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Zarogoulidis P, Huang H, Freitag L. Drug-eluting stents from cardiology to pneumonology. Future Cardiol 2024:1-3. [PMID: 38953508 DOI: 10.1080/14796678.2024.2368346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, General Clinic Euromedica, Thessaloniki, Greece
| | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Lutz Freitag
- Pulmonary Department, Ruhrland Clinic, University of Duisburg-Essen, Essen, Germany
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2
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Chaddha U, Agrawal A, Kurman J, Ortiz-Comino R, Dutau H, Freitag L, Trisolini R, Dooms C, Zuccatosta L, Gasparini S, Herth F, Saka H, Lee P, Fielding D, Oki M, Rosell A, Murgu S. World Association for Bronchology and Interventional Pulmonology (WABIP) guidelines on airway stenting for malignant central airway obstruction. Respirology 2024; 29:563-573. [PMID: 38812262 DOI: 10.1111/resp.14764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
Malignant Central Airway Obstruction (MCAO) encompasses significant and symptomatic narrowing of the central airways that can occur due to primary lung cancer or metastatic disease. Therapeutic bronchoscopy is associated with high technical success and symptomatic relief and includes a wide range of airway interventions including airway stents. Published literature suggests that stenting practices vary significantly across the world primarily due to lack of guidance. This document aims to address this knowledge gap by addressing relevant questions related to airway stenting in MCAO. An international group of 17 experts from 17 institutions across 11 countries with experience in using airway stenting for MCAO was convened as part of this guideline statement through the World Association for Bronchology and Interventional Pulmonology (WABIP). We performed a literature and internet search for reports addressing six clinically relevant questions. This guideline statement, consisting of recommendations addressing these six PICO questions, was formulated by a systematic and rigorous process involving the evaluation of published evidence, augmented with expert experience when necessary. Panel members participated in the development of the final recommendations using the modified Delphi technique.
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Affiliation(s)
- Udit Chaddha
- Division of Pulmonary, Critical Care & Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Rosamaria Ortiz-Comino
- Department of Respiratory Medicine, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Herve Dutau
- Interventional Pulmonology Department, North University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Lutz Freitag
- Ruhrlandklinik, University Hospital, University Duisburg Essen, Essen, Germany
| | - Rocco Trisolini
- Catholic University of the Sacred Hearth-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Christophe Dooms
- Department of Respiratory Diseases, University Hospital Leuven, Leuven, Belgium
| | - Lina Zuccatosta
- Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | | | - Felix Herth
- Thoraxklinik and Translational Lung research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | | | - Pyng Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David Fielding
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Antoni Rosell
- Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
| | - Septimiu Murgu
- Section of Pulmonary and Critical Care, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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3
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Schleich S, Kronen P, Krivitsky A, Paunović N, Brian CF, Karol AA, Geks A, Bao Y, Leroux JC, von Rechenberg B, Franzen D, Klein K. Effects of shape and structure of a new 3D-printed personalized bioresorbable tracheal stent on fit and biocompatibility in a rabbit model. PLoS One 2024; 19:e0300847. [PMID: 38917158 PMCID: PMC11198857 DOI: 10.1371/journal.pone.0300847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 04/03/2024] [Indexed: 06/27/2024] Open
Abstract
To date, several types of airway stents are available to treat central airway obstructions. However, the ideal stent that can overcome anatomical, mechanical and microbiological issues is still awaited. In addition, therapeutic effect and self-elimination of these stents are desirable properties, which pose an additional challenge for development and manufacturing. We aimed to create a prototype bioresorbable tracheal stent with acceptable clinical tolerance, fit and biocompatibility, that could be tested in a rabbit model and in the future be further optimized to enable drug-elution and ensure local therapeutic effect. Twenty-one New Zealand White Rabbits received five different types of bioresorbable tracheal stents, 3D-printed from poly(D,L-lactide-co-ε-caprolactone) metacrylates. Various configurations were tested for their functionality and improved until the best performing prototype could undergo detailed in vivo assessment, regarding clinical tolerance, migration and biocompatibility. Previously tested types of 3D printed stents in our preliminary study required improvement due to several problems, mainly related to breakage, unreliable stability and/or migration within the trachea. Abandoned or refined pre-prototypes were not analyzed in a comparative way. The final best performing prototype stent (GSP2 (Group Stent Prototype 2), n = 8) allowed a transoral application mode and showed good clinical tolerance, minimal migration and acceptable biocompatibility. The good performance of stent type GSP2 was attributed to the helix-shaped surface structure, which was therefore regarded as a key-feature. This prototype stent offers the possibility for further research in a large animal model to confirm the promising data and assess other properties such as bioresorption.
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Affiliation(s)
- Sarah Schleich
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Peter Kronen
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Adva Krivitsky
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETHZ, Zurich, Switzerland
| | - Nevena Paunović
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETHZ, Zurich, Switzerland
| | | | - Agnieszka Anna Karol
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Anna Geks
- Clinic for Small Animals, Stiftung Tierärztliche Hochschule Hannover, Hanover, Germany
| | - Yinyin Bao
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETHZ, Zurich, Switzerland
| | - Jean-Christophe Leroux
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETHZ, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Daniel Franzen
- Department of Internal Medicine, Spital Uster, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Karina Klein
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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4
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Morand J, McClellan P, Isali I, Dikici Y, Fan D, Li L, Shoffstall AJ, Akkus O, Weidenbecher M. Dexamethasone eluting polydopaminated polycaprolactone-poly (lactic-co-glycolic) acid for treatment of tracheal stenosis. J Biomed Mater Res A 2024; 112:781-792. [PMID: 38204293 DOI: 10.1002/jbm.a.37659] [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: 07/14/2022] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
Tracheal stenosis is commonly caused by injury, resulting in inflammation and fibrosis. Inhibiting inflammation and promoting epithelization can reduce recurrence after initial successful treatment of tracheal stenosis. Steroids play an important role in tracheal stenosis management. This study in vitro evaluated effectiveness of a polydopaminated polycaprolactone stent coated with dexamethasone-eluting poly(lactic-co-glycolic) acid microparticles (μPLGA) for tracheal stenosis management. Polydopamination was characterized by Raman spectroscopy and promoted epithelialization while dexamethasone delivery reduced macrophage activity, assessed by individual cell area measurements and immunofluorescent staining for inducible nitric oxide synthase (iNOS). Dexamethasone release was quantified by high-performance liquid chromatography over 30 days. Activation-related increase in cell area and iNOS production by RAW 264.7 were both reduced significantly (p < .05) through dexamethasone release. Epithelial cell spreading was higher on polydopaminated polycaprolactone (PCL) than PCL-alone (p < .05). Force required for stent migration was measured by pullout tests of PCL-μPLGA stents from cadaveric rabbit and porcine tracheas (0.425 ± 0.068 N and 1.082 ± 0.064 N, respectively) were above forces estimated to occur during forced respiration. Biomechanical support provided by stents to prevent airway collapse was assessed by comparing compressive circumferential stiffness, and stiffness of the stent was about 1/10th of the rabbit trachea (0.156 ± 0.023 N/mm vs. 1.420 ± 0.194 N/mm, respectively). A dexamethasone-loaded PCL-μPLGA stent platform can deliver dexamethasone and exhibits sufficient mechanical properties to anchor within the trachea and polydopamination of PCL is conducive to epithelial layer formation. Therefore, a polydopaminated PCL-μPLGA stent is a promising candidate for in vivo evaluation for treatment of tracheal restenosis.
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Affiliation(s)
- Jacob Morand
- Advanced Platform Center, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
| | - Phillip McClellan
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ilaha Isali
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yusuf Dikici
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Di Fan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Longshun Li
- Advanced Platform Center, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Andrew J Shoffstall
- Advanced Platform Center, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ozan Akkus
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mark Weidenbecher
- Advanced Platform Center, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
- Department of Otolaryngology, Case Western Reserve University, Cleveland, Ohio, USA
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5
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Cruz DRD, Zheng A, Debele T, Larson P, Dion GR, Park YC. Drug delivery systems for wound healing treatment of upper airway injury. Expert Opin Drug Deliv 2024; 21:573-591. [PMID: 38588553 PMCID: PMC11208077 DOI: 10.1080/17425247.2024.2340653] [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: 10/27/2023] [Accepted: 04/04/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Endotracheal intubation is a common procedure to maintain an open airway with risks for traumatic injury. Pathological changes resulting from intubation can cause upper airway complications, including vocal fold scarring, laryngotracheal stenosis, and granulomas and present with symptoms such as dysphonia, dysphagia, and dyspnea. Current intubation-related laryngotracheal injury treatment approaches lack standardized guidelines, relying on individual clinician experience, and surgical and medical interventions have limitations and carry risks. AREAS COVERED The clinical and preclinical therapeutics for wound healing in the upper airway are described. This review discusses the current developments on local drug delivery systems in the upper airway utilizing particle-based delivery systems, including nanoparticles and microparticles, and bulk-based delivery systems, encompassing hydrogels and polymer-based approaches. EXPERT OPINION Complex laryngotracheal diseases pose challenges for effective treatment, struggling due to the intricate anatomy, limited access, and recurrence. Symptomatic management often requires invasive surgical procedures or medications that are unable to achieve lasting effects. Recent advances in nanotechnology and biocompatible materials provide potential solutions, enabling precise drug delivery, personalization, and extended treatment efficacy. Combining these technologies could lead to groundbreaking treatments for upper airways diseases, significantly improving patients' quality of life. Research and innovation in this field are crucial for further advancements.
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Affiliation(s)
- Denzel Ryan D. Cruz
- Medical Scientist Training Program, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Avery Zheng
- Chemical Engineering Program, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Tilahun Debele
- Chemical Engineering Program, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Larson
- Department of Otolaryngology – Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Gregory R. Dion
- Department of Otolaryngology – Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Yoonjee C. Park
- Chemical Engineering Program, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, USA
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6
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Lilburn P, Williamson JP, Phillips M, Tillekeratne N, Ing A, Glanville A, Saghaie T. Tracheobronchial stents: an expanding prospect. Intern Med J 2024; 54:204-213. [PMID: 38140778 DOI: 10.1111/imj.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Abstract
The first dedicated tracheobronchial silicone stent was designed by the French pulmonologist Jean-Paul Dumon. The most common indications for stenting are to minimise extrinsic airway compression from mass effect, maintain airway patency due to intrinsic obstruction or treat significant nonmalignant airway narrowing or fistulae. Silicone stents require rigid bronchoscopy for insertion; however, they are more readily repositioned and removed compared with metallic stents. Metallic stents demonstrate luminal narrowing when loads are applied to their ends, therefore stents should either be reinforced at the ends or exceed the area of stenosis by a minimum of 5 mm. Nitinol, a nickel-titanium metal alloy, is currently the preferred material used for airway stents. Airway stenting provides effective palliation for patients with severe symptomatic obstruction. Drug-eluting and three-dimensional printing of airway stents present promising solutions to the challenges of the physical and anatomical constraints of the tracheobronchial tree. Biodegradable stents could also be a solution for the treatment of nonmalignant airway obstruction.
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Affiliation(s)
- Paul Lilburn
- Department of Respiratory and Sleep Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan P Williamson
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Martin Phillips
- MQ Health, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Nikela Tillekeratne
- MQ Health, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Alvin Ing
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Allan Glanville
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tajalli Saghaie
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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7
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Graczyk S, Pasławski R, Grzeczka A, Pasławska U, Świeczko-Żurek B, Malisz K, Popat K, Sionkowska A, Golińska P, Rai M. Antimicrobial and Antiproliferative Coatings for Stents in Veterinary Medicine-State of the Art and Perspectives. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6834. [PMID: 37959431 PMCID: PMC10649059 DOI: 10.3390/ma16216834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
Microbial colonization in veterinary stents poses a significant and concerning issue in veterinary medicine. Over time, these pathogens, particularly bacteria, can colonize the stent surfaces, leading to various complications. Two weeks following the stent insertion procedure, the colonization becomes observable, with the aggressiveness of bacterial growth directly correlating with the duration of stent placement. Such microbial colonization can result in infections and inflammations, compromising the stent's efficacy and, subsequently, the animal patient's overall well-being. Managing and mitigating the impact of these pathogens on veterinary stents is a crucial challenge that veterinarians and researchers are actively addressing to ensure the successful treatment and recovery of their animal patients. In addition, irritation of the tissue in the form of an inserted stent can lead to overgrowth of granulation tissue, leading to the closure of the stent lumen, as is most often the case in the trachea. Such serious complications after stent placement require improvements in the procedures used to date. In this review, antibacterial or antibiofilm strategies for several stents used in veterinary medicine have been discussed based on the current literature and the perspectives have been drawn. Various coating strategies such as coating with hydrogel, antibiotic, or other antimicrobial agents have been reviewed.
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Affiliation(s)
- Szymon Graczyk
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Robert Pasławski
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Arkadiusz Grzeczka
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Urszula Pasławska
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Beata Świeczko-Żurek
- Department of Biomaterials Technology, Faculty of Mechanical Engineering and Ship Technology, Gdansk University of Technology, Gabriela Narutowicza 11/12, 80-229 Gdansk, Poland; (B.Ś.-Ż.); (K.M.)
| | - Klaudia Malisz
- Department of Biomaterials Technology, Faculty of Mechanical Engineering and Ship Technology, Gdansk University of Technology, Gabriela Narutowicza 11/12, 80-229 Gdansk, Poland; (B.Ś.-Ż.); (K.M.)
| | - Ketul Popat
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA;
| | - Alina Sionkowska
- Department of Biomaterials and Cosmetic Chemistry, Faculty of Chemistry, Nicolaus Copernicus University in Torun, Gagarina 7, 87-100 Torun, Poland
| | - Patrycja Golińska
- Department of Microbiology, Nicolaus Copernicus University, ul. Lwowska 1, 87-100 Torun, Poland;
| | - Mahendra Rai
- Department of Chemistry, Federal University of Piaui (UFPI), Teresina 64049-550, Brazil;
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8
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Dong J, Li Y, Wang X, Liu Y, Ren K, Liu X, Zhang H, Li Z, Han X, Uyama H, Li Q. Microinjection Molded Biopolymeric Airway Stent with Antibacterial and Anti-Hyperplastic Properties. Macromol Biosci 2023; 23:e2300113. [PMID: 37326455 DOI: 10.1002/mabi.202300113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/18/2023] [Indexed: 06/17/2023]
Abstract
Central airway stenosis is a condition that the diameter of the trachea or main bronchus shrinkage is caused by external compression or internal tissue hyperplasia, which can cause difficulty breathing, asphyxia, and even death. Airway stenting is an easy way to restore the patency of the central airway, but airway stents commonly used in clinical practice can lead to complications such as mucus plugging, bacterial infection, and granulation tissue hyperplasia. Moreover, the non-degradable characteristic makes it requires a second operation to remove, which has the potential to cause tissue damage. In this study, a biodegradable airway stent is fabricated by microinjection molding using the bioelastomer of poly (L-lactide-co-ε-caprolactone) as the matrix material. The airway stent has excellent mechanical properties and an appropriate degradation rate. The hydrophilic surface of the airway stent can inhibit mucus plugging. The loading of silver nanoparticles and cisplatin endows the stent with antibacterial and anti-hyperplastic functions. In vitro and in vivo experiments demonstrate that this study provides an antibacterial and anti-hyperplastic biodegradable airway stent with elastic properties to avoid secondary removal operation and reduce complications associated with mucus plugging, bacterial infection, and granulation tissue hyperplasia.
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Affiliation(s)
- Jiahui Dong
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou, 450001, China
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou, 450001, China
- Department of Applied Chemistry, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaofeng Wang
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou, 450001, China
| | - Yajing Liu
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou, 450001, China
| | - Kewei Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Engineering Technology Research Center for Minimally Invasive Interventional Tumors of Henan Province, Zhengzhou, 450052, China
| | - Xuedi Liu
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou, 450001, China
| | - Han Zhang
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou, 450001, China
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou, 450001, China
| | - Zongming Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Interventional Institute of Zhengzhou University, Zhengzhou, 450052, China
| | - Hiroshi Uyama
- Department of Applied Chemistry, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Qian Li
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou, 450001, China
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou, 450001, China
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9
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Paunović N, Marbach J, Bao Y, Berger V, Klein K, Schleich S, Coulter FB, Kleger N, Studart AR, Franzen D, Luo Z, Leroux J. Digital Light 3D Printed Bioresorbable and NIR-Responsive Devices with Photothermal and Shape-Memory Functions. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2200907. [PMID: 35896948 PMCID: PMC9507367 DOI: 10.1002/advs.202200907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/23/2022] [Indexed: 06/15/2023]
Abstract
Digital light processing (DLP) 3D printing is a promising technique for the rapid manufacturing of customized medical devices with high precision. To be successfully translated to a clinical setting, challenges in the development of suitable photopolymerizable materials have yet to be overcome. Besides biocompatibility, it is often desirable for the printed devices to be biodegradable, elastic, and with a therapeutic function. Here, a multifunctional DLP printed material system based on the composite of gold nanorods and polyester copolymer is reported. The material demonstrates robust near-infrared (NIR) responsiveness, allowing rapid and stable photothermal effect leading to the time-dependent cell death. NIR light-triggerable shape transformation is demonstrated, resulting in a facilitated insertion and expansion of DLP printed stent ex vivo. The proposed strategy opens a promising avenue for the design of multifunctional therapeutic devices based on nanoparticle-polymer composites.
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Affiliation(s)
- Nevena Paunović
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETH ZurichZurich8093Switzerland
| | - Jessica Marbach
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETH ZurichZurich8093Switzerland
| | - Yinyin Bao
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETH ZurichZurich8093Switzerland
| | - Valentine Berger
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETH ZurichZurich8093Switzerland
| | - Karina Klein
- Musculoskeletal Research UnitVetsuisse FacultyUniversity of ZurichZurich8057Switzerland
| | - Sarah Schleich
- Musculoskeletal Research UnitVetsuisse FacultyUniversity of ZurichZurich8057Switzerland
| | | | - Nicole Kleger
- Complex MaterialsDepartment of MaterialsETH ZurichZurich8093Switzerland
| | - André R. Studart
- Complex MaterialsDepartment of MaterialsETH ZurichZurich8093Switzerland
| | - Daniel Franzen
- Department of PulmonologyUniversity Hospital ZurichZurich8006Switzerland
| | - Zhi Luo
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETH ZurichZurich8093Switzerland
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical EngineeringSouthern University of Science and TechnologyShenzhen518055P. R. China
| | - Jean‐Christophe Leroux
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETH ZurichZurich8093Switzerland
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10
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Shaller BD, Filsoof D, Pineda JM, Gildea TR. Malignant Central Airway Obstruction: What's New? Semin Respir Crit Care Med 2022; 43:512-529. [PMID: 35654419 DOI: 10.1055/s-0042-1748187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced intrathoracic cancer. Although the management of MCAO is multimodal and interdisciplinary, the task of providing patients with prompt palliation falls increasingly on the shoulders of interventional pulmonologists. While a variety of tools and techniques are available for the management of malignant obstructive lesions, advancements and evolution in this therapeutic venue have been somewhat sluggish and limited when compared with other branches of interventional pulmonary medicine (e.g., the early diagnosis of peripheral lung nodules). Indeed, one pragmatic, albeit somewhat uncharitable, reading of this article's title might suggest a wry smile and shug of the shoulders as to imply that relatively little has changed in recent years. That said, the spectrum of interventions for MCAO continues to expand, even if at a less impressive clip. Herein, we present on MCAO and its endoscopic and nonendoscopic management-that which is old, that which is new, and that which is still on the horizon.
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Affiliation(s)
- Brian D Shaller
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Darius Filsoof
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Jorge M Pineda
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
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11
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Guibert N, Héluain V, Brindel A, Plat G, Dutau H. Prothèses des voies aériennes : état de l’art. Rev Mal Respir 2022; 39:477-485. [DOI: 10.1016/j.rmr.2022.02.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/13/2022] [Indexed: 12/17/2022]
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12
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Synergistic effects of silver nanoparticles and cisplatin in combating inflammation and hyperplasia of airway stents. Bioact Mater 2021; 9:266-280. [PMID: 34820570 PMCID: PMC8586718 DOI: 10.1016/j.bioactmat.2021.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/04/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022] Open
Abstract
Anti-inflammatory and antihyperplasia activities are essential requirements for the successful use of airway stents. In this work, silver nanoparticles (AgNPs) and cisplatin (DDP) were combined in a synergistic modification strategy to improve the surface function of airway stents. Using polycaprolactone (PCL) as a drug carrier, a dual-functional PCL-AgNPs-DDP fiber film-coated airway stent was fabricated by electrospinning. The physicochemical and biological properties of the obtained fiber films were examined. The ATR-FTIR, XPS, SEM-EDS and TEM results suggested that AgNPs and DDP could be successfully immobilized onto the airway stent surface. The drug release and surface degradation results revealed that AgNPs and DDP can undergo sustained release from films for 30 d, and the weight loss was approximately 50% after 35 d. In addition, the dual-functional fiber film suppressed human embryonic lung fibroblast growth and exhibited excellent antibacterial activity against Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans. Furthermore, the effectiveness of the dual-functional fiber film-coated airway stent was evaluated by application to the trachea of New Zealand rabbits. The in vivo results indicated that PCL-AgNPs-DDP fiber film-coated airway stent can significantly inhibit granulation tissue formation and collagen deposition, reduced the expression of IL-8, TNF-α, IL-1α, PCNA, α-SMA and CD68, and ultimately achieved anti-inflammatory and antihyperplasia effects. Hence, this study provides a dual-functional surface-coated airway stent to address the clinical complications associated with respiratory tract inflammation and granulation tissue hyperplasia, thus inhibiting tracheal stenosis. This study provides a dual-functional PCL-AgNPs-DDP nanofiber film-coated airway stent. The airway stent processes antibacterial activity and suppress CCC-HPF-1 growth. The stent inhibits tracheal stenosis by antiinflammatory and antihyperplasia treatment.
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13
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Hrichi H, Kouki N, Tar H. Analytical methods for the quantification of cisplatin, carboplatin, and oxaliplatin in various matrices over the last two decades. CURR PHARM ANAL 2021. [DOI: 10.2174/1573412918666210929105058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Platinum derivatives including cisplatin and its later generations carboplatin, and oxaliplatin remain the most largely used drugs in the therapy of malignant diseases. They exert notable anticancer activity towards numerous types of solid tumors such as gastric, colorectal, bladder, ovary, and several others. The chemotherapeutic activity of these compounds, however, is associated with many unwanted side effects and drug resistance problems limiting their application and effectiveness. Proper dosage is still an inherent problem, as these drugs are usually prescribed in small doses.
Objective:
Several analytical methods have been reported for the accurate quantification of cisplatin, carboplatin, and oxaliplatin and their metabolites either alone or in combination with other chemotherapeutic drugs, in different matrices such as pharmaceutical formulations, biological fluids, cancer cells, and environmental samples. The main goal of this review is to systematically study the analytical methods already used for the analysis of cisplatin, carboplatin, and oxaliplatin in various matrices during the last two decades.
Results and Conclusion:
In the literature, reviews showed that numerous analytical methods such as electroanalytical, UV-visible spectrophotometry, chromatographic, fluorescence, atomic absorption spectrophotometry, and other spectroscopic methods combined with mass spectrometry were used for the determination of these compounds in various matrices.
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Affiliation(s)
- Hajer Hrichi
- Chemistry Department, College of Science, Jouf University, P.O. Box: 2014, Sakaka, Saudi Arabia
| | - Noura Kouki
- Chemistry Department, College of Science and Arts, Qassim University, Buraidah, P.O. Box: 51911, Saudi Arabia
| | - Haja Tar
- Chemistry Department, College of Science and Arts, Qassim University, Buraidah, P.O. Box: 51911, Saudi Arabia
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14
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Sindeeva OA, Prikhozhdenko ES, Schurov I, Sedykh N, Goriainov S, Karamyan A, Mordovina EA, Inozemtseva OA, Kudryavtseva V, Shchesnyak LE, Abramovich RA, Mikhajlov S, Sukhorukov GB. Patterned Drug-Eluting Coatings for Tracheal Stents Based on PLA, PLGA, and PCL for the Granulation Formation Reduction: In Vivo Studies. Pharmaceutics 2021; 13:pharmaceutics13091437. [PMID: 34575513 PMCID: PMC8469052 DOI: 10.3390/pharmaceutics13091437] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 01/25/2023] Open
Abstract
Expandable metallic stent placement is often the only way to treat airway obstructions. Such treatment with an uncoated stent causes granulation proliferation and subsequent restenosis, resulting in the procedure’s adverse complications. Systemic administration of steroids drugs in high dosages slows down granulation tissue overgrowth but leads to long-term side effects. Drug-eluting coatings have been used widely in cardiology for many years to suppress local granulation and reduce the organism’s systemic load. Still, so far, there are no available analogs for the trachea. Here, we demonstrate that PLA-, PCL- and PLGA-based films with arrays of microchambers to accommodate therapeutic substances can be used as a drug-eluting coating through securely fixing on the surface of an expandable nitinol stent. PCL and PLA were most resistant to mechanical damage associated with packing in delivery devices and making it possible to keep high-molecular-weight cargo. Low-molecular-weight methylprednisolone sodium succinate is poorly retained in PCL- and PLGA-based microchambers after immersion in deionized water (only 9.5% and 15.7% are left, respectively). In comparison, PLA-based microchambers retain 96.3% after the same procedure. In vivo studies on rabbits have shown that effective granulation tissue suppression is achieved when PLA and PLGA are used for coatings. PLGA-based microchamber coating almost completely degrades in 10 days in the trachea, while PLA-based microchamber films partially preserve their structure. The PCL-based film coating is most stable over time, which probably causes blocking the outflow of fluid from the tracheal mucosa and the aggravation of the inflammatory process against the background of low drug concentration. Combination and variability of polymers in the fabrication of films with microchambers to retain therapeutic compounds are suggested as a novel type of drug-eluting coating.
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Affiliation(s)
- Olga A. Sindeeva
- Skolkovo Innovation Center, Skolkovo Institute of Science and Technology, 3 Nobel Str., 143005 Moscow, Russia
- Correspondence: (O.A.S.); (G.B.S.)
| | - Ekaterina S. Prikhozhdenko
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (E.S.P.); (E.A.M.); (O.A.I)
| | - Igor Schurov
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Nikolay Sedykh
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Sergey Goriainov
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Arfenya Karamyan
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Ekaterina A. Mordovina
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (E.S.P.); (E.A.M.); (O.A.I)
| | - Olga A. Inozemtseva
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (E.S.P.); (E.A.M.); (O.A.I)
| | - Valeriya Kudryavtseva
- Nanoforce Ltd., School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK;
| | - Leonid E. Shchesnyak
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Rimma A. Abramovich
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Sergey Mikhajlov
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Gleb B. Sukhorukov
- Nanoforce Ltd., School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK;
- Correspondence: (O.A.S.); (G.B.S.)
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15
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Chen YC, Gad SF, Chobisa D, Li Y, Yeo Y. Local drug delivery systems for inflammatory diseases: Status quo, challenges, and opportunities. J Control Release 2021; 330:438-460. [PMID: 33352244 DOI: 10.1016/j.jconrel.2020.12.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
Inflammation that is not resolved in due course becomes a chronic disease. The treatment of chronic inflammatory diseases involves a long-term use of anti-inflammatory drugs such as corticosteroids and nonsteroidal anti-inflammatory drugs, often accompanied by dose-dependent side effects. Local drug delivery systems have been widely explored to reduce their off-target side effects and the medication frequency, with several products making to the market or in development over the years. However, numerous challenges remain, and drug delivery technology is underutilized in some applications. This review showcases local drug delivery systems in different inflammatory diseases, including the targets well-known to drug delivery scientists (e.g., joints, eyes, and teeth) and other applications with untapped opportunities (e.g., sinus, bladder, and colon). In each section, we start with a brief description of the disease and commonly used therapy, introduce local drug delivery systems currently on the market or in the development stage, focusing on polymeric systems, and discuss the remaining challenges and opportunities in future product development.
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Affiliation(s)
- Yun-Chu Chen
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA
| | - Sheryhan F Gad
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Dhawal Chobisa
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Integrated product development organization, Innovation plaza, Dr. Reddy's Laboratories, Hyderabad 500090, India
| | - Yongzhe Li
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning 110016, PR China
| | - Yoon Yeo
- Department of Industrial and Physical Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.
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16
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Paunović N, Bao Y, Coulter FB, Masania K, Geks AK, Klein K, Rafsanjani A, Cadalbert J, Kronen PW, Kleger N, Karol A, Luo Z, Rüber F, Brambilla D, von Rechenberg B, Franzen D, Studart AR, Leroux JC. Digital light 3D printing of customized bioresorbable airway stents with elastomeric properties. SCIENCE ADVANCES 2021; 7:7/6/eabe9499. [PMID: 33536222 PMCID: PMC7857684 DOI: 10.1126/sciadv.abe9499] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/17/2020] [Indexed: 05/19/2023]
Abstract
Central airway obstruction is a life-threatening disorder causing a high physical and psychological burden to patients. Standard-of-care airway stents are silicone tubes, which provide immediate relief but are prone to migration. Thus, they require additional surgeries to be removed, which may cause tissue damage. Customized bioresorbable airway stents produced by 3D printing would be highly needed in the management of this disorder. However, biocompatible and biodegradable materials for 3D printing of elastic medical implants are still lacking. Here, we report dual-polymer photoinks for digital light 3D printing of customized and bioresorbable airway stents. These stents exhibit tunable elastomeric properties with suitable biodegradability. In vivo study in healthy rabbits confirmed biocompatibility and showed that the stents stayed in place for 7 weeks after which they became radiographically invisible. This work opens promising perspectives for the rapid manufacturing of the customized medical devices for which high precision, elasticity, and degradability are sought.
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Affiliation(s)
- Nevena Paunović
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Yinyin Bao
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | | | - Kunal Masania
- Complex Materials, Department of Materials, ETH Zurich, Zurich, Switzerland
- Shaping Matter Lab, Faculty of Aerospace Engineering, TU Delft, Delft, Netherlands
| | - Anna Karoline Geks
- Musculoskeletal Research Unit, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Karina Klein
- Musculoskeletal Research Unit, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Ahmad Rafsanjani
- Complex Materials, Department of Materials, ETH Zurich, Zurich, Switzerland
- SDU Biorobotics, The Mærsk Mc-Kinney Møller Institute, University of Southern Denmark, Odense, Denmark
| | - Jasmin Cadalbert
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Peter W Kronen
- Musculoskeletal Research Unit, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Veterinary Anaesthesia Services-International, Winterthur, Switzerland
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland
| | - Nicole Kleger
- Complex Materials, Department of Materials, ETH Zurich, Zurich, Switzerland
| | - Agnieszka Karol
- Musculoskeletal Research Unit, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Zhi Luo
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Fabienne Rüber
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Brambilla
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | | | - Daniel Franzen
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
| | - André R Studart
- Complex Materials, Department of Materials, ETH Zurich, Zurich, Switzerland.
| | - Jean-Christophe Leroux
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland.
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17
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Wu J, Mady LJ, Roy A, Aral AM, Lee B, Zheng F, Catalin T, Chun Y, Wagner WR, Yang K, Trejo Bittar HE, Chi D, Kumta PN. In-vivo efficacy of biodegradable ultrahigh ductility Mg-Li-Zn alloy tracheal stents for pediatric airway obstruction. Commun Biol 2020; 3:787. [PMID: 33339963 PMCID: PMC7749127 DOI: 10.1038/s42003-020-01400-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
Pediatric laryngotracheal stenosis is a complex congenital or acquired airway injury that may manifest into a potentially life-threatening airway emergency condition. Depending on the severity of obstruction, treatment often requires a combination of endoscopic techniques, open surgical repair, intraluminal stenting, or tracheostomy. A balloon expandable biodegradable airway stent maintaining patency while safely degrading over time may address the complications and morbidity issues of existing treatments providing a less invasive and more effective management technique. Previous studies have focused on implementation of degradable polymeric scaffolds associated with potentially life-threatening pitfalls. The feasibility of an ultra-high ductility magnesium-alloy based biodegradable airway stents was demonstrated for the first time. The stents were highly corrosion resistant under in vitro flow environments, while safely degrading in vivo without affecting growth of the rabbit airway. The metallic matrix and degradation products were well tolerated by the airway tissue without exhibiting any noticeable local or systemic toxicity.
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Affiliation(s)
- Jingyao Wu
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Leila J Mady
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Abhijit Roy
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Ali Mübin Aral
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Boeun Lee
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Feng Zheng
- Institute of Metal Research, Chinese Academic of Sciences, Shenyang, 110016, China
| | - Toma Catalin
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, 15261, USA
- McGowan Institute of Regenerative Medicine, Pittsburgh, PA, 15261, USA
| | - Youngjae Chun
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- McGowan Institute of Regenerative Medicine, Pittsburgh, PA, 15261, USA
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - William R Wagner
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- McGowan Institute of Regenerative Medicine, Pittsburgh, PA, 15261, USA
- Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Ke Yang
- Institute of Metal Research, Chinese Academic of Sciences, Shenyang, 110016, China
| | - Humberto E Trejo Bittar
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - David Chi
- Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, 15224, USA
| | - Prashant N Kumta
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
- McGowan Institute of Regenerative Medicine, Pittsburgh, PA, 15261, USA.
- Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
- Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
- Center for Complex Engineering Multi-functional Materials, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
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18
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Stramiello JA, Mohammadzadeh A, Ryan J, Brigger MT. The role of bioresorbable intraluminal airway stents in pediatric tracheobronchial obstruction: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 139:110405. [PMID: 33017664 DOI: 10.1016/j.ijporl.2020.110405] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Tracheal stenosis and tracheobronchomalacia are complicated, patient-specific diseases that can be treated with intraluminal stenting. Most commonly, silicone and metal stents are utilized, however, they pose significant early and late morbidity and are further complicated by growth of the airway in the pediatric population. Given recent improvements in materials science, there is a growing body of evidence suggesting a strong role for bioresorbable intraluminal stents in treating pediatric tracheobronchial obstruction. METHODS A PubMed.gov literature search was performed on December 3, 2019 and May 15, 2020, and a 2-researcher systematic review was performed following the PRISMA criteria. The following search query was utilized: (((((((bioresorbable) OR bioabsorbable) OR resorbable) OR absorbable) OR biodegradable AND airway) OR trachea) AND stent. A pooled statistical analysis was performed on all reported pediatric patients using SPSS software. RESULTS 1369 publications were screened and 26 articles with original data were identified. Materials used included polydioxanone (PDO), poly-l-lactic acid (PLLA), polyglycolic acid/poly-l-lactide co-polymer with Proglactin 910 (Vicryl®-PDS®), polycaprolactone (PCL), magnesium alloys, and co-polymers in varying proportions. Twelve articles presented data on human subjects, 8 of which were case series and case reports on pediatric populations using polydioxanone (PDO) stents. Pooled statistical analysis demonstrated an average age of 19 months (range 0.25-144), 56.5% associated with a cardiovascular anomaly, and overall complication rate of 21.7%, with a stent fragment foreign body being the most common (8.7%), followed by significant granulation tissue (4.3%), stent migration (4.3%), and local stenosis (4.3%). Comparative analysis demonstrated short-term improvement (up to 1 month) has a statistically significant association with tracheobronchomalacia versus tracheal stenosis on chi-squared test (p = 0.001). The remaining analyses did not yield statistical significance. CONCLUSION The reported application of bioresorbable materials as intraluminal airway stents is positive. All comparative animal studies report biocompatibility and fewer morbidities compared to metal and silicone stents, however, in human studies there are concerns over the short interval of degradation and the potential for obstructive foreign bodies in poorly seated stents. Overall, there are clear, reproducible advantages to bioresorbable intraluminal stents in pediatric airway obstruction, as well as common pitfalls, that warrant further research.
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Affiliation(s)
- Joshua A Stramiello
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W Arbor Dr. MC8895, San Diego, CA, 92103, USA
| | - Amir Mohammadzadeh
- UC San Diego School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - Justin Ryan
- 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, 3020 Children's Way MC5166, San Diego, CA, 92123, USA
| | - Matthew T Brigger
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W Arbor Dr. MC8895, San Diego, CA, 92103, USA; Division of Pediatric Otolaryngology, Department of Surgery, Rady Children's Hospital, San Diego, CA, 3020 Children's Way, San Diego, CA, 92123, USA.
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19
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Mondal A, Ha J, Jo VY, Wu FY, Kaza AK, Dupont PE. Preclinical evaluation of a pediatric airway stent for tracheobronchomalacia. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)30572-9. [PMID: 32331821 PMCID: PMC7492470 DOI: 10.1016/j.jtcvs.2020.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We sought to demonstrate in an animal model that helical stents made from a nickel titanium alloy called nitinol (NiTi) and designed for malacic airways could be delivered and removed without significant trauma while minimally impeding mucus clearance during the period of implantation. METHODS Stents were delivered and removed from the tracheas of healthy 20 kg swine (n = 5) using tools designed to minimize trauma. In 4-week experiments, the stents were implanted on day 0, removed after 3 weeks, and swine were put to death after 4 weeks. Weekly bronchoscopies, radiographs, and mucus clearance examinations were performed in vivo. Hematoxylin and eosin staining and scanning electron microscopy imaging were used to evaluate foreign body response, tracheal tissue reaction, and damage and to measure unciliated regions. RESULTS In all in vivo experiments, the stent was implanted and removed atraumatically. Mucus clearance was maintained throughout the experiment period. Hematoxylin and eosin-stained slides showed that foreign body response and tracheal tissue damage were localized to the stented subsections. Tracheal tissue reaction and damage was further restricted to the epithelium and submucosal layers. Scanning electron microscopy imaging revealed that the cilia were absent only over the contact area between the trachea and the wire forming the helical stent. CONCLUSIONS Helical nitinol stents designed to provide radial support for malacic airways were well tolerated in a porcine model, providing for mucus clearance while also enabling atraumatic removal.
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Affiliation(s)
- Abhijit Mondal
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass.
| | - Junhyoung Ha
- Center of Medical Robotics, Korea Institute of Science and Technology, Seoul, South Korea
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Boston, Mass
| | - Fei-Yi Wu
- Department of Surgery, Taipei Veteran General Hospital, Taipei City, Taiwan, Republic of China
| | - Aditya K Kaza
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass
| | - Pierre E Dupont
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass
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20
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Guibert N, Saka H, Dutau H. Airway stenting: Technological advancements and its role in interventional pulmonology. Respirology 2020; 25:953-962. [PMID: 32162394 DOI: 10.1111/resp.13801] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/11/2020] [Accepted: 02/23/2020] [Indexed: 12/17/2022]
Abstract
AS offers rapid and sustained relief of symptoms in most patients treated for malignant or benign CAO and can also be curative in itself in cases of benign tracheobronchial stenosis. In the past 30 years, this field has seen significant progress, from the misuse of vascular non-covered metallic stents to the development of silicone airway stents with an increasingly large panel of shapes and of hybrid, partially or fully covered, SEMS customized to the airways. This study aims to offer an overview on: (i) the respective advantages and drawbacks of these two main categories of devices; (ii) the main indications for AS and the rationale behind the choice of stent in each situation; and (iii) the main promises borne from the progress made in the field in the past few years, including the development of drug-eluting, biodegradable or patient-specific customized AS.
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Affiliation(s)
- Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Hervé Dutau
- Thoracic Oncology, Pleural Disease and Interventional Pulmonology Department, North University Hospital, Marseille, France
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Duvvuri M, Motz K, Tsai HW, Lina I, Ding D, Lee A, Hillel AT. Design of a Biocompatible Drug-Eluting Tracheal Stent in Mice with Laryngotracheal Stenosis. J Vis Exp 2020. [PMID: 32065163 DOI: 10.3791/60483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Laryngotracheal stenosis (LTS) is a pathologic narrowing of the subglottis and trachea leading to extrathoracic obstruction and significant shortness of breath. LTS results from mucosal injury from a foreign body in the trachea, leading to tissue damage and a local inflammatory response that goes awry, leading to the deposition of pathologic scar tissue. Treatment for LTS is surgical due to the lack of effective medical therapies. The purpose of this method is to construct a biocompatible stent that can be miniaturized to place into mice with LTS. We demonstrated that a PLLA-PCL (70% poly-L-lactide and 30% polycaprolactone) construct had optimal biomechanical strength, was biocompatible, practicable for an in vivo placement stent, and capable of eluting drug. This method provides a drug delivery system for testing various immunomodulatory agents to locally inhibit inflammation and reduce airway fibrosis. Manufacturing the stents takes 28-30 h and can be reproduced easily, allowing for experiments with large cohorts. Here we incorporated the drug rapamycin within the stent to test its effectiveness in reducing fibrosis and collagen deposition. Results revealed that PLLA-PCL tents showed reliable rapamycin release, were mechanically stable in physiological conditions, and were biocompatible, inducing little inflammatory response in the trachea. Further, the rapamycin-eluting PLLA-PCL stents reduced scar formation in the trachea in vivo.
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Affiliation(s)
- Madhavi Duvvuri
- Department of General Surgery, University of California, San Francisco
| | - Kevin Motz
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Hsiu-Wen Tsai
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Ioan Lina
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Dacheng Ding
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Andrew Lee
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Alexander T Hillel
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine;
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22
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Tian J, Liu Y, Miao S, Yang Q, Hu X, Han Q, Xue L, Yang P. Amyloid-like protein aggregates combining antifouling with antibacterial activity. Biomater Sci 2020; 8:6903-6911. [DOI: 10.1039/d0bm00760a] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A new class of biopolymer coating based on amyloid-like protein aggregates is reported to combine both antifouling and antibacterial activity.
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Affiliation(s)
- Juanhua Tian
- Department of Urology
- The Second Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710004
- China
| | - Yongchun Liu
- Key Laboratory of Applied Surface and Colloid Chemistry
- Ministry of Education
- School of Chemistry and Chemical Engineering
- Shaanxi Normal University
- Xi'an 710119
| | - Shuting Miao
- Key Laboratory of Applied Surface and Colloid Chemistry
- Ministry of Education
- School of Chemistry and Chemical Engineering
- Shaanxi Normal University
- Xi'an 710119
| | - Qingmin Yang
- School of Chemistry and Chemical Engineering
- Northwestern Polytechnical University
- Xi'an 710072
- China
| | - Xinyi Hu
- Key Laboratory of Applied Surface and Colloid Chemistry
- Ministry of Education
- School of Chemistry and Chemical Engineering
- Shaanxi Normal University
- Xi'an 710119
| | - Qian Han
- Key Laboratory of Applied Surface and Colloid Chemistry
- Ministry of Education
- School of Chemistry and Chemical Engineering
- Shaanxi Normal University
- Xi'an 710119
| | - Li Xue
- Department of Urology
- The Second Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710004
- China
| | - Peng Yang
- Key Laboratory of Applied Surface and Colloid Chemistry
- Ministry of Education
- School of Chemistry and Chemical Engineering
- Shaanxi Normal University
- Xi'an 710119
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Duvvuri M, Motz K, Murphy M, Feeley M, Ding D, Lee A, Elisseeff JH, Hillel AT. Engineering an immunomodulatory drug-eluting stent to treat laryngotracheal stenosis. Biomater Sci 2019; 7:1863-1874. [PMID: 30874257 DOI: 10.1039/c8bm01623b] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Develop a drug-eluting stent construct with a reliable drug-release profile and adequate mechanically stability for a trial in a small animal model of laryngotracheal stenosis (LTS), a debilitating pathologic narrowing of the airway leading to significant shortness of breath. METHODS Biodegradable, biocompatible stents containing 1.0% rapamycin made of PLLA-PCL (70% Poly-l-Lactide and 30% Polycaprolactone blend) and 50 : 50 PDLGA (Poly(dl-lactide-co-glycolide)) were compared. Mechanical strength testing and drug elution rates using high performance liquid chromatography analysis (HPLC) was assessed. Next, efficacy of stent elution on LTS derived scar fibroblasts. Finally, stents were placed in situ in an LTS mouse model. RESULTS The PLLA-PCL stent construct exhibited greater mechanical strength compared to the PDLGA stent over a 4-week period (Young's Modulus (PLLA-PCL) = 13.82; Young's Modulus (PDLGA) = 4.015). Moreover, the PLLA-PCL stent showed a reliable rapamycin release profile for 6 weeks (30% elution for PLLA-PCL stents compared to <1% elution for PDLGA). Collagen 1 (p < 0.05) and fibroblast cell proliferation were decreased in vitro when treated with the rapamycin stent. In vivo, the rapamycin stent reduced lamina propria thickness (p < 0.05) and collagen 1(p < 0.05), collagen 3, TGF-B (p < 0.05) and a-SMA (p < 0.05). CONCLUSIONS The PLLA-PCL construct demonstrated superior mechanical strength and greater drug elution compared to PDLGA stents. We demonstrated the feasibility of testing this drug-eluting stent in vivo, showing that the rapamycin-eluting stent treats fibrosis. To our knowledge this is the first study to deploy a drug-eluting stent to treat tracheal pathology in an animal model. Optimization of a rapamycin-eluting PLLA-PCL stent for translational investigation will lead to improved treatment strategies of LTS.
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Affiliation(s)
- Madhavi Duvvuri
- Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA.
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Abstract
Medical devices are defined as implantable if they are intended to remain in the body after the procedure. In veterinary medicine, use of such devices is marginal but may find some indications. Use in exotic pet medicine is even more challenging due to size restriction and the limited data available. This review focuses on the esophageal and tracheal stent in the case of stricture, ureteral stent and subcutaneous ureteral bypass in the case of ureteral obstruction, permanent urinary diversion in the case of bladder atony, and pacemaker in the case of severe arrythmias. Comparative aspects are developed.
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Affiliation(s)
- Minh Huynh
- Centre Hospitalier Vétérinaire Frégis, 43 Avenue Aristide Briand, Arcueil 94110, France.
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25
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Chan DS, Fnais N, Ibrahim I, Daniel SJ, Manoukian J. Exploring polycaprolactone in tracheal surgery: A scoping review of in-vivo studies. Int J Pediatr Otorhinolaryngol 2019; 123:38-42. [PMID: 31059931 DOI: 10.1016/j.ijporl.2019.04.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Tracheal pathology can be life-threatening if not managed appropriately. There are still some surgical limitations today for certain pathologies, such as in severe tracheomalacia, or when long segments of trachea need to be resected. Poly(ε-caprolactone) (PCL) is a polymer that has recently gained popularity for its use in tracheal surgeries in animal models and in certain human pediatric cases in hopes of addressing these difficult situations. PCL can be 3D printed or manufactured through molds to create tracheal stents, splints, patches and even to reconstruct full circumferential tracheal defects. OBJECTIVE To perform a scoping review, and explore insights into the applications of PCL for tracheal surgeries in-vivo. METHODS A literature search in Embase, MEDLINE, and BIOSIS was performed to include all articles available prior to December 21, 2018 without any language restrictions. We included all original research that investigated the use of a PCL implant, stent, splint, scaffold, or graft in tracheal surgeries in-vivo. Assessment of all articles were performed by two independent authors prior to inclusion for analysis. RESULTS A total of 27 articles were included in the study. All articles were original research studies, primarily consisting of interventional studies (92.4%), there was also 2 case reports (7.4%). Articles were published in the last decade, publications range from 2009 to 2019. The most common animal model used for the tracheal surgeries were the New Zealand rabbits (n = 19, 70%). Two studies (7%) also described the use PCL in a total of 4 human cases. To investigate the PCL reconstructed airways, histology and bronchoscopy were the most commonly implemented methods of analysis in 88.9% and 70.4% respectively. Airway analysis was also done using imaging modalities including CT scan (n = 9, 33.3%), MRI (n = 2, 7.4%), X-ray (n = 1, 3.7%). 17 (62.9%) of the studies used 3D printing processes to create their PCL implants. CONCLUSIONS Overall, this review demonstrates the feasibility of PCL in tracheal reconstruction and tracheal stenting/splinting. It highlights common trends and the limitations of the literature thus far on this topic.
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Affiliation(s)
- David S Chan
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Canada.
| | - Naif Fnais
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Canada
| | - Iman Ibrahim
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Canada
| | - Sam J Daniel
- Department of Otolaryngology Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - John Manoukian
- Department of Otolaryngology Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
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Abstract
Much has changed since the last review of interventional pulmonology (IP) published in this Clinics series. The rate of development of new techniques and their complexities require IP physicians to be constantly maintaining and updating their skill set. International agreed training pathways help ensure that the interventionalists of the present and future have the required knowledge of anatomy, manual dexterity, and clinical judgment to keep up with the continuing advances that are constantly expanding IP's diagnostic and therapeutic boundaries. IP remains one of the most desirable subspecialities in pulmonology, and the technologic advances make the future an exciting one.
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Affiliation(s)
- Alastair J Moore
- Oxford Interventional Pulmonology, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, UK
| | - Rachel M Mercer
- Oxford Interventional Pulmonology, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, UK; Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, UK
| | - Ali I Musani
- Interventional Pulmonology, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, University of Colorado School of Medicine, Denver, Academic Office 1, 12631 East 17th Avenue, M/S C323, Office # 8102, Aurora, CO 80045, USA.
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27
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Liu KS, Chen WH, Lee CH, Su YF, Liu SJ. Extended pain relief achieved by analgesic-eluting biodegradable nanofibers in the Nuss procedure: in vitro and in vivo studies. Int J Nanomedicine 2018; 13:8355-8364. [PMID: 30573957 PMCID: PMC6290868 DOI: 10.2147/ijn.s189505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The most common complaint after the Nuss procedure is severe postoperative chest pain. The aim of this study was to evaluate the effectiveness of analgesic-eluting biodegradable nanofibers in pain relief after the Nuss procedure. Materials and methods Poly(d,l)-lactide-co-glycolide, lidocaine, and ketorolac were dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol. This solution was electrospun into a nanofibrous membrane. The elution method and high-performance chromatography were used to characterize the in vitro drug release. Stainless steel bars with and without coating of the analgesic-eluting nanofibrous membrane were implanted underneath the sternums of New Zealand white rabbits. The in vivo characteristics were further investigated. Results The in vitro study showed that the biodegradable nanofibers released high doses of lidocaine and ketorolac within 10 days. The in vivo study demonstrated high local and systemic concentrations of lidocaine and ketorolac. The serum creatinine level was unaffected. Animals that received implants of the analgesic-eluting nanofiber-coated stainless steel bar exhibited significantly greater food and water ingestion and physical activity than the control group did, indicating effective pain relief. Conclusion The proposed analgesic-eluting biodegradable nanofibers contribute to the achievement of extended pain relief after the Nuss procedure, without obvious adverse effects, in an animal model.
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Affiliation(s)
- Kuo-Sheng Liu
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China
| | - Wei-Hsun Chen
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China
| | - Cheng-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China
| | - Yong-Fong Su
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan, Republic of China,
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan, Republic of China, .,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China,
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28
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Jin Z, Chen Z, Wu K, Shen Y, Guo S. Investigation of Migration-Preventing Tracheal Stent with High Dose of 5-Fluorouracil or Paclitaxel for Local Drug Delivery. ACS APPLIED BIO MATERIALS 2018; 1:1328-1336. [PMID: 34996236 DOI: 10.1021/acsabm.8b00290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Stent migration is one of the common reasons for the failure of tracheal stent. An antitumor drug/tracheal stent combination can promptly relieve dyspnea caused by tracheal stenosis and locally treat malignant occupying lesion or tumor. To prevent stent migration for more effective treatment, we prepared a migration-preventing nitinol tracheal stent (TS) with a high dose of 5-fluorouracil or paclitaxel (5-FU/TS or PTX/TS) by stent surface coating with a bilayered film, which is composed of a drug-loaded layer containing Carbopol 974P as mucoadhesive matrix and a blank Carbopol 974P layer. The resulting stent had a similar mechanical performance with the nitinol tracheal stent itself. The bilayered film containing 30% PTX (PTX30) could keep adhesion to porcine mucosa for 221.7 ± 11.4 min in PBS at a stirring speed of 150 rpm, and the corresponding PTX30/TS was difficult to be moved in the porcine tracheal lumen with a pulling force less than 0.7 N, indicating its good migration-preventing ability. The migration-preventing ability of the 5-FU/TS or PTX/TS was related to the compositions of bilayered films. The 5-FU release from the 5-FU/TS was dominated by a relaxation mechanism, while the PTX release was mainly controlled by a diffusion mechanism. Moreover, the 5-FU permeation from the 5-FU loaded film through the porcine tracheal mucosa was determined by the 5-FU dissolution, and PTX permeation was limited by the trans-mucosa process. After the deployment of PTX30/TS, inflammatory responses were observed in the rabbit tracheas and gradually alleviated during the follow-up period.
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Affiliation(s)
- Zhu Jin
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Zhaoyang Chen
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Keqin Wu
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Yuanyuan Shen
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Shengrong Guo
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
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30
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Flannery A, Daneshvar C, Dutau H, Breen D. The Art of Rigid Bronchoscopy and Airway Stenting. Clin Chest Med 2018; 39:149-167. [DOI: 10.1016/j.ccm.2017.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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31
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Recent developments in drug eluting devices with tailored interfacial properties. Adv Colloid Interface Sci 2017; 249:181-191. [PMID: 28532663 DOI: 10.1016/j.cis.2017.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 11/23/2022]
Abstract
Drug eluting devices have greatly evolved during past years to become fundamental products of great marketing importance in the biomedical field. There is currently a large diversity of highly specialized devices for specific applications, making the development of these devices an exciting field of research. The replacement of the former bare metal devices by devices loaded with drugs allowed the sustained and controlled release of drugs, to achieve the desired local therapeutic concentration of drug. The newer devices have been "engineered" with surfaces containing micro- and nanoscale features in a well-controlled manner, that have shown to significantly affect cellular and subcellular function of various biological systems. For example, the topography can be structured to form an antifouling surface mimicking the defense mechanisms found in nature, like the skin of the shark. In the case of bone implants, well-controlled nanostructured interfaces can promote osteoblast differentiation and matrix production, and enhance short-term and long-term osteointegration. In any case, the goal of current research is to design implants that induce controlled, guided, and rapid healing. This article reviews recent trends in the development of drug eluting devices, as well as recent developments on the micro/nanotechnology scales, and their future challenges. For this purpose medical devices have been divided according to the different systems of the body they are focused to: orthopedic devices, breathing stents, gastrointestinal and urinary systems, devices for cardiovascular diseases, neuronal implants, and wound dressings.
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Wang T, Zhang J, Wang J, Pei YH, Qiu XJ, Wang YL. Paclitaxel Drug-eluting Tracheal Stent Could Reduce Granulation Tissue Formation in a Canine Model. Chin Med J (Engl) 2017; 129:2708-2713. [PMID: 27824004 PMCID: PMC5126163 DOI: 10.4103/0366-6999.193461] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Currently available silicone and metallic stents for tracheal stenosis are associated with many problems. Granulation proliferation is one of the main complications. The present study aimed to evaluate the efficacy of paclitaxel drug-eluting tracheal stent in reducing granulation tissue formation in a canine model, as well as the pharmacokinetic features and safety profiles of the coated drug. Methods: Eight beagles were randomly divided into a control group (bare-metal stent group, n = 4) and an experimental group (paclitaxel-eluting stent group, n = 4). The observation period was 5 months. One beagle in both groups was sacrificed at the end of the 1st and 3rd months, respectively. The last two beagles in both groups were sacrificed at the end of 5th month. The proliferation of granulation tissue and changes in tracheal mucosa were compared between the two groups. Blood routine and liver and kidney function were monitored to evaluate the safety of the paclitaxel-eluting stent. The elution method and high-performance liquid chromatography were used to characterize the rate of in vivo release of paclitaxel from the stent. Results: Compared with the control group, the proliferation of granulation tissue in the experimental group was significantly reduced. The drug release of paclitaxel-eluting stent was the fastest in the 1st month after implantation (up to 70.9%). Then, the release slowed down gradually. By the 5th month, the release reached up to 98.5%. During the observation period, a high concentration of the drug in the trachea (in the stented and adjacent unstented areas) and lung tissue was not noted, and the blood test showed no side effect. Conclusions: The paclitaxel-eluting stent could safely reduce the granulation tissue formation after stent implantation in vivo, suggesting that the paclitaxel-eluting tracheal stent might be considered for potential use in humans in the future.
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Affiliation(s)
- Ting Wang
- Department of Respiratory, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100069, China
| | - Jie Zhang
- Department of Respiratory, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100069, China
| | - Juan Wang
- Department of Respiratory, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100069, China
| | - Ying-Hua Pei
- Department of Respiratory, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100069, China
| | - Xiao-Jian Qiu
- Department of Respiratory, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100069, China
| | - Yu-Ling Wang
- Department of Respiratory, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100069, China
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Guibert N, Mhanna L, Droneau S, Plat G, Didier A, Mazieres J, Hermant C. Techniques of endoscopic airway tumor treatment. J Thorac Dis 2016; 8:3343-3360. [PMID: 28066616 DOI: 10.21037/jtd.2016.11.49] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Interventional bronchoscopy has a predominant role in the management of both early and advanced-stage airway tumors. Given the very poor prognosis of lung cancer, there is a need for new tools to improve early detection and bronchoscopic treatment of endo-bronchial precancerous lesions. In more advanced stages, interventional bronchoscopy plays an important role, as nearly a third of lung cancers lead to proximal airway obstruction. This will cause great discomfort or even life-threatening symptoms related to local extension, such as dyspnea, post-obstructive pneumonia, and hemoptysis. Surgery for very locally advanced disease is only effective for a limited number of patients and the effects of conventional antitumor therapies, like radiation therapy or chemotherapy, are inconstant and are too delayed in a palliative context. In this review, we aim to provide pulmonologists with an exhaustive technical overview of (I) the bronchoscopic management of benign endobronchial lesions; (II) the bronchoscopic management of malignant tumors, including the curative treatment of localized lesions and palliative management of malignant proximal airway stenosis; and (III) descriptions of the emerging endoscopic techniques used to treat peripheral lung tumors.
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Affiliation(s)
- Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Laurent Mhanna
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Sylvain Droneau
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Gavin Plat
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Alain Didier
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Julien Mazieres
- Pulmonology Department, Larrey University Hospital, Toulouse, France
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Yu YH, Hsu YH, Chou YC, Fan CL, Ueng SWN, Kau YC, Liu SJ. Sustained relief of pain from osteosynthesis surgery of rib fracture by using biodegradable lidocaine-eluting nanofibrous membranes. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2016; 12:1785-1793. [PMID: 27157984 DOI: 10.1016/j.nano.2016.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/22/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
Various effective methods are available for perioperative pain control in osteosynthesis surgery, but they are seldom applied intraoperatively. The aim of this study was to evaluate a biodegradable poly([d,l]-lactide-co-glycolide) (PLGA)/lidocaine nanofibrous membrane for perioperative pain control in rib fracture surgery. Scanning electron microscopy showed high porosity of the membrane, and an ex vivo high-performance liquid chromatography study revealed an excellent release profile for both burst and controlled release of lidocaine within 30days. Additionally, the PLGA/lidocaine nanofibrous membrane was applied in an experimental rabbit rib osteotomy model. Implantation of the membrane around the osteotomized rib during osteosynthesis surgery resulted in a significant increase in weight gain, food and water consumption, and daily activity compared to the study group without the membrane. In addition, all osteotomized ribs were united. Thus, application of the PLGA/lidocaine nanofibrous membrane may be effective for sustained relief of pain in oeteosynthesis surgery.
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Affiliation(s)
- Yi-Hsun Yu
- Department of Mechanical Engineering, Chang Gung University, Kweishan, Tao-Yuan, Taiwan; Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Kweishan, Tao-Yuan, Taiwan
| | - Yung-Heng Hsu
- Department of Mechanical Engineering, Chang Gung University, Kweishan, Tao-Yuan, Taiwan; Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Kweishan, Tao-Yuan, Taiwan
| | - Ying-Chao Chou
- Department of Mechanical Engineering, Chang Gung University, Kweishan, Tao-Yuan, Taiwan; Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Kweishan, Tao-Yuan, Taiwan
| | - Chin-Lung Fan
- Department of Mechanical Engineering, Chang Gung University, Kweishan, Tao-Yuan, Taiwan
| | - Steve W N Ueng
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Kweishan, Tao-Yuan, Taiwan
| | - Yi-Chuan Kau
- Department of Anesthesiology, Chang Gung Memorial Hospital, Kweishan, Tao-Yuan, Taiwan
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Kweishan, Tao-Yuan, Taiwan; Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Kweishan, Tao-Yuan, Taiwan.
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35
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Chou YC, Cheng YS, Hsu YH, Yu YH, Liu SJ. A bio-artificial poly([D,L]-lactide-co-glycolide) drug-eluting nanofibrous periosteum for segmental long bone open fractures with significant periosteal stripping injuries. Int J Nanomedicine 2016; 11:941-53. [PMID: 27022261 PMCID: PMC4792178 DOI: 10.2147/ijn.s99791] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Biodegradable poly([d,l]-lactide-co-glycolide) (PLGA) nanofibrous membrane embedded with two drug-to-polymer weight ratios, namely 1:3 and 1:6, which comprised PLGA 180 mg, lidocaine 20 mg, vancomycin 20 mg, and ceftazidime 20 mg, and PLGA 360 mg, lidocaine 20 mg, vancomycin 20 mg, and ceftazidime 20 mg, respectively, was produced as an artificial periosteum in the treatment of segmental femoral fractures. The nanofibrous membrane’s drug release behavior was assessed in vitro using high-performance liquid chromatography and the disk-diffusion method. A femoral segmental fracture model with intramedullary Kirschner-wire fixation was established for the in vivo rabbit activity study. Twenty-four rabbits were divided into two groups. Twelve rabbits in group A underwent femoral fracture fixation only, and 12 rabbits in group B underwent femoral fracture fixation and were administered the drug-loaded nanofibers. Radiographs obtained at 2, 6, and 12 weeks postoperatively were used to assess the bone unions. The total activity counts in animal behavior cages were also examined to evaluate the clinical performance of the rabbits. After the animals were euthanized, both femoral shafts were harvested and assessed for their torque strengths and toughness. The daily in vitro release curve for lidocaine showed that the nanofibers eluted effective levels of lidocaine for longer than 3 weeks. The bioactivity studies of vancomycin and ceftazidime showed that both antibiotics had effective and sustained bactericidal capacities for over 30 days. The findings from the in vivo animal activity study suggested that the rabbits with the artificial drug-eluting periosteum exhibited statistically increased levels of activity and better clinical performance outcomes compared with the rabbits without the artificial periosteum. In conclusion, this artificial drug-eluting periosteum may eventually be used for the treatment of open fractures.
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Affiliation(s)
- Ying-Chao Chou
- Biomaterials Lab, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Shiun Cheng
- Biomaterials Lab, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Heng Hsu
- Biomaterials Lab, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Hsun Yu
- Biomaterials Lab, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Jung Liu
- Biomaterials Lab, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Varela G, Jiménez MF. En la estenosis traqueal benigna nunca deberían emplearse endoprótesis metálicas. Arch Bronconeumol 2016; 52:121-2. [DOI: 10.1016/j.arbres.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/02/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
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Suwannasom P, Sotomi Y, Tateishi H, Tenekecioglu E, Zeng Y, Kraak RP, Wykrzykowska JJ, De Winter RJ, Serruys PW, Onuma Y. Bioresorbable drug-eluting scaffolds for treatment of vascular disease. Expert Opin Drug Deliv 2016; 13:725-39. [PMID: 26865247 DOI: 10.1517/17425247.2016.1153062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Theoretical advantages of fully bioresorbable scaffold (BRS) stem from transient vessel support without rigid caging. Therefore, it could reduce long-term adverse events associated with the presence of foreign materials. AREAS COVERED This article will provide an overview of: drug-eluting BRS for various applications in the treatment of vascular disease; The mechanisms of active agent release from such scaffolds; currently available drug-eluting BRS and their future applications are also discussed. EXPERT OPINION The current BRS have been developed in order to achieve optimal vascular patency while providing long-term safety. The clinical efficacy and safety of BRS in coronary treatment have been reported as equal to that of the current metallic drug eluting stents in simple lesions. The application of BRS can potentially be expanded to other vascular beds. The research in bioengineering for the appropriate materials should not only focus on biocompatibility but also should be tailored according to the sites of implantation, which may require different strength and supporting period. The ultimate goal in this field is to develop a biocompatible device that provides equivalent and complementary therapy to other devices, and is able to disappear when the mechanical support and drug delivery are no longer required.
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Affiliation(s)
- Pannipa Suwannasom
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands.,b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands.,c Northern Region Heart Center, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Yohei Sotomi
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Hiroki Tateishi
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
| | | | - Yaping Zeng
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Robin P Kraak
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Joanna J Wykrzykowska
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Robbert J De Winter
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Patrick W Serruys
- d International Centre for Circulatory Health, NHLI , Imperial College London , London , UK
| | - Yoshinobu Onuma
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
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Hohenforst-Schmidt W, Zarogoulidis P, Pitsiou G, Linsmeier B, Tsavlis D, Kioumis I, Papadaki E, Freitag L, Tsiouda T, Turner JF, Browning R, Simoff M, Sachpekidis N, Tsakiridis K, Zaric B, Yarmus L, Baka S, Stratakos G, Rittger H. Drug Eluting Stents for Malignant Airway Obstruction: A Critical Review of the Literature. J Cancer 2016; 7:377-90. [PMID: 26918052 PMCID: PMC4749359 DOI: 10.7150/jca.13611] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/01/2015] [Indexed: 02/07/2023] Open
Abstract
Lung cancer being the most prevalent malignancy in men and the 3(rd) most frequent in women is still associated with dismal prognosis due to advanced disease at the time of diagnosis. Novel targeted therapies are already on the market and several others are under investigation. However non-specific cytotoxic agents still remain the cornerstone of treatment for many patients. Central airways stenosis or obstruction may often complicate and decrease quality of life and survival of these patients. Interventional pulmonology modalities (mainly debulking and stent placement) can alleviate symptoms related to airways stenosis and improve the quality of life of patients. Mitomycin C and sirolimus have been observed to assist a successful stent placement by reducing granuloma tissue formation. Additionally, these drugs enhance the normal tissue ability against cancer cell infiltration. In this mini review we will concentrate on mitomycin C and sirolimus and their use in stent placement.
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Affiliation(s)
| | - Paul Zarogoulidis
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Bernd Linsmeier
- 3. Department of General Surgery, Coburg Clinic, Coburg, Germany
| | - Drosos Tsavlis
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Papadaki
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lutz Freitag
- 4. Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany
| | - Theodora Tsiouda
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Francis Turner
- 5. Division of Interventional Pulmonology & Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ
| | - Robert Browning
- 6. Pulmonary & Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, U.S.A
| | - Michael Simoff
- 7. Bronchoscopy and Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, School of Medicine, MI, USA
| | - Nikolaos Sachpekidis
- 8. Cardiothoracic Surgery Department, ``Saint Luke`` Private Hospital, Thessaloniki, Panorama, Greece
| | - Kosmas Tsakiridis
- 8. Cardiothoracic Surgery Department, ``Saint Luke`` Private Hospital, Thessaloniki, Panorama, Greece
| | - Bojan Zaric
- 9. Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Serbia
| | - Lonny Yarmus
- 10. Division of Pulmonary and Critical Care Medicine, Sheikh Zayed Cardiovascular & Critical Care Tower, Baltimore, U.S.A
| | - Sofia Baka
- 11. Oncology Department, ``Interbalkan`` European Medical Center, Thessaloniki, Greece
| | - Grigoris Stratakos
- 12. 1st Respiratory Medicine Department of National University of Athens, "Sotiria" General Hospital Athens, Greece
| | - Harald Rittger
- 1. Medical Clinic I, ''Fuerth'' Hospital, University of Erlangen, Fuerth, Germany
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Dutau H, Musani AI, Laroumagne S, Darwiche K, Freitag L, Astoul P. Biodegradable Airway Stents - Bench to Bedside: A Comprehensive Review. Respiration 2015; 90:512-521. [PMID: 26613524 DOI: 10.1159/000442054] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/22/2015] [Indexed: 04/13/2024] Open
Abstract
Airway stents are indicated to treat symptomatic narrowing or to close fistulas of the central airways. They are generally divided into two types: the silicone stents and the metallic stents. Unlike in malignancies, removability is a major objective of temporary stenting in benign conditions, which poses the challenge of a new rigid bronchoscopic procedure under general anesthesia and stent removal with all its attendant risks and costs. The concept of a biodegradable (BD) stent that could maintain the patency of an airway for a predetermined duration of time is very appealing. These BD stents would gradually degrade and eventually vanish from the airway once they are no longer needed. Such stents are currently an area of intense research. Another very promising concept of drug delivery with such stents is also a very exciting area of current research. The aim of this comprehensive review is to discuss all pertinent available literature on the use of BD materials in various clinical applications and to extensively review all animal and humans trials involving BD airway stents.
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Affiliation(s)
- Hervé Dutau
- Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
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A Novel Biodegradable Polycaprolactone Fixator for Osteosynthesis Surgery of Rib Fracture: In Vitro and in Vivo Study. MATERIALS 2015; 8:7714-7722. [PMID: 28793672 PMCID: PMC5458921 DOI: 10.3390/ma8115415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/19/2015] [Accepted: 11/05/2015] [Indexed: 02/07/2023]
Abstract
Osteosynthesis surgery for rib fractures is controversial and challenging. This study developed a noval poly(ε-caprolactone) (PCL)-based biodegradable “cable-tie” fixator for osteosynthesis surgery for rib fractures. A biodegradable fixator specifically for fractured ribs was designed and fabricated by a micro-injection molding machine in our laboratory. The fixator has three belts that could be passed through matching holes individually. The locking mechanism allows the belt movement to move in only one direction. To examine the in vitro biomechanical performance, ribs 3–7 from four fresh New Zealand rabbits were employed. The load to failure and stress-strain curve was compared in the three-point bending test among native ribs, titanium plate-fixed ribs, and PCL fixator-fixed ribs. In the in vivo animal study, the sixth ribs of New Zealand rabbits were osteotomized and osteosynthesis surgery was performed using the PCL fixator. Outcomes were assessed by monthly X-ray examinations, a final micro-computed tomography (CT) scan, and histological analysis. The experimental results suggested that the ribs fixed with the PCL fixator were significantly less stiff than those fixed with titanium plates (p < 0.05). All ribs fixed with the PCL fixators exhibited union. The bridging callus was confirmed by gross, radiographic micro-three-dimensional (3D) CT, and histological examinations. In addition, there was no significant inflammatory response of the osteotomized ribs or the PCL-rib interface during application. The novel PCL fixator developed in this work achieves satisfactory results in osteosynthesis surgery for rib fractures, and may provide potential applications in other orthopedic surgeries.
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Sigler M, Klötzer J, Quentin T, Paul T, Möller O. Stent implantation into the tracheo-bronchial system in rabbits: histopathologic sequelae in bare metal vs. drug-eluting stents. Mol Cell Pediatr 2015; 2:10. [PMID: 26542300 PMCID: PMC4635111 DOI: 10.1186/s40348-015-0021-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/16/2015] [Indexed: 11/12/2022] Open
Abstract
Background Stent implantation into the tracheo-bronchial system may be life-saving in selected pediatric patients with otherwise intractable stenosis of the upper airways. Following implantation, significant tissue proliferation may occur, requiring re-interventions. We sought to evaluate the effect of immunosuppressive coating of the stents on the extent of tissue proliferation in an animal model. Methods Bare metal and sirolimus-coated stents (Bx Sonic and Cypher Select, Johnson & Johnson, Cordis) were implanted into non-stenotic lower airways of New Zealand white rabbits (weight 3.1 to 4.8 kg). Three stents with sirolimus coating and six bare metal stents could be analyzed by means of histology and immunohistochemistry 12 months after implantation. Results On a macroscopic evaluation, all stents were partially covered with a considerable amount of whitish tissue. Histologically, these proliferations contained fiber-rich connective tissue and some fibromuscular cells without significant differences between both stent types. The superficial tissue layer was formed by typical respiratory epithelium and polygonal cells. Abundant lymphocyte infiltrations and moderate granulocyte infiltrations were found in both groups correspondingly, whereas foreign-body reaction was more pronounced around sirolimus-eluting stents. Conclusions After stent implantation in the tracheo-bronchial system of rabbits, we found tissue reactions comparable to those seen after stent implantation into the vascular system. There was no difference between coated and uncoated stents with regard to quality and quantity of tissue proliferation. We found, however, a significantly different inflammatory reaction with a more pronounced foreign-body reaction in sirolimus-coated stents. In our small series, drug-eluting stents did not exhibit any benefit over bare metal stents in an experimental setting.
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Affiliation(s)
- Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Robert Koch Strasse 40, D 37075, Göttingen, Germany.
| | - Julia Klötzer
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Robert Koch Strasse 40, D 37075, Göttingen, Germany.
| | - Thomas Quentin
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Robert Koch Strasse 40, D 37075, Göttingen, Germany.
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Robert Koch Strasse 40, D 37075, Göttingen, Germany.
| | - Oliver Möller
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Robert Koch Strasse 40, D 37075, Göttingen, Germany.
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Hohenforst-Schmidt W, Linsmeier B, Zarogoulidis P, Freitag L, Darwiche K, Browning R, Turner JF, Huang H, Li Q, Vogl T, Zarogoulidis K, Brachmann J, Rittger H. Transtracheal single-point stent fixation in posttracheotomy tracheomalacia under cone-beam computer tomography guidance by transmural suturing with the Berci needle - a perspective on a new tool to avoid stent migration of Dumon stents. Ther Clin Risk Manag 2015; 11:837-50. [PMID: 26045666 PMCID: PMC4448926 DOI: 10.2147/tcrm.s83230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Tracheomalacia or tracheobronchomalacia (TM or TBM) is a common problem especially for elderly patients often unfit for surgical techniques. Several surgical or minimally invasive techniques have already been described. Stenting is one option but in general long-time stenting is accompanied by a high complication rate. Stent removal is more difficult in case of self-expandable nitinol stents or metallic stents in general in comparison to silicone stents. The main disadvantage of silicone stents in comparison to uncovered metallic stents is migration and plugging. We compared the operation time and in particular the duration of a sufficient Dumon stent fixation with different techniques in a patient with severe posttracheotomy TM and strongly reduced mobility of the vocal cords due to Parkinson’s disease. The combined approach with simultaneous Dumon stenting and endoluminal transtracheal externalized suture under cone-beam computer tomography guidance with the Berci needle was by far the fastest approach compared to a (not performed) surgical intervention, or even purely endoluminal suturing through the rigid bronchoscope. The duration of the endoluminal transtracheal externalized suture was between 5 minutes and 9 minutes with the Berci needle; the pure endoluminal approach needed 51 minutes. The alternative of tracheobronchoplasty was refused by the patient. In general, 180 minutes for this surgical approach is calculated. The costs of the different approaches are supposed to vary widely due to the fact that in Germany 1 minute in an operation room costs on average approximately 50–60€ inclusive of taxes. In our own hospital (tertiary level), it is nearly 30€ per minute in an operation room for a surgical approach. Calculating an additional 15 minutes for patient preparation and transfer to wake-up room, therefore a total duration inside the investigation room of 30 minutes, the cost per flexible bronchoscopy is per minute on average less than 6€. Although the Dumon stenting requires a set-up with more expensive anesthesiology accompaniment, which takes longer than a flexible investigation estimated at 1 hour in an operation room, still without calculation of the costs of the materials and specialized staff that the surgical approach would consume at least 3,000€ more than a minimally invasive approach performed with the Berci needle. This difference is due to the longer time of the surgical intervention which is calculated at approximately 180 minutes in comparison to the achieved non-surgical approach of 60 minutes in the operation suite.
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Affiliation(s)
- Wolfgang Hohenforst-Schmidt
- Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany ; II Medical Clinic, "Coburg" Hospital, University of Wuerzburg, Coburg, Germany
| | - Bernd Linsmeier
- Department of Thoracic Surgery, Medinos Clinic Sonneberg, Sonnerberg, Germany
| | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lutz Freitag
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg, Essen, Germany
| | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg, Essen, Germany
| | - Robert Browning
- Pulmonary and Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, MD, USA
| | - J Francis Turner
- Division of Interventional Pulmonology and Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ, USA
| | - Haidong Huang
- Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China
| | - Qiang Li
- Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China
| | - Thomas Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Johannes Brachmann
- II Medical Clinic, "Coburg" Hospital, University of Wuerzburg, Coburg, Germany
| | - Harald Rittger
- Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany
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Wang D, Ge N, Li J, Qiao Y, Zhu H, Liu X. Selective Tumor Cell Inhibition Effect of Ni-Ti Layered Double Hydroxides Thin Films Driven by the Reversed pH Gradients of Tumor Cells. ACS APPLIED MATERIALS & INTERFACES 2015; 7:7843-7854. [PMID: 25825800 DOI: 10.1021/acsami.5b01087] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Nitinol is widely fabricated as stents for the palliation treatment of many kinds of cancers. It is of great importance to develop nitinol stents with selective tumor cell inhibition effects. In this work, a series of pH sensitive films composed of Ni(OH)2 and Ni-Ti layered double hydroxide (Ni-Ti LDH) with different Ni/Ti ratios were prepared on the surface of nitinol via hydrothermal treatment. The films with specific Ni/Ti ratios would release a large amount of nickel ions under acidic environments but were relatively stable in neutral or weak alkaline medium. Cell viability tests showed that the films can effectively inhibit the growth of cancer cells but have little adverse effects to normal cells. Besides, extraordinarily high intracellular nickel content and reactive oxygen species (ROS) level were found in cancer cells, indicating the death of cancer cells may be induced by the excessive intake of nickel ions. Such selective cancer cell inhibition effect of the films is supposed to relate with the reversed pH gradients of tumor cells.
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Affiliation(s)
- Donghui Wang
- †State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
| | - Naijian Ge
- ‡Intervention Center, Eastern Hepatobilialy Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
| | - Jinhua Li
- †State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
| | - Yuqin Qiao
- †State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
| | - Hongqin Zhu
- †State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
| | - Xuanyong Liu
- †State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
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Huang Y, Ng HCA, Ng XW, Subbu V. Drug-eluting biostable and erodible stents. J Control Release 2014; 193:188-201. [DOI: 10.1016/j.jconrel.2014.05.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/29/2014] [Accepted: 05/07/2014] [Indexed: 12/30/2022]
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Kruklitis RJ, Fishbein I, Singhal S, Kapoor V, Levy RJ, Alferiev IS, Sterman DH. Stent-mediated gene delivery for site-specific transgene administration to the airway epithelium and management of tracheobronchial tumors. Respiration 2014; 88:406-17. [PMID: 25323160 DOI: 10.1159/000368164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gene therapy is currently under investigation as a means of managing a variety of pulmonary diseases. Unfortunately, gene transfer to bronchial epithelium has been hampered by the lack of stable and efficient transduction. Recent studies have shown that gene vectors could be tethered to the metallic surfaces of intra-arterial stents. This approach enables efficacious and site-specific adenoviral gene delivery to the vascular endothelium. OBJECTIVES We hypothesized that airway mesh stents impregnated with viral gene vectors could be used for local gene delivery to benign and malignant bronchial epithelium. METHODS Serotype 5 adenoviral vectors (Ad5, E1-/E3-) containing the reporter genes green fluorescent protein (Ad.GFP) or β-galactoside/LacZ (Ad.LacZ), or a therapeutic gene, Ad.INF-β, were coupled to either metallic mesh disks or stents via anti-Ad knob antibodies. These platforms were assessed for their ability to transfect bronchial epithelial cells from both rats and humans, as well as murine (L1C2) and human (A549) lung cancer cell lines. Gene transfer was quantified by fluorescent microscopy, scanning fluorimetry for Ad.GFP, and light microscopy studies assessing β-galactosidase staining for Ad.LacZ. Metallic mesh and stent-mediated gene transfer was also performed in a murine flank tumor model and in a rat endotracheal tumor model in order to evaluate the therapeutic potential. RESULTS In these studies, murine and human non-small cell lung cancer (NSCLC) cells were successfully transfected with reporter genes in vitro. Ad.LacZ-complexed mesh successfully transfected reporter genes into established murine flank NSCLC tumors. In addition, Ad.LacZ-tethered stents could effectively transfect both tracheobronchial epithelium and submucosal glands in rats. Similar epithelial transfection was achieved in ex vivo human bronchial epithelium. Pilot in vivo experimentation provided data supporting the concept that therapeutic genes could also be delivered with this technology. In additional pilot in vivo experiments, the growth of murine flank tumors was inhibited by placement of mesh disks coupled with Ad.muINF-β, and rats bearing endotracheal tumors demonstrated a trend towards prolonged survival with insertion of Ad.ratINF-β-tethered stents. CONCLUSIONS Stent-mediated gene delivery successfully enabled site-specific vector administration to target rat and human airway cells in cell culture, organ culture and in vivo. Local tracheobronchial gene delivery via stents could provide a viable clinical solution for overcoming the difficulties encountered with vector delivery within the lungs, in particular by lowering requisite vector titers and by directing desired vectors to areas of interest. This strategy may prove valuable for treating tumors involving the tracheobronchial tree, as well as other nonmalignant tracheobronchial disorders.
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Affiliation(s)
- Robert J Kruklitis
- Section of Interventional Pulmonology and Thoracic Oncology, Pulmonary, Allergy and Critical Care Division, University of Pennsylvania Medical Center, Philadelphia, Pa., USA
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Surface control of hydrophilicity and degradability with block copolymers composed of lactide and cyclic carbonate bearing methoxyethoxyl groups. POLYMER 2014. [DOI: 10.1016/j.polymer.2014.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Walter RFH, Zarogoulidis P, Mairinger FD, Werner R, Darwiche K, Zarogoulidis K, Freitag L. Cell viability of fibroblasts to pifenidone and sirolimus: a future concept for drug eluting stents. Int J Pharm 2014; 466:38-43. [PMID: 24607204 DOI: 10.1016/j.ijpharm.2014.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 03/01/2014] [Accepted: 03/01/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Currently one of the major problems that interventional pulmonologists have to face is the increased proliferation of fibrinous tissue on the site of the stent placement, and usually at the two ends. MATERIALS AND METHODS The drugs rapamycin and pirfenidone were chosen for our experiment. Fibroblasts were also cultured in order to administer pirfenidone and rapamycin in different concentrations. The following cell viability methods were used: (a) Senescence - Cell Titer Assay, (b) Necrosis - Cyto Tox Assay and (c) Apoptosis - Caspase-Glo 3/7 Assay. RESULTS Rapamycin has minimal to no effect on fibroblasts regarding apoptosis, senescence and necrosis. 0.1 to 1 μM. Pirfenidone concentrations lead to an elevated cell metabolism because cells try to evade the cytotoxic effect of the drug. Increasing Pirfenidone concentrations lead to higher apoptosis rates. 10 μM pirfenidone induces the highest apoptosis rates in this experiment and reduce cell viability to a minimum. CONCLUSION Necrosis is unaffected by the investigated drugs.
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Affiliation(s)
- Robert F H Walter
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, G. Papanikolaou, General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fabian D Mairinger
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Robert Werner
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, G. Papanikolaou, General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lutz Freitag
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany.
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Akulian J, Feller-Kopman D, Lee H, Yarmus L. Advances in interventional pulmonology. Expert Rev Respir Med 2014; 8:191-208. [PMID: 24450415 DOI: 10.1586/17476348.2014.880053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Interventional pulmonology (IP) remains a rapidly expanding and evolving subspecialty focused on the diagnosis and treatment of complex diseases of the thorax. As the field continues to push the leading edge of medical technology, new procedures allow for novel minimally invasive approaches to old diseases including asthma, chronic obstructive pulmonary disease and metastatic or primary lung malignancy. In addition to technologic advances, IP has matured into a defined subspecialty, requiring formal training necessary to perform the advanced procedures. This need for advanced training has led to the need for standardization of training and the institution of a subspecialty board examination. In this review, we will discuss the dynamic field of IP as well as novel technologies being investigated or employed in the treatment of thoracic disease.
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Affiliation(s)
- Jason Akulian
- University of North Carolina, Pulmonary and Critical Care, Chapel Hill, CA, USA
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Non-vascular drug eluting stents as localized controlled drug delivery platform: Preclinical and clinical experience. J Control Release 2013; 172:105-117. [DOI: 10.1016/j.jconrel.2013.08.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/03/2013] [Accepted: 08/05/2013] [Indexed: 01/10/2023]
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Zarogoulidis P, Darwiche K, Tsakiridis K, Teschler H, Yarmus L, Zarogoulidis K, Freitag L. Learning from the Cardiologists and Developing Eluting Stents Targeting the Mtor Pathway for Pulmonary Application; A Future Concept for Tracheal Stenosis. J Mol Genet Med 2013; 7:65. [PMID: 24454525 PMCID: PMC3896392 DOI: 10.4172/1747-0862.1000065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tracheal stenosis due to either benign or malignant disease is a situation that the pulmonary physicians and thoracic surgeons have to cope in their everyday clinical practice. In the case where tracheal stenosis is caused due to malignancy mini-interventional interventions with laser, apc, cryoprobe, balloon dilation or with combination of more than one equipment and technique can be used. On the other hand, in the case of a benign disease such as; tracheomalacia the clinician can immediately upon diagnosis proceed to the stent placement. In both situations however; it has been observed that the stents induce formation of granuloma tissue in both or one end of the stent. Therefore a frequent evaluation of the patient is necessary, taking also into account the nature of the primary disease. Evaluation methodologies identifying different types and extent of the trachea stenosis have been previously published. However; we still do not have an effective adjuvant therapy to prevent granuloma tissue formation or prolong already treated granuloma lesions. There have been proposed many mechanisms which induce the abnormal growth of the local tissue, such as; local pressure, local stress, inflammation and vascular endothelial growth factor overexpression. Immunomodulatory agents inhibiting the mTOR pathway are capable of inhibiting the inflammatory cascade locally. In the current mini-review we will try to present the current knowledge of drug eluting stents inhibiting the mTOR pathway and propose a future application of these stents as a local anti-proliferative treatment.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Kosmas Tsakiridis
- Cardiothoracic Surgery Department, "Saint Luke" Private Hospital of Health Excellence, Panorama, Thessaloniki, Greece
| | - Helmut Teschler
- Pulmonary Department, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Sheikh Zayed Cardiovascular & Critical Care Tower, Johns Hopkins University, Baltimore, USA
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lutz Freitag
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
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