Applying Principles of Regenerative Medicine to Vascular Stent Development - PubMed (original) (raw)

Review

Applying Principles of Regenerative Medicine to Vascular Stent Development

Prakash Parthiban Selvakumar et al. Front Bioeng Biotechnol. 2022.

Abstract

Stents are a widely-used device to treat a variety of cardiovascular diseases. The purpose of this review is to explore the application of regenerative medicine principles into current and future stent designs. This review will cover regeneration-relevant approaches emerging in the current research landscape of stent technology. Regenerative stent technologies include surface engineering of stents with cell secretomes, cell-capture coatings, mimics of endothelial products, surface topography, endothelial growth factors or cell-adhesive peptides, as well as design of bioresorable materials for temporary stent support. These technologies are comparatively analyzed in terms of their regenerative effects, therapeutic effects and challenges faced; their benefits and risks are weighed up for suggestions about future stent developments. This review highlights two unique regenerative features of stent technologies: selective regeneration, which is to selectively grow endothelial cells on a stent but inhibit the proliferation and migration of smooth muscle cells, and stent-assisted regeneration of ischemic tissue injury.

Keywords: bioabsorable; reendothelialization; restenosis; selective regeneration; stent.

Copyright © 2022 Selvakumar, Rafuse, Johnson and Tan.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1

FIGURE 1

Outcomes of endovascular stents. (Top panel) Stents produce undesired outcomes such as in-stent thrombosis and in-stent restenosis. In-stent thrombosis involves accumulation of platelets and presence of fibrinogen. In-stent restenosis causes narrowing of the lumen greater than 50% due to the overgrowth of smooth muscle cells with neointima formation. (Botton panel) The ideal vascular regeneration with stents will have a fully developed endothelial monolayer lining the lumen with either the stent completely bioabsorbed or permanently encapsulated in the intimal layer.

FIGURE 2

FIGURE 2

Two generation mechanisms using surface functionalizations to override drug inhition effects on stent endothelialization. (A) Regeneration from adjacent cells, which can involve the functionalization of stents with angiogenic peptide or NO producing coating. (B) Regeneration from blood-borne cells, which can involve the functionalization of stents with certain cell-capture antibodies, adhesive peptide or growth factor.

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