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Moradi MR, Salahinejad E, Sharifi E, Tayebi L. Controlled drug delivery from chitosan-coated heparin-loaded nanopores anodically grown on nitinol shape-memory alloy. Carbohydr Polym 2023; 314:120961. [PMID: 37173015 PMCID: PMC10585653 DOI: 10.1016/j.carbpol.2023.120961] [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] [Received: 01/29/2023] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
Nitinol (NiTi shape-memory alloy) is an interesting candidate in various medical applications like dental, orthopedic, and cardiovascular devices, owing to its unique mechanical behaviors and proper biocompatibility. The aim of this work is the local controlled delivery of a cardiovascular drug, heparin, loaded onto nitinol treated by electrochemical anodizing and chitosan coating. In this regard, the structure, wettability, drug release kinetics, and cell cytocompatibility of the specimens were analyzed in vitro. The two-stage anodizing process successfully developed a regular nanoporous layer of Ni-Ti-O on nitinol, which considerably decreased the sessile water contact angle and induced hydrophilicity. The application of the chitosan coatings controlled the release of heparin mainly by a diffusional mechanism, where the drug release mechanisms were evaluated by the Higuchi, first-order, zero-order, and Korsmeyer-Pepass models. Human umbilical cord endothelial cells (HUVECs) viability assay also showed the non-cytotoxicity of the samples, so that the best performance was found for the chitosan-coated samples. It is concluded that the designed drug delivery systems are promising for cardiovascular, particularly stent applications.
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Affiliation(s)
- M R Moradi
- Faculty of Materials Science and Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - E Salahinejad
- Faculty of Materials Science and Engineering, K. N. Toosi University of Technology, Tehran, Iran.
| | - E Sharifi
- Department of Tissue Engineering and Biomaterials, School of Advanced Medical Sciences and Technologies, Hamadan University of Medical Sciences, Hamadan, Iran
| | - L Tayebi
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA
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2
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Beshchasna N, Saqib M, Kraskiewicz H, Wasyluk Ł, Kuzmin O, Duta OC, Ficai D, Ghizdavet Z, Marin A, Ficai A, Sun Z, Pichugin VF, Opitz J, Andronescu E. Recent Advances in Manufacturing Innovative Stents. Pharmaceutics 2020; 12:E349. [PMID: 32294908 PMCID: PMC7238261 DOI: 10.3390/pharmaceutics12040349] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases are the most distributed cause of death worldwide. Stenting of arteries as a percutaneous transluminal angioplasty procedure became a promising minimally invasive therapy based on re-opening narrowed arteries by stent insertion. In order to improve and optimize this method, many research groups are focusing on designing new or improving existent stents. Since the beginning of the stent development in 1986, starting with bare-metal stents (BMS), these devices have been continuously enhanced by applying new materials, developing stent coatings based on inorganic and organic compounds including drugs, nanoparticles or biological components such as genes and cells, as well as adapting stent designs with different fabrication technologies. Drug eluting stents (DES) have been developed to overcome the main shortcomings of BMS or coated stents. Coatings are mainly applied to control biocompatibility, degradation rate, protein adsorption, and allow adequate endothelialization in order to ensure better clinical outcome of BMS, reducing restenosis and thrombosis. As coating materials (i) organic polymers: polyurethanes, poly(ε-caprolactone), styrene-b-isobutylene-b-styrene, polyhydroxybutyrates, poly(lactide-co-glycolide), and phosphoryl choline; (ii) biological components: vascular endothelial growth factor (VEGF) and anti-CD34 antibody and (iii) inorganic coatings: noble metals, wide class of oxides, nitrides, silicide and carbide, hydroxyapatite, diamond-like carbon, and others are used. DES were developed to reduce the tissue hyperplasia and in-stent restenosis utilizing antiproliferative substances like paclitaxel, limus (siro-, zotaro-, evero-, bio-, amphi-, tacro-limus), ABT-578, tyrphostin AGL-2043, genes, etc. The innovative solutions aim at overcoming the main limitations of the stent technology, such as in-stent restenosis and stent thrombosis, while maintaining the prime requirements on biocompatibility, biodegradability, and mechanical behavior. This paper provides an overview of the existing stent types, their functionality, materials, and manufacturing conditions demonstrating the still huge potential for the development of promising stent solutions.
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Affiliation(s)
- Natalia Beshchasna
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Maria-Reiche-Str. 2, 01109 Dresden, Germany; (M.S.); (J.O.)
| | - Muhammad Saqib
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Maria-Reiche-Str. 2, 01109 Dresden, Germany; (M.S.); (J.O.)
| | | | - Łukasz Wasyluk
- Balton Sp. z o.o. Modlińska 294, 03-152 Warsaw, Poland; (H.K.); (Ł.W.)
| | - Oleg Kuzmin
- VIP Technologies, Prospect Academicheskiy 8/2, 634055 Tomsk, Russia;
| | - Oana Cristina Duta
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
| | - Denisa Ficai
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
| | - Zeno Ghizdavet
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
| | - Alexandru Marin
- Department of Hydraulics, Hydraulic Machinery and Environmental Engineering, Faculty of Power Engineering, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania;
| | - Anton Ficai
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
- Academy of Romanian Scientists, Spl. Independentei 54, 050094 Bucharest, Romania
| | - Zhilei Sun
- Research School of High-Energy Physics, Tomsk Polytechnic University, Lenin Avenue 30, 634050 Tomsk, Russia;
| | - Vladimir F. Pichugin
- Research School of High-Energy Physics, Tomsk Polytechnic University, Lenin Avenue 30, 634050 Tomsk, Russia;
| | - Joerg Opitz
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Maria-Reiche-Str. 2, 01109 Dresden, Germany; (M.S.); (J.O.)
| | - Ecaterina Andronescu
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
- Academy of Romanian Scientists, Spl. Independentei 54, 050094 Bucharest, Romania
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Delattre C, Velazquez D, Roques C, Pavon-Djavid G, Ollivier V, Lokajczyk A, Avramoglou T, Gueguen V, Louedec L, Caligiuri G, Jandrot-Perrus M, Boisson-Vidal C, Letourneur D, Meddahi-Pelle A. In vitro and in vivo evaluation of a dextran-graft-polybutylmethacrylate copolymer coated on CoCr metallic stent. ACTA ACUST UNITED AC 2019; 9:25-36. [PMID: 30788257 PMCID: PMC6378099 DOI: 10.15171/bi.2019.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
Abstract
Introduction: The major complications of stent implantation are restenosis and late stent thrombosis. PBMA polymers are used for stent coating because of their mechanical properties. We previously synthesized and characterized Dextrangraft-polybutylmethacrylate copolymer (Dex-PBMA) as a potential stent coating. In this study, we evaluated the haemocompatibility and biocompatibility properties of Dex-PBMA in vitro and in vivo. Methods: Here, we investigated: (1) the effectiveness of polymer coating under physiological conditions and its ability to release Tacrolimus®, (2) the capacity of Dex-PBMA to inhibit Staphylococcus aureus adhesion, (3) the thrombin generation and the human platelet adhesion in static and dynamic conditions, (4) the biocompatibility properties in vitro on human endothelial colony forming cells ( ECFC) and on mesenchymal stem cells (MSC) and in vivo in rat models, and (5) we implanted Dex-PBMA and Dex-PBMATAC coated stents in neointimal hyperplasia restenosis rabbit model. Results: Dex-PBMA coating efficiently prevented bacterial adhesion and release Tacrolimus®. Dex-PBMA exhibit haemocompatibility properties under flow and ECFC and MSC compatibility. In vivo, no pathological foreign body reaction was observed neither after intramuscular nor intravascular aortic implantation. After Dex-PBMA and Dex-PBMATAC coated stents 30 days implantation in a restenosis rabbit model, an endothelial cell coverage was observed and the lumen patency was preserved. Conclusion: Based on our findings, Dex-PBMA exhibited vascular compatibility and can potentially be used as a coating for metallic coronary stents.
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Affiliation(s)
- Cécilia Delattre
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat
| | - Diego Velazquez
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat
| | - Caroline Roques
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat.,Université Paris 13, Sorbonne Paris Cité, France
| | - Graciela Pavon-Djavid
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat.,Université Paris 13, Sorbonne Paris Cité, France
| | - Véronique Ollivier
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat.,Université Paris 13, Sorbonne Paris Cité, France
| | - Anna Lokajczyk
- Inserm UMR_S1140, Paris France.,Université Paris Descartes, Sorbonne Paris Cité, France
| | - Thierry Avramoglou
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat.,Université Paris 13, Sorbonne Paris Cité, France
| | - Virginie Gueguen
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat.,Université Paris 13, Sorbonne Paris Cité, France
| | - Liliane Louedec
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat.,Université Paris 13, Sorbonne Paris Cité, France
| | - Giuseppina Caligiuri
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat.,Université Paris 13, Sorbonne Paris Cité, France
| | - Martine Jandrot-Perrus
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat.,Université Paris 13, Sorbonne Paris Cité, France
| | | | - Didier Letourneur
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat.,Université Paris 13, Sorbonne Paris Cité, France
| | - Anne Meddahi-Pelle
- INSERM, UMR_S1148, Laboratory for Vascular Translational Sciences, Hôpital Bichat.,Université Paris 13, Sorbonne Paris Cité, France
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Abstract
Cardiovascular complications are leading causes of most fatalities. Coronary artery disease and surgical failures contribute to the death of the majority of patients. Advanced research in the field of medical devices like stents has efficiently resolved these problems. Clinically, drug-eluting stents have proven their efficacy and safety compared to bare metal stents, which have problems of in-stent restenosis. However, drug-loaded stents coated with polymers have shown adverse effects related to the stability and deterioration of the polymer coating over time. This results in late stent thrombosis and immunogenicity. These reasons laid the foundation for the development of non-polymeric drug-eluting stents. This review focuses on non-polymer drug-eluting stents loaded with different drugs like anti-inflammatory agents, anti-thrombotic, anti-platelet agents, immune suppressants and others. Surface modification techniques on stents like crystalline coating; microporous, macroporous, and nanoporous coatings; and chemically modified self-assembled monolayers are described in detail. There is also an update on clinically approved products and those under development.
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Affiliation(s)
- Nagavendra Kommineni
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500037, India
| | - Raju Saka
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500037, India
| | - Wahid Khan
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500037, India.
| | - Abraham J Domb
- School of Pharmacy-Faculty of Medicine, The Hebrew University of Jerusalem, 91120, Jerusalem, Israel.
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5
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Jha KC, Bekele S, Dhinojwala A, Tsige M. Hydrogen bond directed surface dynamics at tactic poly(methyl methacrylate)/water interface. SOFT MATTER 2017; 13:8556-8564. [PMID: 29095477 DOI: 10.1039/c7sm01959a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The complexity of induced ordering for tactic poly(methyl methacrylate) (PMMA) thin films in contact with water is examined through all-atom molecular dynamics with validated potentials. We observe that for the water molecules that are hydrogen bonded to the PMMA surface, the isotactic and atactic PMMA show a 33% longer relaxation time compared to syndiotactic PMMA. Almost 94% of hydrogen bonds are with the carbonyl groups of PMMA, irrespective of temperature and tacticity. The stability in re-orientation and nature of hydrogen bond participation for the carbonyl groups as well as about 20% higher interaction energies of carbonyl group hydrogen bonded with water for atactic form indicates existence of cooperative effects. Quantifying the dynamics of hydrogen bond at the tactic interface is important in understanding the role tacticity plays in controlling adhesion and biocompatibility, a design choice that has been gaining ground in the soft material science community.
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Affiliation(s)
- Kshitij C Jha
- Department of Polymer Science, The University of Akron, Akron, Ohio 44325, USA.
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6
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Vesga B, Hernandez H, Higuera S, Gasior P, Echeveri D, Delgado JA, Dager A, Arana C, Simonton C, Maehara A, Palmaz J, Granada JF. Biological effect of microengineered grooved stents on strut healing: a randomised OCT-based comparative study in humans. Open Heart 2017; 4:e000521. [PMID: 28674616 PMCID: PMC5471868 DOI: 10.1136/openhrt-2016-000521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/20/2016] [Accepted: 03/29/2017] [Indexed: 11/12/2022] Open
Abstract
Objective To evaluate the biological effect of microengineered stent grooves (MSG) on early strut healing in humans by performing optical coherence tomography (OCT) analysis 3 weeks following the implantation. Background In the experimental setting, MSG accelerate endothelial cell migration and reduce neointimal proliferation compared with bare metal stent (BMS). Methods A total of 37 patients undergoing percutaneous coronary intervention with de novo coronary lesions were randomly assigned to either MSG (n=19) or an identical BMS controls (n=18). All patients underwent OCT imaging at 3 weeks. A total of 7959 struts were included in the final analysis. Results At 3 weeks following stent implantation, almost all struts analysed (~97%) had evidence of tissue coverage. The percentage of partially covered struts was comparable between both groups. However, the percentage of fully embedded struts was higher in the BMS group (81.22%, 49.75–95.52) compared with the MSG group (74.21%, 58.85–86.38). The stent-level analysis demonstrated reduction in neointimal formation (neointimal hyperplasia area and volume reduction of ~14% and ~19%, respectively) in the MSG versus the BMS group. In the strut-level analysis, an even greater reduction (~22% in neointimal thickness) was seen in the MSG group. Layered neointimal was present in ~6% of the OCT frames in the BMS group while it was not present in the MSG group. Conclusions MSG induced a more homogeneous and predictable pattern of surface healing in the early stages following stent implantation. The biological effect of MSG on stent healing has the potential to improve the safety profile of current generation drug-eluting stents. Classifications BMS, OCT, clinical trials.
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Affiliation(s)
- Boris Vesga
- Universidad Industrial de Santander, Bucaramanga, Colombia.,Instituto del Corazon de Bucaramanga, Bucaramanga, Colombia
| | - Hector Hernandez
- Universidad Industrial de Santander, Bucaramanga, Colombia.,Instituto del Corazon de Bucaramanga, Bucaramanga, Colombia
| | - Sergio Higuera
- Universidad Industrial de Santander, Bucaramanga, Colombia.,Instituto del Corazon de Bucaramanga, Bucaramanga, Colombia
| | - Pawel Gasior
- CRF-Skirball Center for Innovation, Orangeburg, New York, USA.,3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Dario Echeveri
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota, Colombia
| | | | | | | | | | - Akiko Maehara
- Cardiology, Cardiovascular Research Foundation/Columbia University Medical Center, New York, USA
| | | | - Juan F Granada
- Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, New York, USA
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7
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Chen W, Habraken TCJ, Hennink WE, Kok RJ. Polymer-Free Drug-Eluting Stents: An Overview of Coating Strategies and Comparison with Polymer-Coated Drug-Eluting Stents. Bioconjug Chem 2015; 26:1277-88. [PMID: 26041505 DOI: 10.1021/acs.bioconjchem.5b00192] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Clinical evaluations have proven the efficacy of drug-elution stents (DES) in reduction of in-stent restenosis rates as compared to drug-free bare metal stents (BMS). Typically, DES are metal stents that are covered with a polymer film loaded with anti-inflammatory or antiproliferative drugs that are released in a sustained manner. However, although favorable effects of the released drugs have been observed, the polymer coating as such has been associated with several adverse clinical effects, such as late stent thrombosis. Elimination of the polymeric carrier of DES may therefore potentially lead to safer DES. Several technologies have been developed to design polymer-free DES, such as the use of microporous stents and inorganic coatings that can be drug loaded. Several drugs, including sirolimus, tacrolimus, paclitaxel, and probucol have been used in the design of carrier-free stents. Due to the function of the polymeric coating to control the release kinetics of a drug, polymer-free stents are expected to have a faster drug elution rate, which may affect the therapeutic efficacy. However, several polymer-free stents have shown similar efficacy and safety as the first-generation DES, although the superiority of polymer-free DES has not been established in clinical trials.
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Affiliation(s)
- Weiluan Chen
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Tom C J Habraken
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Wim E Hennink
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Robbert J Kok
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
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8
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Puranik AS, Dawson ER, Peppas NA. Recent advances in drug eluting stents. Int J Pharm 2012; 441:665-79. [PMID: 23117022 DOI: 10.1016/j.ijpharm.2012.10.029] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 12/18/2022]
Abstract
One of the most common medical interventions to reopen an occluded vessel is the implantation of a coronary stent. While this method of treatment is effective initially, restenosis, or the re-narrowing of the artery frequently occurs largely due to neointimal hyperplasia of smooth muscle cells. Drug eluting stents were developed in order to provide local, site-specific, controlled release of drugs that can inhibit neointima formation. By implementing a controlled release delivery system it may be possible to control the time release of the pharmacological factors and thus be able to bypass some of the critical events associated with stent hyperplasia and prevent the need for subsequent intervention. However, since the advent of first-generation drug eluting stents, long-term adverse effects have raised concerns regarding their safety. These limitations in safety and efficacy have triggered considerable research in developing biodegradable stents and more potent drug delivery systems. In this review, we shed light on the current state-of-the-art in drug eluting stents, problems related to them and highlight some of the ongoing research in this area.
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Affiliation(s)
- Amey S Puranik
- Department of Chemical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
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9
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Tzafriri AR, Groothuis A, Price GS, Edelman ER. Stent elution rate determines drug deposition and receptor-mediated effects. J Control Release 2012; 161:918-26. [PMID: 22642931 DOI: 10.1016/j.jconrel.2012.05.039] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/16/2012] [Accepted: 05/19/2012] [Indexed: 10/28/2022]
Abstract
Drug eluting stent designs abound and yet the dependence of efficacy on drug dose and elution duration remains unclear. We examined these issues within a mathematical framework of arterial drug distribution and receptor binding following stent elution. Model predictions that tissue content linearly tracks stent elution rate were validated in porcine coronary artery sirolimus-eluting stents implants. Arterial content varied for stent types, progressively declining from its Day 1 peak and tracking with rate-limiting drug elution--near zero-order release was three-fold more efficient at depositing drug in the stented lesion than near first-order release. In vivo data were consistent with an overabundance of non-specific sirolimus-binding sites relative to the specific receptors and to the delivered dose. The implication is that the persistence time of receptor saturation and effect is more sensitive to duration of elution than to eluted amount. Consequently, the eluted amount should be sufficiently high to saturate receptors at the target lesion, but dose escalation alone is an inefficient strategy for prolonging the duration of sirolimus deposition. Moreover, receptor saturating drug doses are predicted to be most efficacious when eluted from stents in a constant zero order fashion as this maximizes the duration of elution and receptor saturation.
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10
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Aslanabadi N, Separham A, Beheshti R, Ghaffari S, Sohrabi B. OPTIMA Tacrolimus-eluting Stent: A Twelve-month Clinical Follow up with Two Different Periods of Dual Antiplatelet Therapy; 2-month vs. 6-month Approach. J Cardiovasc Thorac Res 2012; 4:81-4. [PMID: 24250991 DOI: 10.5681/jcvtr.2012.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 07/02/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There are limited data comparing long-term efficacy and safety of OPTIMA tacrolimus-eluting stent (TES) with Dual Antiplatelet Therapy (DAT) in daily practice. Therefore, we evaluated the safety and performance of OPTIMA TES with 2 or 6-month dual antiplatelet therapy in a 12-month follow up period. METHODS In a prospective, non-randomized single center registry in which 106 patients that underwent percutaneous coronary intervention with the OPTIMA TES between January 2010 and February 2011 were enrolled. After stenting, 62 patients received DAT for 2 months and the remainder for 6 months. Major Adverse Cardiac Events (MACE), stent thrombosis rate and target lesion revascularization (TLR) were evaluated in a 12-month follow-up period for 2-and 6-month DAT groups. RESULTS No cases with death, MI or stent thrombosis were observed within the 12-month follow-up period in either of the groups. TLR and MACE rates were higher in 6-month DAT group compared to 2-month group (6.8% vs. 3.2% respectively, P=0.001) which may be due to this group having more diffuse disease (23.60±5.69 vs. 20.88±5.14, P=0.018). CONCLUSION OPTIMA tacrolimus-eluting stent is safe and efficient with short term DAT period. A randomized trial is needed for better evaluations of OPTIMA TES in daily clinical practice.
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Affiliation(s)
- Nasser Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences,Tabriz,Iran
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11
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Reduced antiplatelet therapy after drug-eluting stenting: Multicenter janus flex carbostent implantation with short dual antiplatelet treatment for 2 or 6 months-matrix study. Catheter Cardiovasc Interv 2011; 80:408-16. [DOI: 10.1002/ccd.23223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 04/24/2011] [Indexed: 01/21/2023]
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12
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Inhibition of Neointimal Hyperplasia With a Novel Tacrolimus-Eluting Suture. J Am Coll Cardiol 2011; 58:441-2. [DOI: 10.1016/j.jacc.2011.02.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 02/14/2011] [Accepted: 02/18/2011] [Indexed: 11/23/2022]
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de Prado AP, Pérez-Martínez C, Cuellas-Ramón C, Gonzalo-Orden JM, Regueiro-Purriños M, Martínez B, García-Iglesias MJ, Ajenjo JM, Altónaga JR, Diego-Nieto A, de Miguel A, Fernández-Vázquez F. Time course of reendothelialization of stents in a normal coronary swine model: characterization and quantification. Vet Pathol 2011; 48:1109-17. [PMID: 21393629 DOI: 10.1177/0300985811400446] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Late thrombosis of coronary drug-eluting stents is an infrequent but serious complication of percutaneous transluminal coronary angioplasty. The best predictor of this event is the lack of endothelialization of stent struts. The objective of this study is to characterize and quantify the time course of endothelialization of different stents implanted in nonatherosclerotic swine coronary arteries. Thirty-three Carbofilm-coated stents were implanted percutaneously in 11 anesthetized domestic, crossbred pigs (weight 25 ± 3 kg, 2 months old). Each animal received 1 stainless steel stent (SS), 1 cobalt-chromium stent (CCS), and 1 tacrolimus-eluting stent (TES) in each coronary artery. Follow-up periods were 1 day (n = 9 stents), 3 days (n = 9 stents), and 7 days (n = 15 stents). Longitudinal sections of the stented vessels were examined using scanning electron microscopy. At 1 day, there was scarce, patchy endothelialization with areas of fibrin; the endothelialization rate was similar for all the stents (SS, 29% ± 23%; CCS, 29% ± 24%; TES, 31% ± 25%; P = .9). At 3 days, there were more endothelial cells but with immature features and giant cells over fibrin; the endothelialization was greater in SS and CCS than in TES (SS, 79% ± 14%; CCS, 81% ± 17%; TES, 46% ± 9%; P = .007). At 7 days, arteries showed better endothelialization with few giant cells; the endothelialization was greater in SS and CCS than in TES (SS, 95% ± 4%; CCS, 98% ± 4%; TES, 79% ± 9%; P = .01). In conclusion, the described model is useful for the analysis of endothelialization of coronary stents and facilitates measurement of its rate of formation and characterization of the involved cell types.
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Affiliation(s)
- A Pérez de Prado
- HemoLeon, Grupo Cardiovascular-Fundación Investigación Sanitaria en León, Hospital de León, e Instituto de Biomedicina IBIOMED, Universidad de León, León, Spain.
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14
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Novel Coating Technologies of Drug Eluting Stents. ACTIVE IMPLANTS AND SCAFFOLDS FOR TISSUE REGENERATION 2011. [DOI: 10.1007/8415_2010_54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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15
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Siller-Matula JM, Tentzeris I, Vogel B, Schacherl S, Jarai R, Geppert A, Unger G, Huber K. Tacrolimus-eluting carbon-coated stents versus sirolimus-eluting stents for prevention of symptom-driven clinical end points. Clin Res Cardiol 2010; 99:645-50. [PMID: 20405134 DOI: 10.1007/s00392-010-0165-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 04/07/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coating of stents has been shown to minimize the interactions between platelets, stent surface and vascular response following stent implantation. The aim of our study was to compare the tacrolimus-eluting carbon-coated JANUS(®) stent with sirolimus-eluting CYPHER(®) stent for the prevention of symptom-driven clinical end points in a real world clinical setting. METHODS This prospective registry with a follow-up period of 24 months was conducted in 90 consecutive patients undergoing coronary artery stenting receiving CYPHER(®) (n = 48) or JANUS(®) (n = 42) stents. The primary end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction and target vessel revascularisation, and the secondary end point was clinically driven in-stent restenosis. RESULTS The primary combined endpoint occurred in 38% of patients (n = 16) in the JANUS(®) group compared to 10% (n = 5) in the CYPHER(®) group. The relative risk increase of the composite end point was therefore 63% higher in patients receiving JANUS(®) stents compared to the CYPHER(®) stents (crude HR = 1.63, 95% CI = 1.17-2.28, p = 0.004; adjusted HR = 1.79, CI = 1.26-2.55, p = 0.001). Interestingly, 75% of events in the JANUS(®) group occurred during the first 6 months after stent implantation. Similarly, the rate of clinically driven in-stent restenosis was higher in patients receiving JANUS(®) stent (n = 10, 2%) compared to the CYPHER(®) stent (n = 2, 4%). Concordantly, the relative risk for clinically driven in-stent restenosis was 81% higher in the JANUS(®) group compared to the CYPHER(®) group (crude HR = 1.81, 95% CI = 1.08-3.02, p = 0.02; adjusted HR = 2.24, CI = 1.26-3.96, p = 0.006). CONCLUSION The use of tacrolimus-eluting carbon coated JANUS(®) stent was associated with worse clinical outcome compared to the sirolimus-eluting CYPHER(®) stent in clinical routine use.
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Affiliation(s)
- J M Siller-Matula
- Department of Clinical Pharmacology, Medical University of Vienna, Austria.
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16
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Cilurzo F, Minghetti P, Selmin F, Cupone I, Gennari C, Rossoni G, Montanari L. A new ex vivo method for assessing local pharmacokinetic after tacrolimus eluting stent deployment in rat aorta. J Drug Deliv Sci Technol 2010. [DOI: 10.1016/s1773-2247(10)50033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Hamada N, Miyata M, Eto H, Shirasawa T, Akasaki Y, Nagaki A, Tei C. Tacrolimus-eluting stent inhibits neointimal hyperplasia via calcineurin/NFAT signaling in porcine coronary artery model. Atherosclerosis 2010; 208:97-103. [PMID: 19682688 DOI: 10.1016/j.atherosclerosis.2009.07.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 07/08/2009] [Accepted: 07/15/2009] [Indexed: 10/20/2022]
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18
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Minghetti P, Cilurzo F, Selmin F, Casiraghi A, Grignani A, Montanari L. Sculptured drug-eluting stent for the on-site delivery of tacrolimus. Eur J Pharm Biopharm 2009; 73:331-6. [PMID: 19686848 DOI: 10.1016/j.ejpb.2009.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 07/23/2009] [Accepted: 08/12/2009] [Indexed: 11/24/2022]
Abstract
This work aimed to evaluate the flexibility of a novel pyrolytic carbon coated drug-eluting stent platform, which presents the peculiarity of deep sculptures realized on the stent's outer surface (reservoirs). Tacrolimus (TCR) or TCR/excipient mixtures were loaded into the reservoirs, and their permanence into stent's reservoirs was verified by an in vitro short-time release test in human blood. Moreover, the impact of the excipients on the TCR physical state and surface morphology of the reservoirs and the release kinetics were studied. The reservoirs resulted homogeneously filled. Upon exposure to blood, no loss of materials from reservoirs was observed, and the drug release after 15 min was negligible in all cases. The loading procedure caused the drug amorphization and, AFM revealed that the surfaces were smooth and homogeneous with the exception of the TCR/poloxamer 188 mixture where spatial oriented crystals were evident. Poly(N-vinyl pyrrolidone) improved the in vitro TCR release rate constants (K). Poly(methylmethacrylate) (PMM) significantly reduced the K value both in vitro and in vivo. Indeed, the in vivo drug concentrations in rabbit artery wall significantly decreased, decreasing the TCR/PMM ratio. The characteristics of the stent strut resulted suitable to load material with different physicochemical characteristics.
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Affiliation(s)
- Paola Minghetti
- Dipartimento di Scienze Farmaceutiche "P. Pratesi", Università degli Studi di Milano, Milan, Italy.
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19
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Mutsuga M, Narita Y, Yamawaki A, Satake M, Kaneko H, Usui A, Ueda Y. Development of novel drug-eluting biodegradable nano-fiber for prevention of postoperative pulmonary venous obstruction,. Interact Cardiovasc Thorac Surg 2009; 8:402-6; discussion 406-7. [DOI: 10.1510/icvts.2008.192831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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20
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Tzafriri AR, Levin AD, Edelman ER. Diffusion-limited binding explains binary dose response for local arterial and tumour drug delivery. Cell Prolif 2009; 42:348-63. [PMID: 19438899 DOI: 10.1111/j.1365-2184.2009.00602.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Local drug delivery has transformed medicine, yet it remains unclear how drug efficacy depends on physicochemical properties and delivery kinetics. Most therapies seek to prolong release, yet recent studies demonstrate sustained clinical benefit following local bolus endovascular delivery. OBJECTIVES The purpose of the current study was to examine interplay between drug dose, diffusion and binding in determining tissue penetration and effect. METHODS We introduce a quantitative framework that balances dose, saturable binding and diffusion, and measured the specific binding parameters of drugs to target tissues. RESULTS Model reduction techniques augmented by numerical simulations revealed that impact of saturable binding on drug transport and retention is determined by the magnitude of a binding potential, B(p), ratio of binding capacity to product of equilibrium dissociation constant and accessible tissue volume fraction. At low B(p) (< 1), drugs are predominantly free and transport scales linearly with concentration. At high B(p) (> 40), drug transport exhibits threshold dependence on applied surface concentration. CONCLUSIONS In this paradigm, drugs and antibodies with large B(p) penetrate faster and deeper into tissues when presented at high concentrations. Threshold dependence of tissue transport on applied surface concentration of paclitaxel and rapamycin may explain threshold dose dependence of in vivo biological efficacy of these drugs.
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Affiliation(s)
- A R Tzafriri
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
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21
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Prunotto M, Vignolini C, Lolli V, Black A, Gaggianesi S, Santarelli A, Galloni M. Short-, mid-, and long-term effects of a polymer-free tacrolimus-eluting stent in a porcine coronary model. J Biomed Mater Res A 2009; 88:872-9. [DOI: 10.1002/jbm.a.31940] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Mutsuga M, Narita Y, Yamawaki A, Satake M, Kaneko H, Suematsu Y, Usui A, Ueda Y. A new strategy for prevention of anastomotic stricture using tacrolimus-eluting biodegradable nanofiber. J Thorac Cardiovasc Surg 2009; 137:703-9. [PMID: 19258093 DOI: 10.1016/j.jtcvs.2008.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 10/02/2008] [Accepted: 11/15/2008] [Indexed: 10/21/2022]
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23
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24
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Deconinck E, Sohier J, De Scheerder I, Van den Mooter G. Pharmaceutical aspects of drug eluting stents. J Pharm Sci 2008; 97:5047-60. [DOI: 10.1002/jps.21356] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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25
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Romagnoli E, Leone AM, Burzotta F, Trani C, Angeloni G, Materazzo G, Niccoli G, Maria DV, Perfetti M, Mazzari MA, Mongiardo R, Rebuzzi AG, Schiavoni G, Crea F. Outcomes of the tacrolimus drug-eluting Janus stent: a prospective two-centre registry in high-risk patients. J Cardiovasc Med (Hagerstown) 2008; 9:589-94. [DOI: 10.2459/jcm.0b013e3282f20ad1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Giordano A, Romano S, Mallardo M, D'Angelillo A, Cali G, Corcione N, Ferraro P, Romano MF. FK506 can activate transforming growth factor- signalling in vascular smooth muscle cells and promote proliferation. Cardiovasc Res 2008; 79:519-26. [DOI: 10.1093/cvr/cvn079] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Simmons A, Padsalgikar AD, Ferris LM, Poole-Warren LA. Biostability and biological performance of a PDMS-based polyurethane for controlled drug release. Biomaterials 2008; 29:2987-95. [PMID: 18436300 DOI: 10.1016/j.biomaterials.2008.04.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 04/01/2008] [Indexed: 10/22/2022]
Abstract
Polymers have been used to deliver therapeutic agents in a range of medical devices with drug eluting stents being the most widespread current application. Although polymers enable controlled release of a therapeutic agent, the polymeric surface has been reported to provide suboptimal biocompatibility and haemocompatibility and it has been suggested that currently used polymers may be at least partly responsible for the late adverse events observed in intravascular stent systems. In this study, the biostability and biological performance of a siloxane-based polyurethane elastomer (E2A) demonstrating excellent long-term biostability in the unloaded state was investigated following incorporation of a therapeutic agent. After implantation in an ovine model for 6 months, samples were assessed using SEM and ATR-FTIR to determine changes in the surface chemical structure and morphology of the materials and tensile testing was used to examine changes in bulk characteristics. Biological response was assessed using in vitro cytotoxicity testing and histological analysis. Results indicated that incorporation of 25mg/g dexamethasone acetate (DexA) into the siloxane-based polyurethane resulted in no significant difference in the biostability and biocompatibility of the material. Some level of cytotoxic potential was exhibited which was believed to result from residual DexA leaching from samples during the extraction process. These findings suggest that E2A is a potential candidate for a delivery vehicle of therapeutic agents in implantable drug delivery applications.
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Affiliation(s)
- Anne Simmons
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales 2052, Australia.
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28
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Deuse T, Erben RG, Ikeno F, Behnisch B, Boeger R, Connolly AJ, Reichenspurner H, Bergow C, Pelletier MP, Robbins RC, Schrepfer S. Introducing the first polymer-free leflunomide eluting stent. Atherosclerosis 2008; 200:126-34. [PMID: 18295768 DOI: 10.1016/j.atherosclerosis.2007.12.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 12/27/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND We here describe the pharmacological characteristic, in vivo efficacy, and in vitro mechanisms of a polymer-free leflunomide eluting stent in comparison to its rapamycin-coated equivalent. METHODS Stents were coated with 40 mM solutions of leflunomide (L) or rapamycin (R) or were left uncoated (BM). Neointima formation was assessed 6 weeks after implantation into Sprague Dawley rats by optical coherence tomographies (OCT) and histopathology. In vitro proliferation assays were performed using isolated endothelial and smooth-muscle-cells from Sprague Dawley rats to investigate the cell-specific pharmacokinetic effect of leflunomide and rapamycin. RESULTS HPLC-based drug release kinetics revealed a similar profile with 90% of the drug being released after 12.1+/-0.2 (L) and 13.0+/-0.2 days (R). After 6 weeks, OCTs showed that in-stent luminal obliteration was less for the coated stents (L:12.0+/-9.4%, R:13.3+/-13.1%) when compared to identical bare metal stents (BM:26.4+/-4.7%; p<or=0.046). Histology with computer-assisted morphometry was performed and demonstrated reduced in-stent I/M thickness ratios (L:2.5+/-1.2, R:3.7+/-3.3, BM:6.7+/-2.3, p<or=0.049 for L and R vs. BM) and neointimal areas (L:0.6+/-0.3, R:0.7+/-0.2, BM:1.3+/-0.4, p<or=0.039 for L and R vs. BM) with stent coating. No differences were found for injury and inflammation scores (L and R vs. BM; p=NS). In vitro SMC proliferation was dose-dependently and similarly inhibited by L and R at 1-100 nM (p=NS L vs. R). Interestingly, human EC proliferation at 10-100 nM was significantly inhibited only by R (p<0.001), but not by L (p=NS). CONCLUSIONS The diminished inhibition of EC proliferation may improve arterial healing and contribute to the safety profile of the leflunomide stent.
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Affiliation(s)
- Tobias Deuse
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Dr., CVRB MC 5407, Stanford, CA, USA
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29
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Silicone-Based Vascular Prosthesis: Assessment of the Mechanical Properties. Ann Vasc Surg 2008; 22:106-14. [DOI: 10.1016/j.avsg.2007.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 08/01/2007] [Accepted: 09/14/2007] [Indexed: 11/20/2022]
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30
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Matter CM, Rozenberg I, Jaschko A, Greutert H, Kurz DJ, Wnendt S, Kuttler B, Joch H, Grünenfelder J, Zünd G, Tanner FC, Lüscher TF. Effects of tacrolimus or sirolimus on proliferation of vascular smooth muscle and endothelial cells. J Cardiovasc Pharmacol 2007; 48:286-92. [PMID: 17204907 DOI: 10.1097/01.fjc.0000248233.22570.8b] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Local strategies directed against vascular smooth muscle cell (VSMC) proliferation such as drug-eluting stents reduce the occurrence of restenosis. However, these approaches may also inhibit endothelial cell (EC) proliferation and, thus, impair reendothelialization. We compared the effects of tacrolimus on human VSMC and EC proliferation and migration to sirolimus, a compound with similar molecular structure. Thymidine incorporation was determined in growth factor-stimulated VSMC and EC. The drug concentration at which maximal VSMC proliferation was inhibited by 50% (IC50) was about 10-fold higher for tacrolimus (3.8 x 10 M) than for sirolimus (4.1 x 10 M; P = 0.055). It is interesting that the molar IC50 value in EC was around 10-fold higher for tacrolimus (2.3 x 10 M) than for sirolimus (7.1 x 10 M; P < 0.01). The profile of these drugs on VSMC and EC migration was similar to the one found in the proliferation assays. Inhibition of VSMC proliferation by both tacrolimus and sirolimus was associated with upregulation of the cell-cycle inhibitor p27. Thus, tacrolimus is less potent than sirolimus for inhibiting VSMC proliferation or migration. However, tacrolimus exerts markedly less antiproliferative effects on EC compared with sirolimus. In combination with its potent antiinflammatory effects, tacrolimus may represent a promising compound for the use in drug-eluting stents.
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MESH Headings
- Blotting, Western
- Cell Count/methods
- Cell Cycle/drug effects
- Cell Cycle Proteins/metabolism
- Cell Movement/drug effects
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cells, Cultured
- Chemotaxis/drug effects
- DNA/antagonists & inhibitors
- DNA/biosynthesis
- Endothelial Cells/cytology
- Endothelial Cells/drug effects
- Endothelial Cells/metabolism
- Humans
- Immunosuppressive Agents/pharmacology
- Inhibitory Concentration 50
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Myocytes, Smooth Muscle/cytology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Platelet-Derived Growth Factor/metabolism
- Sirolimus/pharmacology
- Tacrolimus/pharmacology
- Thymidine/metabolism
- Tritium
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Affiliation(s)
- Christian M Matter
- Cardiovascular Research, Institute of Physiology, Zurich University and CardioVascular Center, University Hospital Zurich, Switzerland.
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Midterm outcomes of prospective, randomized, single-center study of the Janus tacrolimus-eluting stent for treatment of native coronary artery lesions. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200704010-00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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32
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Jung JH, Min PK, Kim JY, Park S, Choi EY, Ko YG, Choi D, Jang Y, Shim WH, Cho SY. Systemic immunosuppressive therapy inhibits in-stent restenosis in patients with renal allograft. Catheter Cardiovasc Interv 2006; 68:567-73. [PMID: 16969853 DOI: 10.1002/ccd.20799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cyclosporine is used routinely for prophylaxis for renal allograft rejection. In experimental animal studies, cyclosporine had been shown to inhibit smooth muscle cell proliferation during the arterial response to injury. We investigated whether systemic immunosuppression may inhibit in-stent restenosis in renal transplant patients undergoing coronary stenting. METHODS From 1993 to 2003, 33 renal transplant patients with 45 coronary lesions and 37 dialysis patients with 52 lesions underwent coronary stenting using bare metal stents at our center. We followed all patients clinically for a mean period of 37 +/- 31 months and 40 patients angiographically at 14 +/- 15 months after coronary intervention. Cyclosporine was combined with corticosteroids in 32 patients and one patient received tacrolimus instead of cyclosporine. RESULTS The baseline clinical and angiographical characteristics were similar and the success rate of the procedure was 100% in both groups. In renal transplant group, the mean dose of cyclosporine was 192.5 +/- 68 mg/day and the blood cyclosporine level at the time of procedure was 152.9 +/- 51.5 ng/mL. The rate of in-stent restenosis was 7.1% in renal transplant group and 57.1% in dialysis group (P < 0.0001). The mean late loss was 0.47 +/- 0.57 mm in renal transplant group when compared with 1.51 +/- 1.09 mm in dialysis group (P = 0.004). The overall rate of major adverse cardiac events (MACEs) was 6.1% in renal transplant group and 35.1% in dialysis group (P < 0.0001). CONCLUSIONS Renal transplant patients receiving combined immunosuppressive agents showed markedly low rates of in-stent restenosis and MACE after coronary revascularization with stent. We consider that this result may be related to the ability of combined immunosuppressive therapy to inhibit inflammatory reaction and vascular smooth muscle cell proliferation induced by coronary stenting.
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Affiliation(s)
- Jae-Hun Jung
- Cardiovascualr Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
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Acharya G, Park K. Mechanisms of controlled drug release from drug-eluting stents. Adv Drug Deliv Rev 2006; 58:387-401. [PMID: 16546289 DOI: 10.1016/j.addr.2006.01.016] [Citation(s) in RCA: 276] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Accepted: 01/31/2006] [Indexed: 11/24/2022]
Abstract
The clinical importance of drug-eluting stents (DESs) has been demonstrated by their unparalleled success in preventing restenosis after stenting procedures. The magnitude of success is historic despite their short history. The current DESs deliver a single drug aiming to prevent or minimize proliferation of smooth muscle cells. Since the restenosis process involves several different biological responses, the ability to deliver the right drugs at the right times is critical for further development of the second generation of DESs. As the type of drugs that can be delivered from DESs varies, it is imperative to understand the drug delivery mechanisms and the approaches available for drug coating on the stents. The drug delivery mechanisms of current DESs that have been used clinically and under clinical trials are explained.
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Abstract
In-stent restenosis (ISR) is the major drawback of percutaneous coronary interventions, occurring in 10-40% of patients. Drug eluting stents (DES) are successful in a large majority of patients in preventing restenosis for the first year after implantation. Recently, new stents have emerged that are loaded with anti-inflammatory, antimigratory, antiproliferative, or pro-healing drugs. These drugs are supposed to inhibit inflammation and neointimal growth and subsequently ISR. The future of DES lies in the development of better stents with new stent designs, better polymers including biological polymers and biological biodissolvable stent coatings, and new, better drugs.
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Affiliation(s)
- R R Anis
- Bristol Heart Institute, University of Bristol, Bristol BS2 8HW, UK
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Steffel J, Latini RA, Akhmedov A, Zimmermann D, Zimmerling P, Lüscher TF, Tanner FC. Rapamycin, but not FK-506, increases endothelial tissue factor expression: implications for drug-eluting stent design. Circulation 2005; 112:2002-11. [PMID: 16172265 DOI: 10.1161/circulationaha.105.569129] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drugs released from stents affect the biology of vascular cells. We examined the effect of rapamycin and FK-506 on tissue factor (TF) expression in human aortic endothelial cells (HAECs) and vascular smooth muscle cells (HAVSMCs). METHODS AND RESULTS Rapamycin enhanced thrombin- and tumor necrosis factor (TNF)-alpha-induced endothelial TF expression in a concentration-dependent manner. The maximal increase was 2.5-fold more pronounced than that by thrombin or TNF-alpha alone and was paralleled by a 1.4-fold higher TF surface activity compared with thrombin alone. Rapamycin by itself increased basal TF levels by 40%. In HAVSMCs, rapamycin did not affect thrombin- or TNF-alpha-induced TF expression. In contrast to rapamycin, FK-506 did not enhance thrombin- or TNF-alpha-induced endothelial TF expression. Thrombin induced a transient dephosphorylation of the mammalian target of rapamycin downstream target p70S6 kinase. Rapamycin completely abrogated p70S6 kinase phosphorylation, but FK-506 did not. FK-506 antagonized the effect of rapamycin on thrombin-induced TF expression. Rapamycin did not alter the pattern of p38, extracellular signal-regulated kinase, or c-Jun NH2-terminal kinase phosphorylation. Real-time polymerase chain reaction analysis revealed that rapamycin had no influence on thrombin-induced TF mRNA levels for up to 2 hours but led to an additional increase after 3 and 5 hours. CONCLUSIONS Rapamycin, but not FK-506, enhances TF expression in HAECs but not in HAVSMCs. This effect requires binding to FK binding protein-12, is mediated through inhibition of the mammalian target of rapamycin, and partly occurs at the posttranscriptional level. These findings may be clinically relevant for patients receiving drug-eluting stents, particularly when antithrombotic drugs are withdrawn or ineffective, and may open novel perspectives for the design of such stents.
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MESH Headings
- Aorta
- Cell Proliferation/drug effects
- Cells, Cultured
- Drug Delivery Systems
- Endothelial Cells/drug effects
- Endothelial Cells/metabolism
- Endothelium, Vascular/metabolism
- Equipment Design
- Humans
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Myocytes, Smooth Muscle/cytology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Protein Kinases/drug effects
- RNA, Messenger/metabolism
- Sirolimus/metabolism
- Sirolimus/pharmacology
- Stents
- TOR Serine-Threonine Kinases
- Tacrolimus/pharmacology
- Tacrolimus Binding Protein 1A/metabolism
- Thromboplastin/genetics
- Thromboplastin/metabolism
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Affiliation(s)
- Jan Steffel
- Cardiovascular Research, Physiology Institute, Center for Integrative Human Physiology, University of Zurich, CH-8057 Zürich, Switzerland
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