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Xu J, Ong HX, Traini D, Williamson J, Byrom M, Gomes Dos Reis L, Young PM. Paclitaxel-eluting silicone airway stent for preventing granulation tissue growth and lung cancer relapse in central airway pathologies. Expert Opin Drug Deliv 2020; 17:1631-1645. [PMID: 32815403 DOI: 10.1080/17425247.2020.1811224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Airway stents are used to treat obstructive central airway pathologies including palliation of lung cancer, but face challenges with granulation tissue growth. Paclitaxel is a chemotherapy drug that also suppresses growth of granulation tissue. Yet, side effects arise from administration with toxic solubilizers. By incorporating paclitaxel in silicone stents, delivery of paclitaxel can be localized, and side effects minimized. METHODS Paclitaxel was incorporated into Liquid Silicone Rubber (LSR) containing polydimethylsiloxane, either as a powder or solution, prior to curing. Drug release study was compared in vitro at 37°C over 10 days. Drug release was quantified using HPLC, and bronchial cell lines were grown on LSR to investigate drug cytotoxicity, and expression of inflammatory markers, specifically interleukin-6 and interleukin-8. RESULTS Release rate of paclitaxel incorporated into silicone rubber was consistent with the Korsmeyer and Weibull models (R2 > 0.96). Paclitaxel exposure reduced IL-8 levels in cancer cell lines, whilst no cytotoxic effect was observed in all cell lines at treatment concentration levels (≤ 0.1% (w/v) paclitaxel in silicone). CONCLUSIONS Incorporating paclitaxel into a silicone matrix for future use in a tracheobronchial stent was investigated. Drug release from silicone was observed and is a promising avenue for future treatments of central airway pathologies.
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Affiliation(s)
- Jesse Xu
- Respiratory Technology Group, Woolcock Institute of Medical Research , Sydney, Australia.,Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney , Sydney, Australia
| | - Hui Xin Ong
- Respiratory Technology Group, Woolcock Institute of Medical Research , Sydney, Australia.,Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney , Sydney, Australia
| | - Daniela Traini
- Respiratory Technology Group, Woolcock Institute of Medical Research , Sydney, Australia.,Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney , Sydney, Australia
| | - Jonathan Williamson
- South West Clinical School, The University of New South Wales , Sydney, Australia.,MQ Health, Respiratory and Sleep, Macquarie University , Sydney, Australia
| | - Michael Byrom
- RPA Institute of Academic Surgery , Sydney, Australia
| | - Larissa Gomes Dos Reis
- Respiratory Technology Group, Woolcock Institute of Medical Research , Sydney, Australia
| | - Paul M Young
- Respiratory Technology Group, Woolcock Institute of Medical Research , Sydney, Australia.,Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney , Sydney, Australia
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Xu J, Ong HX, Traini D, Byrom M, Williamson J, Young PM. The utility of 3D-printed airway stents to improve treatment strategies for central airway obstructions. Drug Dev Ind Pharm 2018; 45:1-10. [PMID: 30207189 DOI: 10.1080/03639045.2018.1522325] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Airway stents are commonly used in the management of patients suffering from central airway obstruction (CAO). CAO may occur directly from airway strictures, obstructing airway cancers, airway fistulas or tracheobronchomalacia, resulting from the weakening and dynamic collapse of the airway wall. Current airway stents are constructed from biocompatible medical-grade silicone or from a nickel-titanium (nitinol) alloy with fixed geometry. The stents are inserted via the mouth during a bronchoscopic procedure. Existing stents have many shortcomings including the development of obstructing granulation tissue in the weeks and months following placement, mucous build up within the stent, and cough. Furthermore, airway stents are expensive and, if improperly sized for a given airway, may be easily dislodged (stent migration). Currently, in Australia, it is estimated that approximately 12,000 patients will develop CAO annually, many of whom will require airway stenting intervention. Of all stenting procedures, the rate of failure is currently reported to be at 22%. With a growing incidence of lung cancer prevalence globally, the need for updating airway stent technology is now greater than ever and personalizing stents using 3D-printing technology may offer the best chance of addressing many of the current limitations in stent design. This review article will assess what represents the gold standard in stent manufacture with regards to treatment of tracheobronchial CAO, the challenges of current airway stents, and outlines the necessity and challenges of incorporating 3D-printing technology into personalizing airway stents today.
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Affiliation(s)
- Jesse Xu
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Hui X Ong
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Daniela Traini
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Michael Byrom
- d RPA Institute of Academic Surgery , Sydney , NSW , Australia
| | - Jonathan Williamson
- e MO Respiratory and Sleep, Macquarie University Hospital and Clinic , Macquarie University , Sydney , NSW , Australia.,f Respiratory, Sleep and Environmental and Occupational Health (RSEOH) , The Ingham Institute of Applied Medical Research , Sydney , NSW , Australia
| | - Paul M Young
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
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Dhillon SS, Saoud M, Harris K. Complex multimodality central airway management of aspergillus pseudomembranous tracheobronchitis. J Thorac Dis 2017; 9:915-919. [PMID: 28523137 DOI: 10.21037/jtd.2017.03.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 69-year-old woman developed central airway obstruction due to invasive Aspergillus infection resulting in pseudomembranous tracheobronchitis (PTB). Several challenges were encountered in the airway management of this patient including her having relatively smaller airways which were more prone to obstruction by pseudomembranes and made airway interventions difficult. The patient had clinical deterioration in spite of antifungal therapy and bronchoscopic debridement. The multimodality airway techniques included the use of smaller biliary balloons for dilatation, using a hybrid stent to slowly dilate and maintain patency of right main stem and finally the insertion of right secondary carina peripheral Y stent, which resulted in clinical improvement and allowed time for antifungal therapy to take effect. To the best of our knowledge, the use of a peripheral Y stent has never been described in the setting of PTB.
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Affiliation(s)
- Samjot Singh Dhillon
- Department of Medicine, Pulmonary Medicine/Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Pulmonary, Critical and Sleep Medicine, State University of New York (SUNY), Buffalo, NY, USA
| | - Marwan Saoud
- Department of Medicine, State University of New York (SUNY), Buffalo, NY, USA
| | - Kassem Harris
- Department of Pulmonary, Critical Care and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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Dutau H, Musani AI, Plojoux J, Laroumagne S, Astoul P. The use of self-expandable metallic stents in the airways in the adult population. Expert Rev Respir Med 2014; 8:179-90. [PMID: 24450436 DOI: 10.1586/17476348.2014.880055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.
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Affiliation(s)
- Herve Dutau
- North University Hospital, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, 13015 France
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