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Todd M, Nair PK, Ohayon J, Pettigrew RI, Yazdani SK. Liquid Drug Delivery Approaches for the Treatment of Occlusive Arterial Disease: A Systematic Review. J Endovasc Ther 2024; 31:203-213. [PMID: 36052425 PMCID: PMC11149167 DOI: 10.1177/15266028221120755] [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: 11/17/2022]
Abstract
OBJECTIVE Local Liquid drug (LLD) delivery devices have recently emerged as a novel approach to treat peripheral arterial disease. This systemic review aims to identify and evaluate the clinical utility of the most commonly used delivery devices. METHODS A systemic review was performed using the Medical Subjects Heading terms of "drug delivery," "liquid," "local," and "cardiovascular disease" in PubMed, Google Scholar, and Scopus. RESULTS Four commonly used delivery devices were identified, including (1) the Bullfrog Micro-Infusion Device, (2) the ClearWay RX Catheter, (3) the Occlusion Perfusion Catheter, and (4) the Targeted Adjustable Pharmaceutical Administration. All have shown to successfully deliver liquid therapeutic into the target lesion and have exhibited favorable safety and efficacy profiles in preclinical and clinical trials. The LLD devices have the ability to treat very long or multiple lesions with a single device, providing a more economical option. The safety profile in LLD clinical studies is also favorable in view of recent concerns regarding adverse events with crystalline-paclitaxel-coated devices. CONCLUSION There is clear clinical evidence to support the concept of local liquid delivery to treat occlusive arterial disease. CLINICAL IMPACT The 'leave nothing behind' strategy has been at the forefront of the most recent innovations in the field of interventional cardiology and vascular interventions. Although drug coated balloons have overcome limitations associated with plain old balloon angioplasty and peripheral stents, recent safety concerns and cost considerations have impacted their usage. In this review, various liquid drug delivery devices are presented, showcasing their capabilities and success in both preclinical and clinical settings. These innovative liquid delivery devices, capable of targeted delivery and their ability to be re-used for multiple treatment sites, may provide solutions for current unmet clinical needs.
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Affiliation(s)
- Meagan Todd
- Department of Engineering, Wake Forest University, Winston-Salem, NC, USA
| | | | - Jacques Ohayon
- Savoie Mont-Blanc University, Polytech Annecy-Chambéry, Le Bourget du Lac, France and Laboratory TIMC-IMAG, CNRS, UMR 5525, Grenoble-Alpes University, Grenoble, France
| | - Roderic I. Pettigrew
- Texas A&M University and Houston Methodist Hospital, Engineering Medicine (EnMed), Houston, TX, USA
| | - Saami K. Yazdani
- Department of Engineering, Wake Forest University, Winston-Salem, NC, USA
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2
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Todd M, Liu LB, Saul JM, Yazdani SK. Pre-clinical investigation of liquid sirolimus for local drug delivery. Front Cardiovasc Med 2023; 10:1184816. [PMID: 37781304 PMCID: PMC10540618 DOI: 10.3389/fcvm.2023.1184816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/07/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Sirolimus is currently being explored as an alternative drug to paclitaxel for the treatment of peripheral artery disease (PAD). To date, sirolimus has only been used as drug coatings for stents and balloons and no studies have yet demonstrated the delivery of sirolimus in liquid form. The purpose of this pilot study was to investigate the feasibility of the delivery of liquid sirolimus into arterial segments in a benchtop peripheral artery bioreactor. Methods The feasibility to deliver liquid therapy was first tested on four drug delivery devices using a fluorescently tagged liquid drug and an ex vivo porcine artery benchtop model. The four devices included the Bullfrog micro-infusion device, ClearWay RX catheter, Occlusion perfusion catheter (OPC), and the targeted adjustable pharmaceutical administration system (TAPAS). Penetration of the fluorescently tagged drug was measured via microscopic imaging and quantification of the depth of drug penetration into all device-treated tissue. Based on the penetration outcome, we then selected a single device to deliver liquid sirolimus into the ex vivo porcine artery model undergoing physiological flow and pressure conditions. The liquid sirolimus-treated arteries were collected from the ex vivo bioreactor at 1- and 24-hour post-delivery and arterial drug retention analyzed by liquid chromatography-tandem mass spectrometry. Results Fluorescent microscopy demonstrated that drug delivery with the OPC had greater drug penetration into the medial wall as compared to other devices (OPC: 234 ± 161 µm; TAPAS: 127 ± 68 µm; ClearWay: 118 ± 77 µm; Bullfrog: 2.12 ± 3.78 µm; p = 0.098). The results of the ex vivo flow-circuit bench top model showed that the OPC device successfully delivered the liquid sirolimus at 1-hour (5.17 ± 4.48 ng/mg) and 24-hour (0.78 ± 0.55 ng/mg). Conclusions These results demonstrate for the first time the ability to deliver liquid sirolimus directly to the medial layer of an artery via a liquid delivery catheter.
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Affiliation(s)
- Meagan Todd
- Department of Engineering, Wake Forest University, Winston-Salem, NC, United States
| | - Linda B. Liu
- Department of Engineering, Wake Forest University, Winston-Salem, NC, United States
| | - Justin M. Saul
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH, United States
| | - Saami K. Yazdani
- Department of Engineering, Wake Forest University, Winston-Salem, NC, United States
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3
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Li L, Liu S, Tan J, Wei L, Wu D, Gao S, Weng Y, Chen J. Recent advance in treatment of atherosclerosis: Key targets and plaque-positioned delivery strategies. J Tissue Eng 2022; 13:20417314221088509. [PMID: 35356091 PMCID: PMC8958685 DOI: 10.1177/20417314221088509] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Atherosclerosis, a chronic inflammatory disease of vascular wall, is a progressive pathophysiological process with lipids oxidation/depositing initiation and innate/adaptive immune responses. The coordination of multi systems covering oxidative stress, dysfunctional endothelium, diseased lipid uptake, cell apoptosis, thrombotic and pro-inflammatory responding as well as switched SMCs contributes to plaque growth. In this circumstance, inevitably, targeting these processes is considered to be effective for treating atherosclerosis. Arriving, retention and working of payload candidates mediated by targets in lesion direct ultimate therapeutic outcomes. Accumulating a series of scientific studies and clinical practice in the past decades, lesion homing delivery strategies including stent/balloon/nanoparticle-based transportation worked as the potent promotor to ensure a therapeutic effect. The objective of this review is to achieve a very brief summary about the effective therapeutic methods cooperating specifical targets and positioning-delivery strategies in atherosclerosis for better outcomes.
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Affiliation(s)
- Li Li
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
| | - Sainan Liu
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
| | - Jianying Tan
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
| | - Lai Wei
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
| | - Dimeng Wu
- Chengdu Daxan Innovative Medical Tech. Co., Ltd., Chengdu, PR China
| | - Shuai Gao
- Chengdu Daxan Innovative Medical Tech. Co., Ltd., Chengdu, PR China
| | - Yajun Weng
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
| | - Junying Chen
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
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Cooper K, Cawthon CV, Goel E, Atigh M, Christians U, Yazdani SK. The Development of an ex vivo Flow System to Assess Acute Arterial Drug Retention of Cardiovascular Intravascular Devices. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:675188. [PMID: 35047927 PMCID: PMC8757813 DOI: 10.3389/fmedt.2021.675188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/18/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose: The goal of this study was to develop an ex vivo system capable of rapidly evaluating arterial drug levels in living, isolated porcine carotid arteries. Methods: A vascular bioreactor system was developed that housed a native porcine carotid artery under physiological flow conditions. The ex vivo bioreactor system was designed to quantify the acute drug transfer of catheter-based drug delivery devices into explanted carotid arteries. To evaluate our ex vivo system, a paclitaxel-coated balloon and a perfusion catheter device delivering liquid paclitaxel were utilized. At 1-h post-drug delivery, arteries were removed, and paclitaxel drug levels measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Parallel experiments were performed in a pig model to validate ex vivo measurements. Results: LC-MS/MS analysis demonstrated arterial paclitaxel levels of the drug-coated balloon-treated arteries to be 48.49 ± 24.09 ng/mg and the perfusion catheter-treated arteries to be 25.42 ± 9.74 ng/mg at 1 h in the ex vivo system. Similar results were measured in vivo, as arterial paclitaxel concentrations were measured at 59.23 ± 41.27 ng/mg for the drug-coated balloon-treated arteries and 23.43 ± 20.23 ng/mg for the perfusion catheter-treated arteries. Overall, no significant differences were observed between paclitaxel measurements of arteries treated ex vivo vs. in vivo. Conclusion: This system represents the first validated ex vivo pulsatile system to determine pharmacokinetics in a native blood vessel. This work provides proof-of-concept of a quick, inexpensive, preclinical tool to study acute drug tissue concentration kinetics of drug-releasing interventional vascular devices.
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Affiliation(s)
- Kathryn Cooper
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, United States
| | - Claire V Cawthon
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, United States
| | - Emily Goel
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, United States
| | - Marzieh Atigh
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, United States
| | - Uwe Christians
- iC42 Clinical Research and Development, University of Colorado, Aurora, CO, United States
| | - Saami K Yazdani
- Department of Engineering, Wake Forest University, Winston-Salem, NC, United States
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5
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Villar-Matamoros E, Stokes L, Lloret A, Todd M, Tillman BW, Yazdani SK. Understanding the Mechanism of Drug Transfer and Retention of Drug-Coated Balloons. J Cardiovasc Pharmacol Ther 2022; 27:10742484221119559. [PMID: 35972237 PMCID: PMC9549471 DOI: 10.1177/10742484221119559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The purpose of this study was to determine the impact of varying inflation parameters on paclitaxel delivery and retention using a commercially available DCB. Background: Drug-coated balloons (DCB) have become the standard treatment for peripheral artery disease. Clinical data suggest that varying DCB delivery parameters directly impact patient outcome. Differences in delivery parameters can potentially alter the retention of the drug coating on DCBs. Methods: Harvested porcine carotid arteries were utilized in an ex vivo pulsatile flow bioreactor system. The DCBs were then deployed at a DCB-to-artery ratio of 1:1 or 1.25:1, an inflation time of 30 seconds or 1 minute and transit time of 30 seconds or 3 minutes. The amount of drug retention in arterial tissue was evaluated by pharmacokinetic analysis at 1 hour and 1 day post DCB deployment. Results: Arterial paclitaxel levels were found to be less at an inflation ratio of 1:1 with 3-minute transit time as compared to 30 seconds of transit time at 1 hour (12.3 ± 1.6 ng/mg vs. 391 ± 139 ng/mg, P = .036). At 1-day, DCBs deployed at a ratio of 1:1 resulted in less drug retention as compared to 1.25:1 (61.3 ± 23.1 ng/mg vs. 404 ± 195 ng/mg, P = .013). Conclusion: Arterial paclitaxel retention is reduced with extended transit times and sub-optimal expansion of the balloon. Optimization of delivery parameters can serve as an effective strategy to enhance clinical DCB outcomes.
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Affiliation(s)
| | - Lauren Stokes
- Department of Engineering, 8676Wake Forest University, Winston-Salem, NC, USA
| | - Alyssa Lloret
- Department of Engineering, 8676Wake Forest University, Winston-Salem, NC, USA
| | - Meagan Todd
- Department of Engineering, 8676Wake Forest University, Winston-Salem, NC, USA
| | - Bryan W Tillman
- Division of Vascular Surgery, 2647Ohio State University, Columbus, OH, USA
| | - Saami K Yazdani
- Department of Engineering, 8676Wake Forest University, Winston-Salem, NC, USA
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Tierney JW, Evans BC, Cheung-Flynn J, Wang B, Colazo JM, Polcz ME, Cook RS, Brophy CM, Duvall CL. Therapeutic MK2 inhibition blocks pathological vascular smooth muscle cell phenotype switch. JCI Insight 2021; 6:142339. [PMID: 34622803 PMCID: PMC8525639 DOI: 10.1172/jci.insight.142339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
Vascular procedures, such as stenting, angioplasty, and bypass grafting, often fail due to intimal hyperplasia (IH), wherein contractile vascular smooth muscle cells (VSMCs) dedifferentiate to synthetic VSMCs, which are highly proliferative, migratory, and fibrotic. Previous studies suggest MAPK-activated protein kinase 2 (MK2) inhibition may limit VSMC proliferation and IH, although the molecular mechanism underlying the observation remains unclear. We demonstrated here that MK2 inhibition blocked the molecular program of contractile to synthetic dedifferentiation and mitigated IH development. Molecular markers of the VSMC contractile phenotype were sustained over time in culture in rat primary VSMCs treated with potent, long-lasting MK2 inhibitory peptide nanopolyplexes (MK2i-NPs), a result supported in human saphenous vein specimens cultured ex vivo. RNA-Seq of MK2i-NP-treated primary human VSMCs revealed programmatic switching toward a contractile VSMC gene expression profile, increasing expression of antiinflammatory and contractile-associated genes while lowering expression of proinflammatory, promigratory, and synthetic phenotype-associated genes. Finally, these results were confirmed using an in vivo rabbit vein graft model where brief, intraoperative treatment with MK2i-NPs decreased IH and synthetic phenotype markers while preserving contractile proteins. These results support further development of MK2i-NPs as a therapy for blocking VSMC phenotype switch and IH associated with cardiovascular procedures.
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Affiliation(s)
- J William Tierney
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Brian C Evans
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Joyce Cheung-Flynn
- Division of Vascular Surgery, Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bo Wang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Juan M Colazo
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.,Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Monica E Polcz
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.,Department of General Surgery and
| | - Rebecca S Cook
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Colleen M Brophy
- Division of Vascular Surgery, Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Craig L Duvall
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
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7
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Atigh MK, Goel E, Erwin M, Greer R, Ohayon J, Pettigrew RI, Yazdani SK. Precision delivery of liquid therapy into the arterial wall for the treatment of peripheral arterial disease. Sci Rep 2021; 11:18676. [PMID: 34548563 PMCID: PMC8455692 DOI: 10.1038/s41598-021-98063-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/31/2021] [Indexed: 01/04/2023] Open
Abstract
Perfusion catheters have recently emerged as a novel approach to deliver liquid anti-proliferative agents into flow obstructed arterial segments. The purpose of this study was to determine the impact of luminal delivery pressure on liquid drug penetration into the vessel wall. An ex vivo model using harvested porcine carotid arteries and a two-dimensional computational model were utilized to determine the impact of delivery pressure of liquid therapy into the arterial wall. A pig peripheral injury model determined the impact of intra-luminal delivery pressure on drug retention. Ex vivo results demonstrated that depth of fluid penetration varies from 6.93 ± 1.90% at 0 atm to 27.75 ± 6.61% penetration of the medial layer at 0.4 atm. Computational results had similar outcomes, as penetration varied between 4.4% and 22.84%. The in vivo results demonstrated significant increase in drug delivery to the arterial tissue at 0.4 atm versus 0.1 atm at 1 h (23.43 ± 13.59 ng/mg vs. 2.49 ± 1.81 ng/mg, p = 0.026) and 7 days (0.50 ± 0.39 ng/mg vs. 0.018 ± 0.023 ng/mg, p = 0.0496). The result of this study provides an innovative strategic and technical approach to enable targeted liquid therapy.
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Affiliation(s)
- Marzieh K Atigh
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, 36688, USA
| | - Emily Goel
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, 36688, USA
| | - Megan Erwin
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, 36688, USA
| | - Ricky Greer
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, 36688, USA
| | - Jacques Ohayon
- Savoie Mont-Blanc University, Polytech Annecy-Chambéry, Le Bourget du Lac, France.,Laboratory TIMC-IMAG, CNRS, UMR 5525, Grenoble-Alpes University, Grenoble, France
| | - Roderic I Pettigrew
- Texas A&M University and Houston Methodist Hospital, Engineering Medicine (EnMed), Houston, TX, USA
| | - Saami K Yazdani
- Department of Engineering, Wake Forest University, Winston-Salem, NC, 27101, USA.
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Cawthon CV, Cooper K, Huett C, Lloret A, Villar-Matamoros E, Stokes L, Christians U, Schuler M, Yazdani SK. Pre-Clinical Investigation of Liquid Paclitaxel for Local Drug Delivery: A Pilot Study. Pharmaceuticals (Basel) 2020; 13:ph13120434. [PMID: 33260517 PMCID: PMC7760562 DOI: 10.3390/ph13120434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 12/03/2022] Open
Abstract
The purpose of this pilot study was to investigate the feasibility of a perfusion catheter to deliver liquid paclitaxel into arterial segments. A clinically relevant rabbit ilio-femoral injury model was utilized to determine the impact of liquid paclitaxel delivered locally into the vessel wall using a perfusion catheter at 1 h to 14 days. Treatment by two clinically available forms of liquid paclitaxel, a solvent-based (sb) versus an albumin-bound (nab), along with a control (uncoated balloons), were investigated. Pharmacokinetic results demonstrated an increase in the retention of the sb-paclitaxel versus the nab-paclitaxel at 1 h; however, no other differences were observed at days one, three, and seven. Histological findings at 14 days showed significantly less neointimal area in the sb-paclitaxel treated arteries as compared with the nab-paclitaxel and the uncoated balloon-treated arteries. Additionally, percent area stenosis was significantly less in the sb-paclitaxel group. These results support the concept of local liquid delivery of paclitaxel into the arterial segments.
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Affiliation(s)
- Claire V Cawthon
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA
| | - Kathryn Cooper
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA
| | - Clifton Huett
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL 36688, USA
| | - Alyssa Lloret
- Department of Engineering, Wake Forest University, Winston-Salem, NC 27101, USA
| | | | - Lauren Stokes
- Department of Engineering, Wake Forest University, Winston-Salem, NC 27101, USA
| | - Uwe Christians
- iC42 Clinical Research and Development, University of Colorado, Aurora, CO 80045, USA
| | - Michele Schuler
- Department of Comparative Medicine, University of South Alabama, Mobile, AL 36688, USA
| | - Saami K Yazdani
- Department of Engineering, Wake Forest University, Winston-Salem, NC 27101, USA
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9
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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.
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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
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10
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Bunch F, Nair P, Aggarwala G, Dippel E, Kassab E, Khan MA, LeCroy C, McClure JM, Tolleson T, Walker C. A universal drug delivery catheter for the treatment of infrapopliteal arterial disease using liquid therapy. Catheter Cardiovasc Interv 2020; 96:393-401. [PMID: 32017374 PMCID: PMC7496530 DOI: 10.1002/ccd.28739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/20/2019] [Accepted: 01/11/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the safety and feasibility of treating infrapopliteal lesions using a novel drug delivery catheter locally delivering liquid paclitaxel. BACKGROUND Balloon angioplasty is currently the Gold Standard to treat below-the-knee disease; however, restenosis continues to be a great challenge following these percutaneous revascularization procedures. METHODS The Occlusion Perfusion Catheter for Optimal Delivery of Paclitaxel for the Prevention of Endovascular Restenosis (COPPER-A) study-Below-the-Knee Cohort was a prospective, nonrandomized, multicenter, feasibility, and safety study that enrolled 35 patients at 11 participating sites. The safety endpoints at 1, 3, and 6 months were freedom from thrombosis, major amputation in the target limb and target limb related death. The efficacy endpoints were primary patency and freedom from clinically driven target lesion revascularization at 6 months. RESULTS All patients tolerated the procedure well with no reports of adverse procedural events. Thirty-five patients were treated with a mean lesion length of 112 ± 81.2 mm with the lesion length range of 20-286 mm. At 6-month follow-up, primary patency was 89.3% and freedom from clinically driven target lesion revascularization was 96.4%. No patients demonstrated thrombosis, major amputation in the target limb and target limb related death at the 1-, 3- and 6-months follow-up intervals. CONCLUSIONS The results of this multi-center study demonstrated that infrapopliteal arteries can be safely and effectively treated with liquid paclitaxel using the occlusion perfusion catheter.
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Affiliation(s)
- Frank Bunch
- Interventional Cardiology and Peripheral Vascular Disease, South Baldwin Regional Medical Center, Foley, Alabama
| | - Pradeep Nair
- Interventional Cardiology and Peripheral Vascular Disease, Cardiovascular Institute of the South, Houma, Louisiana
| | - Gaurav Aggarwala
- Interventional Cardiology and Peripheral Vascular Disease, Pulse Physician Organization, Huntsville, Texas
| | - Eric Dippel
- Interventional Cardiology and Peripheral Vascular Disease, Vascular Institute of the Midwest, Davenport, Iowa
| | - Elias Kassab
- Interventional Cardiology and Peripheral Vascular Disease, Michigan Outpatient Vascular Institute, Dearborn, Michigan
| | - Muhammad A Khan
- Interventional Cardiology and Peripheral Vascular Disease, North Dallas Research Associates, Cardiac Center of Texas, McKinney, Texas
| | - Christopher LeCroy
- Department of Vascular Surgery, Coastal Vascular & Interventional, Peripheral Vascular Disease, Pensacola, Florida
| | - John M McClure
- Interventional Cardiology and Peripheral Vascular Disease, Mid-Michigan Heart and Vascular Center, Saginaw, Michigan
| | - Thaddeus Tolleson
- Interventional Cardiology and Peripheral Vascular Disease, Tyler Cardiovascular Consultants, Tyler, Texas
| | - Craig Walker
- Interventional Cardiology and Peripheral Vascular Disease, Cardiovascular Institute of the South, Houma, Louisiana
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11
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Targeting and imaging of monocyte-derived macrophages in rat's injured artery following local delivery of liposomal quantum dots. J Control Release 2020; 318:145-157. [DOI: 10.1016/j.jconrel.2019.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/26/2019] [Accepted: 12/08/2019] [Indexed: 12/27/2022]
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Udofot O, Lin LH, Thiel WH, Erwin M, Turner E, Miller FJ, Giangrande PH, Yazdani SK. Delivery of Cell-Specific Aptamers to the Arterial Wall with an Occlusion Perfusion Catheter. MOLECULAR THERAPY. NUCLEIC ACIDS 2019; 16:360-366. [PMID: 30986697 PMCID: PMC6462795 DOI: 10.1016/j.omtn.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/20/2019] [Accepted: 03/17/2019] [Indexed: 12/13/2022]
Abstract
Current strategies to prevent restenosis following endovascular treatment include the local delivery of anti-proliferative agents to inhibit vascular smooth muscle cell (VSMC) proliferation and migration. These agents, not specific to VSMCs, are deposited on the luminal surface and therefore target endothelial cells and delay vascular healing. Cell-targeted therapies, (e.g., RNA aptamers), can potentially overcome these safety concerns by specifically binding to VSMC and inhibiting proliferation and migration. The purpose of this study was to therefore demonstrate the ability of a perfusion catheter to deliver cell-specific RNA aptamer inhibitors directly to the vessel wall. RNA aptamers specific to VSMCs were developed using an in vitro cell-based systematic evolution of ligand by exponential enrichment selection process. Two aptamers (Apt01 and Apt14) were evaluated ex vivo using harvested pig arteries in a pulsatile flow bioreactor. Local drug delivery of the aptamers into the medial wall was accomplished using a novel perfusion catheter. We demonstrated the feasibility to deliver aptamer-based drugs directly to the medial layer of an artery using a perfusion catheter. Such cell-specific targeted therapeutic drugs provide a potentially safer and more effective treatment option for patients with vascular disease.
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Affiliation(s)
- Ofonime Udofot
- Internal Medicine, University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, USA
| | - Li-Hsien Lin
- Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Megan Erwin
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
| | - Emily Turner
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
| | - Francis J Miller
- Department of Medicine, Duke University, Durham, NC, USA; Pharmacology and Cancer Biology Program, Duke University, Durham, NC, USA; Department of Medicine, Veterans Administration Medical Center, Durham, NC, USA.
| | - Paloma H Giangrande
- Internal Medicine, University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, USA; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA; Radiation Oncology, University of Iowa, Iowa City, IA, USA; Molecular & Cellular Biology Program, University of Iowa, Iowa City, IA, USA; Environmental Health Sciences Research Center (EHSRC), University of Iowa, Iowa City, IA, USA.
| | - Saami K Yazdani
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA.
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Turner E, Erwin M, Atigh M, Christians U, Saul JM, Yazdani SK. In vitro and in vivo Assessment of Keratose as a Novel Excipient of Paclitaxel Coated Balloons. Front Pharmacol 2018; 9:808. [PMID: 30104972 PMCID: PMC6078047 DOI: 10.3389/fphar.2018.00808] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/04/2018] [Indexed: 12/28/2022] Open
Abstract
Purpose: Drug coated balloons (DCB) are continually improving due to advances in coating techniques and more effective excipients. Paclitaxel, the current drug choice of DCB, is a microtubule-stabilizing chemotherapeutic agent that inhibits smooth muscle cell proliferation. Excipients work to promote coating stability and facilitate paclitaxel transfer and retention at the target lesion, although current excipients lack sustained, long-term paclitaxel retention. Keratose, a naturally derived protein, has exhibited unique properties allowing for tuned release of various therapeutic agents. However, little is known regarding its ability to support delivery of anti-proliferative agents such as paclitaxel. The goal of this project was to thus demonstrate the feasibility of keratose as a DCB-coating excipient to promote the release and delivery of paclitaxel. Methods: Keratose was combined with paclitaxel in vitro and the release kinetics of paclitaxel and keratose were evaluated through high performance liquid chromatograph-mass spectroscopy (HPLC-MS) and spectrophotometry, respectively. A custom coating method was developed to deposit keratose and paclitaxel on commercially available angioplasty balloons via an air spraying method. Coatings were then visualized under scanning electron microscopy and drug load quantified by HPLC-MS. Acute arterial transfer of paclitaxel at 1 h was assessed using a novel ex vivo model and further evaluated in vivo in a porcine ilio-femoral injury model. Results: Keratose demonstrated tunable release of paclitaxel as a function of keratose concentration in vitro. DCB coated via air spraying yielded consistent drug loading of 4.0 ± 0.70 μg/mm2. Under scanning electron microscopy, the keratose-paclitaxel DCB showed uniform coverage with a consistent, textured appearance. The acute drug transfer of the keratose-paclitaxel DCB was 43.60 ± 14.8 ng/mg at 1 h ex vivo. These measurements were further confirmed in vivo as the acute 1 h arterial paclitaxel levels were 56.60 ± 66.4 ng/mg. Conclusion: The keratose-paclitaxel coated DCB exhibited paclitaxel uptake and achieved acute therapeutic arterial tissue levels, confirming the feasibility of keratose as a novel excipient for DCB.
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Affiliation(s)
- Emily Turner
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, United States
| | - Megan Erwin
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, United States
| | - Marzieh Atigh
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, United States
| | - Uwe Christians
- Department of Anesthesiology, iC42 Clinical Research and Development, University of Colorado, Aurora, CO, United States
| | - Justin M. Saul
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH, United States
| | - Saami K. Yazdani
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, United States
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Turner EA, Atigh MK, Erwin MM, Christians U, Yazdani SK. Coating and Pharmacokinetic Evaluation of Air Spray Coated Drug Coated Balloons. Cardiovasc Eng Technol 2018; 9:240-250. [PMID: 29497966 DOI: 10.1007/s13239-018-0346-1] [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: 11/27/2017] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Abstract
Drug coated balloons (DCB) are becoming the standard-care treatment for peripheral arterial disease (PAD). DCB use excipients to transfer and retain anti-proliferative drugs, such as paclitaxel. Excipients thus play a vital role in the design and function of DCB, however methods to coat balloons with excipients and anti-proliferative drugs remain unknown. The goal of this study was to thus develop an approach to coat and evaluate DCB for various excipients. An air sprayer method was developed to deposit paclitaxel and various excipients onto non-coated commercially available angioplasty balloons. The coating of the angioplasty balloons was evaluated for drug deposition and coating efficiency using high performance liquid chromatography tandem mass spectrometry. Drug transfer and retention of the coated angioplasty balloons into arterial segments were evaluated ex vivo using harvested pig arteries in a pulsatile flow bioreactor. The air sprayer method successfully delivered varying excipients including bovine serum albumin (BSA), urea and iohexol. The air spray method was configured to coat four angioplasty balloons simultaneously with paclitaxel and iohexol with an average paclitaxel load of 4.0 ± 0.70 µg/mm2. The intra-day (within) and inter-day (between) coating precisions, defined as relative standard deviation (RSD), was 17.2 and 15.5%, respectively. Ex vivo deployment of iohexol-paclitaxel DCB yielded an arterial paclitaxel concentration of 123.4 ± 44.68 ng/mg (n = 3) at 1 h, 126.7 ± 25.27 ng/mg (n = 3) at 1 day, and 12.9 ± 12.88 ng/mg (n = 3) at 7 days. This work provides proof-of-concept of a quick, inexpensive approach to coat commercially available angioplasty balloons with paclitaxel and various excipients.
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Affiliation(s)
- Emily A Turner
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, 36688, USA
| | - Marzieh K Atigh
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, 36688, USA
| | - Megan M Erwin
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, 36688, USA
| | - Uwe Christians
- iC42 Clinical Research and Development, University of Colorado, Aurora, CO, 80045, USA
| | - Saami K Yazdani
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, 36688, USA.
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