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Havelka GE, Moreira ES, Rodriguez MP, Tsihlis ND, Wang Z, Martínez J, Hrabie JA, Kiefer LK, Kibbe MR. Nitric oxide delivery via a permeable balloon catheter inhibits neointimal growth after arterial injury. J Surg Res 2012; 180:35-42. [PMID: 23164361 DOI: 10.1016/j.jss.2012.10.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/17/2012] [Accepted: 10/23/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Neointimal hyperplasia limits the longevity of vascular interventions. Nitric oxide (NO) is well known to inhibit neointimal hyperplasia. However, delivery of NO to the vasculature is challenging. Our study aims to evaluate the efficacy of delivering NO to the site of injury using a permeable balloon catheter. Our hypothesis is that ultra-short duration NO delivery using a permeable balloon catheter will inhibit neointimal hyperplasia. MATERIALS AND METHODS Ten-week-old male Sprague-Dawley rats underwent carotid artery balloon injury. Groups included: (1) control, (2) injury, (3) injury + periadventitial NO, and (4) injury + endoluminal NO via permeable balloon catheter. The catheter was inflated to 5 atm pressure for 5 min. Arteries were harvested 2 wk following injury. Morphometric assessment for neointimal hyperplasia and immunohistochemical staining for inflammatory markers were performed. RESULTS Injury increased neointimal hyperplasia compared with control (intima/media area [I/M] ratio 1.07 versus 0.11, respectively, P < 0.001). Periadventitial delivery of NO reduced the I/M area ratio compared with injury alone (55% decrease, P < 0.001). Endoluminal delivery of NO also reduced the I/M area ratio compared with injury alone (65% decrease; P < 0.001). Both endoluminal and periadventitial NO affected the I/M ratio by reducing the intimal area (64% and 46%, respectively, P < 0.001) whereas neither affected the medial area. Periadventitial NO delivery increased lumen area (P < 0.05), whereas endoluminal NO delivery increased circumference (P < 0.05). Periadventitial NO delivery inhibited macrophage intimal infiltration compared with injury alone (P < 0.05). CONCLUSIONS These data demonstrate that short-duration endoluminal NO delivery via permeable balloon catheters inhibits neointimal hyperplasia following arterial interventions. Endoluminal delivery of NO could become a focus for future clinical interventions.
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Affiliation(s)
- George E Havelka
- Division of Vascular Surgery, Northwestern University, Chicago, Illinois, USA
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Harnek J, Zoucas E, de Sá VP, Ekblad E, Arner A, Stenram U. Intimal hyperplasia in balloon dilated coronary arteries is reduced by local delivery of the NO donor, SIN-1 via a cGMP-dependent pathway. BMC Cardiovasc Disord 2011; 11:30. [PMID: 21663688 PMCID: PMC3123303 DOI: 10.1186/1471-2261-11-30] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 06/11/2011] [Indexed: 02/05/2023] Open
Abstract
Background To elucidate the mechanism by which local delivery of 3-morpholino-sydnonimine (SIN-1) affects intimal hyperplasia after percutaneous transluminal coronary angioplasty (PTCA). Methods Porcine coronary arteries were treated with PTCA and immediately afterwards locally treated for 5 minutes, with a selective cytosolic guanylate cyclase inhibitor, 1 H-(1,2,4)oxadiazole(4,3-alpha)quinoxaline-1-one (ODQ) + SIN-1 or only SIN-1 using a drug delivery-balloon. Arteries were angiographically depicted, morphologically evaluated and analyzed after one and eight weeks for actin, myosin and intermediate filaments (IF) and nitric oxide synthase (NOS) contents. Results Luminal diameter after PCI in arteries treated with SIN-1 alone and corrected for age-growth was significantly larger as compared to ODQ + SIN-1 or to controls (p < 0.01). IF/actin ratio after one week in SIN-1 treated segments was not different compared to untreated segments, but was significantly reduced compared to ODQ + SIN-1 treated vessels (p < 0.05). Expression of endothelial NADPH diaphorase activity was significantly lower in untreated segments and in SIN-1 treated segments compared to controls and SIN-1 + ODQ treated arteries (p < 0.01). Restenosis index (p < 0.01) and intimal hyperplasia (p < 0.01) were significantly reduced while the residual lumen was increased (p < 0.01) in SIN-1 segments compared to controls and ODQ + SIN-1 treated vessels. Conclusions After PTCA local delivery of high concentrations of the NO donor SIN-1 for 5 minutes inhibited injury induced neointimal hyperplasia. This favorable effect was abolished by inhibition of guanylyl cyclase indicating mediation of a cyclic guanosine 3',5'-monophosphate (cGMP)-dependent pathway. The momentary events at the time of injury play crucial role in the ensuring development of intimal hyperplasia.
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Affiliation(s)
- Jan Harnek
- Department of Coronary Heart Disease, Skane University Hospital, Institute of Clinical Sciences, Lunds University, Getingev 4, SE-22185 Lund, Sweden.
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Ahanchi SS, Varu VN, Tsihlis ND, Martinez J, Pearce CG, Kapadia MR, Jiang Q, Saavedra JE, Keefer LK, Hrabie JA, Kibbe MR. Heightened efficacy of nitric oxide-based therapies in type II diabetes mellitus and metabolic syndrome. Am J Physiol Heart Circ Physiol 2008; 295:H2388-98. [PMID: 18931034 DOI: 10.1152/ajpheart.00185.2008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Type II diabetes mellitus (DM) and metabolic syndrome are associated with accelerated restenosis following vascular interventions due to neointimal hyperplasia. The efficacy of nitric oxide (NO)-based therapies is unknown in these environments. Therefore, the aim of this study is to examine the efficacy of NO in preventing neointimal hyperplasia in animal models of type II DM and metabolic syndrome and examine possible mechanisms for differences in outcomes. Aortic vascular smooth muscle cells (VSMC) were harvested from rodent models of type II DM (Zucker diabetic fatty), metabolic syndrome (obese Zucker), and their genetic control (lean Zucker). Interestingly, NO inhibited proliferation and induced G0/G1 cell cycle arrest to the greatest extent in VSMC from rodent models of metabolic syndrome and type II DM compared with controls. This heightened efficacy was associated with increased expression of cyclin-dependent kinase inhibitor p21, but not p27. Using the rat carotid artery injury model to assess the efficacy of NO in vivo, we found that the NO donor PROLI/NO inhibited neointimal hyperplasia to the greatest extent in type II DM rodents, followed by metabolic syndrome, then controls. Increased neointimal hyperplasia correlated with increased reactive oxygen species (ROS) production, as demonstrated by dihydroethidium staining, and NO inhibited this increase most in metabolic syndrome and DM. In conclusion, NO was surprisingly a more effective inhibitor of neointimal hyperplasia following arterial injury in type II DM and metabolic syndrome vs. control. This heightened efficacy may be secondary to greater inhibition of VSMC proliferation through cell cycle arrest and regulation of ROS expression, in addition to other possible unidentified mechanisms that deserve further exploration.
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Affiliation(s)
- Sadaf S Ahanchi
- Division of Vascular Surgery, Institute for BioNanotechnology in Medicine, Northwestern University, 201 E. Huron St., Galter 10-105, Chicago, IL 60611, USA
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Kapadia MR, Chow LW, Tsihlis ND, Ahanchi SS, Eng JW, Murar J, Martinez J, Popowich DA, Jiang Q, Hrabie JA, Saavedra JE, Keefer LK, Hulvat JF, Stupp SI, Kibbe MR. Nitric oxide and nanotechnology: a novel approach to inhibit neointimal hyperplasia. J Vasc Surg 2008; 47:173-82. [PMID: 18178471 PMCID: PMC2268106 DOI: 10.1016/j.jvs.2007.09.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 08/30/2007] [Accepted: 09/03/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Nitric oxide (NO) has been shown to inhibit neointimal hyperplasia after arterial interventions in several animal models. To date, however, NO-based therapies have not been used in the clinical arena. Our objective was to combine nanofiber delivery vehicles with NO chemistry to create a novel, more potent NO-releasing therapy that can be used clinically. Thus, the aim of this study was to evaluate the perivascular application of spontaneously self-assembling NO-releasing nanofiber gels. Our hypothesis was that this application would prevent neointimal hyperplasia. METHODS Gels consisted of a peptide amphiphile, heparin, and a diazeniumdiolate NO donor (1-[N-(3-Aminopropyl)-N-(3-ammoniopropyl)]diazen-1-ium-1,2-diolate [DPTA/NO] or disodium 1-[(2-Carboxylato)pyrrolidin-1-yl]diazen-1-ium-1,2-diolate [PROLI/NO]). Nitric oxide release from the gels was evaluated by the Griess reaction, and scanning electron microscopy confirmed nanofiber formation. Vascular smooth muscle cell (VSMC) proliferation and cell death were assessed in vitro by (3)H-thymidine incorporation and Personal Cell Analysis (PCA) system (Guava Technologies, Hayward, Calif). For the in vivo work, gels were modified by reducing the free-water content. Neointimal hyperplasia after periadventitial gel application was evaluated using the rat carotid artery injury model at 14 days (n = 6 per group). Inflammation and proliferation were examined in vivo with immunofluorescent staining against CD45, ED1, and Ki67 at 3 days (n = 2 per group), and graded by blinded observers. Endothelialization was assessed by Evans blue injection at 7 days (n = 3 per group). RESULTS Both DPTA/NO and PROLI/NO, combined with the peptide amphiphile and heparin, formed nanofiber gels and released NO for 4 days. In vitro, DPTA/NO inhibited VSMC proliferation and induced cell death to a greater extent than PROLI/NO. However, the DPTA/NO nanofiber gel only reduced neointimal hyperplasia by 45% (intima/media [I/M] area ratio, 0.45 +/- 0.07), whereas the PROLI/NO nanofiber gel reduced neointimal hyperplasia by 77% (I/M area ratio, 0.19 +/- 0.03, P < .05) vs control (injury alone I/M area ratio, 0.83 +/- 0.07; P < .05). Both DPTA/NO and PROLI/NO nanofiber gels significantly inhibited proliferation in vivo (1.06 +/- 0.30 and 0.19 +/- 0.11 vs injury alone, 2.02 +/- 0.20, P < .05), yet had minimal effect on apoptosis. Only the PROLI/NO nanofiber gel inhibited inflammation (monocytes and leukocytes). Both NO-releasing nanofiber gels stimulated re-endothelialization. CONCLUSIONS Perivascular application of NO-releasing self-assembling nanofiber gels is an effective and simple therapy to prevent neointimal hyperplasia after arterial injury. Our study demonstrates that the PROLI/NO nanofiber gel most effectively prevented neointimal hyperplasia and resulted in less inflammation than the DPTA/NO nanofiber gel. This therapy has great clinical potential to prevent neointimal hyperplasia after open vascular interventions in patients.
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MESH Headings
- Animals
- Apoptosis/drug effects
- Carotid Arteries/drug effects
- Carotid Arteries/metabolism
- Carotid Arteries/pathology
- Carotid Artery Injuries/drug therapy
- Carotid Artery Injuries/metabolism
- Carotid Artery Injuries/pathology
- Cell Death/drug effects
- Cell Proliferation/drug effects
- Cells, Cultured
- Delayed-Action Preparations
- Disease Models, Animal
- Drug Carriers
- Drug Compounding
- Endothelium, Vascular/drug effects
- Gels
- Hyperplasia
- Male
- Models, Molecular
- Molecular Structure
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Nanotechnology/methods
- Nitric Oxide/metabolism
- Nitric Oxide Donors/chemistry
- Nitric Oxide Donors/metabolism
- Nitric Oxide Donors/pharmacology
- Nitric Oxide Donors/therapeutic use
- Proline/analogs & derivatives
- Proline/pharmacology
- Rats
- Rats, Sprague-Dawley
- Time Factors
- Tunica Intima/drug effects
- Tunica Intima/metabolism
- Tunica Intima/pathology
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Affiliation(s)
- Muneera R Kapadia
- Division of Vascular Surgery, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Lesley W Chow
- Department of Material Science and Engineering, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Nick D Tsihlis
- Division of Vascular Surgery, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Sadaf S Ahanchi
- Division of Vascular Surgery, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Jason W Eng
- Division of Vascular Surgery, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Jozef Murar
- Division of Vascular Surgery, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Janet Martinez
- Division of Vascular Surgery, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Daniel A Popowich
- Division of Vascular Surgery, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Qun Jiang
- Division of Vascular Surgery, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Joseph A Hrabie
- Basic Research Program, SAIC-Frederick, Inc., National Cancer Institute-Frederick, Building 538, Frederick, MD
| | - Joseph E Saavedra
- Basic Research Program, SAIC-Frederick, Inc., National Cancer Institute-Frederick, Building 538, Frederick, MD
| | - Larry K Keefer
- Laboratory for Comparative Carcinogenesis/Center for Cancer Research, National Cancer Institute-Frederick, Building 538, Frederick, MD
| | - James F Hulvat
- Department of Material Science and Engineering, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Samuel I Stupp
- Department of Material Science and Engineering, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
| | - Melina R Kibbe
- Division of Vascular Surgery, Northwestern University, Chicago, IL
- Institute for BioNanotechnology in Medicine, Northwestern University, Chicago, IL
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