Institute of Biomedical Engineering (C.M.T., J.P.S.), University of Toronto, Ontario, Canada.
Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine (J.B.-K., M.P.B.), University of Toronto, Ontario, Canada.
Arterioscler Thromb Vasc Biol. 2023 Jul;43(7):1096-1110. doi: 10.1161/ATVBAHA.123.318450. Epub 2023 May 25.
Despite recent advancements in vascular disease treatments, thrombosis and poor long-term vessel patency remain significant barriers to effective endovascular intervention. Current balloon angioplasty and stenting techniques effectively restore acute blood flow in occluded vessels but have persistent limitations. Damage to the arterial endothelium caused by injury during catheter tracking triggers neointimal hyperplasia and the release of proinflammatory factors leading to increased risk of thrombosis and restenosis. Antirestenotic agents commonly delivered on angioplasty balloons and stents have lowered arterial restenosis rates, but the absence of cell type selectivity significantly delays critical endothelium repair. Targeted delivery of biomolecular therapeutics, coupled with engineered nanoscale excipients, has the potential to redefine cardiovascular interventions by improving long-term efficacy, limiting off-target effects, and reducing costs compared with conventional clinical standards of care. This review analyzes current forms of localized vascular drug delivery, emerging nanoscale therapeutic and excipient strategies, and provides recommendations for future areas of study to advance the treatment of vascular disease through innovations in nanotechnology.
尽管血管疾病治疗在最近取得了进展，但血栓形成和长期血管通畅性差仍然是有效血管内介入治疗的重大障碍。目前的球囊血管成形术和支架置入技术可有效恢复闭塞血管的急性血流，但仍存在持续的局限性。导管跟踪过程中对动脉内皮造成的损伤会触发新生内膜增生和促炎因子的释放，从而增加血栓形成和再狭窄的风险。在血管成形术球囊和支架上常用的抗再狭窄药物降低了动脉再狭窄的发生率，但细胞类型选择性的缺乏显著延迟了关键的内皮修复。生物分子治疗的靶向递送，加上工程纳米级赋形剂，有可能通过提高长期疗效、限制非靶向效应以及降低与传统临床护理标准相比的成本，从而重新定义心血管介入治疗。本文分析了目前局部血管药物递送的形式、新兴的纳米级治疗和赋形剂策略，并为未来的研究领域提供了建议，以通过纳米技术创新来推进血管疾病的治疗。
