous approaches adopted by researchers and proposes the addition of porous artery wall deformation to increase model accuracy.
Collapse
Affiliation(s)
- Barry M O'Connell
- Centre for Applied Biomedical Engineering Research, Department of Mechanical and Aeronautical Engineering and the Materials and Surface Science Institute, University of Limerick, Limerick, Ireland
| | | | | |
Collapse
|
39
|
Rodriguez-Menocal L, Wei Y, Pham SM, St-Pierre M, Li S, Webster K, Goldschmidt-Clermont P, Vazquez-Padron RI. A novel mouse model of in-stent restenosis. Atherosclerosis 2009; 209:359-66. [PMID: 19875114 DOI: 10.1016/j.atherosclerosis.2009.09.071] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 09/15/2009] [Accepted: 09/26/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS In-stent restenosis (ISR) is the major complication that occurs after percutaneous coronary interventions to facilitate coronary revascularization. Herein we described a simple and cost-effective model, which reproduces important features of ISR in the mouse. METHODS AND RESULTS Microvascular bare metal stents were successfully implanted in the abdominal aorta of atherosclerotic ApoE-null mice. Patency of implanted stents was interrogated using ultrasound biomicroscopy. Aortas were harvested at different time points after implantation and processed for histopathological analysis. Thrombus formation was histologically detected after 1 day. Leukocyte adherence and infiltration were evident after 7 days and decreased thereafter. Neointimal formation, neointimal thickness and luminal stenosis simultaneously increased up to 28 days after stent implantation. Using multichannel fluorescence molecular tomography (FMT) for spatiotemporal resolution of MMP activities, we observed that MMP activity in the stented aorta of Apo-E null mice was 2-fold higher than that of wild-type mice. Finally, we compared neointimal formation in response to stenting in two genetically different mouse strains. In-stent neointimas in FVB/NJ mice were 2-fold thicker than in C57BL/6J mice (p=0.002). CONCLUSION We have developed a model that can take advantage of the multiple genetic resources available for the mouse to study the mechanisms of in-stent restenosis.
Collapse
Affiliation(s)
- Luis Rodriguez-Menocal
- University of Miami Miller School of Medicine, 1600 NW 10th Avenue, RMSB 7147A, Miami, FL 33136, United States
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Nef HM, Möllmann H, Joseph A, Troidl C, Voss S, Rauch M, Kinscherf R, Vogt A, Weber M, Hamm CW, Elsässer A. Reduction of neointimal hyperplasia in porcine coronary arteries by 2-deoxy-D-glucose. Clin Res Cardiol 2009; 98:355-61. [PMID: 19543785 DOI: 10.1007/s00392-009-0020-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 04/16/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The drug eluting stents have been shown to play a substantial role in preventing in-stent restenosis. This study was initiated to determine the efficacy of 2-deoxy-D-glucose (2-DG) in an in-stent restenosis model for reducing neointimal hyperplasia after coronary stent placement. METHODS In a porcine overstretch model, three kinds of stents were investigated (n = 12 per group): bare metal stents (BMS), rapamycin-eluted stents (RES), and BMS after intracoronary short-term application of 2-DG (DGS). After 42 days histomorphometric and histopathological analyses were performed. RESULTS Neointimal thickness (BMS: 0.38 +/- 0.08, RES: 0.24 +/- 0.11, DGS: 0.15 +/- 0.01), area stenosis (BMS: 47.39 +/- 2.76, RES: 32.2 +/- 2.08, DGS: 29.30 +/- 2.98) did not differ after 42 days between the RES and DGS but were significantly lower as compared to BMS only. Lumen area (BMS: 3.15 +/- 1.53, RES: 4.37 +/- 1.72, DGS: 4.77 +/- 2.14) was significantly higher in the DGS group in comparison to the BMS group. The calculated injury and inflammation scores were similar and re-endothelialization was confirmed in all groups. CONCLUSIONS This study could demonstrate that in porcine stent model neointimal hyperplasia and re-endothelialization after application of 2-DG are comparable to those seen in RES. Thus, 2-DG might be a promising clinical application for coronary stent coating.
Collapse
Affiliation(s)
- Holger M Nef
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Artinger S, Deiner C, Loddenkemper C, Schwimmbeck PL, Schultheiss HP, Pels K. Complex porcine model of atherosclerosis: induction of early coronary lesions after long-term hyperlipidemia without sustained hyperglycemia. Can J Cardiol 2009; 25:e109-14. [PMID: 19340354 DOI: 10.1016/s0828-282x(09)70068-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The incidence of coronary artery disease (CAD) is still increasing in industrialized countries and it is even higher in diabetic patients. For experimental studies investigating the pathophysiology of CAD, the use of an animal model comparable with the pathological situation in patients is crucial. OBJECTIVE To develop a model of advanced coronary atherosclerosis with induction of hyperlipidemia and hyperglycemia in domestic pigs. METHODS Six pigs were fed a standard pig chow (controls), two were fed a 2% cholesterol and 17% coconut fat diet (Chol group), and two pigs received a 4% cholesterol and 17% coconut fat diet combined with streptozotocin (STZ) injections to induce diabetes (High Chol+STZ group). Serum lipid and plasma glucose values were analyzed, and histochemical staining for morphometric analysis and immunohistochemistry were performed. RESULTS Pigs on the hyperlipidemic diet had elevated mean (+/- SD) serum lipid levels (total cholesterol 5.05+/-1.45 mmol/L [Chol] and 5.03+/-2.41 mmol/L [High Chol+STZ] versus 2.09+/-0.23 mmol/L [controls]). Histopathological evaluation revealed an initial stage of coronary atherosclerosis. None of the STZ-treated pigs showed a sustained elevation of plasma glucose (mean glucose before STZ injection was 5.11+/-0.94 mmol/L and thereafter was 6.03+/-2.39 mmol/L) or a decline in pancreatic beta cells. CONCLUSIONS The current data suggest that the domestic porcine model is not suitable to create severe CAD using an atherogenic diet in combination with STZ injections for experimental interventional vascular research. This may be due to different STZ sensitivities among species. However, hyperlipidemia induced early pathological lesions in coronary arteries resembling initial stages of atherosclerosis without severe luminal narrowing.
Collapse
Affiliation(s)
- Sandra Artinger
- Department of Cardiology, Charité-Campus Benjamin Franklin, Germany
| | | | | | | | | | | |
Collapse
|
42
|
Onuki Y, Bhardwaj U, Papadimitrakopoulos F, Burgess DJ. A review of the biocompatibility of implantable devices: current challenges to overcome foreign body response. J Diabetes Sci Technol 2008; 2:1003-15. [PMID: 19885290 PMCID: PMC2769826 DOI: 10.1177/193229680800200610] [Citation(s) in RCA: 212] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In recent years, a variety of devices (drug-eluting stents, artificial organs, biosensors, catheters, scaffolds for tissue engineering, heart valves, etc.) have been developed for implantation into patients. However, when such devices are implanted into the body, the body can react to these in a number of different ways. These reactions can result in an unexpected risk for patients. Therefore, it is important to assess and optimize the biocompatibility of implantable devices. To date, numerous strategies have been investigated to overcome body reactions induced by the implantation of devices. This review focuses on the foreign body response and the approaches that have been taken to overcome this. The biological response following device implantation and the methods for biocompatibility evaluation are summarized. Then the risks of implantable devices and the challenges to overcome these problems are introduced. Specifically, the challenges used to overcome the functional loss of glucose sensors, restenosis after stent implantation, and calcification induced by implantable devices are discussed.
Collapse
Affiliation(s)
- Yoshinori Onuki
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, Connecticut
| | - Upkar Bhardwaj
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, Connecticut
| | | | - Diane J. Burgess
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, Connecticut
| |
Collapse
|
43
|
Biondi-Zoccai GG, Moretti C, Lotrionte M, Sheiban I. Safety of drug-coated stents. Expert Opin Drug Saf 2008; 7:597-606. [PMID: 18759712 DOI: 10.1517/14740338.7.5.597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Drug-coated (i.e., drug-eluting) stents (DES) are frequently used nowadays in the treatment of coronary artery disease given their superior antirestenotic effect and clear benefits in terms of reduction of repeat revascularizations and major adverse cardiac events. However, a number of safety concerns have been raised on DES. OBJECTIVE To appraise current data on the safety of DES. METHODS A thorough PubMed search was done for pertinent clinical reports on DES safety with the following string (updated December 2007): (drug(*) OR sirolimus OR paclitaxel) AND eluting(*) AND stent(*) AND (safety OR complication(*) OR thrombos(*) OR infarction) NOT (editorial[pt] OR review[pt]). RESULTS/CONCLUSION A total of 1077 citations were retrieved and appraised. The most relevant threats to DES safety were bleeding, difficulties in balloon deflation and retrieval, endothelial dysfunction and vasospasm, hypersensitivity, infection, late acquired malapposition and aneurysm formation, late restenosis, peri-procedural myocardial infarction, plaque prolapse, stent dislodgement or embolization, stent fracture, and stent thrombosis (with ensuing risk of death, myocardial infarction or arrhythmia). Of these, the most important and debated safety issue is the potentially increased risk in late stent thrombosis, which might offset the antirestenotic benefits of DES especially in patients at higher risk of thrombosis or who cannot comply with the recommended dual antiplatelet regimen. Nonetheless, further clinical studies are warranted to clarify whether these safety threats should be a concern for the large target population of patients with coronary artery disease most likely to benefit from DES implantation.
Collapse
Affiliation(s)
- Giuseppe Gl Biondi-Zoccai
- University of Turin, S. Giovanni Battista 'Molinette' Hospital, Interventional Cardiology, Division of Cardiology, Corso Bramante 88-90, 10126 Turin, Italy.
| | | | | | | |
Collapse
|
44
|
Effect of a novel drug-eluted balloon coated with genistein before stent implantation in porcine coronary arteries. Clin Res Cardiol 2008; 97:891-8. [PMID: 18777002 DOI: 10.1007/s00392-008-0705-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 08/04/2008] [Indexed: 02/05/2023]
Abstract
BACKGROUND The major drawback of stent implantation in native human coronary vessels is the occurrence of restenosis. Drug-eluting stents significantly reduce restenosis after percutaneous coronary intervention (PCI), but may be associated with persistent local inflammation involved in the restenosis mechanisms. In this setting coating coronary devices with anti-inflammatory agents represents an intriguing alternative to stent-based local drug delivery. The aim of the present study was to test in a porcine model the safety and efficacy of a novel Genistein-eluting balloon preceding coronary stenting. DESIGN Female piglets underwent PCI in a randomized fashion with either a Genistein-eluting or a standard balloon angioplasty, followed in all vessels by bare-metal stent implantation. Pigs were sacrificed at different time points to appraise safety (i.e. endothelialization) and efficacy (i.e. anti-inflammatory and anti-proliferative effects): 1, 4, and 6-8 weeks following PCI. RESULTS Overall analysis was conducted on 14 piglets. Twenty-five bare-metal stents were implanted preceded by angioplasty with a conventional balloon in 13 vessels and by the Genistein-eluted balloon in 12. No untoward effects were reported in either group. Healing and endothelialization appeared universal within 4 weeks. The Genistein-eluted balloon group disclosed a significant reduction, at four weeks from implantation, of the peri-stent inflammatory cells count (mononucleocytes 39 +/- 32 Vs. 96 +/- 29 per square millimetre, P = 0.019). This effect did not clearly translate into a trend towards a reduced neointimal hyperplasia at 6-8 weeks (0.13 +/- 0.11 Vs. 0.14 +/- 0.09, P = 0.835). CONCLUSION This study provides the first in vivo demonstration of the anti-inflammatory effects of a Genistein-eluting balloon in PCI, warranting further research including the combination of a Genistein-eluting balloon with standard drug-eluting stent.
Collapse
|
45
|
Knotts TA, Rathore N, de Pablo JJ. An entropic perspective of protein stability on surfaces. Biophys J 2008; 94:4473-83. [PMID: 18326646 PMCID: PMC2480681 DOI: 10.1529/biophysj.107.123158] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 01/22/2008] [Indexed: 11/18/2022] Open
Abstract
The interaction of proteins with surfaces regulates numerous processes in nature, science, and technology. In many applications, it is desirable to place proteins on surfaces in an active state, and tethering represents one manner in which to accomplish this. However, a clear understanding of how tether placement and design affects protein activity is lacking. Available theoretical models predict that proteins will be stabilized when tethered to substrates. Such models suggest that the surface reduces the number of states accessible to the unfolded state of the protein, thereby reducing the entropic cost of folding on the surface compared to the bulk case. Recent studies, however, have shown that this stabilization is not always seen. The purpose of this article is to determine the validity of the theory with a thorough thermodynamic analysis of the folding of peptides attached to surfaces. Configuration-temperature-density-of-states Monte Carlo simulations are used to examine the behavior of four different peptides of different secondary and tertiary structure. It is found that the surface does reduce the entropic cost of folding for tethered peptides, as the theory suggests. This effect, however, does not always translate into improved stability because the surface may also have a destabilizing enthalpic effect. The theory neglects this effect and assumes that the enthalpy of folding is the same on and off the surface. Both the enthalpic and entropic contributions to the stability are found to be topology- and tether-placement-specific; we show that stability cannot be predicted a priori. A detailed analysis of the folding of protein A shows how the same protein can be both stabilized and destabilized on a surface depending upon how the tethering enhances or hinders the ability of the peptide to form correct tertiary structures.
Collapse
Affiliation(s)
- Thomas A Knotts
- Department of Chemical Engineering, Brigham Young University, Provo, Utah, USA
| | | | | |
Collapse
|
46
|
Huang G, Zhou Z, Srinivasan R, Penn MS, Kottke-Marchant K, Marchant RE, Gupta AS. Affinity manipulation of surface-conjugated RGD peptide to modulate binding of liposomes to activated platelets. Biomaterials 2008; 29:1676-85. [PMID: 18192005 DOI: 10.1016/j.biomaterials.2007.12.015] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 12/16/2007] [Indexed: 12/21/2022]
Abstract
Platelet adhesion, activation and fibrinogen-mediated aggregation are primary events in vascular thrombosis and occlusion. An injectable delivery system that can carry thrombolytics selectively to the sites of active platelet aggregation has immense potential in minimally invasive targeted therapy of vascular occlusion. To this end we are studying liposomes surface-modified by fibrinogen-mimetic RGD motifs that can selectively target and bind integrin GPIIb-IIIa on activated platelets. Here we report liposome surface-modification with a conformationally constrained high affinity cyclic RGD motif to modulate the GPIIb-IIIa-binding capability of the liposomes. Such affinity enhancement is important for practical in vivo applications to compete with native fibrinogen towards binding GPIIb-IIIa. The platelet-binding of RGD-modified liposomes was studied by fluorescence and scanning electron microscopy, and flow cytometry, in vitro. Binding of RGD-modified liposomes was also tested in vivo in a rat carotid injury model and analyzed ex vivo by fluorescence microscopy. The results from all experiments show that cyclic RGD-liposomes bind activated platelets significantly higher compared to linear RGD-liposomes. Hence, the results establish the feasibility of modulating the platelet-targeting and binding ability of vascularly targeted liposomes by manipulating the affinity of surface-modifying ligands.
Collapse
Affiliation(s)
- Guofeng Huang
- Department of Biomedical Engineering, Case Western Reserve University, Wickenden Building, 10900 Euclid Avenue, Cleveland, OH 44106-7207, USA
| | | | | | | | | | | | | |
Collapse
|
47
|
Scheller B, Kühler M, Cremers B, Mahnkopf D, Böhm M, Boxberger M. Short- and long-term effects of a novel paclitaxel coated stent in the porcine coronary model. Clin Res Cardiol 2007; 97:118-23. [PMID: 18087665 DOI: 10.1007/s00392-007-0597-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 09/12/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Drug eluting stents (DES) are unique in allowing sustained release for weeks after a single short intervention. The challenge with DES still remaining is the combination of a biocompatible drug-eluting matrix including an antiproliferative drug showing efficacy and safety in restenosis prevention. The aim of the present animal studies was to evaluate the novel paclitaxel coated Coroflex. Please stent in the porcine coronary model. METHODS AND RESULTS Stents were implanted into LAD and CX arteries of 49 domestic pigs. After 5 days, 4 weeks, 3 months, or 6 months, the animals underwent control angiography including dissection of the stented coronary arteries for histology. After 5 days, 3 and 6 months the Coroflex. Please stent was compared with its uncoated counterpart and a paclitaxel free but polymer coated version. After 28 days, an additional group received the Taxus Express(2) stent. After 5 days, healing with the paclitaxel coated stent was comparable to the uncoated bare metal stent as reflected in a similar neointimal proliferation. Compared to the Taxus stent, the new Coroflex. Please stent showed a similar neointimal proliferation after 4 weeks. Inflammatory reaction was comparable among the bare stent and polymer coated stent groups. Paclitaxel coating was associated with a slightly increased inflammatory reaction with both DES. After 3 and 6 months, all groups showed a similar neointimal proliferation and inflammatory reaction. CONCLUSION The present porcine studies demonstrate excellent safety of the new paclitaxel coated Coroflex stent in the porcine coronary stent model.
Collapse
Affiliation(s)
- Bruno Scheller
- Klinik für Innere Medizin III (Kardiologie, Angiologie, internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg (Saar), Germany.
| | | | | | | | | | | |
Collapse
|
48
|
Doven O, Ozcan TI, Cicek D, Camsari A, Akkus N, Aytacoglu BN, Ozeren M, Camdeviren H, Cin VG. Angiographic and clinical outcome following paclitaxel-eluting stent (taxus) implantation: a single center experience. Int Heart J 2007; 47:1-12. [PMID: 16479035 DOI: 10.1536/ihj.47.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coronary stents dramatically improve acute outcomes of percutaneous coronary interventions but also induce abundant intraluminal neointimal growth. Drug-eluting stents reduce intimal hyperplasia, the main cause of in-stent restenosis. The safety and beneficial effects of paclitaxel-eluting stents (Taxus) in patients treated in daily practice remains to be defined. The aim of this study was to report the late outcomes of Taxus implantation in patients with coronary artery disease. The study population consisted of 151 patients (202 stents) who had undergone coronary Taxus stent implantation between March 2003 and May 2005. Patients were eligible for enrollment if there was symptomatic coronary artery disease or positive functional testing, and angiographic evidence of single or multivessel disease with a target lesion stenosis of 70% in a 2.0 mm vessel. The control coronary angiographies were performed after stent deployment at 12 +/- 2.8 months, and approximately 2 years of follow-up was completed. The polymer-based paclitaxel-eluting stent has been shown to be effective in reducing restenosis. Patients were followed-up for 16.7 +/- 7.4 months. All patients survived after stent implantation, but 2 (1.3%) patients experienced acute myocardial infarction after 3 and 9 months following angioplasty. Recurrent angina pectoris was observed in 3 patients. Angiographic evidence of restenosis was observed in these 5 patients. Three patients underwent angioplasty because of re- stenosis, and coronary artery bypass grafting was conducted in the other 2 patients. The results indicate that Taxus stents can be implanted with a very high success rate and have encouraging long-term angiographic and clinical results.
Collapse
Affiliation(s)
- Oben Doven
- Department of Cardiology, Mersin University, Mersin, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Charron T, Nili N, Strauss BH. The cell cycle: a critical therapeutic target to prevent vascular proliferative disease. Can J Cardiol 2007; 22 Suppl B:41B-55B. [PMID: 16498512 PMCID: PMC2780832 DOI: 10.1016/s0828-282x(06)70986-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Percutaneous coronary intervention is the preferred revascularization approach for most patients with coronary artery disease. However, this strategy is limited by renarrowing of the vessel by neointimal hyperplasia within the stent lumen (in-stent restenosis). Vascular smooth muscle cell proliferation is a major component in this healing process. This process is mediated by multiple cytokines and growth factors, which share a common pathway in inducing cell proliferation: the cell cycle. The cell cycle is highly regulated by numerous mechanisms ensuring orderly and coordinated cell division. The present review discusses current concepts related to regulation of the cell cycle and new therapeutic options that target aspects of the cell cycle.
Collapse
Affiliation(s)
| | | | - Bradley H Strauss
- Correspondence: Dr Bradley H Strauss, St Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B IW8. Telephone 416-864-5913, fax 416-864-5978, e-mail
| |
Collapse
|
50
|
Russo RJ, Silva PD, Yeager M. Coronary artery overexpansion increases neointimal hyperplasia after stent placement in a porcine model. Heart 2007; 93:1609-15. [PMID: 17639098 PMCID: PMC2095733 DOI: 10.1136/hrt.2006.105981] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine if an aggressive approach to coronary revascularisation with oversized balloons is counterproductive, we studied the effect of increasing balloon-to-artery (B:A) ratio on neointimal hyperplasia following primary stent placement using a non-atherosclerotic porcine coronary overstretch model. METHODS 60 vessels in 33 Yorkshire swine were randomly assigned to one of five B:A ratios between 1.0:1 and 1.4:1. Intravascular ultrasound (IVUS) imaging was performed before bare-metal stent placement to accurately determine vessel size, after stent placement, and at 28 days. RESULTS The mean prestent vessel diameter was 3.05 (0.31) (SD) mm. In-stent neointimal volume, in-stent volume stenosis and cross-sectional area stenosis at the stent minimum lumen diameter increased significantly with increasing achieved B:A ratio (multilevel regression test for slope, p<0.001, p = 0.002 and p<0.001, respectively) and were independent of vessel size. Even minor vessel overstretch at an achieved B:A ratio of 1.1:1 resulted in significant neointimal hyperplasia. Larger B:A ratios were also associated with more neointima beyond the stent edges (p = 0.008). For vessels from the same animal, neointimal response at a given B:A ratio was dependent upon the animal treated. CONCLUSIONS In a porcine model of IVUS-guided coronary primary stent placement, vessel overexpansion is counterproductive. Neointimal hyperplasia at 28 days is strongly associated with increasing B:A ratio. In addition, vessels do not respond independently of each other when multiple stents are placed within the same animal using a range of B:A ratios.
Collapse
Affiliation(s)
- Robert J Russo
- Division of Cardiovascular Diseases, Scripps Clinic, SW206, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA.
| | | | | |
Collapse
|