Steigerwald Kristin, Merl Sabine, Kastrati Adnan, Wieczorek Anna, Vorpahl Marc, Mannhold Raimund, Vogeser Michael, Hausleiter Jörg, Joner Michael, Schömig Albert, Wessely Rainer
Deutsches Herzzentrum, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
Biomaterials. 2009 Feb;30(4):632-7. doi: 10.1016/j.biomaterials.2008.10.005. Epub 2008 Nov 5.
All four currently FDA-approved drug-eluting stents (DESs) contain a durable polymeric coating which can negatively impact vascular healing processes and eventually lead to adverse cardiac events. Aim of this study was the pre-clinical assessment of two novel rapamycin-eluting stent (RES) coating technologies that abstain from use of a durable polymer. Two distinctive RES coating technologies were evaluated in vitro and in the porcine coronary artery stent model. The R-poly(S) stent platform elutes rapamycin from a biodegradable polymer that is top coated with the resin shellac to minimize the amount of polymer. The R-pro(S) stent platform allows dual drug release of rapamycin and probucol, blended by shellac. HPLC-based determination of pharmacokinetics indicated drug release for more than 28 days. At 30 days, neointimal formation was found to be significantly decreased for both DESs compared to bare-metal stents. Assessment of vascular healing revealed absence of increased inflammation in both DESs, which is commonly observed in DES with non-erodible polymeric coating. In conclusion, the pre-clinical assessment of RESs with resin-based or dual drug coating indicated an adequate efficacy profile as well as a beneficial effect for vascular healing processes. These results encourage the transfer of these technologies to clinical evaluation.
目前美国食品药品监督管理局(FDA)批准的所有四种药物洗脱支架(DES)都含有一种耐用的聚合物涂层,这可能会对血管愈合过程产生负面影响,并最终导致不良心脏事件。本研究的目的是对两种不使用耐用聚合物的新型雷帕霉素洗脱支架(RES)涂层技术进行临床前评估。在体外和猪冠状动脉支架模型中评估了两种不同的RES涂层技术。R-poly(S)支架平台从一种可生物降解的聚合物中洗脱雷帕霉素,该聚合物顶部涂有紫胶树脂以尽量减少聚合物的用量。R-pro(S)支架平台允许雷帕霉素和普罗布考通过紫胶混合进行双药释放。基于高效液相色谱法(HPLC)的药代动力学测定表明药物释放超过28天。在30天时,与裸金属支架相比,两种DES的新生内膜形成均显著减少。血管愈合评估显示,两种DES均未出现炎症增加的情况,而在具有不可侵蚀聚合物涂层的DES中通常会观察到这种情况。总之,对基于树脂或双药涂层的RES进行的临床前评估表明其具有足够的疗效以及对血管愈合过程的有益作用。这些结果鼓励将这些技术转化为临床评估。