Bartoli Michel A, Parodi Federico E, Chu Jack, Pagano Monica B, Mao Dongli, Baxter B Timothy, Buckley Celine, Ennis Terri L, Thompson Robert W
Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Ann Vasc Surg. 2006 Mar;20(2):228-36. doi: 10.1007/s10016-006-9017-z. Epub 2006 Mar 30.
Treatment with doxycycline suppresses the development of abdominal aortic aneurysms (AAAs) in experimental animal models, but its use in humans can be accompanied by dose-related side effects. We sought to determine if localized administration of doxycycline can achieve inhibition of AAAs equivalent to that achieved by systemic treatment. C57BL/6 mice underwent transient elastase perfusion of the abdominal aorta to induce the development of AAAs. After 14 days, the mean increase in aortic diameter was reduced from 167.2+/-7.8% in untreated mice to only 129.7+/-13.8% in mice treated with 100 mg/kg/day oral doxycycline (p<0.05). Using osmotic minipumps to provide continuous periaortic infusion of doxycycline, localized infusion at rates of 0.75 to 1.0 mg/kg/day suppressed AAAs to an equivalent or even greater extent than systemic treatment [mean increase in aortic diameter 131.5+/-14.4% at 0.75 mg/kg/day, p<0.05; 103.2+/-13.5% at 1.0 mg/kg/day, p<0.01). Mean plasma doxycycline levels reached 332+/- 62 ng/mL during oral administration, but the drug was undetectable in the circulation during localized infusion. The doxycycline concentration in aortic tissue extracts was 22+/- 6 ng/mL during systemic treatment compared to only 5.6+/- 2.2 ng/mL [at 0.75 mg/kg/day] and 7.8+/- 4.0 ng/mL [at 1.0 mg/kg/day] during localized infusion (p<0.05). Localized administration of doxycycline can effectively suppress experimental AAAs with undetectable plasma drug levels, even at doses 100-fold lower than those used during oral drug administration. Localized delivery of doxycycline holds promise as a novel strategy to inhibit the progressive expansion of aortic aneurysms, perhaps as a pharmacological adjunct to endovascular (stent graft) treatment.
在实验动物模型中,强力霉素治疗可抑制腹主动脉瘤(AAA)的发展,但其在人类中的使用可能会伴随剂量相关的副作用。我们试图确定局部给予强力霉素是否能实现与全身治疗相当的AAA抑制效果。对C57BL/6小鼠进行腹主动脉短暂弹性蛋白酶灌注以诱导AAA的发展。14天后,未治疗小鼠的主动脉直径平均增加167.2±7.8%,而口服100mg/kg/天强力霉素治疗的小鼠仅增加129.7±13.8%(p<0.05)。使用渗透微型泵进行主动脉周围持续输注强力霉素,以0.75至1.0mg/kg/天的速率局部输注对AAA的抑制程度与全身治疗相当甚至更大[0.75mg/kg/天时主动脉直径平均增加131.5±14.4%,p<0.05;1.0mg/kg/天时为103.2±13.5%,p<0.01]。口服给药期间血浆强力霉素平均水平达到332±62ng/mL,但局部输注期间循环中未检测到该药物。全身治疗期间主动脉组织提取物中的强力霉素浓度为22±6ng/mL,而局部输注期间[0.75mg/kg/天]仅为5.6±2.2ng/mL,[1.0mg/kg/天]为7.8±4.0ng/mL(p<0.05)。局部给予强力霉素即使在血浆药物水平检测不到的情况下也能有效抑制实验性AAA,剂量甚至比口服给药时低100倍。强力霉素的局部递送有望成为抑制主动脉瘤渐进性扩张的新策略,或许可作为血管内(支架移植物)治疗的药理学辅助手段。