Nickel-free stainless steel avoids neointima formation following coronary stent implantation

High nitrogen stainless steel drug-eluting stent - Assessment of pharmacokinetics and preclinical safety in vivo

Pharmacokinetic analyses were performed using 20 pigs for 120-days implantation, while one sirolimus-eluting stent was implanted into one of their coronary artery. At different time points, the residual sirolimus on the stent, delivered locally (to artery wall), regionally (to adjacent and downstream muscle) and systemically (to plasma and visceral organs), was detected throughout 120 days. Preclinical safety evaluation was performed using 32 pigs for 180-days implantation to study the safety of metal platform material and the effectiveness of sirolimus eluting coating on the HNS stent. The neointima area, restenosis rate and inflammatory grade for HNS and control group stents were detected and analyzed. Approximately 80% sirolimus was eluted from the sirolimus-eluting stents after 30-days implantation in vivo. Additionally, there was sustained sirolimus in the artery wall, cardiac muscle and heart throughout 120-days implantation, and sirolimus accumulated to the peak at 90-days implantation. It was inferred that the sirolimus eluting stent in this study was covered by neointima before 90-days implantation, indicating that the sirolimus eluting coating on the HNS stent was safe and effective. Very little sirolimus was distributed in visceral organs after 14-days implantation. HNS sirolimus-eluting stent exhibited lower restenosis rate and lower inflammatory grade than control group, which verified that the sirolimus-eluting coating design in this study was reasonable and practical. In addition, there were no significant difference in restenosis rate and inflammatory score between HNS bare-metal stent and drug-eluting stents, illustrating that HNS has good bio-compatibility and is suitable to use as coronary artery stent material.

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First time to investigate the pharmacokinetics of drug eluting stents for 120 days, found the relationship between the pharmacokinetics and tissue response, which has been rarely reported.

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Verified that the drug-eluting stent made of high nitrogen stainless steel endothelialization finished after 90 days implantation, without endothelialization delay.

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HNS has been proved that it is a better biocompatibility and bio-safe metal platform material, owing better property to be used in clinic.

Zinc ions have a potential to attenuate both Ni ion uptake and Ni ion-induced inflammation

Nickel ions (Ni²⁺) are eluted from various metallic materials, such as medical devices implanted in human tissues. Previous studies have shown that Ni²⁺ enters inflammatory cells inducing inflammation. However, the regulation of Ni²⁺ uptake in cells has not yet been reported in detail. In the present study, we investigated the effects of various divalent cations on Ni²⁺ uptake and Ni²⁺-induced interleukin (IL)-8 production in the human monocytic cell line, THP-1. We demonstrated that ZnCl_2, MnCl₂, and CoCl₂ inhibited the Ni²⁺ uptake, while CuCl₂, FeCl₂, MgCl₂, and divalent metal transporter (DMT)-1 inhibitor, Chlorazol Black, did not. Furthermore, ZnCl₂ inhibited Ni²⁺-induced IL-8 production, correlating with the inhibition of Ni²⁺ uptake. These results suggested that Ni²⁺ uptake occurred through Zn²⁺, Mn²⁺, and Co²⁺-sensitive transporters and that the inhibition of Ni²⁺ uptake resulted in the inhibition of IL-8 production. Furthermore, using an Ni wire-implanted mouse model, we found that Ni wire-induced expression of mouse macrophage inflammatory protein-2 (MIP-2) and cyclooxygenase-2 (COX-2) mRNA in the skin tissue surrounding the wire were enhanced by low Zn conditions. These results suggested that the physiological concentration of Zn²⁺ modulates Ni²⁺ uptake by inflammatory cells, and a Zn deficient state might increase sensitivity to Ni.

Stable Titania Nanostructures on Stainless Steel Coronary Stent Surface for Enhanced Corrosion Resistance and Endothelialization

Stainless steel (SS) coronary stents continue to present risk of in-stent restenosis that impact its long term safety and efficacy. The present work focuses on developing a drug-free and polymer-less surface on coronary stents by utilizing a titania (TiO₂ ) nanotexturing approach through hydrothermal processing, that will offer improved stent performance in vivo. Mechanically stable and durable nanotextured coatings are obtained on SS stents that also offer good corrosion resistance. In vitro vascular cell (endothelial and smooth muscle cells) studies on surface modified SS show preferential rapid endothelialization with enhanced nitric oxide production and reduce smooth muscle cell proliferation, in comparison to unmodified SS. In vivo evaluation of the nanotextured stents after subcutaneous implantation in rabbits show reduced irritability and minimal localized inflammatory response. These beneficial effects suggest that the stable, easily scalable titania nanosurface modification strategy on coronary stent surfaces can be a much cheaper alternative to drug eluting stents in addressing in-stent restenosis.

Study of biocompatibility of medical grade high nitrogen nickel-free austenitic stainless steel in vitro

Adverse effects of nickel ions being released into the living organism have resulted in development of high nitrogen nickel-free austenitic stainless steels for medical applications. Nitrogen not only replaces nickel for austenitic structure stability but also improves steel properties. The cell cytocompatibility, blood compatibility and cell response of high nitrogen nickel-free austenitic stainless steel were studied in vitro. The mechanical properties and microstructure of this stainless steel were compared to the currently used 316L stainless steel. It was shown that the new steel material had comparable basic mechanical properties to 316L stainless steel and preserved the single austenite organization. The cell toxicity test showed no significant toxic side effects for MC3T3-E1 cells compared to nitinol alloy. Cell adhesion testing showed that the number of MC3T3-E1 cells was more than that on nitinol alloy and the cells grew in good condition. The hemolysis rate was lower than the national standard of 5% without influence on platelets. The total intracellular protein content and ALP activity and quantification of mineralization showed good cell response. We conclude that the high nitrogen nickel-free austenitic stainless steel is a promising new biomedical material for coronary stent development.