Reliable femoral chronic total occlusion model using a thin biodegradable polymer coated copper stent in a porcine model.

Chronic total occlusions (CTOs) are common in patients with peripheral arterial disease (PAD). This study aimed to examine the feasibility and reliability of a CTO induced by a thin biodegradable polymer (polyglycolic acid) coated copper stent in a porcine femoral artery. Novel thin biodegradable polymer coated copper stents (9 mm long) were crimped on an angioplasty balloon (4.5 mm diameter × 12 mm length) and inserted into the femoral artery. Histopathologic analysis was performed 35 days after stenting. In five of six stented femoral arteries, severe in-stent restenosis and total occlusion with collateral circulation were observed without adverse effects such as acute stent thrombosis, leg necrosis, or death at 5 weeks. Fibrous tissue deposition, small vascular channels, calcification, and inflammatory cells were observed in hematoxylin-eosin, Carstair's, and von Kossa tissue stains; these characteristics were similar to pathological findings associated with CTOs in humans. The neointima volume measured by micro-computed tomography was 93.9 ± 4.04 % in the stented femoral arteries. CTOs were reliably induced by novel thin biodegradable polymer coated copper stents in porcine femoral arteries. Successful induction of CTOs may provide a practical understanding of their formation and application of an interventional device for CTO treatment.

Oral microbiome correlates with selected clinical biomarkers in individuals with no significant systemic disease.

The oral microbiome is an important component of the microbiome in the human body. Although the association of the oral microbiome with various diseases, including periodontitis and cancer, has been reported, information on how the oral microbiome is related to health-related indicators in healthy populations is still insufficient. In this study, we examined the associations of the oral microbiome with 15 metabolic and 19 complete blood count (CBC)-based markers in 692 healthy Korean individuals. The richness of the oral microbiome was associated with four CBC markers and one metabolic marker. Compositional variation in the oral microbiome was significantly explained by four markers: fasting glucose, fasting insulin, white blood cell count, and total leukocyte count. Furthermore, we found that these biomarkers were associated with the relative abundances of numerous microbial genera, such as Treponema, TG5, and Tannerella. By identifying the relationship between the oral microbiome and clinical biomarkers in a healthy population, our study presents a direction for future studies on oral microbiome-based diagnosis and interventions.

Nano-formulations for bone-specific delivery of siRNA for CrkII silencing-induced regulation of bone formation and resorption to maximize therapeutic potential for bone-related diseases.

CrkII, a member of the adaptor protein family, is known to participate in bone homeostasis via the regulation of osteoclasts and osteoblasts. Therefore, silencing CrkII would beneficially impact the bone microenvironment. In this study, CrkII siRNA encapsulated by a bone-targeting peptide (AspSerSer)6-liposome was evaluated for its therapeutic applications using a receptor activator of nuclear factor kappa-B ligand (RANKL)-induced bone loss model. (AspSerSer)6-liposome-siCrkII maintained its gene-silencing ability in both osteoclasts and osteoblasts in vitro and significantly reduced osteoclast formation while increasing osteoblast differentiation in vitro. Fluorescence image analyses showed that the (AspSerSer)6-liposome-siCrkII was present largely in bone, where it remained present for up to 24 hours and was cleared by 48 hours, even when systemically administrated. Importantly, microcomputed-tomography revealed that bone loss induced by RANKL administration was recovered by systemic administration of (AspSerSer)6-liposome-siCrkII. Collectively, the findings of this study suggest that (AspSerSer)6-liposome-siCrkII is a promising therapeutic strategy for the development of treatments for bone diseases, as it overcomes the adverse effects derived from ubiquitous expression via bone-specific delivery of siRNA.

Universal Stretchable Conductive Cellulose/PEDOT:PSS Hybrid Films for Low Hysteresis Multifunctional Stretchable Electronics.

Skin-attachable conductive materials have attracted significant attention for use in wearable devices and physiological monitoring applications. Soft, skin-like conductive films must have excellent mechanical and electrical characteristics with on-skin conformability, stretchability, and robustness to detect body motion and biological signals. In this study, a conductive, stretchable, hydro-biodegradable, and highly robust cellulose/poly(3,4-ethylene dioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) hybrid film is fabricated. Through the synergetic interplay of a conductivity enhancer, nonionic fluorosurfactant, and surface modifier, the mechanical and electrical properties of the stretchable hybrid film are greatly improved. The stretchable cellulose/PEDOT:PSS hybrid film achieves a limited resistance change of only 1.21-fold after 100 stretch-release cycles (30% strain) with exceptionally low hysteresis, demonstrating its great potential as a stretchable electrode for stretchable electronics. In addition, the film shows excellent biodegradability, promising environmental friendliness, and safety benefits. High-performance stretchable cellulose/PEDOT:PSS hybrid films, which have high biocompatibility and sensitivity, are applied to human skin to serve as on-skin multifunctional sensors. The conformally mounted on-skin sensors are capable of continuously monitoring human physiological signals, such as body motions, drinking, respiration rates, vocalization, humidity, and temperature, with high sensitivity, fast responses, and low power consumption (21 µW). The highly conductive hybrid films developed in this study can be integrated as both stretchable electrodes and multifunctional healthcare monitoring sensors. We believe that the highly robust stretchable, conductive, biodegradable, skin-attachable cellulose/PEDOT:PSS hybrid films are worthy candidates as promising soft conductive materials for stretchable electronics.

Successful implantation of a novel polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film with good patency on follow-up angiography: A case report.

RATIONALE: Despite technological advances in interventional cardiology during the last decades, many concerns remain regarding the narrowing and occlusion of the in-stent area. Particularly, polymer materials pose several problems, including chronic arterial inflammation, impaired arterial healing, and stent thrombosis. To avoid these complications, we invented the TIGEREVOLUTION stent with a cobalt-chromium alloy-based stent platform deposited with N-TiO2 film, which has demonstrated good biocompatibility. As this stent is not coated with polymer, it is expected to have decreased risk of stent thrombosis. PATIENT CONCERNS: A 62-year-old Korean man visited our department because of angina. We commenced coronary angiography (CAG). DIAGNOSIS: CAG revealed critical stenosis in the mid-portion of the right coronary artery, with a minimum lumen area of 1.08mm2 on optical coherence tomography (OCT). INTERVENTION: Percutaneous coronary intervention was performed with implantation of a novel 3.5 × 26-mm polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film (TIGEREVOLUTION® stent). Post-percutaneous coronary intervention OCT showed good stent expansion and apposition, and the patient was discharged successfully and uneventfully. OUTCOMES: Eight months later, follow-up coronary angiography demonstrated good stent patency with no definitive evidence of in-stent restenosis, with thin stent strut coverage demonstrated on OCT. LESSONS: We report the first case of TIGEREVOLUTION stent implantation with follow-up OCT at 8 months.

Investigation of radiological properties and water equivalency of PRESAGE dosimeters.

PURPOSE: PRESAGE is a dosimeter made of polyurethane, which is suitable for 3D dosimetry in modern radiation treatment techniques. Since an ideal dosimeter is radiologically water equivalent, the authors investigated water equivalency and the radiological properties of three different PRESAGE formulations that differ primarily in their elemental compositions. Two of the formulations are new and have lower halogen content than the original formulation. METHODS: The radiological water equivalence was assessed by comparing the densities, interaction probabilities, and radiation dosimetry properties of the three different PRESAGE formulations to the corresponding values for water. The relative depth doses were calculated using Monte Carlo methods for 50, 100, 200, and 350 kVp and 6 MV x-ray beams. RESULTS: The mass densities of the three PRESAGE formulations varied from 5.3% higher than that of water to as much as 10% higher than that of water for the original formulation. The probability of photoelectric absorption in the three different PRESAGE formulations varied from 2.2 times greater than that of water for the new formulations to 3.5 times greater than that of water for the original formulation. The mass attenuation coefficient for the three formulations is 12%-50% higher than the value for water. These differences occur over an energy range (10-100 keV) in which the photoelectric effect is the dominant interaction. The collision mass stopping powers of the relatively lower halogen-containing PRESAGE formulations also exhibit marginally better water equivalency than the original higher halogen-containing PRESAGE formulation. Furthermore, the depth dose curves for the lower halogen-containing PRESAGE formulations are slightly closer to that of water for a 6 MV beam. In the kilovoltage energy range, the depth dose curves for the lower halogen-containing PRESAGE formulations are in better agreement with water than the original PRESAGE formulation. CONCLUSIONS: Based on the results of this study, the new PRESAGE formulations with lower halogen content are more radiologically water equivalent overall than the original formulation. This indicates that the new PRESAGE formulations are better suited to clinical applications and are more accurate dosimeters and phantoms than the original PRESAGE formulation. While correction factors are still needed to convert the dose measured by the dosimeter to an absorbed dose in water in the kilovoltage energy range, these correction factors are considerably smaller for the new PRESAGE formulations compared to the original PRESAGE and the existing polymer gel dosimeters.

Synergistic alveolar bone resorption by diabetic advanced glycation end products and mechanical forces.

BACKGROUND: The association between diabetes mellitus (DM) and bone diseases is acknowledged. However, the mechanistic pathways leading to the alveolar bone (AB) destruction remain unclear. This study aims to elucidate the mechanical forces (MF)-induced AB destruction in DM and its underlying mechanism. METHODS: In vivo periodontal tissue responses to MF were evaluated in rats with diabetes. In vitro human periodontal ligament (PDL) cells were either treated with advanced glycation end products (AGEs) alone or with AGEs and MF. RESULTS: In vivo, the transcription of VEGF-A, colony stimulating factor-1 (CSF-1), and Ager was upregulated in diabetes, whereas changes in DDOST and Glo1 mRNAs were negligible. DM induced VEGF-A protein in the vascular cells of the PDL and subsequent angiogenesis, but DM itself did not induce osteoclastogenesis. MF-induced AB resorption was augmented in DM, and such augmentation was morphologically substantiated by the occasional undermining resorption as well as the frontal resorption of the AB by osteoclasts. The mRNA levels of CSF-1 and vascular endothelial growth factor (VEGF) during MF application were highly elevated in diabetes, compared with those of the normal counterparts. In vitro, AGEs treatment elevated Glut-1 and CSF-1 mRNA levels via the p38 and JNK pathways, whereas OGT and VEGF levels remained unchanged. Compressive MF especially caused upregulation of VEGF, CSF-1, and Glut-1 levels, and such upregulation was further enhanced by AGEs treatment. CONCLUSIONS: Overloaded MF and AGEs metabolites may synergistically aggravate AB destruction by upregulating CSF-1 and VEGF. Therefore, regulating the compressive overloading of teeth, as well as the levels of diabetic AGEs, may prove to be an effective therapeutic modality for managing DM-induced AB destruction.

Preparation, characterization, and pharmacokinetics of liposomal docetaxel for oral administration.

A docetaxel (DTX) liposomal formulation composed of egg phosphatidylcholine, sodium deoxycholate, and stearylamine was developed. Eudragit (0.5%) was coated to deliver the drug to the region between the distal small intestine and the colon. Lyophilized trehalose and mannitol were used as cryoprotectants because they preserve the particle integrity and good appearance. In vitro release studies showed that the amount of drug released from the coated liposomes was low in solution 1, which simulated the pH condition of the stomach. Especially during the average gastric emptying time, the amount of drug released decreased when Eudragit was added. The plasma DTX concentration was evaluated in pharmacokinetic studies. The plasma drug concentration after intravenous (i.v.) administration decreased rapidly within 120 min. Free DTX formulated using Tween 80 and the lyophilized Eudragit-coated liposomal formulation were compared after oral administration. The oral liposomal formulation had a longer half-life (t1/2) and three-fold higher oral bioavailability. Thus, lyophilized Eudragit-coated liposomal DTX could be a promising therapy for various solid tumors to improve patient convenience and quality of life.

Functional validation of novel MKS3/TMEM67 mutations in COACH syndrome.

COACH syndrome is an autosomal recessive developmental disorder, a subtype of Joubert syndrome and related disorders, characterized by cerebellar vermis hypoplasia, oligophrenia, ataxia, coloboma, and hepatic fibrosis. Although mutations in TMEM67 (transmembrane protein 67)/MKS3 (Meckel-Gruber syndrome, type 3) were reported to cause COACH syndrome, this causality has not verified by functional studies. In a 20-year-old Korean man, we found cerebellar ataxia, isolated elevation in serum γ-glutamyl transpeptidase (γ-GTP) activity, oligophrenia, the molar tooth sign (MTS) in the brain MR images and congenital hepatic fibrosis (CHF). Two novel compound heterozygous mutations were found in TMEM67 in the patient: i) missense mutation (c.395 G > C and p.Gly132Ala) in exon 3, and ii) deletion in exon 26 (c.2758delT and p.Tyr920ThrfsX40). Western blotting showed that the p.Tyr920ThrfsX40 mutation accelerates turnover of the TMEM67 protein. Although wild-type human TMEM67 RNA rescued phenotypes of zebrafish embryos injected with anti-sense oligonucleotide morpholinos against tmem67, the two human TMEM67 RNAs individually harboring the two mutations did not. Finally, Wnt signaling, but not Hedgehog signaling, was suppressed in tmem67 morphants. To the best of our knowledge, this is the first report verifying the causality between COACH syndrome and TMEM67, which will further our understanding of molecular pathogenesis of the syndrome.

A novel polymer-free drug-eluting stent coated with everolimus using nitrogen-doped titanium dioxide film deposition in a porcine coronary restenosis model.

BACKGROUND: Titanium dioxide (TiO2) films have superior biocompatibility and may be effective as drug-binding matrices for drug-eluting stents (DESs). We sought to evaluate efficacy of a polymer-free DES coated with everolimus using nitrogen-doped TiO2 film deposition in a porcine coronary restenosis model. METHODS: Forty coronary arteries in 20 pigs were randomly allocated to group 1 (bare-metal stents (BMSs), 3.0×18mm, n=10), group 2 (BMSs with nitrogen-doped TiO2 film deposition, 3.0×18mm, n=10), group 3 [commercial everolimus-eluting stent, 3.0×18mm, n=10], and group 4 (polymer-free everolimus-eluting stent using nitrogen-doped TiO2 film deposition, 3.0×18mm, n=10). Stents were randomly implanted in the left anterior descending coronary artery and left circumflex artery with stent:artery ratio of 1.3. Four weeks later, pigs underwent follow-up coronary angiography and were sacrificed for histopathologic analysis. RESULTS: Percent area stenosis was greater in group 1 compared to groups 3 and 4 (46.4±13.8% vs. 30.2±11.7% vs. 29.2±8.9%, respectively, p=0.005). Fibrin score was lower in groups 1 and 2, compared to groups 3 and 4: 0.87±0.67 vs. 0.76±0.61 vs. 2.27±0.24 vs. 1.75±0.31, respectively, p<0.001). Injury score and inflammation score were not different. Comparison between DES showed a higher fibrin score in group 3 than group 4 (2.27±0.24 vs. 1.75±0.31, p=0.023). CONCLUSIONS: In a porcine model of coronary restenosis, a novel polymer-free DES using nitrogen-doped TiO2 film deposition shows higher biocompatibility and compares favorably with a commercial DES.

Effect of polymer-free TiO2 stent coated with abciximab or alpha lipoic acid in porcine coronary restenosis model.

BACKGROUND: Polymer-free drug-eluting stents (DES) may overcome the shortcomings of polymer-based DES. The aim of this study was to examine the effect of the polymer-free TiO2 film-coated stent with abciximab or alpha lipoic acid in a porcine coronary overstretch restenosis model. METHODS: Pigs were randomized into four groups in which the coronary arteries (24 pigs, 48 coronaries in each group) had TiO2 film-coated stent with abciximab (TCA, n = 12), TiO2 film-coated stent with alpha lipoic acid (TCALA, n = 12), biolimus A9-eluting stents with biodegradable polymer (BES, n = 12), and TiO2 film-coated stent (TCstent, n = 12). Histopathologic analysis was performed at 28 days after stenting. RESULTS: There was no significant difference in the injury score and internal elastic lamina (IEL) among the four groups. There were significant differences in the lumen area, neointima area, percent area stenosis, fibrin score, and inflammation score among the four groups [2.7 ± 1.0mm(2), 2.6 ± 0.94 mm(2), 48.9 ± 16.25%, 1.0 (range 0.0-3.0), 1.0 (range 0.0-2.0) in TCA stent group vs. 2.7 ± 1.24 mm(2), 2.9 ± 0.83 mm(2), 53.5 ± 17.19%, 1.0 (range 0.0-2.0), 1.0 (range 0.0-2.0) in TCALA stent group vs. 2.7 ± 1.30 mm(2), 2.6 ± 1.06 mm(2), 50.1 ± 23.20%, 2.0 (range 1.0-3.0), 2.0 (range 1.0-3.0) in BES group vs. 1.7 ± 0.63 mm(2), 3.3 ± 0.58 mm(2), 60.2 ± 10.12%, 0.5 (range 0.0-2.0), 1.0 (range 0.0-2.0) in TC stent group, respectively]. CONCLUSION: TCA and TCALA are more effective to reduce neointimal hyperplasia compared to TC. Moreover, fibrin and inflammation scores are significantly lower in TCA and TCALA than BES in porcine coronary restenosis model.

The impact of triple anti-platelet therapy for endothelialization and inflammatory response at overlapping bioabsorbable polymer coated drug-eluting stents in a porcine coronary model.

BACKGROUND: This study was conducted to evaluate the endothelialization and the inflammatory responses depending on the administration duration of triple anti-platelet therapy at overlapping bioabsorbable polymer coated biolimus-eluting stents (BESs) in a porcine coronary model. METHODS: We successfully deployed 36 overlapping BESs for the left anterior descending coronary and left circumflex artery or right coronary artery in 18 non-injured pigs. Total pigs were divided into 3 groups (12 overlapping stents of 6 pigs in each group) as follows: group I received aspirin 100mg and clopidogrel 75 mg daily for 8 weeks, group II received aspirin 100mg and clopidogrel 75 mg daily for 8 weeks and cilostazol 200mg daily for initial 4 weeks, and group III received aspirin 100mg, clopidogrel 75 mg, and cilostazol 200mg daily for 8 weeks. Follow-up coronary angiograms and histomorphometric and histopahtologic analyses at overlapping and non-overlapping segments were performed respectively. RESULTS: Inflammation score was similar between overlapping and non-overlapping segments in all pigs (1.2 ± 0.33 vs. 1.1 ± 0.17, p=0.117). The neointima area (NA) and percent area stenosis (%AS) at overlapping segments were not significantly different among the 3 groups. However, at non-overlapping segments, NA and %AS in group III were significantly smaller than those in group I (2.3 ± 0.50mm(2) vs. 1.8 ± 0.43 mm(2), p=0.037; 48.9 ± 12.85% vs. 37.7 ± 9.08%, p=0.031). CONCLUSIONS: Our study shows that BES appears to be reliable on the inflammatory response at overlapping segments as well as non-overlapping segments. Long-term administration of cilostazol is more effective in reducing neointimal formation at non-overlapping segments of BESs in a porcine coronary model.

Regulatory mechanism of NFATc1 in RANKL-induced osteoclast activation.

NFATc1 is a master regulator of RANKL-induced osteoclast differentiation and herein we investigate the regulatory mechanism of NFATc1 in osteoclast activation. Inactivation of NFATc1 strongly attenuates RANKL-induced bone resorption and overexpression of a constitutively active form of NFATc1 in osteoclasts induces formation of actin rings and resorption pits on dentin slices. We demonstrate that NFATc1 binds directly to the promoter regions of its target genes and induces expression of various genes, including LTBP3, ClC7, cathepsin K, MMP9, and c-Src, which are key players in bone resorption. Thus, NFATc1 is essential for RANKL-induced osteoclast activation via up-regulation of osteoclast-activating genes.