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McQueen A, Escuer J, Schmidt AF, Aggarwal A, Kennedy S, McCormick C, Oldroyd K, McGinty S. An intricate interplay between stent drug dose and release rate dictates arterial restenosis. J Control Release 2022; 349:992-1008. [PMID: 35921913 DOI: 10.1016/j.jconrel.2022.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
Since the introduction of percutaneous coronary intervention (PCI) for the treatment of obstructive coronary artery disease (CAD), patient outcomes have progressively improved. Drug eluting stents (DES) that employ anti-proliferative drugs to limit excess tissue growth following stent deployment have proved revolutionary. However, restenosis and a need for repeat revascularisation still occurs after DES use. Over the last few years, computational models have emerged that detail restenosis following the deployment of a bare metal stent (BMS), focusing primarily on contributions from mechanics and fluid dynamics. However, none of the existing models adequately account for spatiotemporal delivery of drug and the influence of this on the cellular processes that drive restenosis. In an attempt to fill this void, a novel continuum restenosis model coupled with spatiotemporal drug delivery is presented. Our results indicate that the severity and time-course of restenosis is critically dependent on the drug delivery strategy. Specifically, we uncover an intricate interplay between initial drug loading, drug release rate and restenosis, indicating that it is not sufficient to simply ramp-up the drug dose or prolong the time course of drug release to improve stent efficacy. Our model also shows that the level of stent over-expansion and stent design features, such as inter-strut spacing and strut thickness, influence restenosis development, in agreement with trends observed in experimental and clinical studies. Moreover, other critical aspects of the model which dictate restenosis, including the drug binding site density are investigated, where comparisons are made between approaches which assume this to be either constant or proportional to the number of smooth muscle cells (SMCs). Taken together, our results highlight the necessity of incorporating these aspects of drug delivery in the pursuit of optimal DES design.
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Affiliation(s)
- Alistair McQueen
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK
| | - Javier Escuer
- Aragón Institute for Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | | | - Ankush Aggarwal
- Glasgow Computational Engineering Centre, Division of Infrastructure and Environment, University of Glasgow, Glasgow, UK
| | - Simon Kennedy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Keith Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sean McGinty
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK; Glasgow Computational Engineering Centre, Division of Infrastructure and Environment, University of Glasgow, Glasgow, UK.
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SARIFUDDIN, ALSEMIRY REIMAD, MANDAL PRASHANTAKUMAR. EFFECTS OF COATING PROPERTIES ON CONTROLLED DELIVERY FROM AN EMBEDDED DRUG-ELUTING STENT: A SIMULATION STUDY. J BIOL SYST 2021. [DOI: 10.1142/s0218339021500145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The present investigation deals with the effects of biodegradable, biodurable and polymer-free coating of a stent on the release mechanism of the drug in a porous medium. The Brinkman equations for the interstitial fluid, the unsteady convection-diffusion-reaction equation for the transport of free drug in the tissue and the unsteady reaction equations for the bound as well as the internalized drug have been considered. In the coating, the transport of drug has been modeled as a diffusion process. Effects of different percentages of the embedment, convection and various coating properties of the stent on the transport of free drug, its retention and the internalization of the bound drug have been studied. Immersed Boundary Method (IBM) in the staggered grid formulation (IBM-MAC) has been used to tackle numerically the system of nonlinear governing equations. Simulated results predict the fastest release of drug from a biodegradable coating, but the averaged concentrations of all drug forms do reach a quasi-steady state in case of a biodurable coating irrespective of the degrees of embedment. Moreover, for all embedment levels of the stent, a biodegradable coating is superior to that of biodurable and polymer-free coating in the presence/absence of convection for larger times, but this superiority is lost for smaller times. Unlike biodurable coating, it is also predicted that the more the embedment level does not necessarily imply the more the effectiveness of delivery for biodegradable and polymer-free coatings of a stent.
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Affiliation(s)
- SARIFUDDIN
- Department of Mathematics, Berhampore College, P.O.-Berhampore, Dist.-Murshidabad, WB 742101, India
| | - REIMA D. ALSEMIRY
- Department of Mathematics, Faculty of Science, Taibah University, P.O. Box 89, Yanbu 41911, Saudi Arabia
- Department of Mathematical Sciences, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
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3
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Abbasnezhad N, Shirinbayan M, Chabi F, Champmartin S, Tcharkhtchi A, Bakir F. Viscoelastic Behavior of Drug-Loaded Polyurethane. Polymers (Basel) 2021; 13:2608. [PMID: 34451148 PMCID: PMC8400544 DOI: 10.3390/polym13162608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Drug-eluting stents are desirable platforms for local medicine delivery. However, the incorporation of drugs into polymers can influence the mechanical and physicochemical properties of said matrix, which is a topic that is still poorly understood. In fact, this is more noticeable since the apposition is most often accompanied by mechanical stresses on the polymer coating, which can induce therapeutic failure that can result in death. It is therefore necessary to better understand their behavior by examining their properties in conditions such as those in living beings. We studied polyurethane drug carriers made in-house. Diclofenac epolamine was chosen as a model hydrophilic medicine. We used thermal measurements (DMTA) and tensile tests. The aim was to establish the influence of the loading and release of the drug on the physicochemical properties of this polymer in the presence of a stagnant or circulating fluid medium, phosphate-buffered saline (PBS). For the two PU/drug loadings studied, the effect of the initial drug load was more marked. The free volume fraction and the number of pores in the samples increased with the increasing percent of the drug and with release time. The kinetic profiles were accelerated with the loading ratio and with the presence of flow. Young's modulus and ultimate stress were not significantly influenced by the release time. A relevant relationship between the tensile properties and the viscoelastic behavior of the samples was developed. Our results have implications for optimizing the performance of drug coatings for stents.
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Affiliation(s)
- Navideh Abbasnezhad
- Arts et Metiers Institute of Technology, CNAM, LIFSE, HESAM University, F-75013 Paris, France
- Arts et Metiers Institute of Technology, CNAM, PIMM, HESAM University, F-75013 Paris, France
| | - Mohammadali Shirinbayan
- Arts et Metiers Institute of Technology, CNAM, LIFSE, HESAM University, F-75013 Paris, France
- Arts et Metiers Institute of Technology, CNAM, PIMM, HESAM University, F-75013 Paris, France
| | - Fatiha Chabi
- Arts et Metiers Institute of Technology, CNAM, LIFSE, HESAM University, F-75013 Paris, France
| | - Stephane Champmartin
- Arts et Metiers Institute of Technology, CNAM, LIFSE, HESAM University, F-75013 Paris, France
| | - Abbas Tcharkhtchi
- Arts et Metiers Institute of Technology, CNAM, PIMM, HESAM University, F-75013 Paris, France
| | - Farid Bakir
- Arts et Metiers Institute of Technology, CNAM, LIFSE, HESAM University, F-75013 Paris, France
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4
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Song J, Kouidri S, Bakir F. Review on the numerical investigations of mass transfer from drug eluting stent. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Abbasnezhad N, Zirak N, Shirinbayan M, Tcharkhtchi A, Bakir F. On the importance of physical and mechanical properties of PLGA films during drug release. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102446] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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McQueen A, Escuer J, Aggarwal A, Kennedy S, McCormick C, Oldroyd K, McGinty S. Do we really understand how drug eluted from stents modulates arterial healing? Int J Pharm 2021; 601:120575. [PMID: 33845150 DOI: 10.1016/j.ijpharm.2021.120575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023]
Abstract
The advent of drug-eluting stents (DES) has revolutionised the treatment of coronary artery disease. These devices, coated with anti-proliferative drugs, are deployed into stenosed or occluded vessels, compressing the plaque to restore natural blood flow, whilst simultaneously combating the evolution of restenotic tissue. Since the development of the first stent, extensive research has investigated how further advancements in stent technology can improve patient outcome. Mathematical and computational modelling has featured heavily, with models focussing on structural mechanics, computational fluid dynamics, drug elution kinetics and subsequent binding within the arterial wall; often considered separately. Smooth Muscle Cell (SMC) proliferation and neointimal growth are key features of the healing process following stent deployment. However, models which depict the action of drug on these processes are lacking. In this article, we start by reviewing current models of cell growth, which predominantly emanate from cancer research, and available published data on SMC proliferation, before presenting a series of mathematical models of varying complexity to detail the action of drug on SMC growth in vitro. Our results highlight that, at least for Sodium Salicylate and Paclitaxel, the current state-of-the-art nonlinear saturable binding model is incapable of capturing the proliferative response of SMCs across a range of drug doses and exposure times. Our findings potentially have important implications on the interpretation of current computational models and their future use to optimise and control drug release from DES and drug-coated balloons.
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Affiliation(s)
- Alistair McQueen
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK
| | - Javier Escuer
- Aragón Institute for Engineering Research (I3A), University of Zaragoza, Spain
| | - Ankush Aggarwal
- Glasgow Computational Engineering Centre, Division of Infrastructure and Environment, University of Glasgow, Glasgow, UK
| | - Simon Kennedy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Keith Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sean McGinty
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK; Glasgow Computational Engineering Centre, Division of Infrastructure and Environment, University of Glasgow, Glasgow, UK.
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Effect of Interstitial Fluid Flow on Drug-Coated Balloon Delivery in a Patient-Specific Arterial Vessel with Heterogeneous Tissue Composition: A Simulation Study. Cardiovasc Eng Technol 2018; 9:251-267. [PMID: 29508375 DOI: 10.1007/s13239-018-0345-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/23/2018] [Indexed: 11/27/2022]
Abstract
Angioplasty with drug-coated balloons (DCBs) using excipients as drug carriers is emerging as a potentially viable strategy demonstrating clinical efficacy and proposing additional compliance for the treatment of obstructive vascular diseases. An attempt is made to develop an improved computational model where attention has been paid to the effect of interstitial flow, that is, plasma convection and internalization of bound drug. The present model is capable of capturing the phenomena of the transport of free drug and its retention, and also the internalization of drug in the process of endocytosis to atherosclerotic vessel of heterogeneous tissue composition comprising of healthy tissue, as well as regions of fibrous cap, fibro-fatty, calcified and necrotic core lesions. Image processing based on an unsupervised clustering technique is used for color-based segmentation of a patient-specific longitudinal image of atherosclerotic vessel obtained from intravascular ultrasound derived virtual histology. As the residence time of drug in a stent-based delivery within the arterial tissue is strongly influenced by convective forces, effect of interstitial fluid flow in case of DCB delivery can not be ruled out, and has been investigated by modeling it through unsteady Navier-Stokes equations. Transport of free drug is modeled by considering unsteady advection-reaction-diffusion process, while the bound drug, assuming completely immobilized in the tissue, by unsteady reaction process. The model also takes into account the internalization of drug through the process of endocytosis which gets degraded by the lysosomes and finally recycled into the extracellular fluid. All the governing equations representing the flow of interstitial fluid, the transport of free drug, the metabolization of free drug into bound phase and the process of internalization along with the physiologically realistic boundary and initial conditions are solved numerically using marker and cell method satisfying necessary stability criteria. Simulated results obtained predict that faster drug transfer promotes rapid saturation of binding sites despite perivascular wash out and the concentrations of all drug forms are modulated by the presence of interstitial flow. Such premier attempt of its kind would certainly be of great help in the optimization of therapeutic efficacy of drug.
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Qiu T, He R, Abunassar C, Hossainy S, Zhao L. Effect of two-year degradation on mechanical interaction between a bioresorbable scaffold and blood vessel. J Mech Behav Biomed Mater 2018; 78:254-265. [DOI: 10.1016/j.jmbbm.2017.11.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 11/26/2022]
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Naghipoor J, Rabczuk T. A mechanistic model for drug release from PLGA-based drug eluting stent: A computational study. Comput Biol Med 2017; 90:15-22. [DOI: 10.1016/j.compbiomed.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 11/15/2022]
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Li Y, Chu Z, Li X, Ding X, Guo M, Zhao H, Yao J, Wang L, Cai Q, Fan Y. The effect of mechanical loads on the degradation of aliphatic biodegradable polyesters. Regen Biomater 2017; 4:179-190. [PMID: 28596915 PMCID: PMC5458542 DOI: 10.1093/rb/rbx009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 12/11/2022] Open
Abstract
Aliphatic biodegradable polyesters have been the most widely used synthetic polymers for developing biodegradable devices as alternatives for the currently used permanent medical devices. The performances during biodegradation process play crucial roles for final realization of their functions. Because physiological and biochemical environment in vivo significantly affects biodegradation process, large numbers of studies on effects of mechanical loads on the degradation of aliphatic biodegradable polyesters have been launched during last decades. In this review article, we discussed the mechanism of biodegradation and several different mechanical loads that have been reported to affect the biodegradation process. Other physiological and biochemical factors related to mechanical loads were also discussed. The mechanical load could change the conformational strain energy and morphology to weaken the stability of the polymer. Besides, the load and pattern could accelerate the loss of intrinsic mechanical properties of polymers. This indicated that investigations into effects of mechanical loads on the degradation should be indispensable. More combination condition of mechanical loads and multiple factors should be considered in order to keep the degradation rate controllable and evaluate the degradation process in vivo accurately. Only then can the degradable devise achieve the desired effects and further expand the special applications of aliphatic biodegradable polyesters.
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Affiliation(s)
- Ying Li
- School of Biological Science and Medical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing 100191, People’s Republic of China
| | - Zhaowei Chu
- School of Biological Science and Medical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing 100191, People’s Republic of China
| | - Xiaoming Li
- School of Biological Science and Medical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing 100191, People’s Republic of China
| | - Xili Ding
- School of Biological Science and Medical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing 100191, People’s Republic of China
| | - Meng Guo
- School of Biological Science and Medical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing 100191, People’s Republic of China
| | - Haoran Zhao
- Department of Biomedical Engineer, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Jie Yao
- School of Biological Science and Medical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing 100191, People’s Republic of China
| | - Lizhen Wang
- School of Biological Science and Medical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing 100191, People’s Republic of China
| | - Qiang Cai
- Key Laboratory of Advanced Materials of Ministry of Education of China, Tsinghua University, Beijing 100084, People’s Republic of China
| | - Yubo Fan
- School of Biological Science and Medical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing 100191, People’s Republic of China
- National Research Center for Rehabilitation Technical Aids, Beijing 100176, People’s Republic of China
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11
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Mandal AP, Mandal PK. Computational Modelling of Three-phase Stent-based Delivery. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2017; 2:31-40. [DOI: 10.14218/jerp.2017.00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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McKittrick CM, Kennedy S, Oldroyd KG, McGinty S, McCormick C. Modelling the Impact of Atherosclerosis on Drug Release and Distribution from Coronary Stents. Ann Biomed Eng 2016; 44:477-87. [PMID: 26384667 PMCID: PMC4764635 DOI: 10.1007/s10439-015-1456-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022]
Abstract
Although drug-eluting stents (DES) are now widely used for the treatment of coronary heart disease, there remains considerable scope for the development of enhanced designs which address some of the limitations of existing devices. The drug release profile is a key element governing the overall performance of DES. The use of in vitro, in vivo, ex vivo, in silico and mathematical models has enhanced understanding of the factors which govern drug uptake and distribution from DES. Such work has identified the physical phenomena determining the transport of drug from the stent and through tissue, and has highlighted the importance of stent coatings and drug physical properties to this process. However, there is limited information regarding the precise role that the atherosclerotic lesion has in determining the uptake and distribution of drug. In this review, we start by discussing the various models that have been used in this research area, highlighting the different types of information they can provide. We then go on to describe more recent methods that incorporate the impact of atherosclerotic lesions.
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Affiliation(s)
- C M McKittrick
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - S Kennedy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - K G Oldroyd
- West of Scotland Region Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK
| | - S McGinty
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - C McCormick
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
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