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Conn G, Kidane AG, Punshon G, Kannan RY, Hamilton G, Seifalian AM. Is there an alternative to systemic anticoagulation, as related to interventional biomedical devices? Expert Rev Med Devices 2014; 3:245-61. [PMID: 16515390 DOI: 10.1586/17434440.3.2.245] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To reduce the toxic effects, related clinical problems and complications such as bleeding disorders associated with systemic anticoagulation, it has been hypothesized that by coating the surfaces of medical devices, such as stents, bypass grafts, extracorporeal circuits, guide wires and catheters, there will be a significant reduction in the requirement for systemic anticoagulation or, ideally, it will no longer be necessary. However, current coating processes, even covalent ones, still result in leaching followed by reduced functionality. Alternative anticoagulants and related antiplatelet agents have been used for improvement in terms of reduced restenosis, intimal hyperphasia and device failure. This review focuses on existing heparinization processes, their application in clinical devices and the updated list of alternatives to heparinization in order to obtain a broad overview, it then highlights, in particular, the future possibilities of using heparin and related moieties to tissue engineer scaffolds.
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Affiliation(s)
- Gemma Conn
- Biomaterials & Tissue Engineering Centre, Academic Division of Surgical and Interventional Sciences, University College London, Rowland Hill Street, Hampstead, London NW3 2PF, UK
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Wang GX, Yin TY, Luo LL, Hou YB, Wang YZ, Ruan CG, Guzman RP, Guidoin R. Eluting characteristics of a platelet glycoprotein receptor antibody using a PLLA-coated stent. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2012; 19:359-71. [PMID: 18325236 DOI: 10.1163/156856208783721001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- G.-X. Wang
- a Bioengineering College of Chongqing University, Chongqing, China
| | - T.-Y. Yin
- b Bioengineering College of Chongqing University, Chongqing, China
| | - L.-L. Luo
- c Bioengineering College of Chongqing University, Chongqing, China
| | - Y.-B. Hou
- d Bioengineering College of Chongqing University, Chongqing, China
| | - Y.-Z. Wang
- e Bioengineering College of Chongqing University, Chongqing, China
| | - C.-G. Ruan
- f Jiangshu Institute of Hematology, The First Affiliated Hospital of Suzhou University, Suzhou, China
| | - R. P. Guzman
- g Vascular Surgery, St-Boniface General Hospital, Winnipeg, Canada
| | - R. Guidoin
- h Department of Surgery, Laval University and Quebec Biomaterials Institute, CHUQ, Quebec, Canada G1K 7P4
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Yin TY, Wang GX, Zhang DC, Du DY, Li ZG, Luo LL, Hou YB, Wang YZ, Zhao JB. Endothelialization and in-stent restenosis on the surface of glycoprotein IIIa monoclonal antibody eluting stent. J Biomed Mater Res A 2012; 100:1398-406. [PMID: 22374816 DOI: 10.1002/jbm.a.34078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/13/2011] [Accepted: 01/03/2012] [Indexed: 11/08/2022]
Abstract
Since the percutaneous transtuminal coronary angioplasty was introduced into China in 1984, this procedure has become widely accepted as an important step in coronary revascularization. This study shows the effect of the monoclonal antibody (mAb) on the platelet glycoprotein IIIa receptor during endothelialization and in-stent restenosis by implanting the mAb-eluting stents into iliac arteries of rabbits. The hard tissue cross sections of the stent-implanted arterial segments were made by polymethylmethacrylate embedding. Arterial intima proliferation was observed and analyzed. The endothelialization of the stent surface was observed using scanning electron microscope, whereas the ultrastructure of the neointima was observed using transmission electron microscope. After one month of stent implantation, the surfaces of both groups were covered by intact endothelial layers, but the neointimal areas and the ratio of stenosis were significantly lesser in the mAb-eluting stent group (p < 0.01). After 3 months, the ratio of stenosis in the mAb-eluting stent group was 14.67 ± 0.79, whereas that of the bare stent group was 21.58 ± 1.76 (p < 0.01). Therefore, the mAb eluting from the stent surface has the potential to accelerate endothelialization, prevent thrombosis formation due to the interaction of stent with blood, and decrease the stenosis ratio by inhibiting neointima proliferation.
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Affiliation(s)
- Tie-Ying Yin
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College of Chongqing University, Chongqing University, Chongqing 400030, China
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Iversen A, Galatius S, Jensen JS. The Optimal Route of Administration of the Glycoprotein IIb/IIIa Receptor Antagonist Abciximab During Percutaneous Coronary Intervention; Intravenous Versus Intracoronary. Curr Cardiol Rev 2011; 4:293-9. [PMID: 20066137 PMCID: PMC2801861 DOI: 10.2174/157340308786349480] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 06/02/2008] [Accepted: 06/02/2008] [Indexed: 01/05/2023] Open
Abstract
The use of the glycoprotein (GP) IIb/IIIa receptor antagonist Abciximab has over the years become an important part of the anticoagulant regimen in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Abciximab is a potent inhibitor of platelet aggregation and thrombus formation, but other mechanisms, such as suppression of the inflammatory pathways, have also been proposed to contribute to the benefits of Abciximab. The optimal route of administration, i.e. intravenous versus intracoronary, of the first dose has been questioned, but only tested in small, non-randomised and retrospective studies or studies with short follow-up. No definite conclusion can be made based on these studies. In this review we present the current knowledge published about the intracoronary administration of Abciximab including the mechanisms behind the potential beneficial effects, and the safety. The emphasis will be on clinical trials rather than on studies on the pharmacological mechanisms, as the latter have been reviewed thoroughly elsewhere. Our conclusion from this present review is that randomized trials of intracoronary versus intravenous bolus of Abciximab are needed.
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Affiliation(s)
- Allan Iversen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
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Luo LL, Wang GX, Li YL, Yin TY, Jiang T, Ruan CG. Layer-by-layer assembly of chitosan and platelet monoclonal antibody to improve biocompatibility and release character of PLLA coated stent. J Biomed Mater Res A 2011; 97:423-32. [DOI: 10.1002/jbm.a.33066] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 11/19/2010] [Accepted: 01/04/2011] [Indexed: 11/12/2022]
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Wang GX, Luo LL, Yin TY, Li Y, Jiang T, Ruan CG, Guidoin R, Chen YP, Guzman R. Ultrasonic atomization and subsequent desolvation for monoclonal antibody (mAb) to the glycoprotein (GP) IIIa receptor into drug eluting stent. J Microencapsul 2010. [DOI: 10.3109/02652040903046798] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Takahashi H, Letourneur D, Grainger DW. Delivery of large biopharmaceuticals from cardiovascular stents: a review. Biomacromolecules 2007; 8:3281-93. [PMID: 17929968 PMCID: PMC2606669 DOI: 10.1021/bm700540p] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This review focuses on new and emerging large-molecule bioactive agents delivered from stent surfaces in drug-eluting stents (DESs) to inhibit vascular restenosis in the context of interventional cardiology. New therapeutic agents representing proteins, nucleic acids (small interfering RNAs and large DNA plasmids), viral delivery vectors, and even engineered cell therapies require specific delivery designs distinct from traditional smaller-molecule approaches on DESs. While small molecules are currently the clinical standard for coronary stenting, extension of the DESs to other lesion types, peripheral vasculature, and nonvasculature therapies will seek to deliver an increasingly sophisticated armada of drug types. This review describes many of the larger-molecule and biopharmaceutical approaches reported recently for stent-based delivery with the challenges associated with formulating and delivering these drug classes compared to the current small-molecule drugs. It also includes perspectives on possible future applications that may improve safety and efficacy and facilitate diversification of the DESs to other clinical applications.
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Affiliation(s)
- Hironobu Takahashi
- Department of Pharmaceutics and Pharmaceutical Chemistry, 30 South 2000 East, University of Utah, Salt Lake City, UT 84112-5280, USA
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Kim W, Jeong MH, Hong YJ, Lee SH, Park WS, Kim JH, Kim IS, Choi MJ, Ahn YK, Cho JG, Park JC, Cho DL, Kim H, Kang JC. The long-term clinical results of a platelet glycoprotein IIb/IIIa receptor blocker (Abciximab: Reopro) coated stent in patients with coronary artery disease. Korean J Intern Med 2004; 19:220-9. [PMID: 15683110 PMCID: PMC4531572 DOI: 10.3904/kjim.2004.19.4.220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Previously, the inhibition of coronary restenosis with Abciximab (ReoPro)-coated stent in a porcine model was reported. ReoPro inhibits platelet aggregation, the proliferation of vascular smooth muscle cells and the inflammatory reaction. METHODS A prospective randomized trial was performed to compare two types of stent for revascularization in the native coronary artery. The primary effective end points were major adverse coronary events (MACE): cardiac death, acute myocardial infarction, target vessel revascularization (TVR) and restenosis at the 6-month clinical and angiographic follow-ups. RESULTS One hundred and fifty-five patients were enrolled between August 2001 and June 2003. The mean ages (56.0 +/- 10.0 vs. 56.9 +/- 10.8 years), baseline diameter of stenosis and minimal luminal diameter were no different between the two groups. There was one myocardial infarction and revascularization during the hospital stay in control stent group. During the clinical follow-up there were two myocardial infarctions in control group. Follow-up coronary angiograms were performed in 62.3% (48/77) and 65.4% (51/78) of the coated and control groups, respectively. The diameter of stenosis and late loss were significantly less in the ReoPro-coated stent group compared with the controls (16.4 +/- 5.8% vs. 34.3 +/- 6.1%, p = 0.009; and 0.33 +/- 0.28 mm vs. 0.88 +/- 0.41 mm; p = 0.002). The restenosis and TVR rates of the ReoPro-coated stent were relatively lower compared with the control stent [14.6% (7/48) vs. 29.4% (15/51), p = 0.062; and 9.2% (7/76) vs. 14.7% (11/75); p = 0.327]. CONCLUSION A ReoPro-coated stent is safe, and may be effective in the prevention of coronary restenosis.
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Affiliation(s)
| | - Myung Ho Jeong
- Correspondence to : Myung Ho Jeong, MD, PhD, FACC, FESC, FSCAI, Professor, Chief of Cardiovascular Medicine, Director of the Cardiac Catheterization Laboratory, The Heart Center of Chonnam National University Hospital, 8 Hak-dong, Dong-gu, Gwangju, 501-757, Korea TEL : 82-62-220-6243, fax : 82-62-228-7174, E-mail :
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Kavanagh CA, Rochev YA, Gallagher WM, Dawson KA, Keenan AK. Local drug delivery in restenosis injury: thermoresponsive co-polymers as potential drug delivery systems. Pharmacol Ther 2004; 102:1-15. [PMID: 15056495 DOI: 10.1016/j.pharmthera.2003.01.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The success of percutaneous transluminal coronary angioplasty in treatment of acute coronary syndromes has been compromised by the incidence of restenosis. The physical insult of balloon insertion can damage or remove the endothelial monolayer, thereby generating a prothrombotic surface. The resulting inappropriate response to injury can also lead to penetration of inflammatory cells, conversion of the underlying media to a synthetic phenotype, deposition of extracellular matrix, constrictive remodeling, and neointimal hyperplasia. While stent implantation at the time of balloon insertion has offset some of these events, inflammatory responses to the implanted biomaterial (stent) and intimal hyperplasia are still prominent features of the procedure, leading in 20-30% of cases to in-stent restenosis within a year. Systemic delivery of drugs designed to offset in-stent restenosis injury has been largely unsuccessful, which has led to the development of strategies for coating stents with drugs for local delivery. Drug-eluting stents constitute an innovative means of further reducing the incidence of restenosis injury and clinical trials have shown encouraging results. This review focuses on properties of a class of environment-sensitive hydrogels, the N-isopropylacrylamide-based thermoresponsive co-polymers, on their potential roles as stent coatings, on their demonstrated ability to incorporate and release drugs that modify vascular endothelial and smooth muscle cell functions, and on issues that still await clarification, prior to their adoption in a clinical setting.
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Affiliation(s)
- Caroline A Kavanagh
- Department of Pharmacology, Conway Institute for Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
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Javed Q, Swanson N, Vohra H, Thurston H, Gershlick AH. Tumor necrosis factor-alpha antibody eluting stents reduce vascular smooth muscle cell proliferation in saphenous vein organ culture. Exp Mol Pathol 2002; 73:104-11. [PMID: 12231212 DOI: 10.1006/exmp.2002.2450] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Expression of TNF-alpha a vascular smooth muscle cell (VSMC) mitogen, is up-regulated in injured/proliferating vessel wall. Coronary stents are tested worldwide for their use as local drug delivery devices to address vascular pathophysiology. In this study we have investigated the effect of TNF-alpha antibody eluting stents on VSMC proliferation in human saphenous vein (HSV) organ culture. The adsorption and elution characteristics of TNF-alpha antibody was assessed using stent wires. The stents adsorbed up to 0.25 microg of TNF-alpha antibody/mg of stent and showed a biexponential elution curve, with 34.4% (SD 4.4%) antibody remaining on the stent after 72 h of washing in a perfusion circuit. TNF-alpha antibody delivery from loaded stents to the vessel wall was assessed ex vivo. TNF-alpha and proliferating cell nuclear antigen (PCNA) expression in the vascular specimens was assessed by immunostaining or ELISAs. TNF-alpha ELISAs showed a significant increase in the cytokine levels from the vascular lysates prepared from proliferating tissue culture compared with fresh vein (P < 0.05). Immunohistochemical localization showed an increase in the PCNA positivity of VSMC from these cultures. PCNA staining was barely detected from the fresh tissue. However, a decrease in PCNA staining was observed from tissue sections of venous segments cultured with TNF-alpha antibody eluting stents. PCNA ELISAs demonstrated a 23.7% decline in the antigen levels from the day 7 tissue cultured with such loaded stents. In conclusion, activated VSMC in tissue culture showed an up-regulation of TNF-alpha cytokine, in association with an increase in the PCNA expression in the vessel wall. The local neutralization of this cytokine with TNF-alpha antibody eluting stents reduced VSMC proliferation in the wall. We suggest that TNF-alpha antibody eluting stents may limit restenosis in vivo, which may have important clinical benefits.
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Affiliation(s)
- Qamar Javed
- Division of Cardiology, Clinical Sciences Wing, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
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