An Overview of In Vitro Drug Release Methods for Drug-Eluting Stents

Drug Delivery Opportunities in Esophageal Cancer: Current Treatments and Future Prospects

With one of the highest mortality rates of all malignancies, the 5-year survival rate for esophageal cancer is under 20%. Depending on the stage and extent of the disease, the current standard of care treatment paradigm includes chemotherapy or chemoradiotherapy followed by surgical esophagogastrectomy, with consideration for adjuvant immunotherapy for residual disease. This regimen has high morbidity, due to anatomic changes inherent in surgery, the acuity of surgical complications, and off-target effects of systemic chemotherapy and immunotherapy. We begin with a review of current treatments, then discuss new and emerging targets for therapies and advanced drug delivery systems. Recent and ongoing preclinical and early clinical studies are evaluating traditional tumor targets (e.g., human epidermal growth factor receptor 2), as well as promising new targets such as Yes-associated protein 1 or mammalian target of rapamycin to develop new treatments for this disease. Due the function and location of the esophagus, opportunities also exist to pair these treatments with a drug delivery strategy to increase tumor targeting, bioavailability, and intratumor concentrations, with the two most common delivery platforms being stents and nanoparticles. Finally, early results with antibody drug conjugates and chimeric antigenic receptor T cells show promise as upcoming therapies. This review discusses these innovations in therapeutics and drug delivery in the context of their successes and failures, with the goal of identifying those solutions that demonstrate the most promise to shift the paradigm in treating this deadly disease.

Coatings for Cardiovascular Stents-An Up-to-Date Review

Cardiovascular diseases (CVDs) increasingly burden health systems and patients worldwide, necessitating the improved awareness of current treatment possibilities and the development of more efficient therapeutic strategies. When plaque deposits narrow the arteries, the standard of care implies the insertion of a stent at the lesion site. The most promising development in cardiovascular stents has been the release of medications from these stents. However, the use of drug-eluting stents (DESs) is still challenged by in-stent restenosis occurrence. DESs' long-term clinical success depends on several parameters, including the degradability of the polymers, drug release profiles, stent platforms, coating polymers, and the metals and their alloys that are employed as metal frames in the stents. Thus, it is critical to investigate new approaches to optimize the most suitable DESs to solve problems with the inflammatory response, delayed endothelialization, and sub-acute stent thrombosis. As certain advancements have been reported in the literature, this review aims to present the latest updates in the coatings field for cardiovascular stents. Specifically, there are described various organic (e.g., synthetic and natural polymer-based coatings, stents coated directly with drugs, and coatings containing endothelial cells) and inorganic (e.g., metallic and nonmetallic materials) stent coating options, aiming to create an updated framework that would serve as an inception point for future research.

Hypericin supramolecular assembles: A way to increase the skin availability and photodynamic efficiency in tumor cells

Cyclodextrins (CDs) are molecules approved by the FDA and show promise in increasing the solubility of hydrophobic molecules and making them more available to the skin. These CDs have been used to form complexes with some photosensitizers for Photodynamic Therapy (PDT), such as Hypericin (HY). HY is a lipophilic photosensitizer known for its exceptional fluorescence and singlet oxygen quantum yield generation of over 20 % under 590 nm irradiation. In this study, we found a six-fold increase in the release of HY in vitro after complexation with β-CD. The β-CDHY assembly also demonstrated better skin retention, which is crucial for the topical application of this photosensitizer. Furthermore, the β-CD complexation led to a significant increase in the phototoxicity of HY at three different light doses (3, 6, and 10 J cm-2) due to its improved water solubility and higher in vitro accumulation (approximately two times compared with free HY) in HeLa and Vero cell lines.

3D-Printed Capsaicin-Loaded Injectable Implants for Targeted Delivery in Obese Patients

Diet-induced obesity and hyperlipidemia are a growing public health concern leading to various metabolic disorders. Capsaicin, a major bioactive compound obtained from natural chili peppers, has demonstrated its numerous beneficial roles in treating obesity and weight loss. Current treatment involves either administration of antiobesity drugs or surgical procedures such as Roux-en-Y-gastric bypass or sleeve gastrectomy, both of which are associated with serious side effects and poor patient acceptance. Capsaicin, a pungent molecule, has low oral bioavailability. Therefore, there is a need for the development of site-specific drug delivery system for capsaicin. The present study is aimed at preparing and characterizing 3D-printed capsaicin-loaded rod-shaped implants by thermoplastic extrusion-based 3D printing technology. The implants were printed with capsaicin-loaded into a biodegradable polymer, polycaprolactone, at different drug loadings and infill densities. The surface morphology revealed a smooth and uniform external surface without any capsaicin crystals. DSC thermograms showed no significant changes/exothermic events among the blends suggesting no drug polymer interactions. The in vitro release studies showed a biphasic release profile for capsaicin, and the release was sustained for more than three months (~ 85% released) irrespective of drug loading and infill densities. The HPLC method was stability-indicating and showed good resolution for its analogs, dihydrocapsaicin and nordihydrocapsaicin. The implants were stable for three months at accelerated conditions (40°C) without any significant decrease in the assay of capsaicin. Therefore, capsaicin-loaded implants can serve as a long-acting injectable formulation for targeting the adipose tissue region in obese patients.

Cleverballoon: An integrated approach for developing a drug-coated balloon with everolimus

Coronary artery disease (CAD) is a chronic disease associated with high mortality and morbidity. Although treatment with drug-eluting stents is the most frequent interventional approach for coronary artery disease, drug-coated balloons (DCBs) constitute an innovative alternative, especially in the presence of certain anatomical conditions in the local coronary vasculature. DCBs allow the fast and homogenous transfer of drugs into the arterial wall, during the balloon inflation. Their use has been established for treating in-stent restenosis caused by stent implantation, while recent clinical trials have shown a satisfactory efficacy in de novo small-vessel disease. Several factors affect DCBs performance including the catheter design, the drug dose and formulation. Cleverballoon focuses on the design and development of an innovative DCB with everolimus. For the realization of the development of this new DCB, an integrated approach, including in- vivo, in-vitro studies and in-silico modelling towards the DCB optimization, is presented.Clinical Relevance-The proposed study introduces the integration of in- vivo, in-vitro and in silico approaches in the design and development process of a new DCB, following the principles of 3R's for the replacement, reduction, and refinement of animal and clinical studies.

Engineering In Situ Weldable Vascular Devices

(1) Background: The minimally invasive implantation of medical devices is largely limited by their insertion profile, and, therefore, minimizing them constitutes a leading trend in the field. (2) Methods: This study introduces the in situ welding strategy, whereby the components of the stent grafts used to treat abdominal aortic aneurysms were decoupled, deployed sequentially, and welded together at the aneurysmal site, greatly reducing their insertion profile. Polyurethane elastomers were used to produce the graft and to coat the metallic struts of the stent to render it in vivo weldable. Results: The composition of the polyurethanes was fine-tuned, so to minimize the insertion profiles and optimize the welding properties and the clinical performance of the devices assembled. The stent and graft were deployed successively in pigs via a small 8F introducer, in situ welded, and the patency of the bi-component device was confirmed over a three-month post-implantation period. The strength of the stent/graft welded connection was fully retained, with no de-welding observed. Conclusions: The in situ welding strategy resulted in implantations that were easier to perform and markedly less injurious to tissues and organs, largely expanding the applicability of these ultra-minimally invasive procedures to especially frail segments of the population.

Magnetoresponsive Functionalized Nanocomposite Aggregation Kinetics and Chain Formation at the Targeted Site during Magnetic Targeting

Drug therapy for vascular disease has been promoted to inhibit angiogenesis in atherosclerotic plaques and prevent restenosis following surgical intervention. This paper investigates the arterial depositions and distribution of PEG-functionalized magnetic nanocomposite clusters (PEG_MNCs) following local delivery in a stented artery model in a uniform magnetic field produced by a regionally positioned external permanent magnet; also, the PEG_MNCs aggregation or chain formation in and around the implanted stent. The central concept is to employ one external permanent magnet system, which produces enough magnetic field to magnetize and guide the magnetic nanoclusters in the stented artery region. At room temperature (25 °C), optical microscopy of the suspension model’s aggregation process was carried out in the external magnetic field. According to the optical microscopy pictures, the PEG_MNC particles form long linear aggregates due to dipolar magnetic interactions when there is an external magnetic field. During magnetic particle targeting, 20 mL of the model suspensions are injected (at a constant flow rate of 39.6 mL/min for the period of 30 s) by the syringe pump in the mean flow (flow velocity is Um = 0.25 m/s, corresponding to the Reynolds number of Re = 232) into the stented artery model. The PEG_MNC clusters are attracted by the magnetic forces (generated by the permanent external magnet) and captured around the stent struts and the bottom artery wall before and inside the implanted stent. The colloidal interaction among the MNC clusters was investigated by calculating the electrostatic repulsion, van der Waals and magnetic dipole-dipole energies. The current work offers essential details about PEG_MNCs aggregation and chain structure development in the presence of an external magnetic field and the process underlying this structure formation.