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Gregory EK, Webb A, Vercammen JM, Kelly ME, Akar B, van Lith R, Bahnson EM, Jiang W, Ameer GA, Kibbe MR. Inhibiting intimal hyperplasia in prosthetic vascular grafts via immobilized all-trans retinoic acid. J Control Release 2018; 274:69-80. [PMID: 29391231 PMCID: PMC5847482 DOI: 10.1016/j.jconrel.2018.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/15/2017] [Accepted: 01/22/2018] [Indexed: 12/24/2022]
Abstract
Peripheral arterial disease is a leading cause of morbidity and mortality. The most commonly utilized prosthetic material for peripheral bypass grafting is expanded polytetrafluoroethylene (ePTFE) yet it continues to exhibit poor performance from restenosis due to neointimal hyperplasia, especially in femoral distal bypass procedures. Recently, we demonstrated that periadventitial delivery of all-trans retinoic acid (atRA) immobilized throughout porous poly(1,8 octamethylene citrate) (POC) membranes inhibited neointimal formation in a rat arterial injury model. Thus, the objective of this study was to investigate whether atRA immobilized throughout the lumen of ePTFE vascular grafts would inhibit intimal formation following arterial bypass grafting. Utilizing standard ePTFE, two types of atRA-containing ePTFE vascular grafts were fabricated and evaluated: grafts whereby all-trans retinoic acid was directly immobilized on ePTFE (atRA-ePTFE) and grafts where all-trans retinoic acid was immobilized onto ePTFE grafts coated with POC (atRA-POC-ePTFE). All grafts were characterized by SEM, HPLC, and FTIR and physical characteristics were evaluated in vitro. Modification of these grafts, did not significantly alter their physical characteristics or biocompatibility, and resulted in inhibition of intimal formation in a rat aortic bypass model, with atRA-POC-ePTFE inhibiting intimal formation at both the proximal and distal graft sections. In addition, treatment with atRA-POC-ePTFE resulted in increased graft endothelialization and decreased inflammation when compared to the other treatment groups. This work further confirms the biocompatibility and efficacy of locally delivered atRA to inhibit intimal formation in a bypass setting. Thus, atRA-POC-ePTFE grafts have the potential to improve patency rates in small diameter bypass grafts and warrant further investigation.
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Affiliation(s)
- Elaine K Gregory
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States; Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, United States
| | - Antonio Webb
- The University of Florida, Gainesville, FL 32611, United States
| | - Janet M Vercammen
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States; Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, United States
| | - Megan E Kelly
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States; Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, United States
| | - Banu Akar
- Biomedical Engineering Department, McCormick School of Engineering, Northwestern University, Evanston, IL 60201, United States
| | - Robert van Lith
- Biomedical Engineering Department, McCormick School of Engineering, Northwestern University, Evanston, IL 60201, United States; Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, United States
| | - Edward M Bahnson
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Wulin Jiang
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States; Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, United States
| | - Guillermo A Ameer
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States; Biomedical Engineering Department, McCormick School of Engineering, Northwestern University, Evanston, IL 60201, United States; Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, United States
| | - Melina R Kibbe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States; Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, United States; Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
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Gregory EK, Webb AR, Vercammen JM, Flynn ME, Ameer GA, Kibbe MR. Periadventitial atRA citrate-based polyester membranes reduce neointimal hyperplasia and restenosis after carotid injury in rats. Am J Physiol Heart Circ Physiol 2014; 307:H1419-29. [PMID: 25239800 DOI: 10.1152/ajpheart.00914.2013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral all-trans retinoic acid (atRA) has been shown to reduce the formation of neointimal hyperplasia; however, the dose required was 30 times the chemotherapeutic dose, which already has reported side effects. As neointimal formation is a localized process, new approaches to localized delivery are required. This study assessed whether atRA within a citrate-based polyester, poly(1,8 octanediolcitrate) (POC), perivascular membrane would prevent neointimal hyperplasia following arterial injury. atRA-POC membranes were prepared and characterized for atRA release via high-performance liquid chromatography with mass spectrometry detection. Rat adventitial fibroblasts (AF) and vascular smooth muscle cells (VSMC) were exposed to various concentrations of atRA; proliferation, apoptosis, and necrosis were assessed in vitro. The rat carotid artery balloon injury model was used to evaluate the impact of the atRA-POC membranes on neointimal formation, cell proliferation, apoptosis, macrophage infiltration, and vascular cell adhesion molecule 1 (VCAM-1) expression in vivo. atRA-POC membranes released 12 μg of atRA over 2 wk, with 92% of the release occurring in the first week. At 24 h, atRA (200 μmol/l) inhibited [(3)H]-thymidine incorporation into AF and VSMC by 78% and 72%, respectively (*P = 0.001), with negligible apoptosis or necrosis. Histomorphometry analysis showed that atRA-POC membranes inhibited neointimal formation after balloon injury, with a 56%, 57%, and 50% decrease in the intimal area, intima-to-media area ratio, and percent stenosis, respectively (P = 0.001). atRA-POC membranes had no appreciable effect on apoptosis or proliferation at 2 wk. Regarding biocompatibility, we found a 76% decrease in macrophage infiltration in the intima layer (P < 0.003) in animals treated with atRA-POC membranes, with a coinciding 53% reduction in VCAM-1 staining (P < 0.001). In conclusion, perivascular delivery of atRA inhibited neointimal formation and restenosis. These data suggest that atRA-POC membranes may be suitable as localized therapy to inhibit neointimal hyperplasia following open cardiovascular procedures.
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Affiliation(s)
- Elaine K Gregory
- Division of Vascular Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Simpson Querrey Institute for Bionanotechnology, Northwestern University, Chicago, Illinois
| | - Antonio R Webb
- Biomedical Engineering Department, McCormick School of Engineering, Northwestern University, Evanston, Illinois; Simpson Querrey Institute for Bionanotechnology, Northwestern University, Chicago, Illinois; VesselTek Biomedical, Chicago, Illinois; University of Florida, Gainesville, Florida
| | - Janet M Vercammen
- Division of Vascular Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Simpson Querrey Institute for Bionanotechnology, Northwestern University, Chicago, Illinois
| | - Megan E Flynn
- Division of Vascular Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Simpson Querrey Institute for Bionanotechnology, Northwestern University, Chicago, Illinois
| | - Guillermo A Ameer
- Biomedical Engineering Department, McCormick School of Engineering, Northwestern University, Evanston, Illinois; Simpson Querrey Institute for Bionanotechnology, Northwestern University, Chicago, Illinois
| | - Melina R Kibbe
- Division of Vascular Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Simpson Querrey Institute for Bionanotechnology, Northwestern University, Chicago, Illinois;
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