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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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2
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Aravena C, Gildea TR. Advancements in airway stents: a comprehensive update. Curr Opin Pulm Med 2024; 30:75-83. [PMID: 37937587 DOI: 10.1097/mcp.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW This review provides an overview of the evolving field of airway stenting (AS), highlighting its relevance in the management of central airway obstruction (CAO). It discusses recent advancements, including 3D-printed silicone stents (3DPSS), metallic stents, biodegradable stents (BS), and drug-eluting stents (DES), which are transforming clinical practice. The review underscores the ongoing challenges in patient selection, stent choice, and long-term management in the context of an evolving landscape. RECENT FINDINGS Innovations, particularly 3DPSS, have shown promise in providing patient-specific solutions. These stents offer improved symptom relief, enhanced quality of life, and lower complication rates, especially for complex airway diseases. The use of BS and DES is explored, raising prospects for future applications. SUMMARY The evolution of AS reflects a deepening understanding of airway obstructions. Recent innovations, such as 3DPSS, BS, and DES, show considerable promise in addressing the limitations of conventional stents. However, challenges related to complications, patient selection, and long-term management persist, demanding further research. Wide practice variations in the management of AS highlight the need for more clinical data and standardized guidelines. The search for the ideal stent continues, driven by the pursuit of better outcomes for patients with CAO.
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Affiliation(s)
- Carlos Aravena
- Department of Respiratory Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Thomas R Gildea
- Respiratory Institute. Pulmonary, Allergy and Critical care Medicine and Transplant Center, Cleveland Clinic. Cleveland, Ohio, USA
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3
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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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Wuillemin F, Vachon C, Dunn M, Desrochers A. Management of obstructive urethroliths, urethral pseudodiverticulum, and stricture by diverticulectomy, urethroplasty, and urethral stenting placement in a male goat. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2023; 64:733-741. [PMID: 37529384 PMCID: PMC10352047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
A 5-year-old wether was presented for an acute onset of loss of appetite and inability to urinate. Urethral urolithiasis causing urethral obstruction was diagnosed and a cystostomy catheter was placed. The wether continued to be unable to urinate through the urethra and further developed a perineal pseudodiverticulum. Diverticulectomy followed by a urethroplasty using porcine small intestinal submucosa was performed to relieve the obstruction. The wether developed a urethral stricture following urethroplasty and the owners refused a perineal urethroplasty. Cystourethrography, fluoroscopic-guided balloon dilations, and urethral stent placement were done to establish urethral patency. The wether developed tissue ingrowth through the stent, resulting in recurrent obstruction that necessitated placement of covered urethral stents. Key clinical message: Although obstructive uroliths usually carry a guarded prognosis in small ruminants, the use of novel interventional radiology techniques along with urethroplasty using a xenograft allowed a wether to achieve urethral patency and normal urinations.
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Affiliation(s)
- Florian Wuillemin
- Department of Clinical Sciences, School of Veterinary Medicine, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2
| | - Catherine Vachon
- Department of Clinical Sciences, School of Veterinary Medicine, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2
| | - Marilyn Dunn
- Department of Clinical Sciences, School of Veterinary Medicine, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2
| | - André Desrochers
- Department of Clinical Sciences, School of Veterinary Medicine, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2
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Xu C, Ma Y, Huang H, Ruan Z, Li Y. A Review of Woven Tracheal Stents: Materials, Structures, and Application. J Funct Biomater 2022; 13:jfb13030096. [PMID: 35893464 PMCID: PMC9326637 DOI: 10.3390/jfb13030096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
The repair and reconstruction of tracheal defects is a challenging clinical problem. Due to the wide choice of materials and structures, weaving technology has shown unique advantages in simulating the multilayer structure of the trachea and providing reliable performance. Currently, most woven stent-based stents focus only on the effect of materials on stent performance while ignoring the direct effect of woven process parameters on stent performance, and the advantages of weaving technology in tissue regeneration have not been fully exploited. Therefore, this review will introduce the effects of stent materials and fabric construction on the performance of tracheal stents, focusing on the effects of weaving process parameters on stent performance. We will summarize the problems faced by woven stents and possible directions of development in the hope of broadening the technical field of artificial trachea preparation.
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Affiliation(s)
- Chen Xu
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
| | - Yanxue Ma
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
| | - Haihua Huang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China;
| | - Zheng Ruan
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China;
- Correspondence: (Z.R.); (Y.L.)
| | - Yuling Li
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
- Correspondence: (Z.R.); (Y.L.)
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6
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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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7
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Liu Y, Zhang J, Long J, Qiu X, Wang T, Wang J. The Effects of Rapamycin on the Proliferation, Migration, and Apoptosis of Human Tracheal Fibroblasts (HTrF) and Human Tracheal Epithelial Cells (HTEpiC). J Clin Med 2022; 11:jcm11030608. [PMID: 35160060 PMCID: PMC8837066 DOI: 10.3390/jcm11030608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Restenosis after airway stenting needs to be addressed urgently. Rapamycin has been proven to inhibit restenosis elsewhere. This study aimed at observing its effects on the respiratory tract. Methods: CCK-8, wound healing, Transwell and apoptosis assays were performed to detect the effects of rapamycin on the survival, migration, and apoptosis, respectively, of human tracheal fibroblasts (HTrF) and human tracheal epithelial cells (HTEpiC). Results: The effective concentrations of paclitaxel, mitomycin C and rapamycin on HTrF were 10−7–10−4 mol/L, 10−6–10−4 mol/L, and 10−5–10−4 mol/L, respectively. At the effective concentrations, the inhibition rates of paclitaxel on HTEpiC were (43.03 ± 1.12)%, (49.49 ± 0.86)%, (55.22 ± 1.43)%, and (93.19 ± 0.45)%; the inhibition rates of mitomycin C on HTEpiC were (88.11 ± 0.69)%, (93.82 ± 0.96)%, and (94.94 ± 0.54)%; the inhibition rates of rapamycin on HTEpiC were (10.19 ± 0.35)% and (94.55 ± 0.71)%. At the concentration of (1–4) × 10−5 mol/L, the inhibition rate of rapamycin on HTrF was more than 50%, and that on HTEpiC was less than 20% (p < 0.05). Conclusions: Compared to paclitaxel and mitomycin C, rapamycin had the least effect on HTEpiC while effectively inhibiting HTrF. The optimum concentration range was (1–4) × 10−5 mol/L.
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Affiliation(s)
| | - Jie Zhang
- Correspondence: ; Tel.: +86-13801354306; Fax: +86-010-59976212
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8
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Paclitaxel-Loaded PLGA Coating Stents in the Treatment of Benign Cicatrical Airway Stenosis. J Clin Med 2022; 11:jcm11030517. [PMID: 35159969 PMCID: PMC8836604 DOI: 10.3390/jcm11030517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Airway stent implantation used in the treatment of benign cicatricial airway stenosis (BCAS) can lead to local granulation and scar formation, resulting in restenosis and treatment failure. Methods: We systematically investigated a paclitaxel-loaded PLGA-coating stent (PLPCS) and analyzed the safety and efficacy of the PLPCS in patients with BCAS. Patients were enrolled from four hospitals in China and observed for six months after implantation, by bronchoscopy performed weekly in the first month and monthly thereafter. The stent was removed immediately upon detection of granulation tissue proliferation, leading to immobility of the stent. Results: Granulation tissue was formed one week after stent implantation, most of which was located at the upper edge of the stent and the narrowest airway in the stent. All stents were removed in three months (mean: 6.51 + 4.67 weeks), with a curative outcome in one case and ineffective results in two. The remaining seven patients developed complications within three months, necessitating early stent removal. The main complication was granulation formation, resulting in difficulty in stent removal. Conclusion: Although PLPCS showed beneficial effects in basic and animal experiments, it cannot prevent airway restenosis in actual practice, mainly due to granulation formation.
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9
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Ratwani AP, Davis A, Maldonado F. Current practices in the management of central airway obstruction. Curr Opin Pulm Med 2022; 28:45-51. [PMID: 34720097 DOI: 10.1097/mcp.0000000000000838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Airway obstruction continues to cause substantial pulmonary morbidity and mortality. We present a review of classic, current, and evolving management techniques, highlighting recently published studies on the topic. Recommendations have historically been primarily based on anecdotal experience, case reports, and retrospective studies, but more solid evidence has emerged in the last decade. RECENT FINDINGS Novel endobronchial stents are being developed to mitigate the issues of stent migration, mucus plugging, fracture, and granulation tissue formation. Endobronchial drug delivery has become an active area of translational and clinical research, especially with regards to antineoplastic agents used for malignant airway stenosis. Even classic or updated techniques such as spray cryotherapy, injections of mitomycin-c, and balloon dilation have recently been examined in methodologically sound studies. Finally, recently published data have confirmed that patient breathlessness and quality of life improve significantly with therapeutic airway interventions. A multimodal and multidisciplinary approach to patient care is key to achieving the best outcomes. SUMMARY The treatment of central airway stenosis is often multimodal and should focus on patient-centric factors, taking into account risks and benefits of the procedure, operator, and center expertise, and always occur in the context of a multidisciplinary approach. Evidence-based clinical research is increasingly driving patient management.
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Affiliation(s)
| | - Andrea Davis
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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10
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Li Y, Li M, Wang X, Wang Y, Li C, Zhao Y, Li Z, Chen J, Li J, Ren K, Li Z, Ren J, Han X, Li Q. Comparison of three kinds of self-expandable metallic stents induced granulation tissue hyperplasia in the rabbit trachea. Sci Rep 2021; 11:23115. [PMID: 34848784 PMCID: PMC8632974 DOI: 10.1038/s41598-021-02573-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/17/2021] [Indexed: 12/18/2022] Open
Abstract
To compare stent-induced granulation tissue hyperplasia of bare (SEMS), polyurethane-covered (PU-SEMS) and electrospun nanofibre-covered (EN-SEMS) self-expandable metallic stents in the rabbit trachea. Twenty-seven rabbits were randomly assigned to 3 groups that received SEMS, PU-SEMS or EN-SEMS. Computed tomography and sacrifice were performed as scheduled. Haematoxylin–eosin and Masson’s trichrome staining protocols were performed for pathological analysis. The data for tracheal ventilation area ratio, qualitative histological scoring, number of epithelial layers, and thicknesses of papillary projection and submucosa were documented and statistically analysed. All stents were successfully placed under the guidance of fluoroscopy without complications. Post-stenting 3 and 7 days, computed tomography revealed that the fully expandable EN-SEMS was similar to the SEMS and PU-SEMS. The mean stented tissue score in the SEMS group was higher than those of both the PU-SEMS and EN-SEMS groups at 3 days post-stenting. The pathological findings suggested that there was no papillary projection formation 3 days after stent placement. The thickness of papillary projection in the SEMS group was significantly higher than those of the PU-SEMS and EN-SEMS groups at 7 days post-stenting. After stenting 4 weeks, the tracheal ventilation area ratio of SEMS, PU-SEMS and EN-SEMS was 0.214 ± 0.021, 0.453 ± 0.028 and 0.619 ± 0.033, respectively. There were significant between-group differences. In conclusion, the stent-induced granulation tissue formation in EN-SEMS is less severe than that of PU-SEMS and SEMS. EN-SEMS has smaller radial force, and the tracheal ventilation ratio after stent placement better than that of PU-SEMS.
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Affiliation(s)
- Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
| | - Mengde Li
- School of Mechanics and Engineering Science, National Center for International Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaofeng Wang
- School of Mechanics and Engineering Science, National Center for International Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou, Henan, China
| | - Yuhui Wang
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Chang Li
- Department of Nose, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanan Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
| | - Zhaonan Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
| | - Jianjian Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
| | - Jing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China
| | - Kewei Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China.,Interventional Institute of Zhengzhou University, Zhengzhou, Henan, China
| | - Zongming Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China.,Interventional Institute of Zhengzhou University, Zhengzhou, Henan, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China.,Interventional Institute of Zhengzhou University, Zhengzhou, Henan, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China. .,Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, China. .,Interventional Institute of Zhengzhou University, Zhengzhou, Henan, China.
| | - Qian Li
- School of Mechanics and Engineering Science, National Center for International Research of Micro-Nano Molding Technology, Zhengzhou University, Zhengzhou, Henan, China.
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11
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Johnson CM, Luke AS, Jacobsen C, Novak N, Dion GR. State of the Science in Tracheal Stents: A Scoping Review. Laryngoscope 2021; 132:2111-2123. [PMID: 34652817 DOI: 10.1002/lary.29904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/12/2021] [Accepted: 09/23/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Recent material science advancements are driving tracheal stent innovation. We sought to assess the state of the science regarding materials and preclinical/clinical outcomes for tracheal stents in adults with benign tracheal disease. METHODS A comprehensive literature search in April 2021 identified 556 articles related to tracheal stents. One-hundred and twenty-eight full-text articles were reviewed and 58 were included in the final analysis. Datapoints examined were stent materials, clinical applications and outcomes, and preclinical findings, including emerging technologies. RESULTS In the 58 included studies, stent materials were metals (n = 28), polymers (n = 19), coated stents (n = 19), and drug-eluting (n = 5). Metals included nitinol, steel, magnesium alloys, and elgiloy. Studies utilized 10 different polymers, the most popular included polydioxanone, poly-l-lactic acid, poly(d,l-lactide-co-glycolide), and polycaprolactone. Coated stents employed a metal or polymer framework and were coated with polyurethane, silicone, polytetrafluoroethylene, or polyester, with some polymer coatings designed specifically for drug elution. Drug-eluting stents utilized mitomycin C, arsenic trioxide, paclitaxel, rapamycin, and doxycycline. Of the 58 studies, 18 were human and 40 were animal studies (leporine = 21, canine = 9, swine = 4, rat = 3, ovine/feline/murine = 1). Noted complications included granulation tissue and/or stenosis, stent migration, death, infection, and fragmentation. CONCLUSION An increasing diversity of materials and coatings are employed for tracheal stents, growing more pronounced over the past decade. Though most studies are still preclinical, awareness of tracheal stent developments is important in contextualizing novel stent concepts and clinical trials. Laryngoscope, 2021.
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Affiliation(s)
- Christopher M Johnson
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center-San Diego, San Diego, California, U.S.A
| | - Alex S Luke
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, U.S.A
| | | | - Nicholas Novak
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, U.S.A
| | - Gregory R Dion
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, U.S.A.,Dental and Craniofacial Trauma Research Department, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, U.S.A
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12
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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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13
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Barber KF, Loughin CA, Marino DJ, Lesser M. The Effects of Mycophenolate on the Formation of Granulation Tissue Post-operatively in Canine Tracheal Stent Patients (2014-2020). Front Vet Sci 2021; 8:697513. [PMID: 34414226 PMCID: PMC8370251 DOI: 10.3389/fvets.2021.697513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To determine if mycophenolate mofetil reduces the incidence and severity of granulation tissue in-growth in canine tracheal stent patients. Study design: Randomized clinical trial. Animals: 111 dogs from the hospital population. Methods: Client-owned dogs that received an endoluminal self-expanding tracheal stent for canine tracheal collapse between 2014 and 2020 were randomly assigned into one of two treatment groups. Control group medication protocol consisted of prednisone 0.5 mg/kg PO BID/SID/EOD × 30 days, hydrocodone 0.25 mg/kg PO TID × 30 days, and cefovecin 8 mg/kg SQ post-placement. Mycophenolate group medication protocol was identical to the control group medication protocol with the addition of mycophenolate mofetil 10 mg/kg PO BID × 30 days, SID for life. Recheck tracheoscopy was performed at 1, 3, and 6 months post-stent placement. Presence and severity of granulation tissue were determined by tracheoscopy and were recorded as a percentage of tracheal lumen obstruction by blinded evaluators (none present, <25%, >25-50%, and >50%). Results: At none of the three time points was there a statistically significant difference in grade between controls and those receiving mycophenolate (p = 0.467, p = 0.330, and p = 0.410). Conclusions and Clinical Significance: Our results suggest that mycophenolate can be safely given to these patients but do not support that its administration will reduce the incidence and severity of granulation tissue. Although a difference was observed in the severity of granulation tissue between the two groups, loss to follow-up may have influenced conclusions. A larger study would be warranted to further evaluate the effect of mycophenolate on the development of granulation tissue.
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Affiliation(s)
- Kevin F Barber
- Department of Surgery, Long Island Veterinary Specialists, Plainview, NY, United States
| | - Catherine A Loughin
- Department of Surgery, Long Island Veterinary Specialists, Plainview, NY, United States
| | - Dominic J Marino
- Department of Surgery, Long Island Veterinary Specialists, Plainview, NY, United States
| | - Martin Lesser
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Healthy, Great Neck, NY, United States
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14
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Ali Akbari Ghavimi S, Gehret PM, Aronson MR, Schipani R, Smith KW, Borek RC, Germiller JA, Jacobs IN, Zur KB, Gottardi R. Drug delivery to the pediatric upper airway. Adv Drug Deliv Rev 2021; 174:168-189. [PMID: 33845038 DOI: 10.1016/j.addr.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
Pediatric upper airway disorders are frequently life-threatening and require precise assessment and intervention. Targeting these pathologies remains a challenge for clinicians due to the high complexity of pediatric upper airway anatomy and numerous potential etiologies; the most common treatments include systemic delivery of high dose steroids and antibiotics or complex and invasive surgeries. Furthermore, the majority of innovative airway management technologies are only designed and tested for adults, limiting their widespread implementation in the pediatric population. Here, we provide a comprehensive review of the most recent challenges of managing common pediatric upper airway disorders, describe the limitations of current clinical treatments, and elaborate on how to circumvent those limitations via local controlled drug delivery. Furthermore, we propose future advancements in the field of drug-eluting technologies to improve pediatric upper airway management outcomes.
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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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Li Y, Li M, Wang X, Wang Y, Li C, Zhao Y, Li Z, Chen J, Li J, Ren K, Duan X, Ren J, Han X, Li Q. Arsenic trioxide-eluting electrospun nanofiber-covered self-expandable metallic stent reduces granulation tissue hyperplasia in rabbit trachea. ACTA ACUST UNITED AC 2020; 16:015013. [PMID: 33325379 DOI: 10.1088/1748-605x/abb25a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Stent-related granulation tissue hyperplasia is a major complication that limits the application of stents in airways. In this study, an arsenic trioxide-eluting electrospun nanofiber-covered self-expandable metallic stent (ATO-NFCS) was developed. Poly-L-lactide-caprolactone (PLCL) was selected as the drug-carrying polymer. Stents with two different ATO contents (0.4% ATO/PLCL and 1.2% ATO/PLCL) were fabricated. The in vitro release in simulated airway fluid suggested that the total ATO release time was 1 d. The growth of human embryonic pulmonary fibroblasts (CCC-HPF-1), normal human bronchial epithelial cells and airway smooth muscle cells was inhibited by ATO. When embedded in paravertebral muscle, the nanofiber membrane showed good short-term and long-term biological effects. In an animal study, placement of the ATO-NFCS in the trachea through a delivery system under fluoroscopy was feasible. The changes in liver and kidney function 1 and 7 d after ATO-NFCS placement were within the normal range. On pathological examination, the heart, liver, spleen, lungs and kidneys were normal. The effectiveness of the ATO-NFCS in reducing granulation tissue hyperplasia and collagen deposition was demonstrated in the rabbit airway (n = 18) at 4 weeks. The present study preliminarily investigated the efficacy of the ATO-NFCS in reducing granulation tissue formation in the trachea of rabbits. The results suggest that the ATO-NFCS is safe in vivo, easy to place, and effective for the suppression of granulation tissue formation.
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Affiliation(s)
- Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China. Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, Henan, People's Republic of China. These authors contributed equally to this work
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17
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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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18
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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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Panthier F, Warein E, Cochennec F, Desgranges P, Touma J. Early Onset of Acute Lower Limb Drug-eluting Stent Infection. Ann Vasc Surg 2019; 61:471.e3-471.e7. [PMID: 31394215 DOI: 10.1016/j.avsg.2019.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
The present case describes acute and early infection of a superficial femoral artery drug-eluting stent (DES) in a 65-year-old patient 2 days after its implantation in outpatient clinic, with intense clinical presentation. The initial indication was Rutherford 3 peripheral artery disease. Radical treatment by means of stent explantation and femoro-femoral bypass using autogenous vein was performed. Both stent and blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Informative imaging and intraoperative view are provided. Local evolution was satisfactory but endocarditis occurred secondarily. The pathophysiology of this first reported DES infection and the management of the infected vessel are discussed, in light of data derived from coronary literature and open vascular surgery.
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Affiliation(s)
- Frédéric Panthier
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service de Chirurgie Vasculaire, Créteil, France
| | - Edouard Warein
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service de Chirurgie Vasculaire, Créteil, France
| | - Frederic Cochennec
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service de Chirurgie Vasculaire, Créteil, France
| | - Pascal Desgranges
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service de Chirurgie Vasculaire, Créteil, France
| | - Joseph Touma
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service de Chirurgie Vasculaire, Créteil, France.
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20
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Debiane L, Reitzel R, Rosenblatt J, Gagea M, Chavez MA, Adachi R, Grosu HB, Sheshadri A, Hill LR, Raad I, Ost DE. A Design-Based Stereologic Method to Quantify the Tissue Changes Associated with a Novel Drug-Eluting Tracheobronchial Stent. Respiration 2019; 98:60-69. [PMID: 30799409 DOI: 10.1159/000496152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Granulation tissue is a common complication of airway stenting, but no published methods can quantify the volume and type of tissue that develops. OBJECTIVE To use design-based stereology to quantify changes in tissue volume and type associated with airway stenting. METHODS We compared drug-eluting stents (DES) filled with gendine to standard silicone stents in pigs in an assessor-blinded randomized trial. Tracheal stents were placed via rigid bronchoscopy. After 1 month, animals were euthanized and necropsies were performed. Antimicrobial effects of the DES were assessed in trachea tissue samples, on the DES surface, and with residual gel from the DES reservoir. Tracheal thickness was measured using orthogonal intercepts. Design-based stereology was used to quantify the volume density of tissues using a point-counting method. The volume of each tissue was normalized to cartilage volume, which is unaffected by stenting. RESULTS Pigs were randomized to DES (n = 36) or control stents (n = 9). The drug was successfully eluted from the DES, and the stent surface showed antibacterial activity. DES and controls did not differ in tissue microbiology, tracheal thickness, or granulation tissue volume. Compared to nonstented controls, stented airways demonstrated a 110% increase in soft-tissue volume (p = 0.005). Submucosal connective tissue (118%; p < 0.0001), epithelium (70%; p < 0.0001), submucosal glands (47%; p = 0.001), and smooth muscle (41%; p < 0.0001) increased in volume. CONCLUSION Stenting doubles the volume of soft tissue in the trachea. Design-based stereology can quantify the tissue changes associated with airway stenting.
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Affiliation(s)
- Labib Debiane
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ruth Reitzel
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joel Rosenblatt
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mihai Gagea
- Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Miguel A Chavez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Roberto Adachi
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lori R Hill
- Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA,
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21
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Xu J, Ong HX, Traini D, Byrom M, Williamson J, Young PM. The utility of 3D-printed airway stents to improve treatment strategies for central airway obstructions. Drug Dev Ind Pharm 2018; 45:1-10. [PMID: 30207189 DOI: 10.1080/03639045.2018.1522325] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Airway stents are commonly used in the management of patients suffering from central airway obstruction (CAO). CAO may occur directly from airway strictures, obstructing airway cancers, airway fistulas or tracheobronchomalacia, resulting from the weakening and dynamic collapse of the airway wall. Current airway stents are constructed from biocompatible medical-grade silicone or from a nickel-titanium (nitinol) alloy with fixed geometry. The stents are inserted via the mouth during a bronchoscopic procedure. Existing stents have many shortcomings including the development of obstructing granulation tissue in the weeks and months following placement, mucous build up within the stent, and cough. Furthermore, airway stents are expensive and, if improperly sized for a given airway, may be easily dislodged (stent migration). Currently, in Australia, it is estimated that approximately 12,000 patients will develop CAO annually, many of whom will require airway stenting intervention. Of all stenting procedures, the rate of failure is currently reported to be at 22%. With a growing incidence of lung cancer prevalence globally, the need for updating airway stent technology is now greater than ever and personalizing stents using 3D-printing technology may offer the best chance of addressing many of the current limitations in stent design. This review article will assess what represents the gold standard in stent manufacture with regards to treatment of tracheobronchial CAO, the challenges of current airway stents, and outlines the necessity and challenges of incorporating 3D-printing technology into personalizing airway stents today.
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Affiliation(s)
- Jesse Xu
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Hui X Ong
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Daniela Traini
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Michael Byrom
- d RPA Institute of Academic Surgery , Sydney , NSW , Australia
| | - Jonathan Williamson
- e MO Respiratory and Sleep, Macquarie University Hospital and Clinic , Macquarie University , Sydney , NSW , Australia.,f Respiratory, Sleep and Environmental and Occupational Health (RSEOH) , The Ingham Institute of Applied Medical Research , Sydney , NSW , Australia
| | - Paul M Young
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
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22
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Wang T, Zou H, Liu YX, Zhang XW. Effects of Paclitaxel-conjugated N-Succinyl-Hydroxyethyl Chitosan Film for Proliferative Cholangitis in Rabbit Biliary Stricture Model. Chin Med J (Engl) 2018. [PMID: 29521293 PMCID: PMC5865316 DOI: 10.4103/0366-6999.226904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Paclitaxel (PTX) could inhibit the growth of fibroblasts, which occurs in proliferative cholangitis and leads to biliary stricture. However, its use has been limited due to poor bioavailability and local administration for short time. This study designed and synthesized a new PTX-conjugated chitosan film (N-succinyl-hydroxyethyl chitosan containing PTX [PTX-SHEC]) and evaluated its safety and efficiency using in vivo and in vitro experiments. Methods: The SHEC conjugated with PTX was confirmed by nuclear magnetic resonance (NMR) and Fourier-transform infrared spectroscopy (FT-IR) measurements. Drug releases in vitro and in vivo were determined using high-performance liquid chromatography. Cell viability in vitro was measured using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. Rabbit biliary stricture model was constructed. All rabbits randomly divided into five groups (n = 8 in each group): the sham-operated rabbits were used as control (Group A), Groups B received laparotomies and suture, Group C received laparotomies and covered SHEC suture without the PTX coating, Group D received laparotomies and covered PTX-SHEC suture, and Group E received laparotomies and 1000 μmol/L PTX administration. Liver function tests and residual dosage of PTX from each group were measured by enzyme-linked immunosorbent assay. Histological data and α-smooth muscle actin (SMA) immunohistochemical staining of common bile duct were examined. Results: NMR and FT-IR indicated that PTX was successfully introduced, based on the appearance of signals at 7.41–7.99 ppm, 1.50 ppm, and 1.03 ppm, due to the presence of aromatic protons, methylene protons, and methyl protons of PTX, respectively. No bile leak was observed. The PTX-conjugated film could slowly release PTX for 4 weeks (8.89 ± 0.03 μg at day 30). The in vitro cell viability test revealed significantly different levels of toxicity between films with and without PTX (111.7 ± 4.0% vs. 68.1 ± 6.0%, P < 0.001), whereas no statistically significant difference was observed among the three sets of PTX-contained films (67.7 ± 5.4%, 67.2 ± 3.4%, and 59.1 ± 6.0%, P > 0.05). Histological examinations revealed that after 28 days of implantment, Groups D and E (but not Group C) had less granulation tissue and glandular hyperplasia in the site of biliary duct injury than Group B. The pattern was more obvious in Group D than Group E. Less α-SMA-positive cells were found in tissue from Groups D and E. Comparing with Group E, the liver function was improved significantly in Group D, including total bilirubin (2.69 ± 1.03 μmol/L vs. 0.81 ± 0.54 μmol/L, P = 0.014), alanine aminotransferase (87.13 ± 17.51 U/L vs. 42.12 ± 15.76 U/L, P = 0.012), and alkaline phosphatase (60.61 ± 12.31 U/L vs. 40.59 ± 8.78 U/L, P < 0.001). Conclusions: PTX-SHEC film effectively inhibites the myofibroblast proliferation and extracellular matrix over-deposition during the healing process of biliary reconstruction. This original film might offer a new way for reducing the occurrence of the benign biliary stricture.
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Affiliation(s)
- Tao Wang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101; Graduate Division, Kunming Medical University, Kunming, Yunnan 650500, China
| | - Hao Zou
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Yun-Xia Liu
- Basic Medical Division, Experiment Teaching Center, Kunming Medical University, Kunming, Yunnan 650500, China
| | - Xiao-Wen Zhang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101; Graduate Division, Kunming Medical University, Kunming, Yunnan 650500, China
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Krishnagopal A, Reddy A, Sen D. Stent-mediated gene and drug delivery for cardiovascular disease and cancer: A brief insight. J Gene Med 2018; 19. [PMID: 28370939 DOI: 10.1002/jgm.2954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
This review concisely recapitulates the different existing modes of stent-mediated gene/drug delivery, their considerable advancement in clinical trials and a rationale for other merging new technologies such as nanotechnology and microRNA-based therapeutics, in addition to addressing the limitations in each of these perpetual stent platforms. Over the past decade, stent-mediated gene/drug delivery has materialized as a hopeful alternative for cardiovascular disease and cancer in contrast to routine conventional treatment modalities. Regardless of the phenomenal recent developments achieved by coronary interventions and cancer therapies that employ gene and drug-eluting stents, practical hurdles still remain a challenge. The present review highlights the limitations that each of the existing stent-based gene/drug delivery system encompasses and therefore provides a vision for the future with respect to discovering an ideal stent therapeutic platform that would circumvent all the practical hurdles witnessed with the existing technology. Further study of the improvisation of next-generation drug-eluting stents has helped to overcome the issue of restenosis to some extent. However, current stent formulations fall short of the anticipated clinically meaningful outcomes and there is an explicit need for more randomized trials aiming to further evaluate stent platforms in favour of enhanced safety and clinical value. Gene-eluting stents may hold promise in contributing new ideas for stent-based prevention of in-stent restenosis through genetic interventions by capitalizing on a wide variety of molecular targets. Therefore, the central consideration directs us toward finding an ideal stent therapeutic platform that would tackle all of the gaps in the existing technology.
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Affiliation(s)
| | - Aakash Reddy
- Cellular and Molecular Therapeutics Laboratory, Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT), VIT University, Vellore, Tamil Nadu, India
| | - Dwaipayan Sen
- Cellular and Molecular Therapeutics Laboratory, Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT), VIT University, Vellore, Tamil Nadu, India
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