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Siltari A, Riikonen J, Koskimäki J, Pakarainen T, Ettala O, Boström P, Seikkula H, Kotsar A, Tammela T, Helminen M, Raittinen PV, Lehtimäki T, Fode M, Østergren P, Borre M, Rannikko A, Marttila T, Salonen A, Ronkainen H, Löffeler S, Murtola TJ. Randomised double-blind phase 3 clinical study testing impact of atorvastatin on prostate cancer progression after initiation of androgen deprivation therapy: study protocol. BMJ Open 2022; 12:e050264. [PMID: 35487730 PMCID: PMC9058683 DOI: 10.1136/bmjopen-2021-050264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Blood cholesterol is likely a risk factor for prostate cancer prognosis and use of statins is associated with lowered risk of prostate cancer recurrence and progression. Furthermore, use of statins has been associated with prolonged time before development of castration resistance (CR) during androgen deprivation therapy (ADT) for prostate cancer. However, the efficacy of statins on delaying castration-resistance has not been tested in a randomised placebo-controlled setting.This study aims to test statins' efficacy compared to placebo in delaying development of CR during ADT treatment for primary metastatic or recurrent prostate cancer. Secondary aim is to explore effect of statin intervention on prostate cancer mortality and lipid metabolism during ADT. METHODS AND ANALYSIS In this randomised placebo-controlled trial, a total of 400 men with de novo metastatic prostate cancer or recurrent disease after primary treatment and starting ADT will be recruited and randomised 1:1 to use daily 80 mg of atorvastatin or placebo. All researchers, study nurses and patients will be blinded throughout the trial. Patients are followed until disease recurrence or death. Primary outcome is time to formation of CR after initiation of ADT. Serum lipid levels (total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and trigyserides) are analysed to test whether changes in serum cholesterol parameters during ADT predict length of treatment response. Furthermore, the trial will compare quality of life, cardiovascular morbidity, changes in blood glucose and circulating cell-free DNA, and urine lipidome during trial. ETHICS AND DISSEMINATION This study is approved by the Regional ethics committees of the Pirkanmaa Hospital District, Science centre, Tampere, Finland (R18065M) and Tarto University Hospital, Tarto, Estonia (319/T-6). All participants read and sign informed consent form before study entry. After publication of results for the primary endpoints, anonymised summary metadata and statistical code will be made openly available. The data will not include any information that could make it possible to identify a given participant. TRIAL REGISTRATION NUMBER Clinicaltrial.gov: NCT04026230, Eudra-CT: 2016-004774-17, protocol code: ESTO2, protocol date 10 September 2020 and version 6.
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Affiliation(s)
- Aino Siltari
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Faculty of Medicine, Pharmacology, University of Helsinki, Helsinki, Finland
| | - Jarno Riikonen
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| | - Juha Koskimäki
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| | | | - Otto Ettala
- Department of Urology, University of Turku, Turku, Finland
| | - Peter Boström
- Department of Urology, University of Turku, Turku, Finland
| | - Heikki Seikkula
- Department of Surgery, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Andres Kotsar
- Department of Urology, Tartu University Hospital, Tartu, Tartumaa, Estonia
| | - Teuvo Tammela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Helminen
- Health Sciences, Tampere University, Tampere, Finland
| | - Paavo V Raittinen
- Department of Mathematics and Systems Analysis, Aalto University School of Science and Technology, Espoo, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Tampere University, Tampere, Finland
| | - Mikkel Fode
- Department of Urology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Peter Østergren
- Department of Urology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Michael Borre
- Department of Urology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Antti Rannikko
- Department of Urology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Timo Marttila
- Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Arto Salonen
- Department of Urology, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Ronkainen
- Department of Urology, Oulu University Hospital, Oulu, Finland
| | - Sven Löffeler
- Section of Urology, Vestfold Hospital Trust, Tonsberg, Norway
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Eskelinen T, Veitonmäki T, Kotsar A, Tammela TLJ, Pöyhönen A, Murtola TJ. Improved renal cancer prognosis among users of drugs targeting renin-angiotensin system. Cancer Causes Control 2021; 33:313-320. [PMID: 34921656 PMCID: PMC8776666 DOI: 10.1007/s10552-021-01527-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/15/2021] [Indexed: 12/24/2022]
Abstract
Purpose We explored renal cell cancer (RCC) survival among users of antihypertensive medication as hypertension is proposed to be a risk factor for RCC and ACE-inhibitors and angiotensin receptor blockers (ARBs) have been associated with improved prognosis of RCC. Methods Finnish cohort of 13,873 participants with RCC diagnosed between 1995–2012 was formed from three national databases. RCC cases were identified from Finnish Cancer Registry, medication usage from national prescription database and co-morbidities from Care Registry of Healthcare. Logistic regression was used to calculate odds ratios for metastatic tumor extent at the time of diagnosis. Risk of RCC specific death after diagnosis was analyzed using Cox regression adjusted for tumor clinical characteristics. Results A total of 5,179 participants died of RCC during the follow-up. No risk association was found for metastatic tumor extent for any drug group. ACE-inhibitors, but no other drug group were associated with decreased risk of RCC specific death overall (HR 0.88, 95% CI 0.82–0.95) compared to non-users. In time-dependent analysis high-dose use of ACE-inhibitors (392 Defined Daily Dose (DDD)/year), HR 0.54, 95% CI 0.45–0.66) and ARBs (786.1 DDD/year, HR 0.66, 95% CI 0.50–0.87) associated with improved RCC survival. No information of TNM-classification or tobacco smoking was available. Conclusion ACE-inhibitors and ARBs in high dose associated with improved RCC specific survival. This may reflect overall benefit of treating hypertension with medication targeting renin-angiotensin system (RAS) system among RCC patients. Further studies are needed to explore the role of RAS in RCC. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01527-w.
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Affiliation(s)
- Tommi Eskelinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | | | - Andres Kotsar
- Department of Urology, Tartu University Hospital, Tartu, Estonia
| | - Teuvo L J Tammela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Urology, TAYS Cancer Center, Tampere, Finland
| | - Antti Pöyhönen
- Centre for Military Medicine, The Finnish Defence Forces, Helsinki, Finland
| | - Teemu J Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Urology, TAYS Cancer Center, Tampere, Finland.,Department of Urology, Tartu University Hospital, Tartu, Estonia
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Abstract
The aim of this study is to investigate the expression of the luteinizing hormone/choriogonadotropin (LHCG) receptor in the human penis to see, if the luteinizing hormone (LH) effects are possible in the spongious and cavernous tissue of the penis. The number of men with erection disturbances increases significantly simultaneously with the elevated LH concentrations between 40 and 70 years. It is possible that the elevated LH concentrations may influence locally the erectile mechanisms. The precondition for this is the expression of LHCG receptors in the penis. Penile tissue was obtained from three patients undergoing total or partial penectomy due to a rectal cancer with secondary penile metastasis or squamous cell carcinoma of the penis. Immunohistochemistry was used for the detection of the LHCG receptor. Positive immunoreaction for LHCG receptors was discovered in the endothelial cells of cavernous spaces in the corpus cavernosum and corpus spongiosum penis, also in the endothelial cells of the capillary walls in all patients. Our results show that LHCG receptor is expressed in the spongious and cavernous tissue of the human penis. This finding suggests that LH can affect the spongious and cavernous tissue in human and play a significant role in the development of erectile dysfunction among the aging men.
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Affiliation(s)
- Helen Zirnask
- Department of Anatomy, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
- Department of Anatomy, Institute of Medicine, University of Tampere, Tampere, Finland
| | - Pasi Pöllanen
- Department of Anatomy, Institute of Medicine, University of Tampere, Tampere, Finland
- Department of Administration, CAREA, Kotka, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Siim Suutre
- Department of Anatomy, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Marianne Kuuslahti
- Department of Anatomy, Institute of Medicine, University of Tampere, Tampere, Finland
| | - Andres Kotsar
- Department of Urology, Tampere University Hospital, Tampere, Finland
- Department of Urology, Tartu University Hospital, Tartu, Estonia
| | - Tomi Pakarainen
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Kersti Kokk
- Department of Anatomy, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
- Department of Anatomy, Institute of Medicine, University of Tampere, Tampere, Finland
- Department of Anatomy, University of Helsinki, Helsinki, Finland
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Santala EEE, Kotsar A, Veitonmäki T, Tammela TLJ, Murtola TJ. Risk of urothelial cancer death among people using antihypertensive drugs-a cohort study from Finland. Scand J Urol 2019; 53:185-192. [PMID: 31250699 DOI: 10.1080/21681805.2019.1634147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: To analyse the association between antihypertensive (anti-HT) drug use and risk of urothelial cancer (UC) death. UC occurs as bladder cancer (BCa) and upper tract urothelial carcinomas (UTUCs). Hypertension is a suggested risk factor for BCa and may impair disease prognosis. However, it's unclear if use of anti-HT drugs could improve the prognosis of UC.Materials and methods: This study evaluated the association between use of anti-HT drugs and UC survival among 14,065 participants diagnosed with BCa and 1080 with UTUC during 1995-2012 in Finland. It analyzed data using the multivariable adjusted conditional Cox regression model.Results: Angiotensin-receptor (ATR) blocker use before BCa diagnosis was associated with slightly decreased risk of BCa death (HR = .81, CI = .71-0.93). The association was dose-dependent and it decreased in association with elevated intensity of ATR-blocker use. Post-diagnostic use of ATR-blockers was similarly associated with better survival compared to non-users (HR = .81, CI = .71-0.92. Interestingly, use of calcium-channel blockers also associated with better survival and the risk of BCa death decreased with increasing intensity of use (HR = .67, CI = .52-0.86 for highest intensity).Conclusions: This large population-based cohort suggests decreased risk of BCa death among ATR-blocker and calcium-channel blocker users. The risk association among ATR-blockers and calcium-channel blockers was dose-dependent suggesting a causal explanation. Similar risk associations are not observed for other anti-HT drug users, which may suggest a direct effect of ATR blocker or calcium-channel blocker use. Further studies are needed to elucidate the potential anticancer mechanism.
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Affiliation(s)
- Eerik E E Santala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Andres Kotsar
- Department of Urology, Tartu University Hospital, Tartu, Estonia
| | - Thea Veitonmäki
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teuvo L J Tammela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teemu J Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland
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Innos K, Sepp T, Baburin A, Kotsar A, Lang K, Padrik P, Aareleid T. Increasing kidney cancer incidence and survival in Estonia: role of age and stage. Acta Oncol 2019; 58:21-28. [PMID: 30280624 DOI: 10.1080/0284186x.2018.1512158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Kidney cancer rates in Estonia are high. The study aimed to examine long-term trends in kidney cancer incidence, mortality and survival in Estonia, with special focus on age, birth cohorts, morphology and TNM stage. MATERIAL AND METHODS Estonian Cancer Registry provided data on all incident cases of kidney cancer (ICD-10 C64), diagnosed in adults (age ≥15 years) in Estonia during 1995 - 2014. Relative survival ratios (RSR) were calculated and excess hazard ratios of dying were estimated with gender, age, period of diagnosis and TNM stage as independent variables. Joinpoint regression modeling was used to calculate estimated annual percentage change for incidence (1970-2014) and mortality (1995-2016) trends. Age-specific incidence rates were presented by birth cohort and period of diagnosis. RESULTS Incidence increased significantly in both sexes, with the steepest rise seen for localized cancer. Cohort effects were pronounced particularly in men, while period effects were seen from the mid-1980s to mid-1990s in both sexes. Age-standardized five-year RSR for total kidney cancer increased by 13 percentage units (from 53% to 65%) over the study period; the increase was larger for renal cell carcinoma (from 63% to 78%). Survival increases of about five percentage units were seen for stages I/II and III. Age and gender were not associated with excess risk of dying from renal cell carcinoma after adjusting for stage. CONCLUSION Estonia is currently among countries with the highest incidence of kidney cancer. The results suggest a combined effect of changing risk profiles in successive birth cohorts and increasing diagnostic activity around 1990. Large survival increase can mostly be attributed to earlier detection, but improved diagnosis and treatment have probably influenced stage-specific survival. High proportion of tumors with unspecified morphology and those with unknown stage among the elderly warrants further investigation of diagnostic and treatment practices.
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Affiliation(s)
- Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Teesi Sepp
- Department of Urology and Kidney Transplantation, Clinic of Surgery, Tartu University Hospital, Tartu, Estonia
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Andres Kotsar
- Department of Urology and Kidney Transplantation, Clinic of Surgery, Tartu University Hospital, Tartu, Estonia
| | - Katrin Lang
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Peeter Padrik
- Clinic of Haematology and Oncology, Tartu University Hospital, Tartu, Estonia
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Tiiu Aareleid
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
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Abstract
PURPOSE Androgens may have a role in bladder carcinogenesis. We studied whether 5α-reductase inhibitors were associated with bladder cancer specific mortality in a population based cohort of men with bladder cancer. MATERIALS AND METHODS The study cohort consisted of 10,720 Finnish men with bladder cancer newly diagnosed in 1997 to 2012 who were identified in a national cancer registry. Median followup was 4.17 years after bladder cancer diagnosis. We analyzed the HR and 95% CI of the risk of bladder cancer death by 5α-reductase inhibitor administration using Cox regression adjusted for age, gender, comorbidities, primary bladder cancer treatment and tumor extent at diagnosis. Lag time analyses were performed to assess the long-term risk association. Simultaneous administration α-blockers was considered to estimate possible confounding by indication. RESULTS Administering 5α-reductase inhibitors before bladder cancer diagnosis was associated with a lower risk of bladder cancer death (HR 0.84, 95% CI 0.73-0.97). The risk decrease became stronger with years of use. Conversely prediagnostic administration of α-blockers was not associated with bladder cancer survival (HR 1.02, 95% CI 0.91-1.13). Similarly 5α-reductase inhibitor administration after diagnosis was associated with a decreased risk of bladder cancer death (HR 0.77, 95% CI 0.68-0.88). Bladder cancer survival was not associated with α-blockers (HR 0.98, 95% CI 0.90-1.07). The risk decrease due to 5α-reductase inhibitors persisted up to 5 years. CONCLUSIONS Patients who receive 5α-reductase inhibitors have improved disease specific survival after bladder cancer diagnosis compared to those who do not receive them while α-blockers were not associated with survival. This supports the benefits of 5α-reductase inhibitors in bladder cancer.
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Affiliation(s)
- Ville J Mäkelä
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Andres Kotsar
- Department of Urology, Tartu University Hospital, Tartu, Estonia
| | - Teuvo L J Tammela
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teemu J Murtola
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Department of Urology, Tampere University Hospital, Tampere, Finland
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Affiliation(s)
- Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Andres Kotsar
- Department of Urology and Kidney Transplantation, Clinic of Surgery, Tartu University Clinics, Tartu, Estonia
| | - Ivar-Endrik Eiche
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Katrin Lang
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Affiliation(s)
| | - Andres Kotsar
- Department of Urology, Tarto University Hospital, Tarto, Estonia
| | - Teuvo L.J. Tammela
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teemu J. Murtola
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
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Hämäläinen M, Nieminen R, Uurto I, Salenius JP, Kellomäki M, Mikkonen J, Kotsar A, Isotalo T, Teuvo Tammela LJ, Talja M, Moilanen E. Dexamethasone-eluting vascular stents. Basic Clin Pharmacol Toxicol 2013; 112:296-301. [PMID: 23374962 DOI: 10.1111/bcpt.12056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 01/22/2013] [Indexed: 12/01/2022]
Abstract
Percutaneous transluminal angioplasty (PTA) with stenting is widely used in the treatment of vascular disorders, but restenosis remains a significant problem. Drug-eluting stents (DES) have been developed as an attempt to reduce the intimal response leading to restenosis. Drugs used in DES include mainly immunosuppressive and anti-proliferative compounds. Glucocorticoids are also an interesting possibility for those purposes because they have anti-proliferative effects in vascular smooth muscle cells and down-regulate the production of cytokines and growth factors driving inflammation and fibrosis. In this MiniReview, feasibility and safety of drug-eluting metal and biodegradable vascular stents are discussed with special emphasis on dexamethasone-eluting stents.
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Affiliation(s)
- Mari Hämäläinen
- The Immunopharmacology Research Group, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
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Kotsar A, Nieminen R, Isotalo T, Mikkonen J, Uurto I, Kellomäki M, Talja M, Moilanen E, Tammela TL. Preclinical Evaluation of New Indomethacin-Eluting Biodegradable Urethral Stent. J Endourol 2012; 26:387-92. [DOI: 10.1089/end.2011.0327] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Andres Kotsar
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Riina Nieminen
- Immunopharmacology Research Group, Medical School, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Taina Isotalo
- Department of Surgery, Päijät-Hämeen Central Hospital, Lahti, Finland
| | - Joonas Mikkonen
- Department of Biomedical Engineering, Tampere University of Technology, Tampere, Finland
| | - Ilkka Uurto
- Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
| | - Minna Kellomäki
- Department of Biomedical Engineering, Tampere University of Technology, Tampere, Finland
| | - Martti Talja
- Department of Surgery, Päijät-Hämeen Central Hospital, Lahti, Finland
| | - Eeva Moilanen
- Immunopharmacology Research Group, Medical School, University of Tampere and Tampere University Hospital, Tampere, Finland
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Juuti H, Kotsar A, Mikkonen J, Isotalo T, Talja M, Tammela TLJ, Törmälä P, Kellomäki M. The effect of pH on the degradation of biodegradable poly(L-lactide-co-glycolide) 80/20 urethral stent material in vitro. J Endourol 2012; 26:701-5. [PMID: 22192097 DOI: 10.1089/end.2011.0199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate in vitro whether pH ranging between 6 and 9 has an effect on the degradation of stent fibers made of poly(l-lactide-co-glycolide) (PLGA) 80/20. MATERIALS AND METHODS The fibers were divided into three groups and immersed in sodium phosphate-buffered saline (Na-PBS) solution with three different pH values: 6, 7.4, and 9. The mechanical and thermal properties were studied, and scanning electron microscopy (SEM) images were taken at specific time points of hydrolysis. RESULTS The tensile testing showed that the strength of the fibers decreased through hydrolysis and was lost at 8 weeks in all groups. The T(m) and T(g) of the PLGA fibers did not indicate any significant differences between the different groups. In SEM images taken at 4 weeks, there were no significant differences between the fibers immersed in Na-PBS solutions of different pH values. However, at 8 weeks the surface of the fiber immersed in saline with a pH of 6 seemed coarser than that of those immersed in neutral (pH 7.4) or alkaline (pH 9) Na-PBS. CONCLUSION The studied pH values did not influence the degradation behavior of the PLGA 80/20 fibers. Therefore, rabbits can be used as model animals for human biodegradable urological devices even though the pH of their urine is different.
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Affiliation(s)
- Hanne Juuti
- Department of Biomedical Engineering, Tampere University of Technology, Tampere, Finland
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Kotsar A, Nieminen R, Isotalo T, Mikkonen J, Uurto I, Kellomäki M, Talja M, Moilanen E, Tammela TL. Biocompatibility of New Drug-eluting Biodegradable Urethral Stent Materials. Urology 2010; 75:229-34. [DOI: 10.1016/j.urology.2009.03.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 02/23/2009] [Accepted: 03/06/2009] [Indexed: 11/26/2022]
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Mikkonen J, Uurto I, Isotalo T, Kotsar A, Tammela TLJ, Talja M, Salenius JP, Törmälä P, Kellomäki M. Drug-eluting bioabsorbable stents - an in vitro study. Acta Biomater 2009; 5:2894-900. [PMID: 19394906 DOI: 10.1016/j.actbio.2009.03.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 03/20/2009] [Accepted: 03/26/2009] [Indexed: 11/18/2022]
Abstract
The aim of this study was to investigate the drug elution properties of novel drug-eluting bioabsorbable stents in vitro with four different drugs: dexamethasone, indomethacin, simvastatin and ciprofloxacin. Braided stents of poly-lactic acid (96l/4d) fibers were coated with a solution containing the appropriate bioabsorbable polymer and drug, with acetone as the solvent. Two different drug concentrations for both non-sterile and gamma sterilized stents were used for dexamethasone and indomethacin. For ciprofloxacin and simvastatin, only one drug dose was used. The stents were placed in sodium-phosphate-buffered saline in a shaking incubator (pH 7.4, +37 degrees C) and the eluted drug was measured periodically using an ultraviolet spectrometer. The drugs were hydrophobic to different degrees, as demonstrated by their various speeds of elution. In general, the higher the drug load in the stent, the faster the drug elution and the more hydrophilic the elution profile. In the cases of dexamethasone, indomethacin and ciprofloxacin, the sterilization decreased the drug elution rate slightly and the elution started earlier. However, in the case of ciprofloxacin, the gamma sterilization increased the drug elution rate slightly. Sustained elution was achieved for all four drugs. It was also evident that both the concentration and the hydrophility of the drug had a great influence on the drug elution profile. Gamma sterilization modified the drug elution profiles of dexamethasone, indomethacin and simvastatin, but had little effect on the drug elution profile of ciprofloxacin compared to three other drugs.
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Affiliation(s)
- J Mikkonen
- Institute of Biomaterials, Tampere University of Technology, Tampere 33101, Finland.
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Kotsar A, Isotalo T, Uurto I, Mikkonen J, Martikainen P, Talja M, Kellomäki M, Salenius JP, Tammela TL. Urethralin situbiocompatibility of new drug-eluting biodegradable stents: an experimental study in the rabbit. BJU Int 2009; 103:1132-5. [DOI: 10.1111/j.1464-410x.2008.08203.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kotsar A, Isotalo T, Juuti H, Mikkonen J, Leppiniemi J, Hänninen V, Kellomäki M, Talja M, Tammela TLJ. Biodegradable braided poly(lactic-co-glycolic acid) urethral stent combined with dutasteride in the treatment of acute urinary retention due to benign prostatic enlargement: a pilot study. BJU Int 2008; 103:626-9. [PMID: 18990149 DOI: 10.1111/j.1464-410x.2008.08111.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate, in a pilot study, the efficacy and safety of combining a braided poly(lactic-co-glycolic acid) (PLGA, a copolymer of l-lactide and glycolide) urethral stent and dutasteride in the treatment of acute urinary retention (AUR) due to benign prostatic enlargement (BPE). PATIENTS AND METHODS Ten men with AUR due to BPE were treated as outpatients. A biodegradable braided PLGA urethral stent was inserted into the prostatic urethra, using a specially designed insertion device under visual control. Dutasteride treatment was started and the patients were followed up for 3 months after insertion of the stents. RESULTS In all patients the stents were placed successfully with the new insertion device. All men were able to void after inserting the stent. At 1 month five patients voided freely with a low residual urine volume (<150 mL), two voided but had a high residual urine volume and a suprapubic catheter was placed, and three needed a suprapubic or an indwelling catheter before 1 month, due to AUR or comorbidities. At 3 months five patients were voiding with no problems. CONCLUSIONS We have developed a new and effective insertion device for biodegradable braided prostatic stents. The new braided-pattern stent overcomes the earlier problems of migration and sudden breakage into large particles associated with biodegradable spiral stents. However, the mechanical properties of the new stent need to be improved and tested in a longer follow-up. We consider that this new biodegradable braided-pattern urethral stent could provide a new option in the future treatment of AUR.
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Affiliation(s)
- Andres Kotsar
- Department of Biomedical Engineering, Tampere University of Technology, Tampere, Finland.
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Kotsar A, Isotalo T, Mikkonen J, Juuti H, Martikainen PM, Talja M, Kellomäki M, Törmälä P, Tammela TL. A New Biodegradable Braided Self-Expandable PLGA Prostatic Stent: An Experimental Study in the Rabbit. J Endourol 2008; 22:1065-9. [DOI: 10.1089/end.2007.0047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andres Kotsar
- Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland
| | - Taina Isotalo
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Joonas Mikkonen
- Institute of Biomaterials, Tampere University of Technology, Tampere, Finland
| | - Hanne Juuti
- Institute of Biomaterials, Tampere University of Technology, Tampere, Finland
| | | | - Martti Talja
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Minna Kellomäki
- Institute of Biomaterials, Tampere University of Technology, Tampere, Finland
| | - Pertti Törmälä
- Institute of Biomaterials, Tampere University of Technology, Tampere, Finland
| | - Teuvo L.J. Tammela
- Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland
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Uurto I, Kotsar A, Isotalo T, Mikkonen J, Martikainen PM, Kellomäki M, Törmälä P, Tammela TLJ, Talja M, Salenius JP. Tissue biocompatibility of new biodegradable drug-eluting stent materials. J Mater Sci Mater Med 2007; 18:1543-7. [PMID: 17437066 DOI: 10.1007/s10856-007-3060-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2005] [Accepted: 06/05/2006] [Indexed: 05/14/2023]
Abstract
Drug-eluting stents are a recent innovation for endovascular and endourethral purposes. The aim of this study was to assess the biocompatibility of new biodegradable drug-eluting stent materials in vivo. Rods made of SR-PLDLA (self-reinforced poly-96L,4D: -lactic acid) covered with P(50L/50D)LA and rods made of 96L/4D SR-PLA and covered with P(50L/50D)LA including indomethacin 3.3 microg/mm(2)or dexamethasone 1.5 microg/mm(2), were inserted into the dorsal muscles of 20 rabbits serving as test animals. Rods made of silicone and organotin-positive polyvinylchloride were used as negative and positive controls. The animals were sacrificed after 1 week, 1 month, 2 months or 4 months. Histological changes attributable to the operative trauma were seen in all specimens at 1 week and 1 month. At 2 months both dexamethasone and indomethacin induced less fibrosis than the plain SR-PLDLA covered with P(50L/50D)LA without drug. At 4 months dexamethasone induced both chronic inflammatory changes and foreign body reaction, whereas the reactions in the indomethacin and drug-free plain SR-PLDLA groups were insignificant. The new biodegradable drug-eluting stent materials are highly biocompatible. Drug-eluting biodegradable stents may offer a promising new treatment modality for vascular and urethral diseases. However, further studies are needed to demonstrate their feasibility and efficacy.
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Affiliation(s)
- Ilkka Uurto
- Department of Surgery, Satakunta Central Hospital, Pori, Finland.
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