Drug eluting grafts for hemodialysis access

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S53-S55 ◽  
Author(s):  
Marc Glickman
Keyword(s):  
Neointimal Hyperplasia ◽  
Graft Function ◽  
Prosthetic Graft ◽  
Great Promise ◽  
Graft Material ◽  
Eptfe Graft ◽  
Gene Therapies ◽  
New Methods ◽  
Drug Elution ◽  
Drug Eluting

The development of new methods for drug elution of graft material, biofiber films and resurfacing of prosthetic graft surfaces offers new opportunities for improvement of graft function in arteriovenous (AV) access. Three areas of research include developing grafts that reduce the development of neointimal hyperplasia, reducing infection and reducing thrombogenicity. The only drug eluting graft presently being used, is the heparin coated expanded polytetrafluoroethylene (ePTFE) graft, which has been shown to decrease the incidence of early thrombosis. New drug eluting grafts include those with paclitaxel and those with antibiotics. The development of a hybrid coated prosthetic graft that can deliver targeted gene therapies holds great promise in the field.

scholarly journals The Application of Nanoparticles in Diagnosis and Treatment of Kidney Diseases

2021 ◽  
Vol 23 (1) ◽  
pp. 131
Author(s):  
Patrycja Paluszkiewicz ◽  
Adrian Martuszewski ◽  
Natalia Zaręba ◽  
Kamila Wala ◽  
Mirosław Banasik ◽  
...  
Keyword(s):  
Continuous Monitoring ◽  
Ischemia Reperfusion Injury ◽  
Kidney Diseases ◽  
Ischemia Reperfusion ◽  
Graft Function ◽  
Tubular Secretion ◽  
Great Promise ◽  
Gene Therapies ◽  
New Methods ◽  
Wide Range

Nanomedicine is currently showing great promise for new methods of diagnosing and treating many diseases, particularly in kidney disease and transplantation. The unique properties of nanoparticles arise from the diversity of size effects, used to design targeted nanoparticles for specific cells or tissues, taking renal clearance and tubular secretion mechanisms into account. The design of surface particles on nanoparticles offers a wide range of possibilities, among which antibodies play an important role. Nanoparticles find applications in encapsulated drug delivery systems containing immunosuppressants and other drugs, in imaging, gene therapies and many other branches of medicine. They have the potential to revolutionize kidney transplantation by reducing and preventing ischemia–reperfusion injury, more efficiently delivering drugs to the graft site while avoiding systemic effects, accurately localizing and visualising the diseased site and enabling continuous monitoring of graft function. So far, there are known nanoparticles with no toxic effects on human tissue, although further studies are still needed to confirm their safety.

The Promise and Problem of E-Assessment

2020 ◽  
pp. 299-313
Author(s):  
Michael D. Franzen ◽  
Matthew J. L. Page
Keyword(s):  
Psychological Assessment ◽  
Ecological Validity ◽  
Handheld Devices ◽  
Great Promise ◽  
Research Environment ◽  
New Methods ◽  
Desktop Computers ◽  
Commercial Environment

There has been an explosion in the development of electronic methods for psychological assessment. These include use of handheld devices, desktop computers, and platform-based Internet methods. This development has occurred separately in the commercial environment and in the research environment. This development of new methods presents great promise to improve the accuracy, ecological validity, and range of constructs in psychological assessment. However there are also many problems involved in the development of these electronic methods, including the need to train clinicians in their use, the need to develop safeguards for privacy, and the need to develop methods to ensure the integrity of the data collected. This chapter outlines some of the main considerations in moving forward.

scholarly journals Evaluation of a Targeted Drug‐Eluting Intravascular Nanotherapy to Prevent Neointimal Hyperplasia in an Atherosclerotic Rat Model

2021 ◽  
pp. 2000093
Author(s):  
Emily R. Newton ◽  
David C. Gillis ◽  
Kui Sun ◽  
Brooke R. Dandurand ◽  
Robin Siletzky ◽  
...  
Keyword(s):  
Rat Model ◽  
Neointimal Hyperplasia ◽  
Drug Eluting ◽  
Targeted Drug

scholarly journals The comparison of the chronic-phase vascular healing between bioabsorbable and durable polymer drug eluting stent by using optical coherence tomography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Yamakami ◽  
S Kimura ◽  
K Hara ◽  
M Ohmori ◽  
R Tateishi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Clinical Presentation ◽  
Neointimal Hyperplasia ◽  
Chronic Phase ◽  
Drug Eluting Stents ◽  
Coronary Syndrome ◽  
Durable Polymer ◽  
Drug Eluting

Abstract Background Bioabsorbable polymer drug eluting stents (BP-DESs) were designed to reduce a vascular inflammatory reaction compared to durable polymer drug eluting stents (DP-DESs). However, few studies have compared vascular responses to BP-DESs and DP-DESs. Methods We enrolled 88 consecutive patients with single culprit coronary artery lesions (31 lesions with acute coronary syndrome) undergoing a single stent-implantation. BP-DESs and DP-DESs were implanted in 50 (57%) and 38 patients (43%), respectively. All lesions underwent optical coherence tomography examination at chronic phase and intrastent OCT findings at the follow-up were evaluated in every 1-mm cross-sections (CSs). Results A total of 1887 CSs (BP-DES: 1096, DP-DES: 791) were analyzed. The median period of follow-up OCT was 293 (250–374) days. There were no differences in the patient, lesion, and initial clinical presentation of acute coronary syndrome (ACS). BP-DESs had significantly higher percent neointimal hyperplasia area, defined as neointimal hyperplasia area divided by stent area x 100 (18.4±9.0% vs. 16.1±9.9%, p<0.001), fewer malapposed struts (1.7% vs. 3.9%, p=0.005), fewer uncovered struts (3.6% vs. 5.8%, p=0.02) but higher frequency of superficial low intensity neointima (LIN) (7.7% vs. 3.4%, p<0.001). Multivariate logistic analysis showed that BP-DES (OR: 2.5, 95% CI: 1.49–4.08, p<0.001) and the initial clinical presentation of ACS (OR: 2.31, 95% CI: 1.47–3.62, p<0.001) are independent predictive factors for LIN. Conclusion BP-DESs showed homogenous neointimal growth and complete stent coverage quantitatively. Meanwhile, the significant relationships of BP-DES with LIN may suggest that the neointimal quality remains immature in BP-DESs in this period. Funding Acknowledgement Type of funding source: None

scholarly journals AAV-mediated progranulin delivery to a mouse model of progranulin deficiency causes T cell-mediated hippocampal degeneration

2018 ◽  
Author(s):  
Defne A. Amado ◽  
Julianne M. Rieders ◽  
Fortunay Diatta ◽  
Pilar Hernandez-Con ◽  
Adina Singer ◽  
...  
Keyword(s):  
T Cell ◽  
Frontotemporal Dementia ◽  
Neuronal Ceroid Lipofuscinosis ◽  
Gene Replacement ◽  
Cell Infiltration ◽  
Great Promise ◽  
Wild Type ◽  
Gene Therapies ◽  
Ceroid Lipofuscinosis ◽  
T Cell Infiltration

AbstractAdeno-associated virus (AAV)-mediated gene replacement is emerging as a safe and effective means of correcting single-gene mutations, and use of AAV vectors for treatment of diseases of the CNS is increasing. AAV-mediated progranulin gene (GRN) delivery has been proposed as a treatment for GRN-deficient frontotemporal dementia (FTD) and neuronal ceroid lipofuscinosis (NCL), and two recent studies using focal intraparenchymal AAV-Grn delivery to brain have shown moderate success in histopathologic and behavioral rescue in mouse FTD models. Here, we used AAV9 to deliver GRN to the lateral ventricle to achieve widespread expression in the Grn null mouse brain. We found that despite a global increase in progranulin throughout many brain regions, overexpression of GRN resulted in dramatic and selective hippocampal toxicity and degeneration affecting both neurons and glia. Histologically, hippocampal degeneration was preceded by T cell infiltration and perivascular cuffing, suggesting an inflammatory component to the ensuing neuronal loss. GRN delivery with an ependymal-targeting AAV for selective secretion of progranulin into the cerebrospinal fluid (CSF) similarly resulted in T cell infiltration as well as ependymal hypertrophy. Interestingly, overexpression of GRN in wild-type animals also provoked T cell infiltration. These results call into question the safety of GRN overexpression in the CNS, with evidence for both a region-selective immune response and cellular proliferative response following GRN gene delivery. Our results highlight the importance of careful consideration of target gene biology and cellular response to overexpression in relevant animal models prior to progressing to the clinic.Significance StatementGene therapies using adeno-associated viral (AAV) vectors show great promise for many human diseases, including diseases that affect the central nervous system (CNS). Frontotemporal dementia (FTD) and neuronal ceroid lipofuscinosis (NCL) are neurodegenerative diseases resulting from loss of one or both copies of the gene encoding progranulin (GRN), and gene replacement has been proposed for these currently untreatable disorders. Here, we used two different AAV vectors to induce widespread brain GRN expression in mice lacking the gene, as well as in wild-type mice. Unexpectedly, GRN overexpression resulted in T cell infiltration, followed by marked hippocampal neurodegeneration. Our results call into question the safety of GRN overexpression in the CNS, with wider implications for development of CNS gene therapies.

scholarly journals Long-Term Outcomes of Neointimal Hyperplasia Without Neoatherosclerosis After Drug-Eluting Stent Implantation

2014 ◽  
Vol 7 (8) ◽  
pp. 788-795 ◽  
Author(s):  
Jung-Sun Kim ◽  
Jung-Hee Lee ◽  
Dong-Ho Shin ◽  
Byeong-Keuk Kim ◽  
Young-Guk Ko ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Neointimal Hyperplasia ◽  
Drug Eluting Stent ◽  
Long Term Outcomes ◽  
Drug Eluting

Surgical Treatment of the Infected Aortic Graft

2017 ◽  
Author(s):  
Jayer Chung
Keyword(s):  
Preoperative Evaluation ◽  
Graft Infection ◽  
Prosthetic Graft ◽  
Vascular Reconstruction ◽  
Graft Material ◽  
Aortic Graft ◽  
Operative Planning ◽  
Femoral Vessels ◽  
Aortic Graft Infection ◽  
Autogenous Reconstruction

The primary goal of treatment in dealing with an infected aortic graft is to save life and limb. This goal is best accomplished by eradicating all infected graft material and maintaining adequate circulation with appropriate vascular reconstruction. This review describes the choice of procedures, including an extra-anatomic bypass, an aortic allograft, an antibiotic-treated prosthetic graft, and an in situ autogenous reconstruction. Once a procedure has been decided on, preoperative evaluation and operative planning must take place. The review describes operative technique from the thigh incision and exposure of the femoral vessels to closure. Postoperative care is described. Outcomes and complications are discussed. Special consideration is given to aortoenteric fistulas. This review contains 8 figures, 2 tables, and 83 references. Key words: antibiotic-impregnated Dacron, aortic graft infection, aortoenteric erosion, aortoenteric fistula, axillobifemoral bypass, cryopreserved allograft,  neoaortoiliac surgery  

P3385Difference of vascular healing after percutaneous coronary intervention between 4 kinds of new generation drug-eluting stents: an optical coherence tomography analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Matsuhiro ◽  
M Nishino ◽  
H Nakamura ◽  
K Yasumoto ◽  
A Tanaka ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Biodegradable Polymer ◽  
Neointimal Hyperplasia ◽  
Drug Eluting Stents ◽  
P Value ◽  
Optical Coherence ◽  
Durable Polymer ◽  
Drug Eluting ◽  
New Generation

Abstract Background New generation drug eluting stents (DES) have improved target vessel failure as compared with early generation DES and bare metal stent. Contemporary several new generation DES are different each other regarding strut thickness and drug and polymer type. A little is known about which stent induces a more favorable vascular healing at follow up. Purpose In this study, we compared the vascular healing at 8-month follow up by optical coherence tomography (OCT) between 4 different kinds of new generation DES. Methods We enrolled 112 consecutive patients (121 lesions) who underwent PCI using 4 kinds of new generation DES including biodegradable-polymer everolimus-eluting stents (BP-EES), biodegradable-polymer sirolimus-eluting stents (BP-SES), durable-polymer everolimus-eluting stents (DP-EES) and durable-polymer zotarolimus-eluting stents (DP-ZES) and who underwent 8-month follow up angiogram and OCT between July 2016 and April 2018. We compared the OCT parameters including percentage of covered struts, uncovered struts, well-apposed and uncovered struts, malapposed strut and mean neointimal hyperplasia (NIH) thickness between them. Results BP-EES consisted of 29 lesions, BP-SES consisted of 25 lesions, DP-EES consisted of 38 lesions and DP-ZES consisted of 29 lesions. A total of 734 frames with 5163 struts in BP-EES, 481 frames with 4214 struts in BP-SES, 783 frames with 6119 struts in DP-EES and 583 frames with 4708 struts in DP-ZES were analyzed. As shown in a table, mean NIH thickness was significantly higher in BP-EES and BP-SES. Thus, we compared the OCT parameters between durable-polymer (DP) group including DP-ZES and DP-EES and biodegradable-polymer (BP) group including BP-EES and BP-SES. The percentage of uncovered struts was significantly lower and mean NIH thickness was significantly higher in BP group than DP group. Results of OCT parameters BP-EES (n=29) BP-SES (n=25) DP-EES (n=38) DP-ZES (n=29) P value BP group (n=54) DP group (n=67) P value Covered struts (%) 89.5±13.6 92.4±8.6 85.5±17.5 85.0±17.7 0.29 90.9±11.6 85.3±17.4 0.08 Uncovered struts (%) 8.8±10.8 7.1±8.7 14.5±17.5 15.0±17.7 0.14 8.0±9.9 14.7±17.4 0.03 Well-apposed and uncovered struts (%) 7.9±9.9 5.9±7.7 11.7±13.1 12.3±14.0 0.15 7.0±8.9 11.9±13.4 0.04 Malapposed struts (%) 0.8±1.6 1.3±2.2 2.7±5.8 2.7±4.7 0.33 1.0±1.9 2.7±5.3 0.07 Mean NIH thickness (μm) 102±57 121±48 78±28 88±33 <0.01 111±53 82±31 <0.01 Conclusion The present OCT study demonstrated that delayed neointimal healing characterized by the presence of uncovered struts and lower mean NIH thickness was less common in BP group than DP gruop. Biodegradable-polymer may be more favorable than durable-polymer from the point of view of vascular healing.

Comparison of inflammatory markers for the prediction of neointimal hyperplasia after drug-eluting stent implantation

2011 ◽  
Vol 22 (8) ◽  
pp. 526-532 ◽  
Author(s):  
Woong Chol Kang ◽  
Chan Il Moon ◽  
Kyounghoon Lee ◽  
Seung Hwan Han ◽  
Soon Yong Suh ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Inflammatory Markers ◽  
Neointimal Hyperplasia ◽  
Drug Eluting Stent ◽  
Drug Eluting
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